Sample records for elective coronary bypass

  1. Outcome of non-elective coronary artery bypass grafting without cardio-pulmonary bypass

    Microsoft Academic Search

    David Varghese; Magdi H Yacoub; Richard Trimlett; Mohamed Amrani

    2001-01-01

    Objectives: There is limited experience in the use of beating heart coronary artery bypass grafting (CABG) in emergency and urgent cases. The aim of this study was to retrospectively assess the safety and efficacy of this technique when used in a non-elective setting. Methods: We retrospectively reviewed all urgent and emergency cases of coronary artery bypass grafting performed without cardiopulmonary

  2. Outcome of non-elective coronary artery bypass grafting without cardio-pulmonary bypass

    Microsoft Academic Search

    David Varghese; Magdi H. Yacoub; Richard Trimlett; Mohamed Amrani

    2010-01-01

    Objectives: There is limited experience in the use of beating heart coronary artery bypass grafting (CABG) in emergency and urgent cases. The aim of this study was to retrospectively assess the safety and efficacy of this technique when used in a non-elective setting. Methods :W e retrospectively reviewed all urgent and emergency cases of coronary artery bypass grafting performed without

  3. Coronary Artery Bypass Grafting

    MedlinePLUS

    ... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...

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

    PubMed Central

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

    2014-01-01

    Objective and Design The soluble urokinase plasminogen activator receptor (suPAR) has been recently recognized as a potential biological marker of various disease states, but the impact of a major surgical intervention on the suPAR level has not yet been established. The aim of our study was to investigate if the induction of a systemic inflammatory reaction in response to cardiopulmonary bypass would be accompanied by an increase in the plasma suPAR level. Methods and Subjects Patients undergoing coronary artery bypass grafting under cardiopulmonary bypass (CPB) were added. Based on the baseline suPAR level, patients were divided into group 1 (suPAR within normal range) or group 2 (suPAR above range). Blood was collected before the induction of anesthesia and 6 and 24 hours after surgery. Plasma suPAR, IL-6, IL-8, TNF-?, troponin I, NT-proBNP, and NGAL were quantified to assess the impact of surgical trauma on these markers. Results The baseline suPAR level was within the normal range in 31 patients (3.3 ng/mL), and elevated in 29 (5.1 ng/mL) (p<0.001). Baseline mediators of systemic inflammatory reaction concentrations (IL-6, TNF-?, and IL-8) and organ injury indices (troponin I, NT-proBNP, and NGAL) were low and increased after surgery in all patients (p<0.05). The surgery did not cause significant changes in the suPAR level either at 6 or 24 hours after, however the difference between groups observed at baseline remained substantial during the postoperative period. Conclusions There was no change in the suPAR level observed in patients subjected to elective cardiac coronary artery bypass surgery and CPB, despite activation of a systemic inflammatory reaction. PMID:24911522

  5. Coronary artery bypass grafting

    Microsoft Academic Search

    Kenji Takazawa; Yasuyuki Hosoda; Taira Yamamoto; Shiori Kawasaki; Shiro Sasaguri

    1999-01-01

    Objectives: The aim of this study was to analyze the long-term results of coronary artery bypass grafting in Japanese patients who were\\u000a followed more than 10 years after surgery, and, without resorting to actuarial methods, to determine the factors that influence\\u000a long-term survival.Subjects and Methods: From January 1984 through December 1986, 376 patients received coronary artery bypass grafting at the

  6. Coronary Artery Bypass Grafting

    Microsoft Academic Search

    Liubov Ben-Noun

    1999-01-01

    Long-term psychosocial outcomes were examined in 132 patients 7 to 22 years M = 9.4 years after coronary artery bypass grafting. The control group comprised 145 medically treated patients with coronary heart disease of 7 to 22 year duration M = 9.2. Significantly more medically than surgically treated patients were scored in the clinically significant range for anxiety, and for

  7. Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality

    PubMed Central

    Sobolev, Boris G; Fradet, Guy; Hayden, Robert; Kuramoto, Lisa; Levy, Adrian R; FitzGerald, Mark J

    2008-01-01

    Background Many health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG) surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods. Methods We used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time, 6 weeks for patients needing semi-urgent surgery and 12 weeks for those needing non-urgent surgery. Results Among 7316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1.0% (27 deaths among 2675 patients) for patients treated within the recommended time and 1.5% (70 among 4641) for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96). There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11). Conclusion We found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis. PMID:18803823

  8. Comparison of standard coronary artery bypass grafting and minimary invasive direct coronary artery bypass grafting

    Microsoft Academic Search

    Yasuhide Okawa; Hiroshi Baba; Masaki Hashimoto; Tsuneo Tanaka; Masahiko Toyama; Kouji Matsumoto; Kenichiro Azuma

    2000-01-01

    Objectives: We studied indications and problems involved in minimally invasive coronary artery bypass grafting (MIDCAB)Methods: We compared patients profiles, graft patency, stenosis severity, morbidity, mortality, long-term survival and freedom from\\u000a cardiac accidents in 174 patients undergoing elective standard coronary artery bypass grafting (CABG) and 128 undergoing between\\u000a January 1996 and March 1999.Results: No statiscally difference was seen in gender, diabetes

  9. Adrenal function during coronary artery bypass grafting

    Microsoft Academic Search

    Christoph Henzen; Richard Kobza; Birgit Schwaller-Protzmann; Peter Stulz; Verena A Briner

    2003-01-01

    Objective: To assess adrenal function in patients undergoing coronary artery bypass grafting (CABG) by means of the low-dose (1mg) ACTH test, and to correlate the adrenal function with clinical outcome. Methods: During a 5-month period we prospectively included 45 patients undergoing elective CABG with cardiopulmonary bypass and without symptoms of endocrine disease. Low-dose (1mg) ACTH tests were performed on the

  10. What Is Coronary Artery Bypass Grafting (CABG)?

    MedlinePLUS

    ... Medical Illustrations: Jill Rhead, MA What is Coronary Artery Bypass Grafting (CABG)? What Can Happen When Blockages ... Condition be Like After CABG? WHAT IS CORONARY ARTERY BYPASS GRAFTING (CABG)? Coronary artery bypass grafting or " ...

  11. Erythropoietin deficiency after coronary artery bypass procedures.

    PubMed

    Levine, E A; Rosen, A L; Sehgal, L R; Gould, S A; Egrie, J C; Moss, G S

    1991-05-01

    Erythropoietin is the primary regulator of erythropoiesis. Erythropoietin has been shown to increase exponentially in response to linear decreases in hematocrit in normal, unstressed animals. However, the effect of operation, with its attendant stress, on erythropoietin levels is unknown. The purpose of this study is to evaluate the effect of surgical stress on erythropoietin. Twenty otherwise healthy patients scheduled for elective surgical procedures were studied. The cholecystectomy group included 10 patients who underwent cholecystectomy for documented stone disease. Ten patients who underwent coronary artery bypass procedures constituted the coronary artery bypass grafting group. Patients were studied preoperatively as well as on the first and second postoperative days. The hematocrit and erythropoietin levels were similar in both groups preoperatively. The hematocrit in the coronary artery bypass grafting group was lower than that of the cholecystectomy group on postoperative day 1 (0.31 versus 0.36; p less than 0.003) and postoperative day 2 (0.30 versus 0.36; p less than 0.001). During the first two postoperative days the erythropoietin levels were similar between groups. The data show that postoperative erythropoietin levels are similar after coronary artery bypass grafting, despite more severe anemia, when compared with cholecystectomy. This suggests that after coronary artery bypass grafting there is a relative deficiency of erythropoietin. Administration of recombinant human erythropoietin to patients undergoing surgical procedures could correct the erythropoietin deficiency and accelerate postoperative erythropoiesis. PMID:2025080

  12. The Effect of Intravenous Magnesium Sulfate and Lidocaine in Hemodynamic Responses to Endotracheal Intubation in Elective Coronary Artery Bypass Grafting: A Randomized Controlled Clinical Trial

    PubMed Central

    Mesbah Kiaee, Mehrdad; Safari, Saeid; Movaseghi, Gholam Reza; Mohaghegh Dolatabadi, Mahmoud Reza; Ghorbanlo, Masoud; Etemadi, Mehrnoosh; Amiri, Seyed Arash; Zamani, Mohammad Mahdi

    2014-01-01

    Background: There have been many concerns about alteration in hemodynamic parameters within and shortly after endotracheal intubation (ETI) in patients scheduled for elective coronary artery bypass grafting (CABG). Objectives: We compared the attenuation effect of magnesium sulfate and lidocaine on hemodynamic responses after ETI, in patients undergoing CABG. Patients and Methods: In this randomized controlled trial 150 patients undergoing elective CABG were enrolled. Included patients were randomly allocated to three groups and received lidocaine (1.5 mg/kg), magnesium sulfate (50 mg/kg within five minute), or normal saline, 90 seconds before ETI. Baseline hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded immediately before anesthesia induction, before intubation, immediately after intubation, and at second and fifth minutes after intubation. Results: The baseline hemodynamic variables had no deference among the three groups. HR between intubation and five minute after intubation was significantly lower in two groups received lidocaine or magnesium sulfate in comparison with placebo group. Lidocaine induced more than 20% decrease in HR and MAP immediately after intubation; hence, lidocaine group showed significant MAP reduction in comparison with the two other groups. Conclusions: Lidocaine induced hemodynamic instability but premedication of magnesium sulfate maintained hemodynamic stability after intubation. Therefore, in patients undergoing CABG who received high-dose intravenous analgesic for general anesthesia, the administration of magnesium sulfate might result in maintaining hemodynamic stability after ETI in comparison with lidocaine. PMID:25237632

  13. 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 ...

  14. Who Needs Coronary Artery Bypass Grafting?

    MedlinePLUS

    ... from the NHLBI on Twitter. Who Needs Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is used to treat people ... or after a heart attack to treat blocked arteries. Your doctor may recommend CABG if other treatments, ...

  15. Coronary Artery Bypass

    MedlinePLUS

    ... procedures performed each year in the United States. Arteries can become clogged over time by the buildup ... bypass" around a section of clogged or diseased artery. The surgery involves using a section of blood ...

  16. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: A prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting

    Microsoft Academic Search

    J. D. Puskas; W. H. Williams; P. G. Duke; J. R. Staples; K. E. Glas; J. J. Marshall; M. Leimbach; P. Huber; S. Garas; B. H. Sammons; S. A. McCall; R. J. Petersen; D. E. Bailey; H. Chu; E. M. Mahoney; W. S. Weintraub; R. A. Guyton

    2003-01-01

    Objective: Retrospective comparisons of selected patients undergoing off-pump versus conventional on-pump coronary artery bypass grafting have yielded inconsistent results and raised concerns about completeness of revascularization in off-pump coronary artery bypass grafting.Methods: Two hundred unselected patients referred for elective primary coronary artery bypass grafting were randomly assigned to undergo off-pump coronary artery bypass grafting with an Octopus tissue stabilizer (Medtronic,

  17. Myocardial infarction determined by technetium-99m pyrophosphate single-photon tomography complicating elective coronary artery bypass grafting for angina pectoris

    SciTech Connect

    Burns, R.J.; Gladstone, P.J.; Tremblay, P.C.; Feindel, C.M.; Salter, D.R.; Lipton, I.H.; Ogilvie, R.R.; David, T.E.

    1989-06-15

    The incidence of acute myocardial infarction (AMI) complicating coronary artery bypass grafting (CABG) has previously been based on concordance of electrocardiographic, enzymatic and scintigraphic criteria. Technetium-99m pyrophosphate (Tc-PPi) single-photon emission computed tomography now enables detection of AMI with high sensitivity and specificity. Using this technique, perioperative AMI was detected in 12 of 58 patients (21%) undergoing successful elective CABG for stable angina pectoris. Stepwise multivariate logistic regression analysis was performed to compare the predictive value of preoperative (New York Heart Association class, left ventricular ejection fraction and use of beta blockers) and intraoperative (number of grafts constructed, use of internal mammary anastomoses, use of sequential saphenous vein grafts, smallest grafted distal vessel lumen caliber and aortic cross-clamp time) variables. Preoperative New York Association class (p = 0.04) and smallest grafted distal vessel lumen caliber (p = 0.03) were significant multivariate predictors of perioperative AMI. Only 1 perioperative patient with AMI (and 1 pyrophosphate-negative patient) developed new Q waves. Serum creatine kinase-MB was higher in patients with AMI by repeated measures analysis of variance (p = 0.0003). Five AMIs occurred in myocardial segments revascularized using sequential saphenous vein grafts, and 7 in segments perfused by significantly stenosed epicardial vessels with distal lumen diameter and perfusion territory considered too small to warrant CABG. At 6-month follow-up, the mean left ventricular ejection fraction increased from 0.61 to 0.65 in Tc-PPI-negative patients (p = 0.01), but not in perioperative patients with AMI.

  18. Robotically enhanced coronary artery bypass surgery

    Microsoft Academic Search

    Yugal K. Mishra; H. Wasir; Malhotra Rajneesh; K. K. Sharma; Y. Mehta; N. Trehan

    2007-01-01

    Robotically enhanced telemanipulation surgery is a rapidly developing technique which enables totally endoscopic cardiac surgery\\u000a with utmost precision and perfection on both beating heart and arrested heart. Between December 2002 and September 2006, 268\\u000a patients underwent robotically enhanced coronary artery bypass surgery using the da Vinci telemanipulation system. Fourteen\\u000a patients underwent total endoscopic coronary artery bypass surgery. Of these 12

  19. Coronary artery bypass surgery during pregnancy

    Microsoft Academic Search

    S. Silberman; D. Fink; R. S. Berko; B. Mendzelevski; D. Bitran

    1996-01-01

    A 32-year-old woman, in the 22nd week of pregnancy, underwent emergency coronary artery bypass grafting to the left anterior descending artery (LAD). She had suffered an acute myocardial infarction 10 days previously, and continued to suffer from intractable angina pectoris afterwards. Cardiac catheterization revealed spontaneous dissection of the LAD. The left internal mammary artery was used to bypass the LAD,

  20. Quantitative angiographic assessment of coronary anastomoses performed without cardiopulmonary bypass

    Microsoft Academic Search

    Nancy C. Poirier; Michel Carrier; Jacques Lespérance; Gilles Côté; Michel Pellerin; Louis P. Perrault; L. Conrad Pelletier

    1999-01-01

    Background: The quality of the anastomosis performed during coronary artery bypass grafting without cardiopulmonary bypass is a current concern, and myocardial wall restraining devices have been designed to optimize results. A quantitative angiographic analysis was performed to assess coronary anastomoses performed on beating hearts. Methods: We studied 34 patients who underwent coronary artery bypass grafting without cardiopulmonary bypass between February

  1. Cardiac output monitoring during off-pump coronary artery bypass grafting

    Microsoft Academic Search

    Matthew P Grow; Amrik Singh; Neal W Fleming; Nilas Young; Mitchell Watnik

    2004-01-01

    Objective: To evaluate and compare monitors of cardiac output during repositioning and stabilization of the heart for off-pump coronary artery bypass (OPCAB) surgery.Design: Prospective, observational, clinical study.Setting: University teaching hospital.Participants: Consecutive patients scheduled to undergo elective OPCAB (n = 19).Interventions: Monitoring, induction, and anesthesia followed a routine protocol for coronary artery bypass patients. This included the use of transesophageal echocardiography

  2. Emergency Coronary Artery Bypass Grafting Can Be Performed Safely Without Cardiopulmonary Bypass in Selected Patients

    Microsoft Academic Search

    Faraz Kerendi; John D. Puskas; Joseph M. Craver; William A. Cooper; Ellis L. Jones; Omar M. Lattouf; J. David Vega; Robert A. Guyton

    2005-01-01

    Background. Patients requiring emergency surgical re- vascularization are often not considered for off-pump coronary artery bypass grafting (OPCAB). Methods. From 1996 to 2003, 614 patients underwent emergency coronary artery bypass grafting (Society of Thoracic Surgeons definition) at an academic institution. Forty-four (7%) of these procedures were performed without cardiopulmonary bypass, while 570 were con- ventional coronary artery bypass procedures with

  3. 21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...

  4. 21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...

  5. 21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...

  6. 21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...

  7. 21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...

  8. Coronary Artery Bypass Grafting Is Associated with a Significant Worsening of QT Dynamicity and Heart Rate Variability

    Microsoft Academic Search

    Bunyamin Yavuz; Umit Duman; Gulcan Abali; Omer Faruk Dogan; Alkin Yazicioglu; Levent Sahiner; Kudret Aytemir; Lale Tokgozoglu; Metin Demircin; Nasih Nazli; Giray Kabakci; Ali Oto

    2006-01-01

    Background: Imbalance in autonomic nervous system and impaired myocardial repolarization has been shown to increase the risk for arrhythmias in patients with coronary artery disease. This study evaluated the effects of coronary artery bypass grafting (CABG) on heart rate variability and QT interval dynamicity in subjects with coronary artery disease undergoing elective CABG surgery. Methods: The study group consisted of

  9. Reoperative coronary artery bypass via left thoracotomy

    Microsoft Academic Search

    Hirofumi Ide; Tatsuo Fujiki; Ken-ji Nonaka; Ryoichi Ishida; Kentarou Imamura; Ken-ichi Sudo

    2000-01-01

    The patient was a 49-year-old woman. When she was 39 years old, she underwent coronary artery bypass grafting (left internal\\u000a thoracic artery to left anterior descending artery, saphenous vein graft to first diagonal branch). At the age 48, she had\\u000a effort angina. On coronary angiography, triple-vessel disease was found, and she was treated conservatively. Progression of\\u000a the disease was confirmed

  10. Robotically-Assisted Coronary Artery Bypass Grafting

    PubMed Central

    Folliguet, Thierry A.; Dibie, Alain; Philippe, François; Larrazet, Fabrice; Slama, Michel S.; Laborde, François

    2010-01-01

    Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB), and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB) grafting. Nine patients (16%) were converted to open techniques. The mean total operating time for TECAB was 372 ± 104 minutes and for MIDCAB was 220 ± 69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50%) in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results. PMID:20339505

  11. Economics of coronary artery bypass grafting

    Microsoft Academic Search

    Alan Williams

    1985-01-01

    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

  12. Phlegmonous gastritis following coronary bypass surgery.

    PubMed

    Radhi, J; Kamouna, M; Nyssen, J

    1999-12-01

    Phlegmonous gastritis is a rare, rapidly progressive and potentially fatal gastric bacterial infection. A case of phlegmonous gastritis following a coronary bypass surgery is described. This condition was not diagnosed premortem due to the nonspecific nature of the gastrointestinal symptoms. Upper gastrointestinal endoscopy may be of value in establishing the diagnosis in emergencies with culture of gastric aspirate and biopsy. PMID:10625325

  13. Coronary artery bypass surgery. Physical, psychological, social, and economic outcomes six months later

    Microsoft Academic Search

    C. David Jenkins; Babette-Ann Stanton; Judith A. Savageau; Philip Denlinger; Michael D. Klein

    1983-01-01

    To evaluate the benefits of coronary artery bypass graft (CABG) surgery, we interviewed and tested 318 patients (268 men and 50 women) younger than age 70 before and six months after elective CABG at four university medical centers. Biomedical, psychoneurological, physical function, role function, occupational, social, family, sexual, emotional, and attitudinal variables were assessed. Quantitative comparisons showed improvement on many

  14. Exercise Radionuclide Assessment of Left Ventricular Function Before and After Coronary Bypass Surgery

    Microsoft Academic Search

    Ronald L. Lewis; Jerry S. Videll; Michael D. Strong; Vladir Maranhao; Frank J. Lumia

    1987-01-01

    The effects of elective saphenous vein coronary artery bypass surgery on left ventricular ejection fraction were assessed by using exercise first-pass radionu clide angiography in 66 consecutive patients. All patients with left main coro nary artery or concomitant valvular disease were eliminated from the study. Before surgery, 7 patients had normal postexercise left ventricular function (Group 1), 33 had normal

  15. Effect of Preoperative Aspirin Use on Postoperative Bleeding and Perioperative Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Surgery

    Microsoft Academic Search

    Mohammad Hassan Ghaffarinejad; Amir Farjam Fazelifar; Shahram Mohajer Shirvani; Esmaeel Asdaghpoor; Farzad Fazeli

    2008-01-01

    Background- Continuation or discontinuation of aspirin use in the preoperative period for patients scheduled for elective cardiac surgery has continued to be controversial. In this study, we tried to evaluate clinical outcomes (mortality, postoperative bleeding and perioperative myocardial infarction) in patients who underwent first elective coronary artery bypass grafting and received aspirin during the preoperative period. Methods- The study was

  16. Coronary Artery Bypass Surgery - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... ????) French (français) Hindi (??????) Japanese (???) Korean (???) Russian (???????) Somali (af Soomaali) Spanish (español) ... ????????? - ??? (Japanese) Bilingual PDF Health Information Translations Korean (???) Coronary Artery Bypass Surgery ???? ?? ?? - ...

  17. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    Microsoft Academic Search

    Patrick W. Serruys; Marie-Claude Morice; A. Pieter Kappetein; Antonio Colombo; David R. Holmes; Michael J. Mack; E. Stahle; Ted E. Feldman; Marcel van den Brand; Eric J. Bass; Nic Van Dyck; K. Leadly; Keith D. Dawkins; Friedrich W. Mohr

    2009-01-01

    BACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS We randomly assigned 1800 patients with three-vessel or left

  18. Coronary artery bypass in the context of polyarteritis nodosa.

    PubMed

    Yanagawa, Bobby; Kumar, Pawan; Tsuneyoshi, Hiroshi; Kachel, Erez; Massad, Ehab; Moussa, Fuad; Cohen, Gideon N

    2010-02-01

    A 46-year-old man with polyarteritis nodosa and multiple myocardial infarctions treated with multiple percutaneous coronary interventions presented again with atypical angina. Coronary angiography revealed triple-vessel coronary artery disease. This patient underwent four-vessel coronary artery bypass graft and recovered uneventfully. A review of the literature and discussion of the surgical management of this patient is presented. PMID:20103362

  19. Off-pump multivessel coronary bypass via sternotomy is safe and effective

    Microsoft Academic Search

    John D Puskas; Carolyn E Wright; Russell S Ronson; W. Morris Brown; John Parker Gott; Robert A Guyton

    1998-01-01

    Background. In an attempt to avoid the deleterious effects of cardiopulmonary bypass, off-pump coronary artery bypass grafting has been rediscovered and refined. The purpose of this study was to compare clinical outcomes, length of stay, and hospital costs with coronary artery bypass grafting on cardiopulmonary bypass.Methods. Coronary artery bypass was performed on 51 patients without cardiopulmonary bypass. Patients were selected

  20. Coronary artery bypass grafting without cardiopulmonary bypass using the octopus method: results in the first one hundred patients

    Microsoft Academic Search

    Erik W. L. Jansen; Cornelius Borst; Jaap R. Lahpor; Paul F. Gründeman; Frank D. Eefting; Arno Nierich; Etienne O. Robles de Medina; Johan J. Bredée

    1998-01-01

    Objective: Cardiopulmonary bypass and global cardiac arrest enable safe coronary artery bypass grafting but have adverse effects. In off-pump coronary bypass grafting, invasiveness is reduced, but anastomosis suturing is jeopardized by cardiac motion. Therefore the key to successful off-pump coronary bypass grafting is effective local cardiac wall stabilization. Methods: We prospectively assessed the safety and efficacy of the Octopus tissue

  1. [Coronary artery bypass grafting and replacement of aortic root and ascending aorta; report of a case].

    PubMed

    Nakamura, Koki; Murakami, Mikiko; Asai, Tomohiro; Saito, Yosuke; Yamaguchi, Hiromi

    2006-08-01

    An 87-year-old man was referred to our hospital for chest oppression and syncope attack due to aortic stenosis. Further examination revealed severe aortic stenosis (pressure gradient of 107 mmHg, aortic valve area of 0.75 cm2), ascending aortic aneurysm (60 mm in diameter) and triple-vessel disease of coronary arteries. Therefore, a surgical operation was indicated electively. Under cardiopulmonary bypass with normothermia, coronary artery bypass grafting (CABG) was performed. Then the aortic root and the ascending aorta were replaced with a Freestyle valve (27 mm) and a woven Dacron graft (30 mm Hemashield with 1 branch), respectively. Duration of cardiopulmonary bypass and aortic cross-clamp was 267 and 203 minutes, respectively. Postoperative course was uneventful. On the 14th postoperative day, he underwent coronary and graft angiography, which showed all the grafts were patent with good flow. He was successfully discharged on the 19th postoperative day. PMID:16922444

  2. Coronary artery bypass grafting in Native Americans

    Microsoft Academic Search

    Brahmajee K. Nallamothu; Sanjay Saint; Som Saha; A. Mark Fendrick; Keith Kelley; Scott D. Ramsey

    2001-01-01

    BACKGROUND: While the efficacy and safety of coronary artery bypass grafting (CABG) has been established in several clinical trials,\\u000a little is known about its outcomes in Native Americans.\\u000a \\u000a \\u000a MEASUREMENTS AND MAIN RESULTS: We assessed clinical outcomes associated with CABG in 155 Native Americans using a national database of 18,061 patients from\\u000a 25 nongovernmental, not-for-profit U.S. health care facilities. Patients were

  3. Coronary bypass using bilateral internal mammary arteries in an achondroplast.

    PubMed

    Alassal, Mohamed Abdulwahab; Youssef, Mostafa; Koudieh, Mohammed

    2015-01-01

    Coronary bypass grafting for ischemic heart disease in achondroplastic dwarfs is very rare. Shortage of veins and inadequate vein quality may cause difficulties during surgery. Only 2 cases of coronary bypass surgery in an achondroplastic dwarf, in which the left internal mammary artery and vein grafts were used, have been reported. We describe the case of a 55-year-old male achondroplastic dwarf who had triple-vessel coronary disease and underwent successful coronary bypass surgery using one saphenous vein graft and bilateral internal mammary artery grafts. The anatomic and surgical challenges in achondroplasia are highlighted. PMID:24887865

  4. Transmyocardial laser revascularisation combined with coronary artery bypass grafting without cardiopulmonary bypass1

    Microsoft Academic Search

    Naresh Trehan; Manisha Mishra; Ramesh Bapna; Anil Mishra; Pankaj Maheshwari; Anil Karlekar

    Objective: To achieve complete myocardial revascularisation in patients with diffuse coronary artery disease, patients with inordinately high risk of cardiopulmonary bypass (CPB) like severe systemic disease or diffuse atherosclerosis of the aorta. Methods: We have adopted the technique of combining coronary artery bypass grafting (CABG) with transmyocardial laser revascularisation (TMLR) using 1000 W CO2 laser machine. TMLR is done to

  5. Cerebral dysfunction after coronary artery bypass surgery.

    PubMed

    Goto, Tomoko; Maekawa, Kengo

    2014-04-01

    Cerebral dysfunction after cardiac surgery remains a devastating complication and is growing in importance with our aging populations. Neurological complications following cardiac surgery can be classified broadly as stroke, encephalopathy (including delirium), or postoperative cognitive dysfunction (POCD). These etiologies are caused primary by cerebral emboli, hypoperfusion, or inflammation that has largely been attributed to the use of cardiopulmonary bypass. Preventative operative strategies, such as off-pump coronary artery bypass grafting (CABG), can potentially reduce the incidence of postoperative neurological complications by avoiding manipulation of the ascending aorta. Although off-pump CABG is associated with reduced risk of stroke, there are no convincing differences in POCD between off-pump and on-pump CABG. Recently, the focus of postoperative neurological research has shifted from managing cardiopulmonary bypass to patient-related factors. Identifying changes in brains of aged individuals undergoing cardiac surgery may improve strategies for preventing cerebral dysfunction. Advanced age is associated with more undiagnosed cerebrovascular disease and is a major risk factor for stroke and POCD following cardiac surgery. Preoperative cerebrovascular evaluation and adaptation of surgical strategies will provide preventative approaches for cerebral dysfunction after CABG. This review focuses on recent findings of the relationship between perioperative stress and underlying fragility of the brain in cardiac surgical patients. PMID:23982856

  6. Coronary artery bypass grafting after orthotopic heart transplantationq

    Microsoft Academic Search

    M. Muscia; M. Pasic; R. Meyer; E. Wellnhoferb Loebe; Y. Weng

    Objective: Graft coronary disease (GCD) remains the major determinant of long-term survival after heart transplantation. Therapeutic strategies for the prevention or retardation of GCD in the cardiac allograft are limited, and palliative surgical coronary revascularization has been attempted. The aim of this report was to retrospectively analyze our results of coronary artery bypass grafting after cardiac transplanta- tion. This paper

  7. Coronary artery bypass grafting after orthotopic heart transplantation

    Microsoft Academic Search

    M. Musci; M. Pasic; R. Meyer; M. Loebe; E. Wellnhofer; Y. Weng; H. Kuppe; R. Hetzer

    1999-01-01

    Objective: Graft coronary disease (GCD) remains the major determinant of long-term survival after heart transplantation. Therapeutic strategies for the prevention or retardation of GCD in the cardiac allograft are limited, and palliative surgical coronary revascularization has been attempted. The aim of this report was to retrospectively analyze our results of coronary artery bypass grafting after cardiac transplantation. This paper correlates

  8. Minimally invasive direct coronary artery bypass and off-pump coronary artery bypass surgery: anesthetic considerations.

    PubMed

    Bainbridge, Daniel; Cheng, Davy C H

    2008-09-01

    Many new surgical technologies are being developed, with the overall aim of improving outcomes. One common feature of many new technologies is that they offer a safer approach than previous techniques; one of the greatest forces for change over the last 30 years is risk reduction. Cardiac surgery risk has been effectively undercut by percutaneous-based procedures, which have offered dramatic reductions in risk--at least in the short term. Beating heart techniques, whether minimally invasive direct coronary artery bypass (MIDCAB), off-pump coronary artery bypass surgery (OPCAB), or in other forms, such as percutaneous valve replacement, are likely to dramatically increase over the next decade. What role OPCAB and MIDCAB techniques will play in this new era is anyone's guess. PMID:18765216

  9. Outcomes of coronary artery bypass graft surgery

    PubMed Central

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

    2006-01-01

    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. PMID:17323602

  10. Coronary risk factors in patients underwent coronary artery bypass grafting.

    PubMed

    Safaei, Nasser; Alikhah, Hossein; Abadan, Younes

    2011-01-01

    Coronary Artery Disease (CAD) risk increases with increasing number of risk factors. This study was aimed to assess different coronary risk factors among Coronary Artery Bypass Grafting (CABG) surgery patients. A total of 700 patients younger than 45 or older than 65 years and underwent CABG in Tabriz Shahid Madani Heart Center since 2003 to 2007 were enrolled. We examined the probable differences of CAD risk factors between male and female groups and age groups. We also assessed the change of risk factors presentation in last 5 years. There was not significant difference between risk factor numbers in <45 and >65 years groups, but smoking and dyslipidemia was more prevalent in patients < 45 than > 65 years old. Hypertension and diabetes mellitus was more prevalent in patients > 65 old than < 45 years old; also differences were found between males and females patients, so that dyslipidemia, diabetes and hypertension were more prevalent in women than men. Some risk factors were recognized as acting more on one gender than the other. Also, the majority of patients have one or more risk factors, but different age and gender groups may have different risk factors that suggest the need for exact programming for appropriate prophylactic and therapeutic interventions in all groups. PMID:21913494

  11. What to Expect After Coronary Artery Bypass Grafting

    MedlinePLUS

    ... NHLBI on Twitter. What To Expect After Coronary Artery Bypass Grafting Recovery in the Hospital After surgery, ... incision (cut) and on the areas where an artery or vein was removed for grafting. After you ...

  12. Coronary artery and graft spasm after off-pump coronary artery bypass grafting.

    PubMed

    Fukui, Toshihiro; Takanashi, Shuichiro; Hosoda, Yasuyuki

    2005-02-01

    We report a case of a 52-year-old man with severe coronary artery and graft spasm after triple-vessel off-pump coronary artery bypass grafting. Emergent coronary angiography was performed to identify the location and severity of the spasm. Intracoronary injections of several vasodilators failed to relieve the spasm. Observational treatments including intra-aortic balloon pump and inotropic drugs to increase coronary flow were performed until the spasm resolved. The patient recovered and was discharged. A follow-up coronary angiography revealed patent native coronary artery and bypass grafts without evidence of residual spasm. PMID:15782575

  13. Intrathecal morphine for off-pump coronary artery bypass grafting

    Microsoft Academic Search

    Samuel Metz; Nanette Schwann; Wael Hassanein; Brian Yuskevich; Todd Nixon

    2004-01-01

    Objective: To determine if preinduction intrathecal morphine is associated with successful intraoperative extubation in patients undergoing off-pump coronary artery bypass grafting.Design: A retrospective noncontrolled chart review of all patients undergoing off-pump coronary artery bypass grafting.Setting: Single university hospital.Participants: One hundred twelve patients.Interventions: One hundred twelve of 150 patients received preinduction intrathecal morphine as part of routine anesthetic care for off-pump

  14. Robotically assisted totally endoscopic coronary artery bypass surgery

    PubMed Central

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi

    2013-01-01

    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the “best of both worlds” from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations. PMID:24251021

  15. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass

    Microsoft Academic Search

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

    2000-01-01

    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

  16. The cerebral complications of coronary artery bypass surgery.

    PubMed Central

    Smith, P. L.

    1988-01-01

    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. PMID:3261958

  17. Heparin-Induced Thrombocytopenia After Coronary Artery Bypass Grafting with Cardiopulmonary Bypass: Report of a Case

    Microsoft Academic Search

    Keiichi Ishida; Mizuho Imamaki; Atsushi Ishida; Hitoshi Shimura; Masaru Miyazaki

    2004-01-01

    A 79-year-old man was transferred to our hospital with severe chest pain and a suspected diagnosis of acute myocardial infarction. Emergency cardiac catheterization showed triple-vessel coronary artery disease, and we performed coronary artery bypass grafting under cardiopulmonary bypass (CPB). Continuous hemodiafiltration was started for acute renal failure postoperatively, and heparin was given as an anticoagulanting agent. By 9 days after

  18. Percutaneous vertebral angioplasty before coronary artery bypass grafting

    Microsoft Academic Search

    Ikuo Fukuda; Wahei Mihara; Akinobu Sasaki; Seigo Gomi

    2000-01-01

    We report a case of a 63-year-old male with three-vessel coronary heart disease complicated by stenosis of the bilateral vertebral arteries. Triple coronary bypass grafting, using arterial conduits, was successfully performed after percutaneous balloon angioplasty of the left vertebral artery. Precedent angioplasty of a stenotic vertebral artery is safe and protects the brain from ischemia during extracorporeal circulation.

  19. Dextrocardia with situs inversus totalis: coronary artery bypass grafting

    Microsoft Academic Search

    Salila Hashmi; Mariam Anis; Umer Darr

    2012-01-01

    Dextrocardia with situs inversus is a rare congenital abnormality involving a left-handed mal rotation of the visceral organs. The incidence of coronary artery disease is the same as that in the general population. Performing coronary artery bypass surgery on patients with dextrocardia poses a more challenging task. It is recommended that the right internal mammary artery be the first choice

  20. Combined coronary artery bypass grafting and carotid endarterectomy

    Microsoft Academic Search

    M Vicaretti; J. P Fletcher; P Klineberg; A. J Richardson; S Hazelton; R Allen; P Tomlinson; G Nunn; R Chard; W Meldrum-Hanna

    1997-01-01

    Combined carotid endarterectomy and coronary artery bypass grafting was performed in 52 patients between January 1982 and September 1994. Forty-nine patients had stable or unstable angina and three had symptom-free coronary artery disease detected by stress testing. Thirty-one patients had triple-vessel disease and 17 had left main trunk or left main equivalent coronary artery disease. Five patients had symptom-free carotid

  1. Robotically enhanced totally endoscopic right internal thoracic coronary artery bypass to the right coronary artery.

    PubMed

    Aybek, T; Dogan, S; Andressen, E; Mierdl, S; Westphal, K; Moritz, A; Wimmer-Greinecker, G

    2000-01-01

    Computer-enhanced telemanipulation systems allow totally endoscopic coronary artery bypass grafting. This report demonstrates the feasibility of a coronary artery anastomosis between the right internal thoracic artery and the right coronary artery using the daVinci surgical system (Intuitive Surgical, Inc, Mountain View, CA). PMID:11178295

  2. Coronary Artery Disease Risk Factors, Coronary Artery Calcification and Coronary Bypass Surgery

    PubMed Central

    Ulusoy, Fatih Rifat; Ipek, Emrah; Korkmaz, Ali Fuat; Gurler, Mehmet Yavuz; Gulbaran, Murat

    2015-01-01

    Introduction Atherosclerosis is an intimal disease which affects large and medium size arteries including aorta and carotid, coronary, cerebral and radial arteries. Calcium accumulated in the coronary arterial plaques have substantial contribution to the plaque volume. The aim of our study is to investigate the relationship between coronary artery disease (CAD) risk factors and coronary arterial calcification, and to delineate the importance of CACS in coronary artery bypass surgery. Materials and Methods The current study is retrospective and 410 patients admitted to our clinic with atypical chest pain and without known CAD were included. These individuals were evaluated by 16 slice electron beam computed tomography with suspicion of CAD and their calcium scores were calculated. Detailed demographic and medical history were obtained from all of the patients. Results In our study, we employed five different analyses using different coronary arterial calcification score (CACS) thresold levels reported in previous studies. All of the analyses, performed according to the previously defined thresold levels, showed that risk factors had strong positive relationship with CACS as mentioned in previous studies. Conclusion Coronary arterial calcification is part of the athero-sclerotic process and although it can be detected in atherosclerotic vessel, it is absent in a normal vessel. It can be concluded that the clinical scores, even they are helpful, have some limitations in a significant part of the population for cardiovascular risk determination. It is important for an anastomosis region to be noncalcified in coronary bypass surgery. In a coronary artery, it will be helpness for showing of calcific field and anostomosis spot.

  3. Coronary artery and graft spasm after off-pump coronary artery bypass grafting

    Microsoft Academic Search

    Toshihiro Fukui; Shuichiro Takanashi; Yasuyuki Hosoda

    2005-01-01

    We report a case of a 52-year-old man with severe coronary artery and graft spasm after triple-vessel off-pump coronary artery\\u000a bypass grafting. Emergent coronary angiography was performed to identify the location and severity of the spasm. Intracoronary\\u000a injections of several vasodilators failed to relieve the spasm. Observational treatments including intra-aortic balloon pump\\u000a and inotropic drugs to increase coronary flow were

  4. Coronary Artery Bypass Grafting in Native Americans

    PubMed Central

    Nallamothu, Brahmajee K; Saint, Sanjay; Saha, Som; Fendrick, A Mark; Kelley, Keith; Ramsey, Scott D

    2001-01-01

    BACKGROUND While the efficacy and safety of coronary artery bypass grafting (CABG) has been established in several clinical trials, little is known about its outcomes in Native Americans. MEASUREMENTS AND MAIN RESULTS We assessed clinical outcomes associated with CABG in 155 Native Americans using a national database of 18,061 patients from 25 nongovernmental, not-for-profit U.S. health care facilities. Patients were classified into five groups: 1) Native American, 2) white, 3) African American, 4) Hispanic, and 5) Asian. We evaluated for ethnic differences in in-hospital mortality and length of stay, and after adjusting for age, gender, surgical priority, case-mix severity, insurance status, and facility characteristics (volume, location, and teaching status). Overall, we found the adjusted risk for in-hospital death to be higher in Native Americans when compared to whites (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.5 to 9.8), African Americans (OR, 3.4; 95% CI, 1.1 to 9.9), Hispanics (OR, 7.1; 95% CI, 2.5 to 20.3), and Asians (OR, 2.8; 95% CI, 1.1 to 7.0). No significant differences were found in length of stay after adjustment across ethnic groups. CONCLUSIONS The risk of in-hospital death following CABG may be higher in Native Americans than in other ethnic groups. Given the small number of Native Americans in the database (n = 155), however, further research will be needed to confirm these findings. PMID:11556933

  5. Single and multivessel port-access coronary artery bypass grafting with cardioplegic arrest: Technique and reproducibility

    Microsoft Academic Search

    Daniel S. Schwartz; Greg H. Ribakove; Eugene A. Grossi; Jess D. Schwartz; Patricia M. Buttenheim; F. Gregory Baumann; Stephen B. Colvin; Aubrey C. Galloway

    1997-01-01

    Objectives: Although minimally invasive coronary artery bypass grafting is now feasible, using this technique to perform anastomoses on the beating or fibrillating heart may yield poorer graft patency than the standard open techniques that use cardioplegic arrest. This study tested the feasibility and anastomotic reproducibility of minimally invasive coronary bypass using newly developed port-access coronary artery bypass technology (Heartport, Inc.,

  6. Atrial fibrillation: prevalence after minimally invasive direct and standard coronary artery bypass

    Microsoft Academic Search

    Marilyn Hravnak; Leslie A Hoffman; Melissa I Saul; Thomas G Zullo; Julie F Cuneo; Gayle R Whitman; John M Clochesy; Bartley P Griffith

    2001-01-01

    Background. This study identified and compared the prevalence of new-onset atrial fibrillation (AFIB) following standard coronary artery bypass grafting (SCABG) with cardiopulmonary bypass (CPB) and minimally invasive direct vision coronary artery bypass grafting (MIDCAB) without CPB. A further comparison was made between AFIB prevalence in SCABG and MIDCAB subjects with two or fewer bypasses.Methods. This is a retrospective, comparative survey.

  7. Off-pump coronary artery bypass grafting in octogenarians

    Microsoft Academic Search

    Tomoki Shimokawa; Naoki Minato; Noriko Yamada; Yuji Takeda; Yasushi Hisamatsu; Manabu Itoh

    2003-01-01

    Objectives: Off-pump coronary artery bypass grafting (CABG) has become accepted for myocardial revascularization because it reduces perioperative\\u000a morbidity. We assessed the safety and efficacy of bypass surgery on the beating heart in elderly patients. Methods: Off-pump CABG was done in 25 patients aged 80 years or older between February 1996 and February 2001. We retrospectively\\u000a compared clinical results for these

  8. Coronary artery bypass grafting for a patient with Tangier disease

    Microsoft Academic Search

    Hiroshi Takami; Tohru Kobayashi; Tsutomu Nakagawa; Makoto Sakurai; Nobuhisa Awata; Shizuya Yamashita

    2002-01-01

    A 56-year-old man with Tangier disease suffering from angina pectoris due to triple-vessel coronary artery disease evidenced\\u000a extremely low blood high-density lipoprotein of 1 mg\\/dl, a specific laboratory indicator of this rare genetic disorder of\\u000a lipid metabolism, considered to accompany juvenile arteriosclerosis. Because of the calcified ascending aorta, we conducted\\u000a combined minimally invasive coronary artery bypass (CAB) for the left

  9. Hyperhomocysteinemia and Mortality after Coronary Artery Bypass Grafting

    Microsoft Academic Search

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

    2006-01-01

    BackgroundThe 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 FindingsWe prospectively

  10. Institutional report - Coronary Factors affecting post minimally invasive direct coronary artery bypass grafting incidence of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting and mortality of cardiac origin

    Microsoft Academic Search

    Theo Kofidis; Hans Gerd Paeschke; Artur Lichtenberg; Maximilian Emmert; Felix Woitek; Vassilios Didilis; Axel Haverich; Uwe Klima

    2010-01-01

    In the present study we identify parameters which influence the incidence of myocardial infarction (MI), need for percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and cardiac mortality after minimal invasive coronary artery bypass grafting (MIDCABG). With a mean follow-up of 30\\

  11. Improved Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Grafting With Coronary Endarterectomy

    Microsoft Academic Search

    Oz M. Shapira; Gabriel Akopian; Ali Hussain; Mitchell Adelstein; Harold L. Lazar; Gabriel S. Aldea; Richard J. Shemin

    2010-01-01

    Background. Coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) has been associated with increased morbidity and mortality. We sought to evaluate the impact of recent advances in operative and perioperative management on outcomes after CE. Methods. One hundred fifty-one consecutive patients undergoing first-time CABG with CE between 1991 and 1997 were compared with a concurrent group of 757 patients

  12. Predictors of low cardiac output syndrome after coronary artery bypass

    Microsoft Academic Search

    Vivek Rao; Joan Ivanov; Richard D. Weisel; John S. Ikonomidis; George T. Christakis; Tirone E. David

    1996-01-01

    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

  13. Carotid arterial disease in patients undergoing coronary artery bypass operations.

    PubMed

    Breslau, P J; Fell, G; Ivey, T D; Bailey, W W; Miller, D W; Strandness, D E

    1981-11-01

    The occurrence of stroke associated with coronary artery bypass operations is approximately 2%. In an attempt to reduce this incidence some centers have proposed carotid thromboendarterectomy for symptomatic and asymptomatic carotid arterial disease in patients undergoing a coronary artery bypass operation. To obtain a better understanding of the incidence of carotid occlusive disease in candidates for the coronary bypass operation and to evaluate the practical use of a noninvasive method to screen patients preoperatively, we evaluated 102 patients preoperatively with an ultrasonic Duplex scanner; 24 studies were requested on the basis of either previous neurologic problems or the presence of a bruit and 78 patients were evaluated as part of a study protocol. In the unrequested group 6% (5/78) of the patients had a stenosis of 50% diameter reduction or more. In the requested group 54% (13/24) had a stenosis of 50% diameter reduction or more. In the postoperative phase one stroke and one transient ischemic attack were noted among the unrequested group and none in those suspected of having carotid disease on clinical grounds. Neither affected patient had a high-grade stenosis. There is little evidence to support the contention that noninvasive screening of patients free of symptoms or signs of carotid disease prior to coronary artery bypass operation is a valuable method of screening for patients who will sustain a focal neurologic event. PMID:6975404

  14. Depression and anxiety and outcomes of coronary artery bypass surgery

    Microsoft Academic Search

    Virginie Pignay-Demaria; François Lespérance; Roland G Demaria; Nancy Frasure-Smith; Louis P Perrault

    2003-01-01

    Psychological and psychiatric disorders independently increase the risk of cardiovascular disease and worsen the prognosis in patients with established cardiovascular lesions. The objective of this literature review is to discuss recent data concerning the relationships between depression and anxiety and the outcomes of coronary artery bypass grafting. Pathophysiological hypotheses are put forward to explain observed links. We suggest recommendations aimed

  15. Role of radionuclide cardiac imaging in coronary artery bypass surgery

    SciTech Connect

    Iskandrian, A.S.; Heo, J.; Mostel, E.

    1987-01-01

    The main applications of cardiac nuclear imaging in coronary artery bypass surgery include: patient selection, prediction of improvement in resting LV function after revascularization, diagnosis of perioperative myocardial infarction, assessment of the results of revascularization, evaluation of new or recurrent symptoms, and in risk stratification. Proper understanding of which test to be used, when, and why may be important to optimize patient management.

  16. Retropericardial hematoma complicating off-pump coronary artery bypass surgery

    Microsoft Academic Search

    Toshihiro Fukui; Shigefumi Suehiro; Toshihiko Shibata; Koji Hattori; Hidekazu Hirai

    2002-01-01

    We report the case of a retropericardial hematoma after triple-vessel off-pump coronary artery bypass grafting. Transesophageal echocardiography demonstrated a retropericardial hematoma that compressed the left atrium anteriorly and suppressed cardiac function. Injury to the pulmonary vein during placement of deep pericardial sutures and postoperative infusion of heparin were the likely causes of this rare but potentially fatal complication of an

  17. Cognitive Change 5 Years After Coronary Artery Bypass Surgery

    Microsoft Academic Search

    Jan Stygall; Stanton P. Newman; Geraldine Fitzgerald; Liz Steed; Kathleen Mulligan; Joseph E. Arrowsmith; Wilfred Pugsley; Steve Humphries; Michael J. Harrison

    2003-01-01

    A longitudinal study of cognitive function after coronary artery bypass surgery examined 107 participants using 11 tests, preoperatively and at 6 days, 8 weeks, and 5 years after surgery. The overall neuropsychological (NP) change score declined at 6 days, showed some recovery at 8 weeks, and declined again at 5 years. The number of microemboli recorded during surgery, postoperative short-term

  18. Angiographic coronary diffuseness and outcomes in dialysis patients undergoing coronary artery bypass grafting surgery

    Microsoft Academic Search

    Daniel Wong; Greg Thompson; Karen Buth; John Sullivan; Imtiaz Ali

    2010-01-01

    Objective: Pre-operative dialysis-dependent renal failure (DDRF) is a predictor of morbidity and mortality following coronary artery bypass grafting surgery (CABG). Whether this is due in part to a more diffuse coronary atherosclerotic burden in these patients is unknown. The purpose of this study was to compare coronary atherosclerotic disease burden in patients with and without pre-existing DDRF undergoing CABG. Methods:

  19. Angiographic coronary diffuseness and outcomes in dialysis patients undergoing coronary artery bypass grafting surgery

    Microsoft Academic Search

    Daniel Wong; Greg Thompson; Karen Buth; John Sullivan; Imtiaz Ali

    2003-01-01

    Objective: Pre-operative dialysis-dependent renal failure (DDRF) is a predictor of morbidity and mortality following coronary artery bypass grafting surgery (CABG). Whether this is due in part to a more diffuse coronary atherosclerotic burden in these patients is unknown. The purpose of this study was to compare coronary atherosclerotic disease burden in patients with and without pre-existing DDRF undergoing CABG. Methods:

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

    SciTech Connect

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

    1991-07-01

    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.

  1. Protective effect of silymarin during coronary artery bypass grafting surgery

    PubMed Central

    Altaei, Tagreed

    2012-01-01

    BACKGROUND: An inflammatory response and systemic oxidative stress are directly caused by coronary artery bypass grafting (CABG) surgery. Cytokines, such as interleukin (IL) 1?, IL-6 and tumour necrosis factor-? (TNF-?), can also be stimulated. Reducing the release of pro-inflammatory cytokines plays an important role in limiting the postoperative inflammatory response. Silymarin has strong anti-inflammatory, antioxidant and cytoprotective properties. OBJECTIVE: To investigate the protective anti-inflammatory and antioxidant properties of silymarin against the inflammation and oxidative stresss inherent to CABG surgery. METHODS: Of the 102 patients undergoing elective first-time CABG surgery that were recruited, 50 (49.02%) received silymarin treatment and 52 (50.9%) were controls. Plasma cytokine levels (IL-1?, IL-6 and TNF-?) were measured preoperatively, 6 h and 24 h after CABG surgery. C-reactive protein (CRP) levels, trolox equivalent antioxidant capacity (TEAC) and glutathione (GSH) and malondialdehyde (MDA) levels were analyzed. RESULTS: Postoperative cytokine levels in the silymarin group were significantly lower compared with preoperative levels, and were significantly lower compared with postoperative control group levels. The area under the curve for cytokines and CRP for the silymarin group were significantly lower compared with preoperative levels, and were significantly lower compared with postoperative control group levels. Postoperative levels of TEAC and MDA in the silymarin-treated group were significantly lower than in the control group. GSH levels were significantly elevated in the silymarin group compared with control. No side effects or mortality were associated with the use of silymarin. CONCLUSION: The anti-inflammatory and antioxidant effects of silymarin treatment provided protection against reperfusion injury and inflammation after CABG surgery. PMID:23204899

  2. Total endoscopic off-pump coronary artery bypass grafting.

    PubMed

    Falk, V; Diegeler, A; Walther, T; Jacobs, S; Raumans, J; Mohr, F W

    2000-01-01

    Two cases of totally endoscopic off-pump coronary artery bypass grafting (TECAB) of the left internal thoracic artery to the left anterior descending artery using the da Vincitrade mark telemanipulation system (Intuitive Surgical, Mountain View, CA) are described. A new articulating endoscopic stabilizer with cleats was developed to enable endoscopic anchoring of silastic vessel loops for vascular occlusion. Newly created attachments for irrigation and suction, along with active robotic enhanced assistance by a second surgical console, permitted our group to perform for the first time a truly endoscopic bypass grafting without any thoracotomy. PMID:11064543

  3. High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study

    Microsoft Academic Search

    Dong-Liang Mu; Dong-Xin Wang; Li-Huan Li; Guo-Jin Shan; Jun Li; Qin-Jun Yu; Chun-Xia Shi

    2010-01-01

    INTRODUCTION: The pathophysiology of postoperative delirium remains poorly understood. The purpose of this study was to examine the relationship between serum cortisol level and occurrence of early postoperative delirium in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 243 patients undergoing elective CABG surgery were enrolled. Patients were examined twice daily during the first five postoperative

  4. Is body size the cause for poor outcomes of coronary artery bypass operations in women?

    Microsoft Academic Search

    George T. Christakis; Richard D. Weisel; Karen J. Buth; Stephen E. Fremes; Vivek Rao; Kostas P. Panagiotopoulos; Joan Ivanov; Bernard S. Goldman; Tirone E. David

    1995-01-01

    Although small body size and coronary artery diameter are recognized as major contributors to the increased risk of coronary artery bypass grafting in women, few studies have established the independent influence of body size and gender on outcome. We studied 7025 consecutive patients (5694 men, 1331 women) undergoing isolated coronary artery bypass grafting between 1990 and 1994. Women were older,

  5. Multiple minimally invasive direct coronary artery bypass grafting for the complete revascularization of the left ventricle

    Microsoft Academic Search

    Go Watanabe; Takuro Misaki; Keijyu Kotoh; Kyousuke Kawakami; Akio Yamashita; Katsushi Ueyama

    1999-01-01

    Background. Single-vessel coronary artery bypass grafting of the left internal mammary artery to the left anterior descending coronary artery using a minithoracotomy has been shown to produce excellent results with a very low mortality rate. However, this procedure cannot be used in patients with double- or triple-vessel disease. Our goal was to develop a minimally invasive direct coronary artery bypass

  6. Bilateral Thoracoscopic Minimally Invasive Direct Coronary Artery Bypass Grafting Using Internal Thoracic Arteries

    Microsoft Academic Search

    Go Watanabe; Takuro Misaki; Keijyu Kotoh; Akio Yamashita; Katsushi Ueyama

    1998-01-01

    Background. Single-vessel coronary artery bypass grafting of the left internal mammary artery (ITA) to the left anterior descending coronary artery using a minithoracotomy has been shown to produce excellent results with a very low mortality. However, this procedure cannot be used in patients with double- or triple-vessel disease. Our goal was to develop a minimally invasive direct coronary artery bypass

  7. Minimally Invasive Direct Coronary Artery Bypass Grafting: Two-Year Clinical Experience

    Microsoft Academic Search

    Valavanur A Subramanian; John C McCabe; Charles M Geller

    1997-01-01

    Background. Interest in minimally invasive coronary artery bypass grafting has been increasing.Methods. From April 1994 through December 1996, 199 patients (age, 36 to 93 years) underwent minimally invasive coronary artery bypass grafting through minithoracotomy, subxiphoid, and lateral thoracotomy incisions, with internal mammary artery, gastroepiploic artery, and composite grafts placed using local coronary artery occlusion.Results. The conversion rate to sternotomy was

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

    Microsoft Academic Search

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

    1996-01-01

    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

  9. The early clinical and angiographic outcome of sequential coronary artery bypass grafting with the off-pump technique

    Microsoft Academic Search

    Sharif Al-Ruzzeh; Shane George; Mahmoud Bustami; Koki Nakamura; Shahid Khan; Magdi Yacoub; Mohamed Amrani

    2002-01-01

    Objective: The emergence of the off-pump coronary artery bypass technique has made surgeons consider combining it with other techniques developed and learned with conventional coronary artery bypass grafting with cardiopulmonary bypass. One of these techniques is the construction of a sequential graft to bypass more than one coronary vessel. The purpose of this study is to review the outcome of

  10. Off-pump coronary artery bypass with multiple arterial conduits

    Microsoft Academic Search

    Daniel Navia; Mariano Vrancic; Guillermo Vaccarino; Fernando Piccinini; Eduardo Iparraguirre; Marcelo Casas; Jorge Thierer

    2005-01-01

    Objective: to analyze intra-hospital results in patients undergoing elective off-pump total arterial revascularization and identify morbidity and mortality predictors using this surgical strategy. Methods: From May 1999 to February 2004, 203 myocardial revascularization procedures with total arterial revascularization without cardiopulmonary bypass (off-pump) were carried out in patients with multivessel disease (three vessels 81.7 %, one vessel disease was excluded). We

  11. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation

    Microsoft Academic Search

    Anno Diegeler; Robert Hirsch; Felix Schneider; Lars-Oliver Schilling; Volkmar Falk; Thomas Rauch; Friedrich W. Mohr

    2000-01-01

    Background. Cardiopulmonary bypass seems to be a major cause for both intraoperative microemboli and cerebral hypoperfusion. This study investigates high intensive transient signals (HITS) in transcranial Doppler ultrasound (TCD) and serum levels of the neurobiochemical marker protein S-100 in patients who underwent coronary artery bypass operation without cardiopulmonary bypass (off-pump CABG) in comparison with the conventional procedure using cardiopulmonary bypass

  12. Pain in the Postoperative Coronary Artery Bypass Graft Patient

    Microsoft Academic Search

    Bunny Pozehl; Susan Barnason; Lani Zimmerman; Janet Nieveen; Joyce Crutchfield

    1995-01-01

    The purpose of this study was to assess and describe the multidimensional postoperative pain experience of patients (N = 194) undergoing coronary artery bypass graft surgery (CABG) using the McGill Pain Questionnaire. Postoperative pain significantly decreased from postoperative day 2 to postoperative day 3 for all components of the McGill Pain Questionnaire. Sensory words chosen from the McGill Pain Questionnaire

  13. Multivessel Distal Sutureless Off-Pump Coronary Artery Bypass Grafting Procedure Using Magnetic Connectors

    Microsoft Academic Search

    Filip P. Casselman; Massimo Meco; Helge Dom; Luc Foubert; Frank Van Praet; Hugo Vanermen

    2010-01-01

    ff-pump coronary artery bypass surgery (OPCAB) is an increasingly popular procedure because of proven and speculative advantages that surpass on- pump surgery (1). Because of its avoidance of the cardio- pulmonary bypass system OPCAB is considered \\

  14. Improved clinical outcomes in patients undergoing coronary artery bypass grafting with coronary endarterectomy

    Microsoft Academic Search

    Oz M Shapira; Gabriel Akopian; Ali Hussain; Mitchell Adelstein; Harold L Lazar; Gabriel S Aldea; Richard J Shemin

    1999-01-01

    Background. Coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) has been associated with increased morbidity and mortality. We sought to evaluate the impact of recent advances in operative and perioperative management on outcomes after CE.Methods. One hundred fifty-one consecutive patients undergoing first-time CABG with CE between 1991 and 1997 were compared with a concurrent group of 757 patients undergoing

  15. Coronary Artery Bypass Surgery: Science and Practice

    Microsoft Academic Search

    Michael W. A. Chu; W. Randolph Chitwood; T. Bruce Ferguson

    Ischemic heart disease remains the most common cause of death in developed countries. Significant advances have been made\\u000a in the treatment of coronary artery disease (CAD), resulting in several options for medical, percutaneous and surgical therapies.\\u000a The goals of treatment must be rigorously upheld when considering the optimal therapy for each patient with CAD, which include\\u000a anginal relief, improved quality

  16. Combined Carotid Endarterectomy and off Pump CoronaryArtery Bypass Grafting :A Case Report

    Microsoft Academic Search

    SAN ALAM; R RAHMAN

    2009-01-01

    Summary: A 64 years male presented as a case of triple vessel coronary artery disease with bilateral asymptomatic carotid lesion. He underwent combined right carotid endarterectomy (CEA) and off pump coronary artery bypass grafting (OPCAB) with excellent outcome.

  17. Coronary artery bypass grafting in a 12-year-old girl with familial hypercholesterolemia.

    PubMed

    Göksel, O S; Tireli, E; El, H; Oflaz, H; Dayio?lu, E

    2009-01-01

    We present the case of a 12-year-old girl with familial hypercholesterolemia and coronary artery disease. She underwent triple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery grafting without adverse events. Pediatric patients with familial hypercholesterolemia may present with premature coronary atherosclerosis requiring coronary artery bypass grafting. In situ internal mammary artery grafts should be the graft of choice. PMID:19341213

  18. Off-pump coronary artery bypass grafting in a patient with behçet’s disease

    Microsoft Academic Search

    Akira Kobayashi; Ryuzo Sakata; Tamahiro Kinjo; Goichi Yotsumoto; Kazuhisa Matsumoto; Yoshifumi Iguro

    2004-01-01

    We report the case of a 58-year-old man with Behet’s disease who developed chest pain. Coronary angiography showed severe\\u000a triple-vessel disease, and the patient was transferred to our department for urgent coronary artery bypass grafting. Because\\u000a of the risk of anastomotic leakage or pseudoaneurysm formation, we performed off-pump coronary artery bypass grafting with\\u000a the aortic no-touch technique. Postoperative coronary angiography

  19. [Integrated coronary artery bypass strategy prevents urgent pump conversion during off-pump coronary artery bypass grafting].

    PubMed

    Yokoyama, H; Takase, S; Misawa, Y; Hagiwara, K; Tanji, M; Takahashi, S; Watanabe, M; Kondo, S

    2009-01-01

    Urgent pump conversion during off-pump coronary artery bypass (OPCAB) results in high morbidity and mortality. We retrospectively evaluated if the peri-operative integrated strategy prevents this lethal event in our 400 consecutive OPCAB operations. The patients with preoperative cardiogenic shock and/or ventricular arrhythmias underwent on-pump coronary artery bypass grafting (CABG). All other patients (99% of total CABG) were scheduled to undergo OPCAB (n=400). Prophylactic intraaortic balloon pumping (IABP) was applied to the patients with critical (>95%) left main trunk stenosis or low (<0.35) left ventricular ejection fraction. All the patients received the deep pericardial suture, apex-traction device, suction-type stabilizer, test-clamp of target coronary arteries by micro bulldog clamp, and intra-coronary shunts. Intra-operative IABP was applied in the case of sustained ST-segment change and/or elevated pulmonary artery pressure. Pump conversion was indicated for the patients with ventricular fibrillation and/or cardiogenic shock. Two patients (0.5%) had pump conversion due to ventricular arrhythmia and sustained hypotension, respectively. These pump conversion did not result in hospital mortality. Three hospital deaths (0.7%) occurred due to non-cardiac causes. The integrated strategy using prophylactic or intra-operative IABP in OPCAB produce a low pump conversion rate even during an early period of surgeon's learning curve. PMID:19195183

  20. Spirometric values and chest pain intensity three days post-operative coronary artery bypass graft surgery?

    PubMed Central

    AlOtaibi, Kholoud D.; El-Sobkey, Salwa B.

    2015-01-01

    Aim Coronary artery bypass graft surgery (CABG) is proved to have ventilatory complications and reduction in spirometric values. This study aimed to examine the hypothesis that reduction of post-operative chest pain intensity would be associated with improvement in the spirometric values for patient underwent CABG. Materials and method 26 cardiac patients recruited for this study. Their convenience to the study inclusion criteria decided their eligibility. Through 3 days after elective CABG their spirometric values were measured along with their perception to chest pain intensity using 0–10 numeric rating scale. Collected data were recorded and analyzed statistically. Results Chest pain intensity showed progressive significant (P = 0.0001) reduction through the 3 days post-operative. On the other hand spirometric values also showed progressive improvement through the 3 days post-operative. This improvement was significant for all measured spirometric values except for the ratio of forced expiratory volume in the 1st second to the forced vital capacity (P = 0.134). There was no significant relationship between the chest pain intensity and spirometric values. This was applied to all measured spirometric values and to the 3 days postoperative. Conclusion The current study findings rejected the examined hypothesis that reduction of post-operative chest pain intensity would be associated with improvement in the spirometric values for patient underwent coronary artery bypass graft surgery. There was no significant relationship between the chest pain intensity and any of the spirometric values at any of the 3 post-operative days.

  1. [Off-pump coronary artery bypass: analysis of 1080 patients].

    PubMed

    Monassier, F; Mattei, C; Gavra, G; Dallemand, R; Lallemant, P; Olteane, C; Semenescu, A; Durasnel, P; Monassier, J P; Bischoff, N

    2005-11-01

    A consecutive cohort including 1080 patients undergoing "off-pump" myocardial revascularization was reviewed. An average of 2.22 bypass/patients was performed. The death-rate during the first 30 days after surgery was 0.65%. Four cases needed cross-over to on-pump. The postoperative events were: need of inotropic drugs (2.7%), atrial fibrillation (12.4%), myocardial infarction (6.6%). The extubation was performed before the first postoperative 24 h in 91.9% of cases. The majority of patients was discharged from hospital before 8 days after surgery. Off pump coronary artery bypass surgery exhibit good results for most of the patients even if they present multiple vessel disease and high operating risk. PMID:17183823

  2. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting

    Microsoft Academic Search

    William E. Trick; William E. Scheckler; Jerome I. Tokars; Kevin C. Jones; Mel L. Reppen; Ellen M. Smith; William R. Jarvis

    2000-01-01

    Objective: Our objective was to identify risk factors for deep sternal site infection after coronary artery bypass grafting at a community hospital. Methods: We compared the prevalence of deep sternal site infection among patients having coronary artery bypass grafting during the study (January 1995–March 1998) and pre-study (January 1992–December 1994) periods. We compared any patient having a deep sternal site

  3. Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients

    Microsoft Academic Search

    John D Puskas; Vinod H Thourani; J. Jeffrey Marshall; Steven J Dempsey; Mark A Steiner; Bonnie H Sammons; W. Morris Brown; John Parker Gott; William S Weintraub; Robert A Guyton

    2001-01-01

    Background. This retrospective study compared clinical outcomes and resource utilization in patients having off-pump coronary artery bypass grafting (OPCAB) versus conventional coronary artery bypass grafting (CABG). Angiographic patency was documented in the OPCAB group.Methods. From April 1997 through November 1999, OPCAB was performed in 200 consecutive patients, and the results were compared with those in a contemporaneous matched control group

  4. Glycemic Control during Coronary Artery Bypass Graft Surgery

    PubMed Central

    Lazar, Harold L.

    2012-01-01

    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. PMID:23209941

  5. A review of 1,582 consecutive Octopus off-pump coronary bypass patients

    Microsoft Academic Search

    James C Hart; Ted H Spooner; John Pym; Thomas F Flavin; James R Edgerton; Michael J Mack; Erik W. L Jansen

    2000-01-01

    Background. Off-pump coronary bypass may provide a safer form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in the increasingly complex patients being referred for operation. This study reviews the entire experience of the Medtronic Octopus System (Medtronic, Minneapolis, MN) for beating heart bypass from 7 surgeons. Demographics, operative procedures, early outcomes, and trends in usage

  6. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity

    Microsoft Academic Search

    Joseph C Cleveland; A. Laurie W Shroyer; Anita Y Chen; Eric Peterson; Frederick L Grover

    2001-01-01

    Background. The purpose of this study was to determine whether coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG) decreases risk-adjusted operative death and major complications after coronary artery bypass grafting in selected patients.Methods. Using The Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database, procedural outcomes were compared for conventional and off-pump CABG procedures from January 1, 1998,

  7. Numerical analysis of coronary artery bypass grafts: an over view.

    PubMed

    Owida, Amal Ahmed; Do, Hung; Morsi, Yos S

    2012-11-01

    Arterial bypass grafts tend to fail after some years due to the development of intimal thickening (restenosis). Non-uniform hemodynamics following a bypass operation contributes to restenosis and bypass failure can occur due to the focal development of anastomotic intimal hyperplasia. Additionally, surgical injury aggravated by compliance mismatch between the graft and artery has been suggested as an initiating factor for progress of wall thickening along the suture line Vascular grafts that are small in diameter tend to occlude rapidly. Computational fluid dynamics (CFD) methods have been effectively used to simulate the physical and geometrical parameters characterizing the hemodynamics of various arteries and bypass configurations. The effects of such changes on the pressure and flow characteristics as well as the wall shear stress during a cardiac cycle can be simulated. Recently, utilization of fluid and structure interactions have been used to determine fluid flow parameters and structure forces including stress and strains relationships under steady and transient conditions. In parallel to this, experimental diagnostics techniques such as Laser Doppler Anemometry, Particle Image Velocimetry, Doppler Guide wire and Magnetic Resonance Imaging have been used to provide essential information and to validate the numerical results. Moreover, clinical imaging techniques such as magnetic resonance or computed tomography have assisted considerably in gaining a detailed patient-specific picture of the blood flow and structure dynamics. This paper gives a review of recent numerical investigations of various configurations of coronary artery bypass grafts (CABG). In addition, the paper ends with a summary of the findings and the future directions. PMID:22217920

  8. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with conventional off-pump coronary artery bypass

    PubMed Central

    Kon, Zachary N.; Brown, Emile N.; Tran, Richard; Joshi, Ashish; Reicher, Barry; Grant, Michael C.; Kallam, Seeta; Burris, Nicholas; Connerney, Ingrid; Zimrin, David; Poston, Robert S.

    2010-01-01

    Objectives Less-invasive options are available for surgical treatment of multivessel coronary artery disease. We hypothesized that stenting combined with grafting of the left anterior descending artery with the left internal thoracic artery through a minithoracotomy (hybrid procedure) would provide the best outcome. Methods Patients with equivalent numbers of coronary lesions (2.8 ± 0.4) underwent either hybrid (n = 15) or off-pump coronary artery bypass through a sternotomy (n = 30). Early and 1-year outcomes were compared. Blood drawn from the aorta and coronary sinus immediately postoperatively was analyzed for activation of coagulation (prothrombin fragment 1.2 and activated Factor XII), myocardial injury (myoglobin), and inflammation (interleukin 8) by using an enzyme-linked immunosorbent assay. Target-vessel patency was determined by means of computed tomographic angiographic analysis. Results The hybrid procedure was associated with significantly shorter lengths of intubation and stays in the intensive care unit and hospital and perioperative morbidity (P < .05). Intraoperative costs were increased but postoperative costs were reduced for the hybrid procedure compared with off-pump coronary artery bypass through a sternotomy. As a result, overall total costs were not significantly different between the groups. After adjusting for potential confounders, assignment to the hybrid group was an independent predictor of shortened time to return to work (t = ?2.12, P = .04). Patient satisfaction after the hybrid procedure, as judged on a 6-point scale, was greater versus that after off-pump coronary artery bypass through a sternotomy. Finally, the hybrid procedure showed significantly reduced transcardiac gradients of markers of coagulation, myocardial injury, and inflammation and a trend toward significant improvement in target-vessel patency. Conclusions Perhaps because of reduced myocardial injury, inflammation, and activation of coagulation, patients undergoing the hybrid procedure had better perioperative outcomes and satisfaction, with excellent patency at 1 year’s follow-up. These promising preliminary findings warrant further investigation of this procedure. PMID:18242270

  9. Off-pump coronary artery bypass surgery in a renal transplant patient

    Microsoft Academic Search

    Koji Hattori; Ryo Hoshino; Masato Tochii; Masato Sato; Mitsuru Yamashita; Motomi Ando

    2006-01-01

    Off-pump coronary artery bypass grafting is rarely applied to patients who have previously received a renal transplant in\\u000a Japan. A 59-year-old male renal transplant recipient was admitted for unstable angina pectoris. Emergency coronary angiography\\u000a revealed triple-vessel disease. Intraaortic balloon pumping was applied, followed by emergency off-pump coronary bypass grafting\\u000a for complete revascularization. Intraaortic balloon pumping was ceased immediately after the

  10. Clinical Symptoms and Angiographic Findings of Patients Undergoing Elective Coronary Angiography without Prior Stress Testing

    E-print Network

    Abdallah, Mouin Sami

    2012-12-31

    or obstructive coronary artery disease (CAD), proceeding directly to angiography would represent efficient resource utilization. Methods: We identified patients without a prior history of obstructive CAD undergoing elective coronary angiography performed between...

  11. Sensorineural hearing loss in patients with coronary artery bypass surgery

    PubMed Central

    Sadeghi, Mohsen Mirmohammad; Radman, Masoud; Bidaki, Reza; Sonbolestan, Mehdi

    2013-01-01

    Background: This study is planned to obtain a better understanding of the correlation between sudden sensorineural hearing loss and cardiopulmonary bypass. There are many causes for sudden hearing loss which include infectious, circulatory, inner ear problems like meniere's disease, neoplastic, traumatic, metabolic, neurologic, immunologic, toxic, cochlear, idiopathic (unknown cause) and other causes. One of the less common cause is surgery include cardiopulmonary bypass procedures. Materials and Methods: This study is a self controlled clinical trial on 105 patients that was carried out in chamran Hospital, Esfahan, Iran. Participants were including all those patients undergoing coronary artery bypass surgery in the hospital who fell under the criteria for inclusion. Patients underwent audiometric testing at our hospital on three or two different occasions during the course of this study, Initially before the procedure to test the baseline hearing capacity; then two week after the procedure to assess any changes in hearing ability following the surgery. Data analysis performed by co-variance analysis. Results: In our study the changes in the threshold of hearing in frequency of 1000 in right ear and in frequencies of 2000 and 4000 in left ear were significant, but this changes were about 2-3 db and were not noticeable. The difference in degree of SNHL, before and after surgery in different frequencies were been shown. Conclusion: As loss of the patients with symptomatic sensory neural hearing loss in this study, It isn't commanded the routin auditory assessment pre and post surgery was been done. PMID:23930250

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

    Microsoft Academic Search

    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

    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

  13. Changes in Body Mass Index and Late Postoperative Outcomes in Elderly Coronary Artery Bypass Grafting Patients: A Follow-up Study

    Microsoft Academic Search

    Rose Ann DiMaria-Ghalili

    2004-01-01

    The purpose of this study was to describe the extent to which late postoperative health outcomes vary as a function of change in body mass index (BMI) in persons 65 years of age undergoing elective coronary artery bypass grafting (CABG). The mean age of the 90 persons in the original sample was 72.27 (±4.85) years. At follow-up (x = 18.73,s

  14. Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications

    Microsoft Academic Search

    A Bowling; M Bond; D McKee; M McClay; A P Banning; N Dudley; A Elder; A Martin; I Blackman

    2001-01-01

    OBJECTIVESTo assess whether patients with heart disease in a single UK hospital have equitable access to exercise testing, coronary angiography, and coronary artery bypass graft surgery (CABG).METHODRetrospective analysis of patients' medical case notes (n = 1790), tracking each case back 12 months and forward 12 months from the patient's date of entry to the study.SETTINGSingle UK district hospital in the

  15. Conservative Management of Chylothorax after Coronary Artery Bypass Grafting

    PubMed Central

    Pulathan, Zerrin; Kutanis, Dilek; Hemsinli, Dogus; Erturk, Engin; Civelek, Ali

    2015-01-01

    Chylothorax is a rare sequela to cardiac surgery, associated with high rates of morbidity and mortality. There are various medical and surgical options for its management. We describe 2 cases of chylothorax that developed after coronary artery bypass grafting and were managed successfully with medical therapy alone. Conservative treatment such as we describe aims to reduce chyle flow, to drain the pleural cavity in an effective manner, and to prevent chronic sequelae. Optimal conservative treatment, consisting of nothing by mouth and the administration of a pleurodetic agent, should be started immediately upon diagnosis. In most cases, it reduces the need for reoperation and long-term hospitalization. Prospective randomized controlled trials are nonetheless needed to confirm these assumptions. PMID:25873827

  16. Constrictive pericarditis as a complication of coronary artery bypass surgery.

    PubMed Central

    Ribeiro, P; Sapsford, R; Evans, T; Parcharidis, G; Oakley, C

    1984-01-01

    Although it is now recognised as a rare complication of cardiac surgery, constrictive pericarditis was diagnosed in three patients after coronary artery bypass surgery. The time interval between cardiac surgery and the development of constrictive features varied from two to six weeks. All three patients presented with severe congestive heart failure. Haemodynamic findings were characteristic of constrictive pericarditis. Pericardial thickening detected by computed tomography in one patient was useful in establishing a definite diagnosis. One of the patients had a serous constrictive effusive pericarditis, and surgical pericardial drainage was needed. The other patient underwent pericardiectomy with preservation of the grafts. The diagnosis of constrictive pericarditis should be considered in patients presenting with unexplained right sided heart failure after cardiac surgery. Images PMID:6607061

  17. An appraisal of symptom relief after coronary bypass grafting.

    PubMed Central

    Frick, M. H.

    1976-01-01

    Subjective symptomatic improvement is experienced by 90% of patients after coronary bypass surgery. Objective exercise testing reduces this incidence to 70%. An analysis of the multifactorial genesis of pain relief based on data of non-randomized trials reveals that graft patency plays a dominant but not unique role in causing improved symptomatology. In a number of cases, intra-operative myocardial infarctions seem to explain the pain relief but may also have opposite effects. Changes in left ventricular function operate bidirectionally but data on this variable in relation to changes in symptomatology are not amenable for detailed analysis. Progression in native vessel lesions apparently opposes pain relief and has its greatest impact in connection with graft closure. Residual post-operative angina is evidently related also to incomplete revascularization. PMID:64978

  18. Coronary artery bypass grafting with left internal mammary artery and right gastroepiploic artery, with and without bypass

    Microsoft Academic Search

    Olivier Chavanon; Michel Durand; Rachid Hacini; Hélène Bouvaist; Marianne Noirclerc; Tarek Ayad; Dominique Blin

    2002-01-01

    Background. Total arterial and off-pump revascularization are increasingly used in coronary artery bypass grafting. This study describes our experience with the exclusive use of both left internal thoracic artery and gastroepiploic artery by means of a median sternotomy, with and without cardiopulmonary bypass, in a subgroup of patients with two-vessel disease.Methods. From January 1995 to July 2000, 171 consecutive patients

  19. On-Pump Beating Coronary Artery Bypass in High Risk Coronary Patients

    PubMed Central

    Afrasiabirad, Abbas; Safaie, Naser; Montazergaem, Hosein

    2015-01-01

    Background There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG) with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG) in coronary high-risk patients in comparison with the conventional methods. Methods In a prospective research study, 3000 off-pump CABG patients were considered during June 2003 to December 2011. Among these, 157 patients with one or more of the following risk factors were included for OPBCABG; severe left main stenosis, early post-acute myocardial infarction with ongoing chest pain, unstable angina, intractable ventricular arrhythmia, post complicated coronary intervention and severe left ventricular dysfunction. These patients were compared with 157 similar patients undergone CCABG with aortic cross clamp before 2003. Results Preoperative patient characteristics revealed no significant differences between the two groups. The patients’ mean age and number of grafts were 57 years and 3 per patient respectively. Hospital mortality was 3.2% and 9% in OPBCABG and CCABG groups, respectively (P<0.001). Preoperative myocardial infarction, requirement of inotropic agents and intraaortic balloon pump, renal dysfunction and prolonged ventilation time were significantly higher in CCABG group. Conclusion Our results suggest that OPBCABG is effective in coronary high-risk patients and significantly reduces mortality and the incidence of perioperative MI and other major complications. PMID:25650152

  20. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis

    PubMed Central

    2014-01-01

    Background Postoperative Acute Kidney Injury (AKI) after coronary artery bypass grafting (CABG) is a common complication associated with significant morbidity and mortality. Cardiopulmonary bypass (CPB) is accepted to contribute to the occurrence of AKI and is of particular importance as it can be avoided by using the off-pump technique. However the renoprotective properties of off-pump (CABG) are controversial. This analysis evaluates the impact of cardiopulmonary bypass on renal function. Methods A matched-pair analysis of 1428 patients undergoing coronary artery bypass grafting was conducted. The patients were stratified according to their preoperative renal function and to risk factors for postoperative AKI. The development of the glomerular filtration rate (GFR) from before surgery until hospital discharge was analyzed. Incidence of AKI were analyzed. Furthermore the impact of CPB duration on postoperative GFR was assessed. Results The occurrence of AKI increases the risk of thirty-day mortality (odds ratio of 4.3). The postoperative GFR decreases significantly after coronary artery bypass grafting but does not differ between onpump and offpump CABG (60.2?±?24.5 vs 60.7?±?24.8; p?=?0.54). No difference regarding the incidence (26.6% vs 25%) and severity of AKI between cardiopulmonary bypass and the off-pump technique could be found. Duration of cardiopulmonary bypass does not correlate with the decline in postoperative glomerular filtration rate (Pearson Product Moment Correlation; p?>?0.050). Conclusion Neither the mere use nor duration of cardiopulmonary bypass proofed to be a risk factor for developing postoperative AKI in CABG patients with a comparable preoperative risk profile for postoperative renal dysfunction. Furthermore, the severity of postoperative AKI is not affected by the use of cardiopulmonary bypass. PMID:24438155

  1. Are Coronary Angiograms of Value in the Risk Stratification of Patients Undergoing Coronary Artery Bypass Surgery?

    PubMed Central

    Lawrence, David R; Somaskanthan, Rajael; Barnard, Matthew J; Curtis, Miles; Keogh, Bruce E

    2009-01-01

    INTRODUCTION There are currently more than 20 risk-scoring systems that attempt to predict peri-operative mortality following coronary artery bypass surgery (CABG). All these scoring systems use objective criteria to assess operative risk. Angiographic data are currently not included in any of these systems. This pilot study assessed the value of coronary angiography in predicting peri-operative mortality following CABG. PATIENTS AND METHODS Fourteen patients who died following first-time isolated CABG surgery were identified. These were matched with 14 patients of similar age, sex, left ventricle function and European System for Cardiac Operative Risk Evaluation (EuroSCORE). A panel of 25 clinicians were given details of the patients' age, sex, diabetic status, family history, smoking history, hypertensive status, lipid status, pre-operative symptoms, left ventricle ejection fraction and weight and shown the coronary angiograms of the patient. They were asked to predict the outcome following CABG for each patient. RESULTS Receiver operator characteristic curves were constructed and the area under the curves calculated and analysed using a commercially available statistical package (PRISM). The area under the curve for the group was 0.6820 for the group. Consultant clinicians achieved an area of 0.6789 versus their trainees 0.6844 (P = NS). The cardiologists achieved an area of 0.7063 versus the cardiothoracic surgeons 0.6491 (P = NS). CONCLUSIONS Despite the EuroSCORE predicting equal risk for the two groups of patients, it would appear that clinicians are able to identify individual higher risk patients by assessing pre-operatively the quality of the patient' coronary vasculature. Although the clinicians were able to predict individual patient mortality better than the EuroSCORE, the area under the curve indicates that it is not a robust method and clinicians, with all the clinical information to hand, are only moderately good at predicting the outcome following coronary artery bypass surgery. PMID:19344558

  2. Off-pump coronary artery bypass graft without systemic heparin in a Jehovah Witness patient.

    PubMed

    Garcia, Lester; Avramovich, Aharon; Paparcuri, Gian; Karras, Riny; Salerno, Tomas A

    2011-05-01

    A Jehovah Witness patient with renal failure on dialysis, with low hemoglobin, underwent urgent off-pump coronary artery bypass grafting without systemic heparinization. The pros, cons, and details of the technique used are discussed. PMID:21443737

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

    Microsoft Academic Search

    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

    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

  4. Total i.v. anaesthesia with propofol and alfentanil for coronary artery bypass grafting.

    PubMed

    Manara, A R; Monk, C R; Bolsin, S N; Prys-Roberts, C

    1991-06-01

    The haemodynamic effects of total i.v. anaesthesia with a combination of propofol and alfentanil infusions were studied in eight patients with good left ventricular function undergoing coronary artery bypass surgery. Haemodynamic indices were measured before anaesthesia and at specified intervals before cardiopulmonary bypass. The technique resulted in haemodynamic changes comparable to those reported with opioid-based anaesthesia for coronary artery surgery, and has potential advantages. PMID:2064887

  5. Safety and efficacy of off-pump coronary artery bypass grafting

    Microsoft Academic Search

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

    2000-01-01

    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

  6. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting

    Microsoft Academic Search

    Vinod H Thourani; William S Weintraub; Bernardo Stein; Suzanne S. P Gebhart; Joseph M Craver; Ellis L Jones; Robert A Guyton

    1999-01-01

    Background. Diabetes mellitus is an established independent risk factor for significant morbidity and mortality after coronary artery bypass grafting.Methods. The impact of diabetes on short- and long-term follow-up after coronary artery bypass grafting was studied by comparing the outcomes between 9,920 patients without diabetes mellitus and 2,278 patients with diabetes from 1978 to 1993.Results. Compared with nondiabetic patients, the group

  7. Off-pump quintuple coronary artery bypass grafting for situs inversus totalis

    Microsoft Academic Search

    Toshiyuki Kuwata; Tetsuji Kawata; Takashi Ueda; Hidehito Sakaguchi; Shigeo Nagasaka; Shigeki Taniguchi

    2004-01-01

    Dextrocardia associated with situs inversus totalis is a rare condition. A 49-year-old man with dextro-cardia and situs inversus\\u000a totalis underwent off-pump quintuple coronary artery bypass grafting using bilateral internal thoracic arteries and bilateral\\u000a radial arteries. The operative technique was similar to that of off-pump coronary artery bypass grafting for situs solitus.\\u000a His postoperative recovery was uneventful.

  8. Routine postoperative care of patients undergoing coronary artery bypass grafting on cardiopulmonary bypass.

    PubMed

    Lighthall, Geoffrey K; Olejniczak, Megan

    2015-06-01

    The postoperative course of a patient undergoing cardiac surgery (CS) is dictated by a largely predictable set of interactions between disease-specific and therapeutic factors. ICU personnel need to quickly develop a detailed understanding of the patient's current status and how critical care resources can be used to promote further recovery and eventual independence from external support. The goal of this article is to describe a typical operative and postoperative course, with emphasis on the latter, and the diagnostic and therapeutic options necessary for the proper care of these patients. This paper will focus on coronary artery bypass grafting as a model for understanding the course of CS patients; however, many of the principles discussed are applicable to most cardiac surgery patients. PMID:25975592

  9. On-pump versus off-pump coronary artery bypass: independent risk factors and off-pump graft patency

    Microsoft Academic Search

    Ole Lund; John Christensen; Susanne Holme; Kim Fruergaard; Arne Olesen; Eli Kassis; Ulrik Abildgaard

    2001-01-01

    Objective: Current knowledge on off-pump coronary artery bypass (OPCAB) generally stems from single surgeons’ experience or from series where OPCABs constituted a minor fraction of coronary operations. The present center decided to venture as far into OPCAB as possible during 1999. The present series thus represents the average surgeon's experience. Methods: During 1999, 533 patients underwent coronary artery bypass grafting

  10. Hemodynamic changes during displacement of the beating heart using epicardial stabilization for off-pump coronary artery bypass graft surgery

    Microsoft Academic Search

    Manisha Mishra; Rajneesh Malhotra; Anil Mishra; Zile Singh Meharwal; Naresh Trehan

    2002-01-01

    Objective: To evaluate the hemodynamic alterations during off-pump coronary artery bypass graft surgery to determine the degree of impairment caused and the techniques to rectify them. Design: Prospective, observational cohort study performed from January 2000 through September 2000. Participants: Patients (n = 500) with coronary artery disease undergoing multivessel off-pump coronary artery bypass graft surgery using the Octopus tissue stabilizer

  11. Determinant Factors of Renal Failure after Coronary Artery Bypass Grafting with On-Pump Technique

    Microsoft Academic Search

    Hossein Ahmadi; Abbasali Karimi; Saeed Davoodi; Namvar Movahedi; Mehrab Marzban; Kyomars Abbasi; Abbas Salehi Omran; Mahmud Shirzad; Seyed Hesameddin Abbasi; Mokhtar Tazik

    2009-01-01

    Objective: The aim of the present study was to investigate the determinant factors of acute renal failure (ARF) after isolated on-pump coronary artery bypass grafting (CABG). Subjects and Methods: This was a retrospective study of 13,315 adult patients who underwent isolated CABG with cardiopulmonary bypass (CPB) in Tehran Heart Center from May 2002 to May 2007. The exclusion criteria were

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

    Microsoft Academic Search

    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

    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

  13. [The correlation between flow pattern during cardiopulmonary bypass and patency of the coronary artery bypass grafts].

    PubMed

    Hagiwara, H; Shirakawa, M; Nakayama, T; Asai, T; Nakayama, M; Ito, T; Yano, Y

    2005-07-01

    Recently the availability of transit time flow measurement (TTFM) is reported especially in off-pump coronary artery bypass grafting (CABG). But little is known about TTFM findings in on-pump CABG. We examined the correlation between the TTFM flow pattern and the angiography findings in on-pump CABG. The subjects consisted of 52 patients who underwent on-pump CABG and angiography early after operation. In these patients, 55 internal thoracic artery (ITA), 17 gastroepiploic artery (GEA), 13 saphenous vein graft (SVG) and 41 radial artery (RA) were tested with TTFM during cardiopulmonary bypass (CPB). TTFM demonstrated a diastolic filling pattern in 53 ITA, 16 GEA, 13 SVG and 36 RA. The angiography revealed that all these grafts were perfectly patent with the exception of a GEA with a flow competition pattern. TTFM revealed an abnormal flow pattern in 2 ITA (these 2 grafts were revised during CPB and the angiography demonstrated their perfect patency), 1 GEA (to and fro pattern), 0 SVG and 5 RA (the abnormal pattern was due to graft spasm in 3 of 5, and the angiography revealed their perfect patency, however, the angiography detected stenosis in the remaining 2 grafts). The present study found that the TTFM flow pattern during CPB correlated well with the angiography findings. TTFM during CPB was useful to detect graft failure, and grafts were revised safely during CPB. PMID:16004331

  14. The left internal thoracic artery and radial artery composite graft in off-pump coronary artery bypass grafting.

    PubMed

    Tanaka, Hiroyuki; Narisawa, Takashi; Mori, Nobutaka; Masuda, Mikio; Kishi, Daijirou; Suzuki, Takashi; Takaba, Toshihiro

    2002-08-01

    Arterial multivessel bypass grafting without extra corporeal circulation and manipulation of the ascending aorta should be a good surgical option for the treatment of coronary artery disease. An internal thoracic artery (ITA)-radial artery (RA) composite graft was used for this purpose. Between July 2000 and October 2001, we employed the LITA-RA composite graft for off-pump coronary artery bypass in 15 cases. Mean patient age was 71.3 +/- 5.8 years old. Left main trunk disease was present in six patients and triple-vessel disease in four patients. Preoperative concomitant disease was renal dysfunction in three cases, cerebrovascular disease in four and diabetes mellitus in five cases. Two patients had a so-called bad aorta. Twelve elective operations and three urgent operations were carried out for unstable angina. Two to four (mean 2.6 +/- 0.7) anastomoses were performed per patient. Complete revascularization was achieved in 12 out of 15 patients. Mean operating time was 335 +/- 53 min. Mean intraoperative blood loss was 595 +/- 375 ml and nine patients underwent the operation without blood transfusion. There was no PMI, no brain disorder, and no death. Postoperative coronary angiography in all patients documented a good patency rate (LITA 15/15, RA 21/21, right gastroepiploic artery (RGEA) 2/2, and saphenous vein graft (SVG) 0/2). LITA-RA composite grafting in off-pump coronary artery bypass enables arterial multivessel revascularization using an aortic no touch technique. This can be done with minimum postoperative complications and without risk of cerebral infarction even in patients at high risk for extracorporeal circulation (ECC). PMID:12472383

  15. Autotransfusion in coronary artery bypass grafting: Disparity in laboratory tests and clinical performance

    Microsoft Academic Search

    Hanne I. Flom-Halvorsen; Eivind Øvrum; Geir Tangen; Frank Brosstad; Mari-Anne L. Ringdal; Rolf Øystese

    1999-01-01

    Objective: Autotransfusion during and after cardiac surgery is widely performed, but its effects on coagulation, fibrinolysis, and inflammatory response have not been known in detail. Methods: Hemostatic and inflammatory markers were extensively studied in 40 coronary artery bypass patients undergoing a consistent intraoperative and postoperative autotransfusion protocol. An identical autotransfusion protocol was applied to 4916 consecutive coronary patients and the

  16. The changing mortality of myocardial revascularization: Coronary artery bypass and angioplasty

    Microsoft Academic Search

    Keith S. Naunheim; Andrew C. Fiore; J. Jeffrey Wadley; Kirk R. Kanter; Lawrence R. McBride; D. Glenn Pennington; Hendrick B. Barner; Ubeydullah Deligonul; Morton J. Kern; Michel Vandormael; Vallee L. Willman; George C. Kaiser

    1995-01-01

    The risk factors and outcome for the first 150 consecutive patients undergoing coronary artery bypass grafting (CABG) in 1985 (CABG '85) were compared with those of the first 150 patients undergoing CABG in 1975 (CABG '75) and those of the first 150 patients to have percutaneous transluminal coronary angioplasty (PTCA) in 1985 (PTCA '85). The CABG '85 patients had a

  17. Continuous Retrograde Cardiac Perfusion Decreases Risk of Reoperative Coronary Artery Bypass Grafting

    Microsoft Academic Search

    Scott M. Goldman; Francis P. Sutter; Brian P. Priest; Mary Ann C. Wertan

    1997-01-01

    Embolization of atheromatous debris from old saphenous vein grafts is a major factor that increases the risk of reoperative coronary artery bypass grafting (CABG) when compared with primary CABG. To decrease this risk, a technique consisting of minimal dissection of the heart prior to cross clamping, continuous retrograde coronary sinus perfusion with 32°C blood, and temporary posterior cardiac interventricular vein

  18. Survival benefit of coronary-artery bypass grafting accounted for deaths in those who remained untreated

    Microsoft Academic Search

    Boris G Sobolev; Guy Fradet; Robert Hayden; Lisa Kuramoto; Adrian R Levy; Mark J FitzGerald

    2008-01-01

    BACKGROUND: Currently there are no direct estimates of mortality reduction afforded by coronary-artery bypass grafting (CABG) that take into account the deaths among patients for whom coronary revascularization was indicated but who did not undergo the treatment. The objective of this analysis was to compare survival after the treatment decision between patients who underwent CABG and those who remained untreated.

  19. Off-pump coronary bypass grafting: how to use the octopus tissue stabilizer

    Microsoft Academic Search

    Erik W. L Jansen; JaapR Lahpor; Cornelius Borst; PaulF Gründeman; JohanJ Bredée

    1998-01-01

    Off-pump coronary artery bypass grafting requires immobilization of the coronary artery. A suction device (Octopus Tissue Stabilizer), attached to the epicardium and connected rigidly to the operating table rail, was used through limited and full surgical access for single-vessel and multivessel arterial revascularization, respectively. An outline for its application, as used by us to construct 122 anastomoses in 70 patients,

  20. The Sexual Adjustment of Coronary Bypass Surgery Patients: A 4-Year Follow-Up.

    ERIC Educational Resources Information Center

    Thurer, Shari; Thurer, Robert L.

    1983-01-01

    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)

  1. Factors predicts skin ulcer following coronary artery bypass.

    PubMed

    Sabzi, F; Faraji, R

    2014-01-01

    The number of off-pump coronary artery surgery procedures in high-risk patients such as renal failure, hepatic failure and in anticoagulant drug using patients is increasing. The associated co morbidity and repeated use of electrocautery in postoperative bleeding, caused a susceptibility of patients to pressure or electrocautery ulcers. During a period of three years, 1400 off-pump coronary artery bypass surgery were performed in our center. Of these patients, 20 (A group) suffered from electrocautery sore (ES) and 40 (B group) had pressure sore (PS). These patients were compared with respect to variables such as age, hypertension, hypercholesterolemia, operating time, smoking, opium using, diabetes, weight, sex, respiratory failure, renal failure, and cerebrovascular accident, intra aortic balloon pump using, inotropic drug using by x2 or t test, according to categorical or continuous variables consequently. Electrocautery sore and pressure ulcer as dependence variables and others variables with p value less than 0.1 entered a multivariable logistic regression model and odd ratio of significant variables were obtained. These two groups of patients were different with respect to variables such as age, sex, respiratory failure and cerebrovascular accident and, in the logistic regression model, two factors predicted pressure sore, respiratory failure and cerebrovascular accident, but the only factor that was significant in predicting electrocautery sore in multiple logistic regression analysis was postoperative bleeding. Results of this study revealed that pressure sore is a patient dependent complication in contrast with the electrocautery sore, which is related to technical or device faults and to experience and care of operating room staff. PMID:25870669

  2. The history and development of direct coronary surgery without cardiopulmonary bypass.

    PubMed

    Thanikachalam, Mohan; Lombardi, Pierluca; Tehrani, Hassan Y; Katariya, Kushagra; Salerno, Tomas A

    2004-01-01

    The history of direct myocardial revascularization without cardiopulmonary bypass dates to 1961 in the dawn of coronary artery surgery. With the introduction and development of techniques of extracorporeal circulation around the same time, beating heart surgery was largely abandoned. Over the subsequent decades, cardiopulmonary bypass and electromechanical cardioplegic arrest became popular as means of revascularization in a bloodless and motionless field. While coronary artery surgery on the arrested heart remained undisputed for decades, myocardial revascularization on the beating heart was pursued by a few pioneering surgeons around the world, based on the belief that coronary revascularization could be performed equally well without the detrimental effects of cardiopulmonary bypass and electromechanical arrest. Various concepts and techniques developed during the 1980s by these pioneers enabled minimally invasive coronary surgery to be performed in the early 1990s. This break from the mainstream allowed selective myocardial revascularization using a minimal incision and no cardiopulmonary bypass to develop and constructed a base for future extensive revascularizations off-pump. With the subsequent explosion of new techniques for coronary exposure and myocardial stabilization, complete revascularization without cardiopulmonary bypass became possible with consistent results. Emerging from the preview of only a few surgeons just a decade ago, off-pump surgery is currently one of the accepted modalities for complete myocardial revascularization worldwide. This paradigm shift in the approach to myocardial revascularization has led to exiting new future possibilities, such as beating heart totally endoscopic coronary artery surgery. PMID:15548184

  3. Preventing Deep Wound Infection after Coronary Artery Bypass Grafting

    PubMed Central

    Bryan, Charles S.; Yarbrough, William M.

    2013-01-01

    The consequences of deep wound infections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include prolonged perfusion time, the use of one or more internal mammary arteries as grafts, blood transfusion, and mechanical circulatory assistance. The chief postoperative risk factor is reoperation, usually for bleeding. Unresolved issues include the optimal approach to Staphylococcus aureus nasal colonization and the choice of a prophylactic antibiotic regimen. We recommend that cardiac surgery programs supplement their audit processes and ongoing vigilance for infections with periodic, multidisciplinary reviews of best-practice standards for preoperative, intraoperative, and postoperative patient care. PMID:23678210

  4. Augmented reality image guidance for minimally invasive coronary artery bypass

    NASA Astrophysics Data System (ADS)

    Figl, Michael; Rueckert, Daniel; Hawkes, David; Casula, Roberto; Hu, Mingxing; Pedro, Ose; Zhang, Dong Ping; Penney, Graeme; Bello, Fernando; Edwards, Philip

    2008-03-01

    We propose a novel system for image guidance in totally endoscopic coronary artery bypass (TECAB). A key requirement is the availability of 2D-3D registration techniques that can deal with non-rigid motion and deformation. Image guidance for TECAB is mainly required before the mechanical stabilization of the heart, thus the most dominant source of non-rigid deformation is the motion of the beating heart. To augment the images in the endoscope of the da Vinci robot, we have to find the transformation from the coordinate system of the preoperative imaging modality to the system of the endoscopic cameras. In a first step we build a 4D motion model of the beating heart. Intraoperatively we can use the ECG or video processing to determine the phase of the cardiac cycle. We can then take the heart surface from the motion model and register it to the stereo-endoscopic images of the da Vinci robot using 2D-3D registration methods. We are investigating robust feature tracking and intensity-based methods for this purpose. Images of the vessels available in the preoperative coordinate system can then be transformed to the camera system and projected into the calibrated endoscope view using two video mixers with chroma keying. It is hoped that the augmented view can improve the efficiency of TECAB surgery and reduce the conversion rate to more conventional procedures.

  5. Off-pump coronary artery bypass surgery in patients with chronic renal failure Kronik böbrek yetmezlikli hastalarda \\

    Microsoft Academic Search

    Ömer Tetik; Bilgin Emrecan; Berkan Özpak; Levent Yilik; Mert Kestelli; Nagihan Karahan; Cengiz Özbek; Ali Gürbüz

    Objective: Patients with dialysis-dependent renal disease frequently present with coronary artery disease. These patients are considered to be at high risk for coronary artery bypass grafting. Therefore, off-pump coronary artery surgery may become a good option for these patients. Off-pump coronary artery bypass surgery in patients with dialysis-dependent renal failure was retrospectively reviewed in this study. Methods: From March 2001

  6. Percutaneous Closure of a Coronary Artery-to-Vein Graft Anastomotic Pseudoaneurysm Presenting as Acute Coronary Syndrome after Recent Coronary Artery Bypass Grafting

    PubMed Central

    Sharma, Suresh; Gupta, Kamal; Wiley, Mark; Parashara, Deepak

    2015-01-01

    Pseudoaneurysm formation has been reported in degenerated coronary artery saphenous vein bypass grafts, as well as in native coronary arteries after interventional procedures or blunt trauma. In contrast, pseudoaneurysm formation arising from the anastomotic site of native coronary vessels soon after coronary artery bypass grafting is rare, and neither the clinical presentation of this phenomenon nor its treatment is well described. We present the case of a 63-year-old man, a recent coronary artery bypass grafting patient, who presented with acute coronary syndrome due to a large and expanding pseudoaneurysm of the saphenous vein-to-ramus intermedius artery graft anastomosis. After several attempts, we successfully treated the pseudoaneurysm by means of percutaneous coil embolization. To our knowledge, this is the first report of acute coronary syndrome secondary to a pseudoaneurysm at the coronary artery–saphenous vein graft anastomosis. In addition, this appears to be the first report of the percutaneous treatment of such a pseudoaneurysm by means of coil embolization. PMID:26175645

  7. Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease

    Microsoft Academic Search

    Robert H. Jones; Karen Kesler; Harry R. Phillips; Daniel B. Mark; Peter K. Smith; Charlotte L. Nelson; Mark F. Newman; Joseph G. Reves; Robert W. Anderson; Robert M. Califf

    1996-01-01

    The purpose of this study was to evaluate long-term survival benefits of bypass surgery and angioplasty versus medical therapy in 9263 patients at Duke University Medical Center between 1984 and 1990 with coronary artery disease confirmed by cardiac catheterization to involve one, two, or three vessels. Clinical data were prospectively entered into an established cardiovascular database, and annual follow-up was

  8. Venous Coronary Artery Bypass Grafting: Late Results of a 15Year Actuarial Follow-Up in 486 Patients

    Microsoft Academic Search

    Kenji Takazawa; Yasuyuki Hosoda; Taira Yamamoto; Akifusa Hariya; Noboru Ishikawa; Hiroyuki Miyagawa; Shizuyuki Dohi; Atsushi Amano

    2003-01-01

    Purpose. The aim of this study was to clarify the long-term results of venous coronary artery bypass grafting in Japanese patients. Methods. The study population included 492 patients who underwent venous coronary artery bypass procedures at the Department of Cardiothoracic Surgery of Juntendo University from January 1984 to December 1989. The great majority of patients, 420 of 492 (85.4%), were

  9. Cardiovascular medication use after coronary bypass surgery in patients with renal dysfunction: A National Veterans Administration study1

    Microsoft Academic Search

    ERIC M GIBNEY; ADRIANNE W CASEBEER; LYNN M SCHOOLEY; FRANCESCA CUNNINGHAM; FREDERICK L GROVER; MISSY R BELL; GERALD O MCDONALD; A LAURIE SHROYER; CHIRAG R PARIKH

    2005-01-01

    Cardiovascular medication use after coronary bypass surgery in patients with renal dysfunction: A national Veterans Administration study.BackgroundChronic kidney disease is now recognized as an independent risk factor for cardiovascular events. We sought to determine if cardiovascular medications were utilized less in patients with renal dysfunction following coronary artery bypass grafting (CABG) and if the association of decreased medication use was

  10. Factors influencing blood transfusion requirements in robotic totally endoscopic coronary artery bypass grafting on the arrested heart

    Microsoft Academic Search

    Johannes Bonatti; Thomas Schachner; Dominik Wiedemann; Felix Weidinger; Christian Kolbitsch; Hans Knotzer; Zachary N. Kon; Nikolaos Bonaros

    2011-01-01

    Objective: Robotic technology enables totally endoscopic coronary artery bypass grafting (TECAB) procedures. These operations can be performed on either the beating or arrested heart. One challenge of the latter version is a potentially increased need for blood transfusions. We investigated factors associated with transfusion requirements in totally endoscopic coronary artery bypass on the arrested heart (AH-TECAB). Patients and methods: A

  11. Safe, highly selective use of pulmonary artery catheters in coronary artery bypass grafting: an objective patient selection method

    Microsoft Academic Search

    Thomas A Schwann; Anoar Zacharias; Christopher J Riordan; Samuel J Durham; Milo Engoren; Robert H Habib

    2002-01-01

    Background. Routine versus selective use of pulmonary artery catheter (PAC) monitoring in coronary artery bypass grafting operations is a topic of significant debate. Accordingly, we retrospectively examined operative outcomes in 2,685 consecutive (1994 to 1998) coronary artery bypass grafting patients in whom PAC use was highly selective. Next, we developed a quantitative model of PAC use in terms of its

  12. Safe, Highly Selective Use of Pulmonary Artery Catheters in Coronary Artery Bypass Grafting: An Objective Patient Selection Method

    Microsoft Academic Search

    Thomas A. Schwann; Anoar Zacharias; Christopher J. Riordan; Samuel J. Durham; Milo Engoren; Robert H. Habib

    2010-01-01

    Background. Routine versus selective use of pulmo- nary artery catheter (PAC) monitoring in coronary artery bypass grafting operations is a topic of significant debate. Accordingly, we retrospectively examined operative out- comes in 2,685 consecutive (1994 to 1998) coronary artery bypass grafting patients in whom PAC use was highly selective. Next, we developed a quantitative model of PAC use in terms

  13. The effects of stress management on the quality of life of patients following acute myocardial infarction or coronary bypass surgery

    Microsoft Academic Search

    A. Trzcieniecka-Green; A. Steptoe

    1996-01-01

    The objective of this study was to assess the impact of group-based stress management training on emotional well- being, functional status, social activity and chest pain in cardiac patients, within a randomized controlled trial. Fifty acute myocardial infarction and 50 coronary artery bypass patients were randomized to experimental (27 myo- cardial infarction and 23 coronary artery bypass) and control (23

  14. Perivascular Nitric Oxide Delivery to Saphenous Vein Grafts Prevents Graft Stenosis after Coronary Artery Bypass Grafting: A Novel Sheep Model

    Microsoft Academic Search

    Kyomars Abbasi; Keivan Shalileh; Maryam Sotudeh Anvari; Shahram Rabbani; Abolfazl Mahdanian; Seyed Hosein Ahmadi; Naghmeh Moshtaghi; Namvar Movahedi; Abbasali Karimi

    2011-01-01

    Objectives: Graft stenosis is a major complication of coronary artery bypass grafting with autologous saphenous vein grafts. Nitric oxide (NO) is believed to prevent this phenomenon. We studied the effect of perivascular application of an NO donor on the degree of stenosis of such grafts in an ovine model. Methods: Twenty white Iranian ewes were randomized to coronary artery bypass

  15. Epidemiology of coronary artery bypass grafting at the Hospital Beneficência Portuguesa, São Paulo

    PubMed Central

    de Sousa, Alexandre Gonçalves; Fichino, Maria Zenaide Soares; da Silva, Gilmara Silveira; Bastos, Flávia Cortez Colosimo; Piotto, Raquel Ferrari

    2015-01-01

    Introduction The knowledge of the prevalence of risk factors and comorbidities, as well as the evolution and complications in patients undergoing coronary artery bypass graft allows comparison between institutions and evidence of changes in the profile of patients and postoperative evolution over time. Objective To profile (risk factors and comorbidities) and clinical outcome (complications) in patients undergoing coronary artery bypass graft in a national institution of great surgical volume. Methods A retrospective cohort study of patients undergoing coronary artery bypass graft in the hospital Beneficência Portuguesa de São Paulo, from July 2009 to July 2010. Results We included 3,010 patients, mean age of 62.2 years and 69.9% male. 83.8% of patients were hypertensive, 36.6% diabetic, 44.5% had dyslipidemia, 15.3% were smokers, 65.7% were overweight/obese, 29.3% had a family history of coronary heart disease. The expected mortality calculated by logistic EuroSCORE was 2.7%. The isolated CABG occurred in 89.3% and 11.9% surgery was performed without cardiopulmonary bypass. The most common complication was cardiac arrhythmia (18.7%), especially acute atrial fibrillation (14.3%). Pneumonia occurred in 6.2% of patients, acute renal failure in 4.4%, mediastinites in 2.1%, stroke in 1.8% and AMI in 1.2%. The in-hospital mortality was 5.4% and in isolated coronary artery bypass graft was 3.5%. The average hospital stay was 11 days with a median of eight days (3-244 days). Conclusion The profile of patients undergoing coronary artery bypass graft surgery in this study is similar to other published studies. PMID:25859865

  16. Patient Selection and Current Practice Strategy for Off-pump Coronary Artery Bypass Surgery

    Microsoft Academic Search

    Mitchell J. Magee; Laura P. Coombs; Eric D. Peterson; Michael J. Mack

    Objective—Previous studies comparing off-pump coronary artery bypass surgery (OPCABG) to conventional techniques utilizing cardiopulmonary bypass (CABG-CPB) have failed to provide patient selection guidelines. We sought to determine guidelines, attempting to rectify the limitations of previous studies. Methods and Results—A retrospective analysis of prospectively collected data from the Society of Thoracic Surgeons National Database, from January 1999 through December 2000, identified

  17. Targeting cefuroxime plasma concentrations during coronary artery bypass graft surgery with cardiopulmonary bypass.

    PubMed

    Aalbers, Marieke; Ter Horst, Peter G J; Hospes, Wobbe; Hijmering, Michel L; Spanjersberg, Alexander J

    2015-08-01

    Backgound Patients are at risk for severe postoperative infections after coronary artery bypass graft (CABG) surgery. Clinical laboratory data showed that unbound plasma concentrations of cefuroxime were not always adequate, therefore we developed a new dosing regimen. Objective The aim of this prospective study is to evaluate the new dosing strategy by monitoring patients for unbound cefuroxime plasma concentrations during CABG surgery with cardiopulmonary bypass (CPB). Setting A Dutch teaching hospital. Methods In this prospective trial, patients scheduled for CABG surgery with CPB were included. A starting dose of 1500 mg cefuroxime was given with anesthesia induction, followed by 750 mg cefuroxime every hour until wound closure. In case of renal failure the dosing regimen was adapted. Serial blood samples were collected before, during and after the CPB process. Pharmacokinetic modelling was performed by using an 'iterative two-stage Bayesian population procedure'. Main outcome measure Unbound plasma concentrations of cefuroxime. Results 22 patients were included, data could be evaluated of 21 patients. In 24 % of the patients the unbound cefuroxime plasma concentration was below the target range during surgery before CPB started. Patients with a bodyweight above 100 kg or age <60 years were more likely to have unbound plasma concentrations below the target range (P = 0.030 and P = 0.008). During CPB, the half-life of unbound cefuroxime increased by 17 % and the clearance decreased by 11 % compared to before CPB (P = 0.033 and P = 0.014). The mean pharmacokinetic parameters before, during and after CPB were as follows: elimination half-life 72, 84 and 76 min; clearance of unbound cefuroxime (Clu) 14.2, 12.7, 13.8 l/h and volume of distribution (Vu) 0.280, 0.284 and 0.290 l/kg respectively. Variations in unbound fractions before, during and after CPB were below 2 %, implicating the unbound fraction of cefuroxime is not influenced by CPB. Conclusion Our results show that CPB during CABG surgery does not lead to inadequate unbound cefuroxime concentrations. Age, renal function and possibly also weight are more important factors that can result in unbound plasma cefuroxime concentrations below the target value. PMID:25791346

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

    SciTech Connect

    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

    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.

  19. Air embolism during off-pump coronary artery bypass graft surgery -A case report-

    PubMed Central

    Chang, Choo-Hoon; Cho, Hyun-Sung

    2012-01-01

    There have been several reports of gas embolism occurring during off-pump coronary artery bypass graft (OPCAB) surgery. However, all these cases of air embolism were associated with the repair of venous circulation, using a CO2 blower. In this report, we describe a rare case of air embolism in the coronary arteries associated with the use of a CO2 blower during OPCAB. There was no injury to the veins during OPCAB. The air embolism was treated successfully with cardiopulmonary bypass. PMID:22870370

  20. Changes in Heart Rate Variability after Coronary Artery Bypass Grafting and Clinical Importance of These Findings

    PubMed Central

    Lakusic, Nenad; Mahovic, Darija; Cerkez Habek, Jasna; Novak, Miroslav; Cerovec, Dusko

    2015-01-01

    Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented.

  1. Prediction of length of stay following elective percutaneous coronary intervention.

    PubMed

    Negassa, Abdissa; Monrad, E Scott

    2011-01-01

    There have been published risk stratification approaches to predict complications following percutaneous coronary interventions (PCI). However, a formal assessment of such approaches with respect to predicting length of stay (LOS) is lacking. Therefore, we sought to assess the performance of, an easy-to-use, tree-structured prognostic classification model in predicting LOS among patients with elective PCI. The study is based on the New York State PCI database. The model was developed on data for 1999-2000, consisting of 67,766 procedures. Validation was carried out, with respect to LOS, using data for 2001-2002, consisting of 79,545 procedures. The risk groups identified by the model exhibited a strong progressively increasing relative risk pattern of longer LOS. The predicted average LOS ranged from 3 to 9 days. The performance of this model was comparable to other published risk scores. In conclusion, the tree-structured prognostic classification is a model which can be easily applied to aid practitioners early on in their decision process regarding the need for extra resources required for the management of more complicated patients following PCI, or to justify to payors the extra costs required for the management of patients who have required extended observation and care after PCI. PMID:22084771

  2. Prediction of Length of Stay Following Elective Percutaneous Coronary Intervention

    PubMed Central

    Negassa, Abdissa; Monrad, E. Scott

    2011-01-01

    There have been published risk stratification approaches to predict complications following percutaneous coronary interventions (PCI). However, a formal assessment of such approaches with respect to predicting length of stay (LOS) is lacking. Therefore, we sought to assess the performance of, an easy-to-use, tree-structured prognostic classification model in predicting LOS among patients with elective PCI. The study is based on the New York State PCI database. The model was developed on data for 1999-2000, consisting of 67,766 procedures. Validation was carried out, with respect to LOS, using data for 2001-2002, consisting of 79,545 procedures. The risk groups identified by the model exhibited a strong progressively increasing relative risk pattern of longer LOS. The predicted average LOS ranged from 3 to 9 days. The performance of this model was comparable to other published risk scores. In conclusion, the tree-structured prognostic classification is a model which can be easily applied to aid practitioners early on in their decision process regarding the need for extra resources required for the management of more complicated patients following PCI, or to justify to payors the extra costs required for the management of patients who have required extended observation and care after PCI. PMID:22084771

  3. The effects of cardiopulmonary bypass on systemic and coronary levels of von Willebrand factor

    Microsoft Academic Search

    D. R. Holdright; B. J. Hunt; R. Parratt; H. Segal; D. Clarke; D. Taggart; G. Bennett; P. Collins

    1995-01-01

    Von Willebrand factor antigen (vWF Ag) is a marker of endothelial injury which has been shown to rise during surgical procedures, including cardiopulmonary bypass (CPB). The aim of this study was to determine whether intermittent aortic cross-clamping during CPB causes the release of vWF Ag from the coronary vascular bed, which would suggest coronary vascular endothelial cell perturbation. Fifteen consecutive

  4. Off-pump coronary artery bypass for a heparin-allergic patient

    Microsoft Academic Search

    Hirofumi Ide; Tatsuo Fujiki; Masaya Sato; Hidehito Endo; Kentarou Imamura; Ken-ichi Sudo

    2001-01-01

    A 46-year-old man with no history of drug allergy developed acute myocardial infarction. Coronary angiographic findings revealed\\u000a triple vessel disease. Serum hepatic enzymes were elevated due to heparin administered to control infarction, and an allergic\\u000a reaction developed exclusively due to heparin. To avoid heparin use, we adopted heparin-free off-pump coronary artery bypass\\u000a grafting through median sternotomy. The systemic anticoagulant agent

  5. Off-Pump Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction

    Microsoft Academic Search

    Zile Singh Meharwal; Naresh Trehan

    2001-01-01

    Background: Coronary artery bypass grafting in patients with severe left ventricular (LV) dysfunction still remains a high risk procedure due to its high mortality and morbidity. Off-pump surgery can be an alternative technique in these patients. We analyzed our results of off-pump coronary surgery in patients with left ventricular dysfunction and com- pared them with patients operated on-pump. Methods: Between

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

    Microsoft Academic Search

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

    2002-01-01

    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

  7. Fatal fungal infection complicating aortic dissection following coronary artery bypass grafting

    Microsoft Academic Search

    D. M Rassl; S. K Suvarna; G. J Cooper

    2000-01-01

    The case of a 52-year-old man with severe coronary atheroma\\/ischaemic heart disease, who underwent successful triple vessel coronary artery bypass grafting is described. One month later this was complicated by aortic dissection arising at the aortic cannulation site. An emergency resection and Dacron graft placement were performed. Five weeks later he represented with haemoptysis. Despite inconclusive investigations the patient went

  8. Collateral blood flow between left coronary artery bypass grafts and chronically occluded right coronary circulation in patients with triple vessel disease. Observations during complete revascularisation of beating hearts

    Microsoft Academic Search

    Jean-Philippe Verhoye; Issam Abouliatim; Agnes Drochon; Bertand de Latour; Christophe Leclercq; Alain Leguerrier

    2010-01-01

    Objective: Preoperative measurements of collateral blood flow in patients with triple vessel disease and chronic occlusions of the right coronary artery do not, currently, ascertain the need to revascularise an occluded right coronary artery. We performed direct measurements of flow across left coronary bypass grafts to determine their contributions to collateral blood flow. Methods: Collateral blood flow was scored preoperatively

  9. Collateral blood flow between left coronary artery bypass grafts and chronically occluded right coronary circulation in patients with triple vessel disease. Observations during complete revascularisation of beating hearts

    Microsoft Academic Search

    Jean-Philippe Verhoye; Issam Abouliatim; Agnes Drochon; Bertand de Latour; Christophe Leclercq; Alain Leguerrier; Hervé Corbineau

    2007-01-01

    Objective: Preoperative measurements of collateral blood flow in patients with triple vessel disease and chronic occlusions of the right coronary artery do not, currently, ascertain the need to revascularise an occluded right coronary artery. We performed direct measurements of flow across left coronary bypass grafts to determine their contributions to collateral blood flow. Methods: Collateral blood flow was scored preoperatively

  10. On-pump versus off-pump coronary artery bypass: independent risk factors and off-pump graft patency

    Microsoft Academic Search

    Ole Lund; John Christensen; Susanne Holme; Kim Fruergaard; Arne Olesen; Eli Kassis; Ulrik Abildgaard

    Abstract Objective: Current knowledge,on off-pump coronary artery bypass (OPCAB) generally stems from single surgeons’ experience or from series where OPCABs constituted a minor fraction of coronary operations. The present center decided to venture as far into OPCAB as possible during 1999. The present series thus represents the average surgeon’s experience. Methods: During 1999, 533 patients underwent coronary artery bypass grafting

  11. Prospective randomized comparison of cefodizime versus cefuroxime for perioperative prophylaxis in patients undergoing coronary artery bypass grafting.

    PubMed Central

    Wenisch, C; Bartunek, A; Zedtwitz-Liebenstein, K; Hiesmayr, M; Parschalk, B; Pernerstorfer, T; Graninger, W

    1997-01-01

    The effects of cefodizime and cefuroxime on neutrophil phagocytosis and reactive oxygen production in 54 patients undergoing elective coronary artery bypass grafting were studied. Both drugs were administered twice at a dosage of 40 mg/kg of body weight (pre- and intraoperative). Phagocytic capacity was assessed by measuring the uptake of fluorescein isothiocyanate-labeled Escherichia coli and Staphylococcus aureus by flow cytometry. Reactive oxygen generation after phagocytosis was estimated by determining the amount of dihydrorhodamine 123 converted to rhodamine 123 intracellularly. In both groups the mean phagocytic ability for E. coli and S. aureus decreased during surgery (-21 and -8%, respectively, for the cefodizime group and -39 and -38%, respectively, for the cefuroxime group; P < 0.05 for all). In the cefodizime group a normalization of mean E. coli and S. aureus neutrophil phagocytosis was seen on day 5 (+9 and -4% compared to preoperative values; P > 0.35 for both), whereas in cefuroxime-treated patients phagocytic ability remained depressed (-37 and -31%; P < 0.04 for both). In both groups mean neutrophil reactive oxygen intermediate (ROI) production after E. coli and S. aureus phagocytosis increased during cardiopulmonary bypass (+44 and +83%, respectively, in the cefodizime group and +58 and +73%, respectively, in the cefuroxime group; P < 0.05 for all). One day after surgery E. coli- and S. aureus-driven neutrophil ROI production was not different from the preoperative values (-2 and +12%, respectively, for the cefodizime group and +7 and +15%, respectively, for the cefuroxime group; P > 0.15 for all). Postoperative serum levels of the C-reactive protein on days 2 and 7 were lower in cefodizime-treated patients (19 +/- 6 and 4 +/- 2 mg/liter versus 23 +/- 6 and 11 +/- 5 mg/liter; P < 0.05 for both). In addition to cefodizime's antimicrobial activity during perioperative prophylaxis, its use in coronary artery bypass grafting can prevent procedure-related prolonged postoperative neutrophil phagocytosis impairment. PMID:9210690

  12. Configurations and classifications of composite arterial grafts in coronary bypass surgery.

    PubMed

    Yuan, Shi-Min; Shinfeld, Amihay; Raanani, Ehud

    2008-01-01

    The aim of this review is to present the configurations and classifications of composite arterial grafts in coronary bypass surgery. Articles were collected by tracking references cited in the literature with regard to the configurations of composite arterial grafts in coronary bypass surgery. Figures of the configurations were drawn in accordance to the schematic drawings, angiograms, photographs, table contents or written captions of the literature. According to their structural nature, composite arterial grafts can be classified as: (i) alphabetical (Y, T, I, U, K, X and H) and (ii) complex grafts (TY, loop, pi and sling grafts). According to the conduits that form the composite graft, they can be classified as: (i) definite (all standard alphabetical grafts, classic pi and sling grafts); (ii) varying [internal mammary artery (IMA) loop, modified pi graft]; and (iii) indefinite conduit graft (TY graft). According to their application in coronary artery bypass grafting (CABG), they can be divided into complete arterial revascularization for: (i) triple vessel disease (T, Y, K, X, TY, pi and sling grafts); (ii) two vessel disease (U, right Y, and two-thirds right IMA T grafts); and (iii) single vessel disease, mainly the left anterior descending artery with or without the diagonal branch (H, I, IMA loop and left IMA T grafts). According to the CABG method, they can be classified as: (i) for conventional CABG (sling graft); (ii) for minimally invasive direct coronary artery bypass (H graft); and (iii) for both conventional CABG and off-pump coronary artery bypass (T, Y, U, K, I, TY, IMA loop, and pi grafts). Standard Y and T grafts have been accepted as the common figurations of composite arterial grafts to maximum graft length for the bypass of triple vessel disease. Composite arterial grafts overcome the limited availability of arterial conduits for performing total arterial myocardial revascularization, allow a gain in conduit length, and minimize the ascending aorta manipulation. PMID:18268413

  13. Comparing cardiovascular factors in opium abusers and non-users candidate for coronary artery bypass graft surgery

    PubMed Central

    Aghadavoudi, Omid; Eizadi-Mood, Nastaran; Najarzadegan, Mohammad Reza

    2015-01-01

    Background: In some opinions, opium consumption has traditionally been considered to be a means to lower blood lipids and to put off heart diseases. In this study, the relationship between opium consumption and risk factors of coronary artery diseases, hemodynamic factors and cardiac related functions before and after surgery was evaluated. Materials and Methods: In a cross-sectional study 325 patient's candidate for elective coronary artery bypass grafting were enrolled in a period of 6 months. Opium addicted patients were recognized based on taking history from the patients by an anaesthesiologist. Serum lipid profile was determined at the beginning of the study. Frequency and distribution of coronary artery diseases were assessed according to the pre-operative coronary angiography. Results: From 325 patients, 117 patients were opium abusers and 208 patients were not. Mean duration of opium abuse was 12.6 ± 7.7 years. Mean total serum cholesterol levels were not significantly different in abusers and non-users patients (185 ± 47 vs. 190 ± 49, P > 0.05). Mean level of low-density lipoprotein cholesterol was significantly higher in addicted group (121 ± 27 vs. 81 ± 22, P < 0.05). Mean triglyceride level was also higher in addicted patients (203 ± 114 vs. 162 ± 98, P < 0.05). The prevalence of diabetes and glucose levels was considerably lower in opium addicted cases. Mean body mass index was also lower in addicted patients significantly (25.3 ± 3.7 vs. 27.5 ± 4.1, P < 0.05). Conclusion: There may be a relationship between opium abuse and aggravating lipid profile and hypercholesterolemia and coronary artery disease. PMID:25625118

  14. One-stage combined thoracic ancient schwannomas total removal and coronary artery bypass.

    PubMed

    Ceberut, Kadri; Naseri, Erdinc; Celik, Atac; Muslehiddinoglu, Ahmet; Ergin, Ismail

    2011-01-01

    Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13?cm in the middle mediastinum and 5?cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature. PMID:21961014

  15. Do manual assisting maneuvers increase speed and technical performance in robotically sutured coronary bypass graft anastomoses?

    Microsoft Academic Search

    J. Bonatti; J. Alfadlhi; T. Schachner; N. Bonaros; E. Rützler; G. Laufer

    2007-01-01

    Background  Robotic endoscopic coronary artery bypass grafting procedures usually are performed as solo surgery operations. This study\\u000a aimed to investigate whether manual assistance can reduce suturing times and anastomotic suturing problems in robotic coronary\\u000a artery surgery.\\u000a \\u000a \\u000a \\u000a Methods  In isolated pig hearts, the right coronary artery was excised from the epicardium as a pedicle. This pedicled vessel, which\\u000a resembles the internal mammary artery,

  16. A comparison of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in patients on hemodialysis 1 Presented at the 23rd World Congress of the International Society for Cardiovascular Surgery, September 21–26, London, UK 1

    Microsoft Academic Search

    S. A Simsir; D Kohlman-Trigoboff; J Lindsay; B. M Smith

    1998-01-01

    The hospital records of 22 patients on hemodialysis undergoing coronary artery bypass grafting, and 19 others undergoing percutaneous transluminal coronary angioplasty were reviewed to compare the outcomes of these procedures in this population. Evidence of previous myocardial infarction or triple vessel or left main coronary artery disease was more common in patients undergoing coronary artery bypass graft than those undergoing

  17. Risk factors for stroke in patients undergoing coronary artery bypass grafting

    Microsoft Academic Search

    Lynda L. Mickleborough; Paul M. Walker; Yasushi Takagi; Masanori Ohashi; Joan Ivanov; Miguel Tamariz

    1996-01-01

    Objective: To determine predictors of stroke in patients undergoing first-time coronary bypass grafting, we prospectively collected data on 1631 consecutive patients. Methods: Patients with a history of stroke and\\/or central nervous system symptoms (n = 134) and\\/or carotid bruits (n = 95) underwent carotid Doppler evaluation. Stenosis greater than 70% was considered significant. Patients with symptomatic disease or asymptomatic bilateral

  18. Effect of gender on postoperative outcomes and hospital stays after coronary artery bypass grafting

    Microsoft Academic Search

    Gabriel S. Aldea; Jennifer M. Gaudiani; Oz M. Shapira; Alice K. Jacobs; Janice Weinberg; Adrienne L. Cupples; Harold L. Lazar; Richard J. Shemin

    1999-01-01

    Background. Compared to men, women undergoing coronary artery bypass grafting appear to have a higher morbidity and mortality, particularly in the perioperative period. This study was designed to answer the questions of whether such differences in clinical outcomes between men and women still exist with improvements in surgical techniques and determine whether it is gender or associated comorbid conditions in

  19. Evaluation of Taste Sensitivity in Patients Undergoing Coronary Artery Bypass Graft Surgery

    Microsoft Academic Search

    Mary Keith; Rose Mokbel; Mario San Emeterio; Jacquelin Song; Lee Errett

    2010-01-01

    Patients report changes in their perception of food tastes following cardiac surgery. This study was designed to explore changes in taste sensitivity following coronary artery bypass graft (CABG) surgery. Detection and recognition thresholds for sweet (sucrose), salty (sodium chloride), sour (citric acid), and bitter (quinine hydrochloride) were determined using the multiple forced-choice ascending concentration series method at baseline (presurgical), discharge,

  20. The role of preoperative radial artery ultrasound and digital plethysmography prior to coronary artery bypass grafting

    Microsoft Academic Search

    Evelio Rodriguez; Michael L. Ormont; Erica H. Lambert; Laurence Needleman; Ethan J. Halpern; James T. Diehl; Richard N. Edie; John D. Mannion

    2001-01-01

    Objective: Doppler ultrasound and digital plethysmography are used at our institution to determine the suitability of the radial artery for harvest prior to coronary artery bypass grafting (CABG). The purpose of this study is to determine the value of this preoperative evaluation. Methods: A retrospective analysis of non-invasive radial artery testing was performed on 187 CABG patients. Criteria used to

  1. Silent left ventricular dysfunction during exercise after coronary artery bypass surgery

    Microsoft Academic Search

    M. Kawasuji; T. Tedoriya; N. Sakakibara; M. Takahashi; J. Taki; Y. Watanabe

    1991-01-01

    Serial changes in left ventricular function during exercise were assessed by radionuclide continuous ventricular function monitoring in 80 patients undergoing coronary artery bypass surgery before and after operation. This monitor records serial beat by beat radionuclide and electrocardiographic data and calculates the left ventricular ejection fraction every 20s. The profiles of ejection fractions during graded bicycle exercise were divided into

  2. Preoperative prediction of prolonged mechanical ventilation following coronary artery bypass grafting

    Microsoft Academic Search

    J. F. Legare; G. M. Hirsch; K. J. Buth; C. MacDougall; J. A. Sullivan

    2010-01-01

    Objective: Few studies have attempted to evaluate who would require prolonged mechanical ventilation following heart surgery. The objectives of this study were to identify predictors of prolonged ventilation in a large group of coronary artery bypass grafting (CABG) patients from a single institution. Methods: One thousand, eight hundred and twenty-nine consecutive patients undergoing CABG were reviewed retrospectively and evaluated for

  3. Effect of training on outcomes following coronary artery bypass graft surgeryq

    Microsoft Academic Search

    Aung Y. Oo; Antony D. Grayson; Abbas Rashid

    Objective: We examined our coronary artery bypass surgery (CABG) experience to assess the effect of training on mortality and morbidity outcomes. Methods: Between April 1997 and September 2002, 5678 consecutive patients underwent isolated CABG. Five hundred and fifty- five (9.9%) were performed by trainee surgeons. Multivariate logistic regression was used to assess the effect of training on adverse outcomes, while

  4. The impact of sequential grafting on clinical outcomes following coronary artery bypass grafting

    Microsoft Academic Search

    Maral Ouzounian; Ansar Hassan; Alexandra M. Yip; Karen J. Buth; Roger J. F. Baskett; Imtiaz S. Ali; Gregory M. Hirsch

    2010-01-01

    Objectives: Sequential anastomoses in coronary artery bypass grafting (CABG) offer theoretical advantages including increased graft flow and more complete revascularisation. However, published studies concerning the safety and efficacy of this technique are not definitive. The objective of this study was to assess the effect of sequential anastomoses on outcomes following CABG. Methods: Perioperative data were prospectively collected on all patients

  5. Preoperative prediction of prolonged mechanical ventilation following coronary artery bypass grafting

    Microsoft Academic Search

    J. F Légaré; G. M Hirsch; K. J Buth; C MacDougall; J. A Sullivan

    2001-01-01

    Objective: Few studies have attempted to evaluate who would require prolonged mechanical ventilation following heart surgery. The objectives of this study were to identify predictors of prolonged ventilation in a large group of coronary artery bypass grafting (CABG) patients from a single institution. Methods: One thousand, eight hundred and twenty-nine consecutive patients undergoing CABG were reviewed retrospectively and evaluated for

  6. Effect of training on outcomes following coronary artery bypass graft surgery

    Microsoft Academic Search

    Aung Y. Oo; Antony D. Grayson; Abbas Rashid

    2004-01-01

    Objective: We examined our coronary artery bypass surgery (CABG) experience to assess the effect of training on mortality and morbidity outcomes. Methods: Between April 1997 and September 2002, 5678 consecutive patients underwent isolated CABG. Five hundred and fifty-five (9.9%) were performed by trainee surgeons. Multivariate logistic regression was used to assess the effect of training on adverse outcomes, while adjusting

  7. Coronary Artery Bypass Grafting (CABG) Without General Anaesthesia An Initial Experience in NICVD, Dhaka, Bangladesh

    Microsoft Academic Search

    MN HAQUE; S FERDOUS; AK BEG; NAK AHSAN; AYFE CHOWDHURY

    2009-01-01

    Summary: Objective: our initial experience with 15 patients operated on without general anesthesia is reviewed to explore the validity of our surgical strategy. Material and Methods: 15 males between 45-65 years underwent off-pump coronary artery bypass grafting (OPCAB) with high thoracic epidural anesthesia (HTEA) between April to September 2006. Target vessels involved were the single vessel in 5, double vessel

  8. Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery

    Microsoft Academic Search

    Rachel M Massey; Oliver J Warren; Michal Szczeklik; Sophie Wallace; Daniel R Leff; John Kokotsakis; Ara Darzi; Thanos Athanasiou

    2007-01-01

    The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding

  9. Off-Pump Coronary Artery Bypass Grafting for Patients with Left Main Disease

    Microsoft Academic Search

    Hitoshi Hirose

    2004-01-01

    Background: Multivessel off-pump coronary artery bypass grafting (CABG) has been performed with favorable results in our institute. In this study, we analyzed the outcomes in patients who underwent off-pump CABG for left main disease, since the surgical outcomes for such patients have not been clarified. Methods: Between March 1, 1999 and July 30, 2002, a total of 147 patients with

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

    Microsoft Academic Search

    Didier Loulmet; Alain Carpentier; Nicola d'Attellis; Alain Berrebi; Cyril Cardon; Olivier Ponzio; Bertrand Aupècle; John Y. M. Relland

    1999-01-01

    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,

  11. Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery

    Microsoft Academic Search

    Dominique Blommaert; Manuel Gonzalez; Joseph Mucumbitsi; Olivier Gurné; Patrick Evrard; Michel Buche; Yves Louagie; Philippe Eucher; Jacques Jamart; Etienne Installé; Luc De Roy

    2000-01-01

    OBJECTIVESThe present study was aimed to evaluate the efficacy of a specific algorithm with continuous atrial dynamic overdrive pacing to prevent atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery.BACKGROUNDAtrial fibrillation occurs in 30% to 40% of patients after cardiac surgery with a peak incidence on the second day. It still represents a challenge for postoperative prevention and treatment

  12. Development and validation of a prediction model for strokes after coronary artery bypass grafting

    Microsoft Academic Search

    David C Charlesworth; Donald S Likosky; Charles A. S Marrin; Christopher T Maloney; Hebe B Quinton; Jeremy R Morton; Bruce J Leavitt; Robert A Clough; Gerald T O’Connor

    2003-01-01

    BackgroundA prospective study of patients undergoing coronary artery bypass graft surgery (CABG) was conducted to identify patient and disease factors related to the development of a perioperative stroke. A preoperative risk prediction model was developed and validated based on regionally collected data.

  13. The influence of cognitive reserve on neuropsychological functioning following coronary artery bypass grafting (CABG)

    Microsoft Academic Search

    Susan A. Ropacki; Arthur A. Bert; Michael T. Ropacki; Brook L. Rogers; Robert A. Stern

    2007-01-01

    Neuropsychological impairment is common, yet variable, after coronary artery bypass grafting (CABG). Similar variability has been observed in other CNS-related diseases. Empirical findings in Alzheimer's disease and HIV, among other areas, suggest cognitive reserve (CR) may mediate the cognitive impact of these diseases. The present study examined whether CR mediates neuropsychological outcome after CABG. Participants were 42 (N=42) individuals who

  14. Postoperative dissociation of blood levels of cortisol and adrenocorticotropin after coronary artery bypass grafting surgery

    Microsoft Academic Search

    Angela K. Roth-Isigkeit; Peter Schmucker

    1997-01-01

    The regulation of the hypothalamo-pituitary-adrenal (HPA) axis in the operative and perioperative period of major surgical procedures is necessary for successful adaption to surgical stress. We report evidence on an altered response of HPA axis regulation in patients who underwent coronary artery bypass grafting (CABG) surgery. Plasma levels of adrenocorticotropin (ACTH), ?-endorphin, and cortisol were determined with radioimmune assay in

  15. Outcome of Renal Insufficiency Patients Undergoing Coronary Artery Bypass Graft Surgery

    Microsoft Academic Search

    Amala P. Chirumamilla; Michael F. Wilson; Gregory E. Wilding; Rameela Chandrasekhar; Hashmat Ashraf

    2008-01-01

    Renal insufficiency (RI) is a prognostic marker in patients with cardiovascular disease. In this study, the latest standard of glomerular filtration rate (GFR) calculation, that is the modification of diet in renal disease (MDRD) study equation, is used to measure the difference in the outcome of coronary artery bypass graft (CABG) surgery in various GFR groups. Between 2000 and 2005,

  16. The course of anxiety and depression in patients undergoing coronary artery bypass graft surgery

    Microsoft Academic Search

    A. A. Duits; H. J. Duivenvoorden; S. Boeke; M. A. Taams; B. Mochtar; X. H. Krauss; J. Passchier; R. A. M. Erdman

    1998-01-01

    A semilongitudinal study was designed to follow-up the course of anxiety and depression in patients undergoing coronary artery bypass graft (CABG) surgery. The focus was on possible effects of gender and age on variations in both mean level and interindividual differences over time. At two timepoints before and two after surgery, 217 patients completed self-report questionnaires. Multivariate testing revealed an

  17. Depression and Geographic Status as Predictors for Coronary Artery Bypass Surgery Outcomes

    ERIC Educational Resources Information Center

    Dao, Tam K.; Chu, Danny; Springer, Justin; Hiatt, Emily; Nguyen, Quang

    2010-01-01

    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…

  18. Does Off-Pump Coronary Artery Bypass Grafting Negatively Impact Long-Term Survival and Freedom from Reintervention?

    PubMed Central

    Raja, Shahzad G.; Husain, Mubassher; Popescu, Florentina L.; Chudasama, Dimple; Daley, Siobhan; Amrani, Mohamed

    2013-01-01

    Recently published evidence has raised concerns about worse late mortality and increasing need for reintervention after off-pump coronary artery bypass grafting. We undertook this study to assess the impact of off-pump coronary artery bypass grafting on survival and freedom from reintervention at 10 years. From January 2002 to December 2002, 307 consecutive patients who had isolated multivessel off-pump coronary artery bypass grafting at our institution were compared to a control group of 397 patients that underwent multivessel on-pump coronary artery bypass grafting during the same period. In addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years. Kaplan-Meier survival was similar for the two cohorts. After adjusting for clinical covariates, off-pump coronary artery bypass grafting did not emerge as a significant independent predictor of long-term mortality (Hazard Ratio 0.91; 95% Confidence Interval 0.70–1.12), readmission to hospital for cardiac cause (Hazard Ratio 0.96; 95% Confidence Interval 0.78–1.10), or the need for reintervention (Hazard Ratio 0.93; 95% Confidence Interval 0.87–1.05). Off-pump coronary artery bypass grafting compared with on-pump coronary artery bypass grafting does not adversely impact survival or freedom from reintervention at a 10-year follow-up. PMID:24106710

  19. Simulation of Blood Flow Coronary Artery with Consecutive Stenosis and Coronary-Coronary Bypass

    PubMed Central

    Razavi, Seyed Esmail; Zanbouri, Ramin; Arjmandi-Tash, Omid

    2011-01-01

    Introduction In this research the behavior of coronary arteries has been studied with symmetric and asymmetric consecutive stenosis, and grafted vessels. Methods The incompressible Navier-Stokes and energy equations were discretized with second-order upwind method. Assumptions such as Newtonian fluid, wall rigidity and steady-flow were used. Results All the calculations showed the same results with Newtonians and non- Newtonian fluids. It was found that the possibility of stenosis be reduced by increasing the graft angle. However, there exists further stenosis possibility. Among the three graft angles 20, 30 ? and 40, the 30 ? was found to be the reliable ones. Conclusion Based on these findings, it can be deduced that there would be a high risk of further atherosclerosis when the first stenose has the maximum percentage. PMID:23678413

  20. Association of pre and intraoperative variables with postoperative complications in coronary artery bypass graft surgery

    PubMed Central

    Gimenes, Camila; Barrile, Silvia Regina; Martinelli, Bruno; Ronchi, Carlos Fernando; Arca, Eduardo Aguilar; Gimenes, Rodrigo; Okoshi, Marina Politi; Okoshi, Katashi

    2013-01-01

    Objective To associate the pre- and intraoperative variables with postoperative complications of patients undergoing coronary artery bypass graft surgery. Methods The pre- and intraoperative risk factors of individuals of both genders with diagnosis of coronary insufficiency undergoing coronary artery bypass graft have been studied. Results Fifty-eight individuals with median age 62 ± 10 year-old were included in the study, 67% of whom were male. Fourteen (24.1%) patients were smokers, 39 (67.2%) had previous myocardial infarction history, 11 (19%) had undergone coronary angioplasty, 74% had hypertension, 27% had diabetes mellitus, 64% had dyslipidemia and 15.5% had chronic obstructive pulmonary disease. Eighteen (31%) patients presented postoperative complications, most frequent being: infection in surgical incision, difficulties in deambulation, dyspnea, urinary infection and generalized weakness. Male patients had fewer complications than females (P=0.005). Patients with chronic obstructive pulmonary disease remained hospitalized for longer time periods (P=0.019). Postoperative complications occurred in 50% of the patients with creatinine increased, while only 27.1% of the patients with normal value of creatinine had complications (P=0.049). In addition, complications occurred in 50% of the patients with diabetes mellitus, while only 23.8% of patients without diabetes mellitus had complications (P=0.032). The intraoperative factors showed no statistically significant differences. Conclusion The preoperative factors are associated with postoperative complications in patients undergoing coronary artery bypass graft surgery. PMID:24598958

  1. Endothelial Injury Associated with Cold or Warm Blood Cardioplegia during Coronary Artery Bypass Graft Surgery

    PubMed Central

    Kuhn, Elmar W.; Choi, Yeong-Hoon; Pyun, Jung-Min; Neef, Klaus; Liakopoulos, Oliver J.; Stamm, Christof; Wittwer, Thorsten; Wahlers, Thorsten

    2015-01-01

    The aim of this investigation was to analyze the impact of intermittent cold blood cardioplegia (ICC) and intermittent warm blood cardioplegia (IWC) on endothelial injury in patients referred to elective on-pump coronary artery bypass graft (CABG) surgery. Patients undergoing CABG procedures were randomized to either ICC or IWC. Myocardial injury was assessed by CK-MB and cardiac troponin T (cTnT). Endothelial injury was quantified by circulating endothelial cells (CECs), von Willebrand factor (vWF), and soluble thrombomodulin (sTM). Perioperative myocardial injury (PMI) and major adverse cardiac events (MACE) were recorded. Demographic data and preoperative risk profile of included patients (ICC: n = 32, IWC: n = 36) were comparable. No deaths, PMI, or MACE were observed. Levels of CK-MB and cTnT did not show intergroup differences. Concentrations of CECs peaked at 6?h postoperatively with significantly higher values for IWC-patients at 1?h (ICC: 10.1 ± 3.9/mL; IWC: 18.4 ± 4.1/mL; P = 0.012) and 6?h (ICC: 19.3 ± 6.2/mL; IWC: 29.2 ± 6.7/mL; P < 0.001). Concentrations of vWF (ICC: 178.4 ± 73.2?U/dL; IWC: 258.2 ± 89.7?U/dL; P < 0.001) and sTM (ICC: 3.2 ± 2.1?ng/mL; IWC: 5.2 ± 2.4?ng/mL; P = 0.011) were significantly elevated in IWC-group at 1?h postoperatively. This study shows that the use of IWC is associated with a higher extent of endothelial injury compared to ICC without differences in clinical endpoints.

  2. Simulation of pulsatile flow of blood in stenosed coronary artery bypass with graft.

    PubMed

    Wiwatanapataphee, B; Poltem, D; Wu, Y H; Lenbury, Y

    2006-04-01

    In this paper, we investigate the behavior of the pulsatile blood flow in a stenosed right coronary artery with a bypass graft. The human blood is assumed to be a non-Newtonian fluid and its viscous behavior is described by the Carreau model. The transient phenomena of blood flow though the stenosed region and the bypass grafts are simulated by solving the three dimensional unsteady Navier-Stokes equations and continuity equation. The influence of the bypass angle on the flow interaction between the jet flow from the native artery and the flow from the bypass graft is investigated. Distributions of velocity, pressure and wall shear stresses are determined under various conditions. The results show that blood pressure in the stenosed artery drops dramatically in the stenosis area and that high wall shear stresses occur around the stenosis site. PMID:20361829

  3. Hemodynamic Responses to Two Different Anesthesia Regimens in Compromised Left Ventricular Function Patients Undergoing Coronary Artery Bypass Graft Surgery: Etomidate-Midazolam Versus Propofol-Ketamine

    PubMed Central

    Aghdaii, Nahid; Ziyaeifard, Mohsen; Faritus, Seyedeh Zahra; Azarfarin, Rasoul

    2015-01-01

    Background: Various methods have been suggested to prevent hemodynamic instability caused by propofol and adverse effects caused by etomidate induction. The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction. Objectives: The aim of this study was to evaluate the hemodynamic effects of etomidate-midazolam by comparing it with propofol-ketamine for the induction of anesthesia in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Patients and Methods: One-hundred patients aged between 40 and 65 with coronary artery disease and low ejection fraction scheduled for elective coronary artery bypass surgery participated in this study. The patients were randomly allotted to one of the two groups to receive either propofol-ketamine or etomidate-midazolam combination. Two groups were compared for pain on injection and myoclonus, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular Resistance (SVR), before and one minute after induction of anesthesia, and one, three and five minutes after intubation. Results: Incidence of pain on injection (2 - 4%) and myoclonus (10%) was less in both groups. The hemodynamic response was similar in the two groups for all variables over the time interval, except for CI at one and three minutes after intubation (P = 0.024 and P = 0.048, respectively), and SVR in five minutes after intubation (P = 0.009), with differences being statistically significant. Conclusions: Both anesthetic regimens were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction undergoing coronary artery bypass graft surgery.

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

    PubMed Central

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

    2014-01-01

    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. PMID:24814114

  5. Closed chest totally endoscopic coronary artery bypass surgery: fantasy or reality?

    PubMed

    Kappert, U; Schneider, J; Cichon, R; Gulielmos, V; Schade, I; Nicolai, J; Schueler, S

    2000-11-01

    With the introduction of the da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA) into minimally invasive cardiac surgery, the outlook of performing coronary artery bypass operations "closed chest" became a reality. Between May 1999 and July 2000 this wrist-enhanced instrumentation was used in 143 patients (107 men, 36 women, median age 63 10.3 y). Thirteen patients suffering from coronary artery disease (CAD) were treated as totally endoscopic coronary artery bypass (TECAB), 79 patients underwent a minimally invasive direct coronary artery bypass procedure, and 35 patients were treated using the robotic-enhanced Dresden Technique. Preoperative survival was 100%. All patients in the TECAB group were operated upon via a three- or four-point stab incision using the da Vinci robot for internal mammary artery takedown and for performance of anastomoses. These new robotic-enhanced surgical techniques promote an optimistic way of thinking about the further development of these procedures and its application in patients suffering from CAD. PMID:11060584

  6. Expanding the use of the internal mammary artery to improve patency in coronary artery bypass grafting.

    PubMed

    Tector, A J; Schmahl, T M; Canino, V R

    1986-01-01

    To improve the early and late benefits from coronary artery bypass grafting, we have expanded the use of the internal mammary artery by bypassing three or more coronary arteries with mammary grafts. Experience with higher power magnification and the use of the single internal mammary artery are necessary prerequisites of this procedure. The first 100 patients who had three or more mammary artery-coronary artery anastomoses are reviewed. Eighty-six patients received three mammary-coronary anastomoses, 13 received four, and one received six. An average of 3.2 internal mammary artery grafts and 1.7 saphenous vein grafts per patient were placed. Twenty-five of 27 mammary grafts were open on postoperative graft visualization. There were no early deaths and only one patient died late of complications of gangrene of the lower extremities. None of the patients had significant left ventricular failure and only three had perioperative myocardial infarctions. None of the patients complain of angina and 58 of 59 postoperative stress tests were normal. This procedure should significantly reduce the late closure of bypass grafts and the complications thereof, including the need for reoperation. PMID:3484531

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

    Microsoft Academic Search

    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

    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).

  8. Incremental prognostic value of exercise thallium-201 myocardial single-photon emission computed tomography late after coronary artery bypass surgery

    Microsoft Academic Search

    Walter Palmas; Scott Bingham; George A. Diamond; Timothy A. Denton; Hosen Kiat; John D. Friedman; Debra Scarlata; Jamshid Maddahi; Ishac Cohen; Daniel S. Berman

    1995-01-01

    Objectives. This study assessed the incremental prognostic value of exercise thallium-201 myocardial perfusion single-photon emission computed tomography (SPECT) performed ?5 years after coronary artery bypass surgery.Background. Thallium-201 scintigraphy has shown significant prognostic value in a variety of populations with suspected and known coronary artery disease. However, its value in patients with previous bypass surgery remains unknown.Methods. We studied 294 patients

  9. Coronary Artery Bypass Grafting is Associated With Excellent Long-Term Survival and Quality of Life: A Prospective Cohort Study

    Microsoft Academic Search

    Joel Dunning; Julian R. L. Waller; Barbara Smith; Sue Pitts; Simon W. H. Kendall; Khalid Khan

    Background. We investigated the long-term outcome of coronary artery bypass grafting both in terms of survival and quality of life. Methods. Ten-year postsurgery survival was collated on patients undergoing coronary artery bypass grafting from 1994 to 1996, and quality of life was assessed using EQ-5D and a quality-of-life thermometer. We analyzed data from 1,180 patients. Mean age was 61 years,

  10. The Left Internal Thoracic Artery and Radial Artery Composite Graft in Off-pump Coronary Artery Bypass Grafting

    Microsoft Academic Search

    Hiroyuki Tanaka; Takashi Narisawa; Nobutaka Mori; Mikio Masuda; Daijirou Kishi; Takashi Suzuki; Toshihiro Takaba

    2002-01-01

    Arterial multivessel bypass grafting without extra corporeal circulation and manipulation of the ascending aorta should be a good surgical option for the treatment of coronary artery disease. An internal thoracic artery (ITA)-radial artery (RA) composite graft was used for this purpose. Between July 2000 and October 2001, we employed the LITA-RA composite graft for off-pump coronary artery bypass in 15

  11. Reappearance of anterior QRS forces after coronary bypass surgery. An electrovectorcardiographic study.

    PubMed

    Zeft, H J; Friedberg, H D; King, J F; Manley, J C; Huston, J H; Johnson, W D

    1975-08-01

    This report describes the reappearance of anterior QRS electrical forces in six patients after direct coronary arterial bypass surgery. Each patient had severe coronary artery disease including a segmental stenosis of the left anterior descending artery. Revascularization was performed by direct anastomosis of the left mammary artery to the left anterior descending coronary artery and saphenous vein bypass of other stenotic coronary arteries. Preoperative electrocardiograms and vectorcardiograms showed patterns of anterior wall myocardial infarction with absent or diminutive anterior QRS forces. In each case, postoperative studies demonstrated the regeneration of anterior QRS forces within 10 days of operation. Although these patients represent a small percent of those with a preoperative pattern of infarction who undergo coronary revascularization, the findings demonstrate that electrically silent areas of myocardium may be altered and are not always synonymous with myocardial cell death. Chronic myocardial ischemia may in certain instances produce electrocardiographic and vectorcardiographic patterns of myocardial infarction that may be reversible upon reestablishment of perfusion to ischemic areas. PMID:1080350

  12. AANA journal course: update for nurse anesthetists--anesthetic considerations for minimally invasive direct vision coronary artery bypass grafting.

    PubMed

    Creager, N; Kraska, S; Struebing, V L

    1999-08-01

    A recently developed procedure known as MIDCAB (minimally invasive direct vision coronary artery bypass) offers a select group of patients with coronary artery disease an alternative to coronary artery bypass grafting with cardiopulmonary bypass. Compared with customary coronary artery bypass graft surgery, the MIDCAB procedure has a smaller modified incision, requires less operative time, eliminates the risk of cardiopulmonary bypass, and is, as the name implies, far less invasive. Single or multiple vessels are revascularized while the heart remains warm and beating. Movement of the beating heart is dampened in the area of the targeted bypass vessel with the use of mechanical stabilizers by the surgeon. The heart rate may be pharmacologically slowed by the anesthetist. The combination of slowed heart rate and mechanical tamponade by the stabilizers may lead to profound hemodynamic and ischemic changes that may be poorly tolerated in a patient with multiple vessel disease and concurrent disease processes. Extubation and recovery times are far shorter for MIDCAB procedures, leading to earlier discharge and substantial cost savings. The surgical techniques for cardiac bypass surgery have evolved dramatically during the past few years. It is the unique combination of anesthetic monitoring, quick response to hemodynamic changes, and manipulation of physiologic parameters that makes providing anesthesia for minimally invasive cardiac bypass surgery exceptionally challenging. PMID:10497458

  13. The impact of new preventive measures and treatment of surgical site infections after coronary artery bypass graft surgery

    Microsoft Academic Search

    Fernando Antoniali; Ana Paula; Nunes de ALBUQUERQUE; Ana P. N. Albuquerque; Gleice A. A. Reinert; Gustavo C. A. Ribeiro

    2005-01-01

    Objective: To assess the impact of new preventive measures of surgical site infections after coronary artery bypass graft (CABG) surgery. Method: A retrospective study of 468 patients who underwent CABG surgery with cardiopulmonary bypass was performed. These patients were distributed into two groups: Group A (n=224) and Group B (n=244), respectively before and after a new protocol. The two groups

  14. 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

    Cynthia A. Yock; Derek B. Boothroyd; Douglas K. Owens; Carla Winston; Mark A. Hlatky

    2000-01-01

    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

  15. Early Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery Results From a Randomized Study

    Microsoft Academic Search

    Diederik van Dijk; Arno P. Nierich; Erik W. L. Jansen; Hendrik M. Nathoe; Willem J. L. Suyker; Jan C. Diephuis; Wim-Jan van Boven; Cornelius Borst; Erik Buskens; Diederick E. Grobbee; Etienne O. Robles de Medina

    Background—The use of cardiopulmonary bypass during coronary artery bypass surgery (CABG) has been associated with substantial morbidity. The recent introduction of cardiac stabilizers facilitates CABG without cardiopulmonary bypass (off-pump CABG), but it is unknown whether cardiac outcome after off-pump surgery is similar to that for the on-pump procedure. Methods and Results—In a multicenter trial, 281 patients (mean age 61 years,

  16. Atrioventricular block in coronary artery bypass surgery: perioperative predictors and impact on mortality

    PubMed Central

    Piantá, Ricardo Medeiros; Ferrari, Andres Di Leoni; Heck, Aline Almeida; Ferreira, Débora Klein; Piccoli, Jacqueline da Costa Escobar; Albuquerque, Luciano Cabral; Guaragna, João Carlos Vieira da Costa; Petracco, João Batista

    2015-01-01

    Introduction Disturbances of the cardiac conduction system are frequent in the postoperative period of coronary artery bypass surgery. They are mostly reversible and associated with some injury of the conduction tissue, caused by the ischemic heart disease itself or by perioperative factors. Objective Primary: investigate the association between perioperative factors and the emergence of atrioventricular block in the postoperative period of coronary artery bypass surgery. Secondary: determine the need for temporary pacing and of a permanent pacemaker in the postoperative period of coronary artery bypass surgery and the impact on hospital stay and hospital mortality. Methods Analysis of a retrospective cohort of patients submitted to coronary artery bypass surgery from the database of the Postoperative Heart Surgery Unit of the Sao Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, using the logistic regression method. Results In the period from January 1996 to December 2012, 3532 coronary artery bypass surgery were carried out. Two hundred and eighty-eight (8.15% of the total sample) patients had atrioventricular block during the postoperative period of coronary artery bypass surgery, requiring temporary pacing. Eight of those who had atrioventricular block progressed to implantation of a permanent pacemaker (0.23% of the total sample). Multivariate analysis revealed a significant association of atrioventricular block with age above 60 years (OR=2.34; CI 95% 1.75-3.12; P<0.0001), female gender (OR=1.37; CI 95% 1.06-1.77; P=0.015), chronic kidney disease (OR=2.05; CI 95% 1.49-2.81; P<0.0001), atrial fibrillation (OR=2.06; CI 95% 1.16-3.66; P=0.014), functional class III and IV of the New York Heart Association (OR=1.43; CI 95% 1.03-1.98; P=0.031), perioperative acute myocardial infarction (OR=1.70; CI 95% 1.26-2.29; P<0.0001) and with the use of the intra-aortic balloon in the postoperative period of coronary artery bypass surgery (OR=1.92; CI 95% 1.21-3.05; P=0.006). The presence of atrioventricular block resulted in a significant increase in mortality (17.9% vs. 7.3% in those who did not develop atrioventricular block) (OR=2.09; CI 95% 1.46-2.99; P<0.0001) and a longer hospital stay (12.75 days x 10.53 days for those who didn't develop atrioventricular block) (OR=1.01; CI 95% 1.00-1.02; P=0.01). Conclusions In most cases, atrioventricular block in the postoperative period of coronary artery bypass surgery is transient and associated with several perioperative factors: age above 60 years, female sex, chronic kidney disease, atrial fibrillation, New York Heart Association functional class III or IV, perioperative acute myocardial infarction and use of an intra-aortic balloon. Its occurrence prolongs hospitalization and, above all, doubles the risk of mortality.

  17. Off-pump versus on-pump coronary artery bypass surgery for the treatment of left main with triple coronary artery disease ? ? This work was supported by the Fund of Social Development in Jiangsu province(NO: BS2006013)

    Microsoft Academic Search

    Zhibing Qiu; Xin Chen; Ming Xu; Kaihu Shi; Yinshuo Jiang; Liqiong Xiao

    2008-01-01

    ObjectiveTo obtain early results of off-pump coronary artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery(CCAB).

  18. Removal of Thrombus from Aortocoronary Bypass Grafts and Coronary Arteries Using the 6Fr Hydrolyser

    Microsoft Academic Search

    1997-01-01

    This study evaluates the feasibility and safety of a 6Fr hydrodynamic thrombectomy catheter, the Hydrolyser, in native coronary arteries and aortocoronary bypass grafts. With use of a conventional contrast injector, saline solution is injected into the narrow lumen of the catheter which makes a 180° bend at the tip. The resultant high-velocity jet (150 km\\/hour) is directed over a sidehole

  19. Three-Dimensional Simulation of Coronary Artery Bypass Grafting with the Use of Computational Fluid Dynamics

    Microsoft Academic Search

    Min-Ho Song; Masaru Sato; Yuichi Ueda

    2000-01-01

    In search of an optimal anastomosis conformation in coronary artery bypass grafting surgery and flow visualization, three-dimensional\\u000a simulation of the anastomosis has been developed with the use of computational fluid dynamics. To simulate the surgery, a\\u000a Y-figure model with proximal stenosis was developed in three cases according to angles ranging from 10° to 30°. The boundary\\u000a condition of velocity and

  20. Effects of preparatory videotapes on self-efficacy beliefs and recovery from coronary bypass surgery

    Microsoft Academic Search

    Heike I. M. Mahler; James A. Kulik

    1998-01-01

    This study evaluated the relative effects of three experimental videotapes that involved different approaches for preparing\\u000a coronary artery bypass graft (CABG) patients for surgery and the inhospital recovery period. One of the tapes conveyed information\\u000a via a health care expert only. The other two featured the same health care expert and also included clips of interviews with\\u000a patient models. These

  1. Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting

    Microsoft Academic Search

    Victor A Ferraris; Suellen P. Ferraris; Frederick C. Lough; William R. Berry

    1995-01-01

    Thirty-four patients were entered into a non-blinded, randomized study to test the effect of preoperative aspirin ingestion on postoperative blood loss and transfusion requirements after coronary artery bypass grafting. Sixteen patients in the aspirin-treated group had significantly increased chest-tube blood loss 12 hours after operation (1,513 ± 978 versus 916 ± 482 ml; p = 0.038). In addition, aspirin users

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

    Microsoft Academic Search

    J. Kusukawa; Y. Hirota; K. Kawamura; H. Suma; A. Takeuchi; I. Adachi; H. Akagi

    1989-01-01

    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

  3. Coronary artery bypass grafting in patients who require long-term dialysis

    Microsoft Academic Search

    Leena Khaitan; Francis P Sutter; Scott M Goldman

    2000-01-01

    Background. Should coronary artery bypass grafting (CABG) be performed in patients on long-term dialysis? This subject has been debated for several years. We retrospectively reviewed the charts of all patients who had CABG from August 1989 to October 1997.Methods. We identified 70 patients who were on long-term dialysis and had CABG during that time period. Patients were evaluated by chart

  4. Minimal Access Surgical Techniques in Coronary Artery Bypass Grafting for Triple-Vessel Disease

    Microsoft Academic Search

    Pyng Jing Lin; Chau-Hsiung Chang; Jaw-Ji Chu; Hui-Ping Liu; Feng-Chun Tsai; Fen-Chiung Lin; Cheng-Wen Chiang; Peter P. C Tan

    1998-01-01

    Background. Minimal access surgical techniques in coronary artery bypass grafting have been used mainly in the management of single-vessel disease.Methods. Fifteen patients, 11 men and 4 women with a mean age of 64.1 years (range, 35.7 to 78.0 years), underwent operation for triple-vessel disease using minimal access techniques. The procedures were performed through a limited left parasternal thoracotomy using femorofemoral

  5. Transfusion associated in-hospital mortality and morbidity in isolated Coronary Artery Bypass Graft surgery

    Microsoft Academic Search

    Abbas Salehiomran; Hossein Ahmadi; Abbasali Karimi; Mokhtar Tazik; Samaneh Dowlatshahi; Mahmood Sheikh Fathollahi; Seyed Hesameddin Abbasi

    2009-01-01

    Transfusion after cardiac surgery is very common. This rate varies between institutions and has remained high despite established\\u000a transfusion guidelines. We analyzed our database of patients who underwent isolated CABG (Coronary Artery Bypass Graft) to\\u000a determine the predictive factors of homologous transfusion and associated postoperative morbidity, mortality and resource\\u000a utilization. All 14,152 patients who underwent first-time isolated CABG, with or

  6. Nodal vessels disease as a risk factor for atrial fibrillation after coronary artery bypass graft surgery

    Microsoft Academic Search

    Saud Al-Shanafey; Linda Dodds; Don Langille; Idris Ali; Harry Henteleff; Rebecca Dobson

    2001-01-01

    Objective: Atrial fibrillation (AF) is common after coronary artery bypass graft (CABG) surgery. Atrial ischaemia due to diseased atrioventricular (AV) and sinoatrial (SA) arteries has been proposed as a cause of AF post-CABG. We examined if the presence of diseased nodal arteries was a significant predictor of the development of AF post-CABG. Methods: 100 consecutive cases (AF post-CABG) were compared

  7. Nodal vessels disease as a risk factor for atrial fibrillation after coronary artery bypass graft surgeryq

    Microsoft Academic Search

    Saud Al-Shanafey; Linda Dodds; Don Langille; Idris Ali; Harry Henteleff; Rebecca Dobson

    Objective: Atrial fibrillation (AF) is common after coronary artery bypass graft (CABG) surgery. Atrial ischaemia due to diseased atrioventricular (AV) and sinoatrial (SA) arteries has been proposed as a cause of AF post-CABG. We examined if the presence of diseased nodal arteries was a significant predictor of the development of AF post-CABG. Methods: 100 consecutive cases (AF post-CABG) were compared

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

    Microsoft Academic Search

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

    2012-01-01

    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

  9. Aspects of psychological and social morbidity in patients awaiting coronary artery bypass grafting

    Microsoft Academic Search

    M J Underwood; R K Firmin; D Jehu

    1993-01-01

    OBJECTIVES--To assess anxiety, depression, and social adjustment in patients awaiting coronary artery bypass surgery. DESIGN--Patient completed questionnaire study. SETTING--Regional cardiothoracic centre. PATIENTS--109 questionnaires were sent to patients on the waiting list of two cardiothoracic surgeons. Sixty eight (62%) were returned and 15 (22%) of the respondents were women. There was no difference in the response rates for men (53\\/84) 63%

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

    Microsoft Academic Search

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

    2007-01-01

    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

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

    Microsoft Academic Search

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

    2010-01-01

    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

  12. Minimally invasive approach for coronary artery bypass surgery

    Microsoft Academic Search

    Yi-Cheng Wu; Chau-Hsiung Chang; Pyng Jing Lin; Jaw-Ji Chu; Feng-Chun Tsai; Min-Wen Yang; Peter P. C Tan

    1997-01-01

    Forty-two patients, 33 male and 9 female, aged 35.7 to 81.6 years old (mean 62.7), were operated on for left main and\\/or triple vessel coronary artery disease by using minimally invasive cardiac surgical techniques. A myocardial infarction had occurred in 26 patients (61.9%). The left ventricular ejection fraction ranged from 17 to 83% (52±22). The surgeries were performed through left

  13. Wrapping of an Ascending Aortic Aneurysm with the Multiple Boot-Straps Technique in a Patient Undergoing Off-Pump Coronary Artery Bypass Grafting

    PubMed Central

    Na, Kwon Joong; Kim, Jun Sung; Park, Kay-Hyun; Lim, Cheong

    2015-01-01

    Ascending aortic aneurysms are usually treated with graft replacement under cardiopulmonary bypass. However, if a candidate for off-pump coronary artery bypass grafting has an enlarged ascending aorta, surgeons may consider wrapping it without cardiopulmonary bypass. Here, we report a 78-year-old female who underwent successful wrapping of the ascending aorta concomitant with off-pump coronary artery bypass grafting, using a new wrapping technique that involves multiple bootstraps. PMID:26078929

  14. Tissue engineering of a hybrid bypass graft for coronary and lower limb bypass surgery

    Microsoft Academic Search

    S. T. Rashid; B. Fuller; A. M. Seifalian

    2008-01-01

    Tissue-engineered blood vessels have largely relied on inelastic scaffolds or biological solu- tions with uncertain long-term in vivo durability. In this report we present for the first time a hybrid tissue- engineered bypass graft consisting of an elastic scaffold of compliant poly(carbonate-urea)urethane (CPU), in- corporated with human smooth muscle cells (SMCs) and endothelial cells (ECs) from the same human source.

  15. Oblique aortic valve replacement and coronary artery bypass grafting for severely calcified narrow aortic root with unstable angina

    Microsoft Academic Search

    Toru Ishida; Kiyoharu Nakano; Akihiko Gomi; Hayao Nakatani; Tokuya Sato; Naoki Saegusa

    2001-01-01

    We report an 84-year-old woman diagnosed with aortic stenosis and regurgitation with a severely calcified narrow aortic root\\u000a and left main coronary artery trunk stenosis with triple-vessel coronary artery disease. Emergency aortic valve replacement\\u000a and triple coronary artery bypass grafting were successful. The aortic annulus was small and heavily calcified, and the ascending\\u000a aorta, the sinus of valsalva and the

  16. Off-pump coronary artery bypass grafting using skeletonized in situ arterial grafts

    PubMed Central

    Suzuki, Tomoaki; Nota, Hiromitsu; Kuroyanagi, Satoshi; Kinoshita, Takeshi; Takashima, Noriyuki; Hayakawa, Masato; Naito, Shiho

    2013-01-01

    Skeletonization is an advanced technique of graft harvesting for coronary artery bypass grafting (CABG), and while it requires meticulous attention, it has many advantages. For example, skeletonization of internal thoracic artery (ITA) can minimize sternal ischemia and lower the risk of mediastinitis, and is longer and larger than pedicled ITA. In this article we describe the surgical techniques demonstrated in our video, which details our techniques of skeletonization of arterial grafts and off-pump coronary artery bypass (OPCAB) exclusively using these in situ grafts. Our method of right gastroepiploic artery (GEA) skeletonization has only three technical steps. The first step is to pass thin vessel loops under the GEA. The second step is to unroof the tissue surrounding the GEA. The last step is to seal and sever all the branches. Skeletonization of the GEA not only prevents vasospasm but also leads to GEA dilatation, and facilitates inspection and makes sequential anastomosis easier. Bilateral use of the skeletonized ITA and use of the skeletonized GEA can cover most coronary artery target sites without any manipulation of the ascending aorta. In our consecutive series of over 1,000 patients, the stroke rate was 0.5%. Our method helps to make the technique simple and secure in this technically demanding operation, and we believe that OPCAB with these grafts provides the best possible coronary revascularization. PMID:23977635

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

    PubMed Central

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

    2014-01-01

    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

  18. Redux valvular surgery with coronary artery bypass graft in familial hypercholesterolemia.

    PubMed

    Jalel, Ziadi; Sobhi, Mleyhi; Skander, Ben Omrane; Adel, Khayati

    2014-01-01

    Familial hypercholesterolemia (FH) is a dominantly inherited disorder caused by mutation at the locus for the low-density lipoprotein (LDL) receptor and is frequently associated with premature coronary artery disease and aortic valve involvement. The surgical treatment of these complications is accompanied by a high degree of risk, even in skillful hands. An intensive cholesterol-lowering therapy and LDL aphaeresis in association with surgery may be useful. The case of a 12-year-old girl, with a medical history of familial hypercholesterolemia is reported here, operated two years previously for valvular aortic stenosis; Ross intervention was done. She was readmitted for acute coronary syndrome. Three coronary artery bypass grafting was performed with saphenous veins with positive results. PMID:24701091

  19. Elective percutaneous coronary intervention: the relationship between preprocedural blood glucose levels and periprocedural myocardial injury.

    PubMed

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

    2013-01-01

    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. PMID:24082370

  20. Pathology of hearts after aortocoronary saphenous vein bypass grafting for coronary artery disease, studied by post-mortem coronary angiography.

    PubMed Central

    Heard, B E

    1976-01-01

    A detailed pathological study was made in 10 patients dying up to 13 months after aortocoronary saphenous vein bypass grafting for coronary atherosclerosis. The coronary arteries and vein grafts were investigated by injection with a radio-opaque mass, radiography, dissection, and histology. The report is to some extent historical since the patients died during a period when the operation was first being introduced into two cardiothoracic hospitals. About 80 operations were performed during the time the 10 deaths occurred, a mortality of 12-5 per cent (including cases followed up to 13 months after operation). Seven of the patients were operated on for intractable angina and 3 with a view to aneurysmectomy. All the patients selected for operation were severely disabled despite medical treatment. The main cause of death was extremely severe coronary artery disease and its effects on the left ventricle; in one case, over two-thirds of the left ventricle had been destroyed by infarction before operation. Other causes or contributing causes of death were pulmonary embolism, myocardial infarction complicating angiography (ostial stenosis), and cerebral damage. Ten of the 14 vein grafts (71%) were patent at necropsy. A free flow of injection medium usually occurred between patent grafts and coronary arteries. Thrombosis of a graft was thought to have contributed to death in 3 patients, but not in a fourth who died of pulmonary embolism. Since thrombosis of grafts was usually secondary to poor run-off blood into severely atheromatous coronary arteries, this was also an indirect effect of the advanced coronary arterial disease. In one case, thrombosis followed severe chronic intimal thickening of a graft in place for 13 months. The study of these deaths emphasizes that in some patients the pathological changes in the coronary arteries and left ventricle are too severe for them to benefit from surgery. Vein grafts cannot be expected to distribute blood effectively through grossly narrowed coronary arteries. In addition, when a large part of the left ventricle is infarcted or scarred, it is almost certain that improving the blood supply by grafting will not result in significant regeneration of cardiac muscle. Since the time when this study was made, there have been few deaths among the many vein graft operations subsequently carried out in the hospitals involved. The two most important factors thought responsible for the improvement are the selection of cases more suitable for surgery by continued improvement of diagnostic techniques, and also the employment of more radical surgical procedures in the form of coronary endarterectomy and the insertion of more grafts per patient. Images PMID:1086091

  1. Choice of conduits for coronary artery bypass grafting: craft or science?

    PubMed

    Buxton, Brian F; Hayward, Philip A R; Newcomb, Andrew E; Moten, Simon; Seevanayagam, Siven; Gordon, Ian

    2009-04-01

    Long-term patency of a bypass graft is an important determinant in reducing morbidity and increasing survival after coronary bypass surgery. The purpose of this review is to analyse factors contributing to improved outcomes of commonly used conduits. Progress has been limited by the lack of uniform definitions of graft failure and development of appropriate statistical models. Evolving techniques for assessing patency at more frequent intervals has provided insight into the time and sites of early disease. The explosion of scientific knowledge of graft physiology has added to improving harvest, storage and early protection procedures thereby reducing early morbidity. Similarly, the understanding and management of risk factors have contributed to graft durability and possibly survival. Conduits have different characteristics and applications, which are patient dependent. Competitive flow remains a problem especially with arterial conduits; functional studies as opposed to anatomy of the target artery may improve understanding of the contribution of the collateral circulation. Selected patency data provide comparison between grafts. The role of the second internal thoracic artery graft is the subject of the Arterial Revascularisation Trial. Off-pump bypass procedures and patient characteristics affect conduit selection. Stroke is a major complication, which can be minimised by avoiding the aorta especially during off-pump surgery. There are few randomised controlled trials on the late outcomes comparing different bypass grafts and between bypass grafting and current percutaneous intervention methods. Accurate reporting of outcomes of graft patency will improve the scientific content and emphasise the importance of surgery in the management of coronary disease. PMID:19231230

  2. High Postoperative Serum Cortisol Level Is Associated with Increased Risk of Cognitive Dysfunction Early after Coronary Artery Bypass Graft Surgery: A Prospective Cohort Study

    PubMed Central

    Mu, Dong-Liang; Li, Li-Huan; Wang, Dong-Xin; Li, Nan; Shan, Guo-Jin; Li, Jun; Yu, Qin-Jun; Shi, Chun-Xia

    2013-01-01

    Context Stress response induced by surgery is proposed to play an important role in the pathogenesis of postoperative cognitive dysfunction. Objective To investigate the association between postoperative serum cortisol level and occurrence of cognitive dysfunction early after coronary artery bypass graft surgery. Design Prospective cohort study. Setting Two teaching hospitals. Patients One hundred and sixth-six adult patients who were referred to elective coronary artery bypass graft surgery from March 2008 to December 2009. Intervention None. Main Outcome Measures Neuropsychological tests were completed one day before and seven days after surgery. Cognitive dysfunction was defined using the same definition as used in the ISPOCD1-study. Blood samples were obtained in the first postoperative morning for measurement of serum cortisol concentration. Multivariate Logistic regression analyses were performed to assess the relationship between serum cortisol level and occurrence of postoperative cognitive dysfunction. Results Cognitive dysfunction occurred in 39.8% (66 of 166) of patients seven days after surgery. Multivariate Logistic regression analysis showed that high serum cortisol level was significantly associated with the occurrence of postoperative cognitive dysfunction (odds ratio [OR] 2.603, 95% confidence interval [CI] 1.371-4.944, P = 0.003). Other independent predictors of early postoperative cognitive dysfunction included high preoperative New York Heart Association functional class (OR 0.402, 95% CI 0.207-0.782, P = 0.007), poor preoperative Grooved Pegboard test score of nondominant hand (OR 1.022, 95% CI 1.003-1.040, P = 0.020), use of penehyclidine as premedication (OR 2.565, 95% CI 1.109-5.933, P = 0.028), and occurrence of complications within seven days after surgery (OR 2.677, 95% CI 1.201-5.963, P = 0.016). Conclusions High serum cortisol level in the first postoperative morning was associated with increased risk of cognitive dysfunction seven days after coronary artery bypass graft surgery. PMID:24143249

  3. Identification of internal carotid artery stenosis in coronary artery bypass candidates.

    PubMed

    Keagy, B A; Battaglini, J W; Lucas, C L; Thomas, D D; Wilcox, B R

    1983-08-01

    Identification of stenotic internal carotid arteries in neurologically asymptomatic coronary artery bypass candidates is difficult. We correlated carotid arteriograms with carotid bruits in 422 vessels and demonstrated a sensitivity of 79% and a specificity of 65% with regard to the bruit's identification of vessels with a 50% or more reduction in angiographic diameter. The noninvasive duplex scan, used in conjunction with Fast Fourier Transform spectral analysis, had a sensitivity and a specificity of 90% in this same regard. Since there is only a 6% incidence of significant internal carotid stenosis in bypass candidates, Bayes' theorem used in conjunction with our findings showed that a carotid bruit was an incorrect predictor of internal carotid stenosis 87% of the time. The duplex scan was somewhat better, but still inaccurate 64% of the time. Thus neither parameter alone has a high enough predictive value to determine whether preoperative carotid angiography is necessary. However, if one limits duplex scanning to patients with a carotid bruit, the predictive value is raised to 92%. At the same time, there is minimal increase in the number of undiagnosed patients. Thus far this combined approach is recommended for preoperative evaluation of patients scheduled for coronary artery bypass. PMID:6603663

  4. Choice of vein-harvest technique for coronary artery bypass grafting: rationale and design of the REGROUP trial.

    PubMed

    Zenati, Marco A; Gaziano, J Michael; Collins, Joseph F; Biswas, Kousick; Gabany, Jennifer M; Quin, Jacquelyn A; Bitondo, Jerene M; Bakaeen, Faisal G; Kelly, Rosemary F; Shroyer, A Laurie; Bhatt, Deepak L

    2014-06-01

    The Randomized Endo-vein Graft Prospective (REGROUP) trial (ClinicalTrials.gov NCT01850082) is a randomized, intent-to-treat, 2-arm, parallel-design, multicenter study funded by the Cooperative Studies Program (CSP No. 588) of the US Department of Veterans Affairs. Cardiac surgeons at 16 Veterans Affairs (VA) medical centers with technical expertise in performing both endoscopic vein harvesting (EVH) and open vein harvesting (OVH) were recruited as the REGROUP surgeon participants. Subjects requiring elective or urgent coronary artery bypass grafting using cardiopulmonary bypass with use of ?1 saphenous vein graft will be screened for enrollment using pre-established inclusion/exclusion criteria. Enrolled subjects (planned N = 1150) will be randomized to 1 of the 2 arms (EVH or OVH) after an experienced vein harvester has been assigned. The primary outcomes measure is the rate of major adverse cardiac events (MACE), including death, myocardial infarction, or revascularization. Subject assessments will be performed at multiple times, including at baseline, intraoperatively, postoperatively, and at discharge (or 30 days after surgery, if still hospitalized). Assessment of leg-wound complications will be completed at 6 weeks after surgery. Telephone follow-ups will occur at 3-month intervals after surgery until the participating sites are decommissioned after the trial's completion (approximately 4.5 years after the full study startup). To assess long-term outcomes, centralized follow-up of MACE for 2 additional years will be centrally performed using VA and non-VA clinical and administrative databases. The primary MACE outcome will be compared between the 2 arms, EVH and OVH, at the end of the trial duration. PMID:24633760

  5. C-Reactive protein gene variants are associated with postoperative C-reactive protein levels after coronary artery bypass surgery

    PubMed Central

    Perry, Tjörvi E; Muehlschlegel, Jochen D; Liu, Kuang-Yu; Fox, Amanda A; Collard, Charles D; Body, Simon C; Shernan, Stanton K

    2009-01-01

    Background Elevated baseline C-reactive protein (CRP) levels are associated with increased risk for developing cardiovascular disease. Several CRP gene variants have been associated with altered baseline CRP levels in ambulatory populations. However, the influence of CRP gene variants on CRP levels during inflammatory states, such as surgery, is largely unexplored. We describe the association between candidate CRP gene variants and postoperative plasma CRP levels in patients undergoing primary, elective coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). Methods Using a multicenter candidate gene association study design, we examined the association between seventeen candidate CRP single nucleotide polymorphisms (SNPs) and inferred haplotypes, and altered postoperative CRP levels in 604 patients undergoing CABG surgery with CPB. Perioperative CRP levels were measured immediately prior to surgery, post-CPB and on postoperative days (POD) 1–4. Results CRP levels were significantly elevated at all postoperative time points when compared with preoperative levels (P < 0.0001). After adjusting for clinical covariates, the minor allele of the synonymous coding SNP, rs1800947 was associated with lower peak postoperative CRP levels (P = 2.4 × 10-4) and lower CRP levels across all postoperative time points (P = 4.8 × 10-5). rs1800947 remained highly significant after Bonferroni adjustment for multiple comparisons. Conclusion We identified a CRP gene SNP associated with lower postoperative CRP levels in patients undergoing CABG surgery with CPB. Further investigation is needed to clarify the significance of this association between CRP gene variants and the acute-phase rise in postoperative CRP levels with regard to the risk of adverse postoperative outcomes. PMID:19426506

  6. Intraoperative Measurement of Fractional Flow Reserve in Off-Pump Coronary Artery Bypass: A Pilot Study.

    PubMed

    Chiu, Kuan-Ming; Lin, Tzu-Yu; Chen, Jer-Shen; Huang, Jih-Hsin; Chen, Robert Jeen-Chen; Chu, Shu-Hsun

    2015-06-01

    Backgrounds?Fractional flow reserve of myocardium (FFRmyo) is a functional study of significant coronary artery stenosis, defined as the ratio of the pressure distal to the stenosis (poststenosis) divided by the pressure of aortic root (prestenosis). Instead of cath laboratory, we could measure it in operating room for off-pump coronary artery bypass (OPCAB) surgery and here shared our methods in the pilot study. Methods and Results?We used needles, catheters, and pressure tracing but without guidewires or fluoroscopy to measure FFRmyo during OPCAB. In February 2010, we conducted the pilot study and collected 32 anastomosis data from 10 patients. Without revising the anastomosis plans based on coronary angiographies, 24 FFRmyo of the 32 anastomoses (75%) were less than 0.75, which represented significant functional stenosis. The FFRmyo measurements did not lead to any adverse events. Conclusion?The measurement of fractional flow reserve in OPCAB is safe and feasible. It can serve as a functional assessment of coronary artery stenosis in adjuvant to conventional coronary angiography. PMID:25032723

  7. Bivalirudin, blood loss, and graft patency in coronary artery bypass surgery.

    PubMed

    Merry, Alan F

    2004-06-01

    A safe and effective alternative is needed for patients in whom unfractionated heparin (UFH) or protamine is contraindicated (e.g., those with heparin-induced thrombocytopenia or allergy to protamine). Furthermore, choice of anticoagulant may influence graft patency in coronary surgery and may therefore be important even when there is no contraindication to UFH. Direct thrombin inhibitors have several potential advantages over UFH, demonstrated in acute coronary syndromes. However, there are also potential difficulties with their use related to lack of reversal agents and paucity of clinical experience in monitoring their anticoagulant activity at the levels required for cardiac surgery with cardiopulmonary bypass (CPB). In the first prospective randomized trial of an alternative to heparin in cardiac surgery, we compared bivalirudin (a short-acting direct thrombin inhibitor) with UFH in 100 patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Blood loss for the 12 hours following study drug initiation in the bivalirudin group was not significantly greater than in the heparin group. Median graft flow was significantly higher in the bivalirudin group. We concluded that anticoagulation for OPCAB surgery with bivalirudin was feasible without a clinically important increase in perioperative blood loss. A larger study is needed to investigate the impact of improved graft patency on other clinical outcomes after cardiac surgery. PMID:15282656

  8. Should computed tomography angiography supersede invasive coronary angiography for the evaluation of graft patency following coronary artery bypass graft surgery?

    PubMed

    Gabriel, Joseph; Klimach, Stefan; Lang, Peter; Hildick-Smith, David

    2015-08-01

    Invasive coronary angiography (ICA) has long been the established gold standard in assessing graft patency following coronary artery bypass graft (CABG). Over the past decade or so however, improvements in computed tomography angiography (CTA) technology have allowed its emergence as a useful clinical tool in graft assessment. The recent introduction of 64-slice and now 128-slice scanners into widespread distribution, and the development of 320-detector row technology allowing volumetric imaging of the entire heart at single points in time within one cardiac cycle, has increased the potential of CTA to supersede ICA in this capacity. This study sought to examine the evidence surrounding this potential. A best evidence topic was constructed according to a structured protocol. The enquiry: In [patients who have undergone coronary artery bypass graft surgery] is [computed tomography angiography or invasive coronary angiography] superior in terms of [graft patency assessment, stenosis detection, radiation exposure and complication rate]? Four hundred and twenty-four articles were identified from the search strategy. Four additional articles were identified from references of key articles. Seventeen articles selected as best evidence were tabulated. The reliability of CTA as a tool in the detection of graft patency and stenosis has continued to improve with each successive generation of multislice technology. The latest 64- and 128-slice CTA techniques are able to detect graft patency and stenosis with very high sensitivities and specificities comparable with ICA, while remaining non-invasive procedures associated with fewer complications (ICA carries a 0.08% risk of myocardial infarction and 0.7% risk of minor complications in clinically stable patients). Present limitations of the technology include the accurate visualization of distal anastomoses and clip artefacts. In addition, the capacity of diagnostic ICA to be combined simultaneously with percutaneous coronary interventions is an important advantage and a further limitation of CTA alone. Recent developments, however, including the derivation of fractional flow reserve and perfusion assessment from CTA as functional measures of stenosis severity have given CTA at present the capacity to become a first-line tool in the assessment of patients with suspected graft dysfunction. Novel computer-automated diagnostic software, though currently in infancy, has shown promise in facilitating and speeding image interpretation. With further improvements in scanning technologies, CTA is likely to supersede ICA for graft assessment in the near future. PMID:25924868

  9. [Coronary artery spasm induced by neuroleptic malignant syndrome during off-pump coronary artery bypass grafting; report of a case].

    PubMed

    Mori, Akiko; Yamaya, Kazuhiro; Nitta, Yoshio; Yoshida, Seijiro

    2014-03-01

    A 61-year-old woman with a left main lesion and coronary spastic angina was scheduled for off-pump coronary artery bypass grafting (OPCAB). She had been orally receiving selective serotonin reuptake inhibitor( SSRI) for the treatment of depression. OPCAB to left anterior discending artery( LAD) and left circumflex branch (LCX) was performed using the bilateral internal thoracic arteries assisted by intra-aortic balloon pumping. When the sternotomy was going to be closed, ST elevation of electrocardiogram (ECG) occurred and was followed by complete atrio-ventricular (AV) block. After returning to intensive care unit (ICU), the patient showed rapid elevation of the body temperature, excessive sweating, progressive metabolic acidosis, and abnormal high levels in white blood cell count and creatine phosphokinase. On suspicion of neuroleptic malignant syndrome(NMS) onset, dantrolene sodium hydrate was administered, resulting in marked improvement of the symptoms. We have concluded that this case was an NMS combined with coronary artery spasm during OPCAB treated successfully with dantrolene sodium hydrate. PMID:24743539

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

    PubMed Central

    2013-01-01

    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

  11. The internal mammary artery graft: the best choice for bypass of the diseased left anterior descending coronary artery.

    PubMed

    Tector, A J; Schmahl, T M; Canino, V R

    1983-09-01

    The atherosclerotic plaque that critically obstructs the proximal left anterior descending coronary artery is three times more likely to produce a fatal myocardial infarction than lesions in the other coronary arteries. Severe obstruction in a bypass graft to the proximally stenosed left anterior descending artery is probably at high risk of provoking a fatal infarction. Selection of the bypass graft with adequate flow and the greatest longevity is of great importance. Review of 298 patients who received internal mammary artery grafts illustrates that this bypass has excellent long-term patency, minimal attrition, and little evidence suggesting late atherosclerotic formation. Difficulties with anastomosis and pedicle injury during preparation (the most frequent reasons for internal mammary artery failure) can be reduced to 2% or less by introducing magnification and microsurgical techniques. The properly prepared internal mammary artery graft has the longest lasting patency and should be used when bypassing proximal left anterior descending lesions. PMID:6135516

  12. Remote ischemic preconditioning reduces myocardial injury after coronary artery bypass surgery with crystalloid cardioplegic arrest

    Microsoft Academic Search

    Matthias Thielmann; Eva Kottenberg; Kerstin Boengler; Christoph Raffelsieper; Markus Neuhaeuser; Jürgen Peters; Heinz Jakob; Gerd Heusch

    2010-01-01

    Remote ischemic preconditioning (RIPC) with transient upper limb ischemia reduces myocardial injury in patients undergoing\\u000a on-pump coronary artery bypass grafting (CABG) with cross-clamp fibrillation or blood cardioplegia for myocardial protection.\\u000a Whether or not such protection is still operative when standard crystalloid cardioplegic arrest is used is uncertain. Fifty-three\\u000a consecutive, non-diabetic patients with triple-vessel disease and 64 ± 12 years of age (mean ± SD), who

  13. Preoperative hemoglobin A1c predicts atrial fibrillation after off-pump coronary bypass surgery

    PubMed Central

    Kinoshita, Takeshi; Asai, Tohru; Suzuki, Tomoaki; Kambara, Atsushi; Matsubayashi, Keiji

    2012-01-01

    OBJECTIVE Diabetes mellitus has been recognized as a risk factor for mortality and morbidity after coronary bypass grafting, but a significant association between diabetes mellitus and postoperative atrial fibrillation (AF) has not been found. Although a recent study demonstrated a potential link between preoperative hemoglobin A1c level and risk of postoperative AF, there has not been sufficient examination of this relationship. We aimed to investigate the association between preoperative hemoglobin A1c and AF after isolated off-pump coronary bypass grafting. METHODS Of 912 consecutive patients undergoing isolated coronary bypass surgery, 805 were retrospectively analyzed for AF after excluding the following 107 cases: emergency (n = 81), chronic AF (n = 18), and pacemaker rhythm (n = 8). We performed a group analysis with hemoglobin A1c levels categorized into tertiles of the baseline distribution and a continuous analysis based on 1% increments in hemoglobin A1c levels. The cutoff points for the tertiles were as follows: lower, 3.8–5.6% (n = 283); middle, 5.7–6.7% (n = 282); upper, 6.8–11.4% (n = 240). RESULTS AF occurred in 159 patients (19.8%) after surgery. The median value (25th–75th percentile) of preoperative hemoglobin A1c was significantly lower in patients who developed AF than in those who did not (5.8 (5.4–6.3) vs 6.1 (5.5–7.2), p = 0.01). The incidence of postoperative AF was 28.3% (80/283) in the lower tertile, 17.4% (49/282) in the middle tertile, and 12.5% (30/240) in the upper tertile (p for trend = 0.01). The unadjusted odds ratio (95% confidence interval) for the association between hemoglobin A1c and postoperative AF was 0.70 (0.61–0.83) per 1% increase and 0.42 (0.29–0.70) for the upper versus the lower tertile. This association persisted after adjustment for the univariate predictors (0.74 (0.60–0.92) per 1% increase; 0.54 (0.31–0.90) for upper vs lower tertile) and the known risk factors (0.78 (0.63–0.95) per 1% increase; 0.55 (0.35–0.88) for upper vs lower tertile). The area under the receiver operator characteristic curve (95% confidence interval) for preoperative hemoglobin A1c as a predictor of postoperative AF was 0.70 (0.65–0.75) (p = 0.01). CONCLUSIONS Preoperative hemoglobin A1c independently predicts the occurrence of AF after isolated off-pump coronary bypass grafting. PMID:21612941

  14. [Minimally invasive saphenous vein harvesting for coronary artery bypass grafting. Use of Vega system].

    PubMed

    Simek, M; Nemec, P

    2005-05-01

    The authors present their first experience with minimally invasive saphenous vein harvesting for coronary artery bypass grafting (CABG). From February 2004 to June 2004 33 patients undergoing CABG were scheduled for minimally vein harvest with the use of Vega system (B/Braun-Aesculap, Tuttlingen, Germany). We evaluated wound and neurological complications associated with the vein harvest at the time of discharge and at the 3-month follow-up. The limited experience suggests that minimally invasive vein harvesting offers improved patient outcome in term of wound healing. PMID:16045115

  15. Adverse Hospital Events for Mentally Ill Patients Undergoing Coronary Artery Bypass Surgery

    PubMed Central

    Li, Yue; Glance, Laurent G; Cai, Xueya; Mukamel, Dana B

    2008-01-01

    Context Patients with mental disorders show higher burden of coronary heart disease, and may face special safety issues during in-hospital cardiac care. Objectives To compare the postoperative complication rate between patients with and without mental disorders undergoing isolated coronary artery bypass graft (CABG) surgery. Design, Setting, and Patients Retrospective analyses of New York state hospital claims between 1997 and 2004 (N=135,701). Complications were defined using the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ PSI). Principal Findings Mental disorders were significantly associated with higher anesthesia complications (adjusted odds ratio [AOR]=6.44, p<.001), decubitus ulcer (AOR=1.42, p=.006), postoperative hip fracture (AOR=3.29, p<.001), and overall complication rate representing nine PSIs (AOR=1.27, p<.001). Conclusions Mentally ill patients undergoing CABG surgery are more likely to experience potentially preventable complications and injuries. The mechanism underlying this observation warrants further study. PMID:18665856

  16. A Comparison of Outcomes between On-Pump and Off-Pump Beating Heart and Traditional Coronary Artery Bypass Surgeries

    Microsoft Academic Search

    Lindsey Dang

    2005-01-01

    Background\\/Objective: Three basic modalities exist as options to the surgeon performing coronary artery bypass graft surgery (CABO). Traditional CABO employs cardiopulmonary bypass (CPB) and cardioplegic arrest. In an attempt to avoid complications associated with CPB\\/global myocardial ischemia as a result of cardioplegic arrest, surgeons are re-exploring performing off-pump beating heart CABO (OffPBH). OffPBH is being revealed as a safe and

  17. Thoracic endovascular aortic repair and off-pump coronary artery bypass grafting after renal transplantation: a case report.

    PubMed

    Yanase, Yohsuke; Muraki, Satoshi; Koyanagi, Tetsuya; Watanabe, Noriyasu; Kurimoto, Yoshihiko

    2011-01-01

    Twelve years after receiving a renal transplant, a 50-year-old woman developed asthmatic symptoms. Chest CT revealed a descending thoracic aortic aneurysm. She had undergone percutaneous coronary intervention to treat the left anterior descending artery 10 years earlier. Coronary artery angiography revealed restenosis of the left anterior descending artery (99%, #6 in-stent). Because cardiopulmonary bypass may cause problems for transplanted kidney, we performed off-pump coronary artery bypass grafting (left internal thoracic artery to left anterior descending artery) and thoracic endovascular graft placement to treat the aortic aneurysm. Considering that the artery of the transplanted kidney was attached to the right iliac artery, and then the left common femoral artery was selected as the access root for GORE TAG(®) endografts (34 × 200 and 34 × 150 mm) (stentgrafts were deployed for the descending aortic artery). Postoperative angiography showed a patent bypass graft. Postoperative CT confirmed the absence of endoleaks. The postoperative course was uneventful, and she was discharged without complications. Ischemic heart disease and descending thoracic aortic aneurysm in recipients of kidney transplants can be treated using off-pump coronary bypass grafting and thoracic endovascular graft placement. The transplanted kidney was protected without using cardiopulmonary bypass (CPB). PMID:21881367

  18. Combined off-pump coronary artery by-pass and right upper lobectomy for lung cancer through median sternotomy.

    PubMed

    József, Furák; Jenö, Szolnoky; Imre, Troján; Gábor, Bogáts; Tamás, Szöke

    2003-12-01

    Patients who smoke are at risk of both coronary artery disease and lung cancer, but concomitant lesions of the heart and lung are uncommon. Management of these concomitant lesions is controversial because of the systemic side-effects of a cardiopulmonary by-pass (CPB) and the difficult approach of the lung. An off-pump coronary artery by-pass (OPCAB) can be a successful procedure in the combined treatment of lung cancer and cardiac disease. This study reports on a successful one-stage OPCAB grafting procedure with right upper lobe lobectomy for a primary lung cancer. PMID:15119270

  19. Effect of hypothermia in patients undergoing simultaneous carotid endarterectomy and coronary artery bypass graft surgery

    PubMed Central

    Ozen, Yucel; Aksoy, Eray; Sarikaya, Sabit; Aydin, Ebuzer; Altas, Ozge; Rabus, Murat Bulent; Kirali, Kaan

    2015-01-01

    Summary Purpose We sought to determine whether hypothermia provided any benefit in patients undergoing simultaneous coronary artery bypass graft surgery (CABG) and carotid endarterectomy (CEA) using one of two different surgical strategies. Methods Group 1 patients (n = 34, 88.2% male, mean age 65.94 ± 6.67 years) underwent CEA under moderate hypothermia before cross clamping the aorta, whereas group 2 patients (n = 23, 69.6% male, mean age 65.78 ± 9.29 years) underwent CEA under normothermic conditions before initiating cardiopulmonary bypass (CPB). Primary outcome of interest was the occurrence of any new neurological event. Results The two groups were similar in terms of baseline characteristics. Permanent impairment occurred in one patient (2.9%) in group 1. One patient from each group (2.9 and 4.3%) had transient neurological events and they recovered completely on the sixth and 11th postoperative days, respectively. Overall, there was no statistically significant difference between the two groups with regard to occurrence of early neurological outcomes (n = 2, 5.8% vs n = 1, 4.3%, p = 0.12). Conclusions This study could not provide evidence regarding benefit of hypothermia in simultaneous operations for carotid and coronary artery disease because of the low occurrence rate of adverse outcomes. The single-stage operation is safe and completion of the CEA before CPB may be considered when short duration of CPB is required. PMID:25629395

  20. Clinical Symptoms and Angiographic Findings of Patients Undergoing Elective Coronary Angiography without Prior Stress Testing

    PubMed Central

    Abdallah, Mouin S.; Spertus, John A.; Nallamothu, Brahmajee K.; Kennedy, Kevin F.; Arnold, Suzanne V.; Chan, Paul S.

    2014-01-01

    Many patients undergo elective coronary angiography without pre-procedural stress testing which may be suitable if performed in patients with more angina pectoris or more frequently identified obstructive coronary artery disease (CAD). Patients in the NCDR CathPCI Registry® undergoing elective coronary angiography between July 2009 and April 2013 were assessed for differences in angina (Canadian Cardiovascular Society [CCS] class) and severity of obstructive CAD in those with and without pre-procedural stress testing, stratified by prior CAD history. Given the large sample size, differences were considered clinically meaningful if the standardized difference (SD) was >10%. Of 790,601 patients without prior CAD history, 36.9% did not undergo prior stress testing. Compared to patients with prior stress testing, patients without prior stress testing were more frequently angina free (CCS class 0; 28.2% with stress test vs. 38.5% without, SD=14.8%) and had similar rates of obstructive CAD (40.1% with stress test vs. 35.7% without, SD=9.0). Among 449,579 patients with prior CAD history, 44.2% did not undergo prior stress testing. Patients without prior stress testing reported more angina (CCS Class III/IV angina: 17.8% vs. 13.4%; SD=11.3%) but were not more likely to have obstructive CAD (78.7% vs. 81.1%; SD=5.8%) than patients with prior stress testing. In conclusion, approximately 40% of patients undergoing elective coronary angiography did not have pre-procedural risk stratification with stress testing. For these patients, the clinical decision to proceed directly to invasive evaluation was not driven primarily by severe angina and did not result in higher detection rates for obstructive CAD. PMID:24890987

  1. Frequency of myocardial indium-111 antimyosin uptake after uncomplicated coronary artery bypass grafting

    SciTech Connect

    van Vlies, B.; van Royen, E.A.; Visser, C.A.; Meyne, N.G.; van Buul, M.M.; Peters, R.J.; Dunning, A.J. (Academic Medical Center, Amsterdam (Netherlands))

    1990-11-15

    The reported incidence of myocardial damage after coronary artery bypass grafting (CABG) is highly related to the methods used. Since indium-111 monoclonal antimyosin antibody scintigraphy has been shown to be highly specific and sensitive for myocardial necrosis, even in small lesions, uptake of this radiotracer was evaluated after CABG. In 23 consecutive patients without previous myocardial infarction who underwent CABG for stable angina, 80 MBq indium-111 antimyosin was injected on the third postoperative day. Planar images were obtained 48 hours later and analyzed for myocardial uptake of indium-111 antimyosin. Scintigraphic results were related to creatine kinase MB levels, duration of both aortic cross-clamping and cardiopulmonary bypass, and electrocardiographic changes. In all patients surgical procedure and postoperative course was uncomplicated. Indium-111 antimyosin uptake was present in 19 of 23 patients (82%). It was diffused in 7 patients and localized in 12. No pathologic Q waves occurred postoperatively. Fourteen patients exhibited ST-segment changes. No good relation was found among indium-111 antimyosin uptake and creatine kinase MB levels, duration of cross-clamping or bypass, and ST-T changes. It is concluded that some degree of myocardial damage, though silent, is common after CABG.

  2. Food pattern and quality of life in metabolic syndrome patients who underwent coronary artery bypass grafting in Taiwan

    Microsoft Academic Search

    Heng-Hsin Tung; Li-Hua Tseng; Jeng Wei; Cheng-Hsin Lin; Tsae-Jyy Wang; Shu-Yuan Liang

    2011-01-01

    Metabolic syndrome is associated with poor operative outcomes of coronary artery bypass grafting surgery (CABG). A healthy food pattern for metabolic syndrome patients is necessary not only in the initial stage to prevent cardiovascular disease but for those who experience cardiovascular problems and undergo heart surgery. Empirical studies that explore food pattern and quality of life metabolic syndrome patients who

  3. Increased risk of heart failure as a consequence of perioperative myocardial injury after coronary artery bypass grafting

    Microsoft Academic Search

    J Steuer; F Granath; U de Faire; A Ekbom; E Sta?hle

    2005-01-01

    Objective: To analyse the relation between perioperative myocardial injury (PMI) and the risk of subsequent heart failure after coronary artery bypass grafting (CABG).Design and setting: Clinical data were documented prospectively in all patients and stored in a computer. All hospital readmissions were identified and the registered primary diagnoses were analysed. Survival information on all patients was obtained by use of

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

    Microsoft Academic Search

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

    1999-01-01

    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

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

    PubMed

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

    2012-04-01

    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. PMID:22511433

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

    PubMed Central

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

    2012-01-01

    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. PMID:22511433

  7. Clinical Consequences and Cost of Limiting Use of Vancomycin for Perioperative Prophylaxis: Example of Coronary Artery Bypass Surgery

    Microsoft Academic Search

    Giorgio Zanetti; Sue J. Goldie; Richard Platt

    2001-01-01

    Routine use of vancomycin for perioperative prophylaxis is discouraged, principally to minimize microbial resistance to it. However, outcomes and costs of this recommendation have not been assessed. We used decision- analytic models to compare clinical results and cost-effectiveness of no pro- phylaxis, cefazolin, and vancomycin, in coronary artery bypass graft sur- gery. In the base case, vancomycin resulted in 7%

  8. The St Jude Medical symmetry aortic connector system for proximal vein graft anastomoses in coronary artery bypass grafting

    Microsoft Academic Search

    Friedrich S. Eckstein; Luis F. Bonilla; Lars Englberger; Franz F. Immer; Todd A. Berg; Jürg Schmidli; Thierry P. Carrel

    2002-01-01

    Objectives: A new device designed to create proximal vein graft anastomoses to the aorta in coronary artery bypass grafting was recently developed by the St Jude Medical Anastomotic Technology Group (Minneapolis, Minn). This new anastomosis system consists of a nickel-titanium (nitinol) connector, an aortic cutter, and a delivery device. Methods: The loading of the vein on the aortic connector and

  9. The effect of peripheral vascular disease on in-hospital mortality rates with coronary artery bypass surgery

    Microsoft Academic Search

    John D. Birkmeyer; Gerald T. O'Connor; Hebe B. Quinton; Michael A. Ricci; Jeremy R. Morton; Bruce J. Leavitt; David C. Charlesworth; Felix Hernandez; Martha D. McDaniel

    1995-01-01

    Purpose: The purpose of this study was to examine the effect of peripheral vascular disease (PVD) on in-hospital mortality rates after coronary artery bypass grafting (CABG).Methods: We performed a regional cohort study of 3003 patients undergoing CABG between 1987 and 1989 at five tertiary care centers in Maine, New Hampshire, and Vermont. Data reflecting patient characteristics, severity of heart disease,

  10. Psychological and Somatic Factors in Patients Undergoing Coronary Artery Bypass Graft Surgery: Towards Building a Psychological Framework

    Microsoft Academic Search

    Annelien Duits; Hugo Duivenvoorden; Saskia Boeke; Bas Mochtar; Jan Passchier; Ruud Erdman

    2002-01-01

    The present study explored the relationships between psychological and somatic factors in patients undergoing Coronary Artery Bypass Graft surgery (CABG). The data-analysis of previous work was extended by adding somatic factors, including feelings of disability, somatic complaints and fatigue. The focus was on their relationships with psychological factors, including anxiety, depression and neuroticism. Prior to surgery and six months postoperatively,

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

    ERIC Educational Resources Information Center

    LaFontaine, Tom; Bruckerhoff, Diane

    1987-01-01

    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)

  12. Simultaneous coronary artery bypass grafting and carotid endarterectomy in an awake Jehova's witness patient without endotracheal intubation

    Microsoft Academic Search

    Gino Gerosa; Franco Grego; Gianclaudio Falasco; Francesca di Marco

    2005-01-01

    Complex surgical procedures are associated with a major risk of peri-operative bleeding. Jehova's witnesses (JW) necessitate a tailored strategy warranting the optimal surgical management, in observance to their religion principles. In this report, we present a JW female patient, who underwent combined coronary artery bypass grafting and carotid endarterectomy, with neither endotracheal intubation nor general anaesthesia. Patient had previously undergone

  13. Case report Simultaneous coronary artery bypass grafting and carotid endarterectomy in an awake Jehova's witness patient without endotracheal intubation

    Microsoft Academic Search

    Gino Gerosa; Franco Grego

    Complex surgical procedures are associated with a major risk of peri-operative bleeding. Jehova's witnesses (JW) necessitate a tailored strategy warranting the optimal surgical management, in observance to their religion principles. In this report, we present a JW female patient, who underwent combined coronary artery bypass grafting and carotid endarterectomy, with neither endotracheal intubation nor general anaesthesia. Patient had previously undergone

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

    SciTech Connect

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

    1989-09-01

    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.

  15. Coronary artery disease performance measures and statin use in patients with recent percutaneous coronary intervention or recent coronary artery bypass grafting (from the NCDR PINNACLE registry).

    PubMed

    Bandeali, Salman J; Gosch, Kensey; Alam, Mahboob; Kayani, Waleed T; Jneid, Hani; Fiocchi, Fran; Wilson, James M; Chan, Paul S; Deswal, Anita; Maddox, Thomas M; Virani, Salim S

    2015-04-15

    The association between coronary revascularization strategy (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) and compliance with coronary artery disease (CAD) performance measures is not well studied. Our analysis studied patients enrolled in the Practice Innovation and Clinical Excellence registry, who underwent coronary revascularization using PCI or CABG in the 12 months before their most recent outpatient visit in 2011. We compared the attainment of CAD performance measures and statin use in eligible patients with PCI and CABG using hierarchical logistic regression models. Our study cohort consisted of 112,969 patients (80,753 with PCI and 32,216 with CABG). After adjustment for site and patient characteristics, performance measure compliance for tobacco use query (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.76 to 0.86), antiplatelet therapy (OR 0.9; 95% CI 0.86 to 0.94) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy (OR 0.89; 95% CI 0.84 to 0.94) was lower in CABG compared with patients with PCI. Patients who underwent recent CABG had higher rates of ?-blocker (OR 1.25; 95% CI 1.16 to 1.33) and statin treatment (OR 1.37; 95% CI 1.31 to 1.43) compared with patients with PCI. Of the 79 practice sites, 15 (19%) had ?75% of their patients with CAD (CABG or PCI) meeting 75% to 100% of all eligible CAD performance measures. In conclusion, gaps persist in compliance with specific CAD performance measures in patients with recent PCI or CABG, and 1 in 5 practices had ?75% compliance of eligible CAD performance measures in the most of their patients. PMID:25721483

  16. Mortality in Medicare Patients Undergoing Elective Percutaneous Coronary Intervention With or Without Antecedent Stress Testing

    PubMed Central

    Lin, Grace A.; Lucas, F.L.; Malenka, David J.; Skinner, Jonathan; Redberg, Rita F.

    2013-01-01

    Background Guidelines advise testing for ischemia – such as with stress testing – prior to elective percutaneous coronary intervention (PCI). However, pre-PCI stress testing is not always done; the implications of this practice are not known. Our objective was to evaluate whether receipt of stress testing prior to elective PCI predicts mortality. Methods and Results Using claims data from a 20% random sample of Medicare beneficiaries, we identified patients who had elective PCI in 2004 and followed them for a median of 3.4 years (N=23,887). Cox proportional hazards models were used to test the relationship of pre-PCI stress testing to survival. Population-based rates of elective PCI and stress testing were calculated for 306 hospital referral regions (HRR) and categorized into four groups: high stress test rate/high PCI rate, low stress test/low PCI, low stress test/high PCI, and high stress/low PCI regions. Cox modeling was used to test if category of HRR related to survival. Patients who underwent pre-PCI stress testing had a 13% lower risk of mortality than those who did not (adjusted hazard ratio (HR) 0.87, 95% CI 0.81–0.92) after median follow-up of 3.4 years. Patients in low stress test/high PCI regions had a 14% higher risk of mortality than those in high stress test/high PCI regions (adjusted HR 1.14, 95% CI 1.03, 1.26). Conclusions Pre-PCI stress testing is associated with lower mortality in patients undergoing elective PCI. Greater adherence to guidelines with respect to documenting ischemia prior to elective PCI may result in improved outcomes for patients. PMID:23674314

  17. Superiority of moderate control of hyperglycemia to tight control in patients undergoing coronary artery bypass grafting

    PubMed Central

    Bhamidipati, Castigliano M.; LaPar, Damien J.; Stukenborg, George J.; Morrison, Christine C.; Kern, John A.; Kron, Irving L.; Ailawadi, Gorav

    2011-01-01

    Objective Although consensus in cardiac surgery supports tight control of perioperative hyperglycemia (glucose <120 mg/dL), recent studies in critical care suggest moderate glycemic control may be superior. We sought to determine whether tight control or moderate glycemic control is optimal after coronary artery bypass grafting. Methods From 1995 to 2008, a total of 4658 patients with known diabetes or perioperative hyperglycemia (preoperative glycosylated hemoglobin ?8 or postoperative serum glucose >126 mg/dL) underwent isolated coronary artery bypass grafting at our institution. Patients were stratified into 3 postoperative glycemic groups: tight (?126 mg/dL), moderate (127–179 mg/dL), and liberal (?180 mg/dL). Preoperative risk factors, glycemic management, and postoperative outcomes were analyzed. Results Operative mortality was 2.5%(119/4658); major complication rate was 12.5%(581/4658). Relative to moderate group, more patients in tight group had preoperative renal failure (tight 16.4%, 22/134, moderate 8.3%, 232/2785, P = .001) and underwent emergent operations (tight 5.2%, 7/134, moderate 1.9%, 52/2785, P = .007); however, Society of Thoracic Surgeons predicted mortality risk was lower in tight group (P < .001). Moderate group had lowest mortality (tight 2.9%, 4/134, moderate 2.0%, 56/2785, liberal 3.4%, 59/1739, P = .02) and incidence of major complications (tight 19.4%, 26/134, moderate 11.1%, 308/2785, liberate 14.2%, 247/1739, P < .001). Risk-adjusted major complication incidence (adjusted odds ratio 0.7, 95% confidence interval 0.58–0.87) and mortality (adjusted odds ratio 0.6, 95% confidence interval 0.37–0.83) were lower with moderate glucose control than with tight or liberal management. Conclusions Moderate glycemic control was superior to tight glycemic control, with decreased mortality and major complications, and may be ideal for patients undergoing isolated coronary artery bypass grafting. PMID:21163498

  18. The effect of postoperative positive end-expiratory pressure on postoperative bleeding after off-pump coronary artery bypass grafting

    PubMed Central

    Salihoglu, Ece; Celik, Sezai; Ugurlucan, Murat; Caglar, Ilker Murat; Turhan-Caglar, Fatma Nihan; Isik, Omer

    2014-01-01

    Introduction To compare postoperative prophylactic use of two positive end-expiratory pressure (PEEP) levels in order to prevent postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery. Material and methods Sixty patients undergoing an elective off-pump CABG operation were included in this prospective, nonrandomized clinical trial. Patients were divided into two groups as receiving either 5 cm H2O (group 1) or 8 cm H2O PEEP (group 2) after the operation until being extubated. Chest tube outputs, use of blood products and other fluids, postoperative hemoglobin levels, accumulation of pleural and pericardial fluid after the removal of chest tubes, and duration of hospital stay were recorded and compared. Results Low- and high-pressure PEEP groups did not differ with regard to postoperative chest tube outputs, amounts of transfusions and crystalloid/colloid infusion requirements, or postoperative hemoglobin levels. However, low-pressure PEEP application was associated with significantly higher pleural (92 ±37 ml vs. 69 ±29 ml, p = 0.03) and pericardial fluid (17 ±5 ml vs. 14 ±6 ml, p = 0.04) accumulation. On the other hand, high-pressure PEEP application was associated with significantly longer duration of hospitalization (6.25 ±1.21 days vs. 5.25 ±0.91 days, p = 0.03). Conclusions Prophylactic administration of postoperative PEEP levels of 8 cm H2O, although safe, does not seem to reduce chest-tube output or transfusion requirements in off-pump CABG when compared to the lower level of PEEP. Further studies with larger sample sizes are warranted to confirm the benefits and identify ideal levels of PEEP administration in this group of patients. PMID:25395944

  19. Off-pump coronary artery bypass surgery compared with stent implantation and on-pump bypass surgery: clinical outcome and cost-effectiveness at one year

    PubMed Central

    Nathoe, H.M.; van Dijk, D.; Jansen, E.W.L.; Borst, C.; Grobbee, D.E.; de Jaegere, P.P.T.

    2005-01-01

    Background Coronary revascularisation by means of surgery or percutaneous intervention plays an important role in the management of patients with ischaemic heart disease. Coronary bypass surgery without cardiopulmonary bypass (off-pump surgery) has been reintroduced into clinical practice to avoid complications related to the use of cardiopulmonary bypass. It is unknown whether off-pump surgery can match the outcomes of bypass surgery with cardiopulmonary bypass (on-pump surgery) or intracoronary stent implantation. Methods The Octopus study comprised two multicentre randomised trials. In the Octopump trial, on-pump surgery was compared with off-pump surgery (139 vs. 142 patients). In the Octostent trial stent implantation was compared with off-pump surgery (138 vs. 142 patients). The primary cardiac endpoint was survival free from the following cardiovascular events: stroke, myocardial infarction and repeated coronary revascularisation. Secondary endpoints included quality of life and cost-effectiveness. The uncertainty surrounding the cost-effectiveness analysis was addressed by bootstrapping. Results Octopump trial: at one year, event-free survival in the on-pump group was 90.6% and in the off-pump group 88.0% (difference 2.6%, 95% CI-4.6 to 9.8). Quality-adjusted years of life were 0.83 and 0.82 (p=0.81), respectively. On-pump surgery was associated with €2089 (14.1%) additional direct medical costs per patient (p<0.01). Off-pump was more cost-effective than on-pump surgery in 95% of bootstrap estimates. Octostent trial: at one year, event-free survival in the stent group was 85.5% and in the off-pump surgery group 91.5% (difference -6.0%, 95% CI -13.5 to 1.4). Quality-adjusted years of life were 0.82 and 0.79 (p=0.09), respectively. Stent implantation reduced direct medical costs by €2813 (26.0%) per patient (p=0.01). Stent implantation was more cost-effective in 95% of bootstrap estimates. Conclusion In selected patients eligible for bypass surgery, there was no difference in cardiac outcome between on-pump and off-pump surgery. Off-pump surgery, however, was more cost-effective than on-pump surgery and may be preferred from an economic perspective. In selected patients eligible for percutaneous coronary intervention, stent implantation was more cost-effective than off-pump surgery while maintaining comparable cardiac outcome. Therefore, stent implantation rather than off-pump surgery can be recommended as a first-choice revascularisation strategy. ImagesFigure 2AFigure 2B PMID:25696506

  20. Survival benefit of coronary-artery bypass grafting accounted for deaths in those who remained untreated

    PubMed Central

    Sobolev, Boris G; Fradet, Guy; Hayden, Robert; Kuramoto, Lisa; Levy, Adrian R; FitzGerald, Mark J

    2008-01-01

    Background Currently there are no direct estimates of mortality reduction afforded by coronary-artery bypass grafting (CABG) that take into account the deaths among patients for whom coronary revascularization was indicated but who did not undergo the treatment. The objective of this analysis was to compare survival after the treatment decision between patients who underwent CABG and those who remained untreated. Methods We used a population-based registry to identify patients with established coronary artery disease who were to undergo first-time isolated CABG. We measured the effect of surgical revascularization on survival after the treatment decision in two cohorts of patients categorized by symptoms, coronary anatomy, and left ventricular function. Results One in 10 patients died during the five years after treatment decision. The hazard of death among patients who underwent CABG was 51 percent of that for the untreated group, the adjusted hazard ratio was 0.51 (95 percent confidence interval, 0.43 to 0.61). The effect was stronger when CABG was performed within the recommended time: adjusted hazard ratios were 0.43 (95 percent confidence interval, 0.35 to 0.53) and 0.58 (95 percent confidence interval, 0.48 to 0.70) for early and late intervention, respectively; chi-square for the difference between hazard ratios was 12.2 (P < 0.001). Conclusion Estimates that account for patients who died before they could undergo a required CABG indicate a significant survival benefit of performing early surgical revascularization even for patients registered to undergo the operation on the non-urgent basis. PMID:18637196

  1. Myasthenia gravis: a careful perioperative anesthetic management of coronary artery bypass grafting.

    PubMed

    Kowalczyk, Micha?; Nestorowicz, Andrzej; Stachurska, Katarzyna; Fija?kowska, Anna; St??ka, Janusz

    2015-06-01

    Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis. We describe successful management without any pulmonary complications of two patients with myasthenia gravis undergoing coronary artery bypass grafting. In addition, antiacetylcholine receptor antibodies concentrations were evaluated during treatment time. In conclusion, we have found that reduced titrated doses of cisatracurium may be safely used in patients with myasthenia gravis undergoing cardiac surgery without anesthesia and respiratory-related complications. PMID:25943997

  2. [Off-pump beating heart coronary artery bypass. Technical points of view and surgical results].

    PubMed

    Matei, C; Gavra, G; Billaud, P; Dallemand, R; Semenescu, A; Lallemant, P; Réal, P; Jacquemin, L; el Belghiti, R; Monassier, J P; Bischoff, N

    2002-11-01

    A consecutive series of 746 patients undergoing heart beating myocardial revascularization was reviewed. An average of 2.30 grafts/patients was performed. The rate of mortality in the first 30 postoperative days was 0.28%. Two cases had to be terminated on-pump. We used the inotropic drugs in 0.6% of cases. The postoperative events were: atrial fibrillation (12.6%), myocardial infarction (0.3%). The rate of transfusion was 7.4%. The extubation was performed in the first 24 h postoperatively in 94.7% of cases. The majority of patients (91.3%) left the hospital in the first 8 d postoperatively. Off pump coronary artery bypass grafting gives good result for the most of the patients even for those with multiple vessel disease and high operating risk. PMID:12515102

  3. Simple exposure of the internal thoracic artery for minimally invasive coronary artery bypass

    PubMed Central

    Gill, Inderjit S.

    2000-01-01

    A simple method is described for harvesting a pedicle of internal thoracic artery for minimally invasive coronary artery bypass grafting with the use of a small scapular retractor. The technique has been used successfully in 39 patients. All patients were followed up early postoperatively by angiography, and the patency rate was 96%. Follow-up angiography (mean [and standard error] 9.6 [4.8] months) was carried out in 63% of the patients, demonstrating a cumulative patency rate of 95.4% with no evidence of steal. None of the patients died and there were no cases of myocardial infarction perioperatively. Recurrent angina developed in 2 patients. This technique is safe, effective and inexpensive. PMID:10812351

  4. Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting.

    PubMed

    Agrawal, Dharmesh R; Sayeed, Mohammed Rehan; Chakravarthy, Murali R; Patil, T A

    2013-01-01

    Acute left ventricular (LV) failure has been reported after surgical closure of atrial septal defect (ASD) in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG) and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5). The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB) under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D ) recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure. PMID:23287085

  5. Changes in body mass index and late postoperative outcomes in elderly coronary bypass grafting patients: a follow-up study.

    PubMed

    DiMaria-Ghalili, Rose Ann

    2004-07-01

    The purpose of this study was to describe the extent to which late postoperative health outcomes vary as a function of change in body mass index (BMI) in per-sons > or = 65 years of age undergoing elective coronary artery bypass grafting (CABG). The mean age of the 90 persons in the original sample was 72.27 (+/-4.85) years. At follow-up x = 18.73, s = 2.56 months postsurgery), 90% (n = 79 alive, n = 2 deceased, proxy completed interview) were contacted; 73% (n = 59)completed the telephone interview; and 9% (n = 8) were alive but lost to follow-up. BMI (kg/m(2)) was calculated from self-reported weight at follow-up. Out-comes included the Physical Component Summary(PCS) scale of the SF-36 Health Survey and readmission data. The (_)x (s) for BMI at preoperative, postoperative, postdischarge, and follow-up were 28.1 (4.9) kg/m(2), 28.76 (4.9) kg/m(2), 27.11 (4.8) kg/m(2), and 27.95(4.7) kg/m(2), respectively. BMI changed over time, P <0.05. Those who were readmitted lost more weight between preoperative and postdischarge than those who were not readmitted ((_)f BMI = -2.26 vs. (_)x BMI =-1.35), t = 2.17, df = 27.05, P = 0.04. Those who lost less weight between preoperative and postdischarge were less likely to be readmitted, X2 = 5.755 (1), P =0.02, with 25% sensitivity and 92% specificity. The (_)x(s(x)(-)) for PCS at preoperative, postdischarge, and follow-up were 36.93 (1.62), 35.72 (1.27), and 42.26 (1.45), respectively, reflecting change over time, F =11.43 (2), P < 0.001. At follow-up, older elective CABG patients do not appear to regain weight lost between preoperative and postdischarge; however,self-reported physical health is improved. Also, initial weight loss is related to readmissions. PMID:15230244

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

    PubMed Central

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

    2013-01-01

    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. PMID:23936769

  7. The effect of gender on the early results of coronary artery bypass surgery in the younger patients' group

    PubMed Central

    Uncu, Hasan; Acipayam, Mehmet; Altinay, Levent; Do?an, Pinar; Davarc?, Isil; Özsöyler, ?brahim

    2014-01-01

    Introduction In this retrospective study, we aimed to determine the risk factors for coronary artery bypass surgery in patients under 45 years of age, and evaluate the early postoperative results and the effect of gender. Methods A total of 324 patients under 45 years of age who undergone on-pump coronary artery bypass surgery between April 12, 2004 and January 10, 2012 were included to the study. Patients divided into groups as follows: Group 1 consisted of 269 males (mean age 41.3), Group 2 consisted of 55 females (mean age 41.6). Preoperative risk factors, intraoperative and postoperative data and early mortality rates of the groups were compared. Results Smoking rate was significantly higher in Group 1. Diabetes mellitus incidence and body mass index were significantly higher in Group 2 (P values P=0.01; P=0.0001; P=0.04 respectively). The aortic cross-clamping and cardiopulmonary bypass time and number of grafts per patient were significantly higher in Group 1 (P values P=0.04; P=0.04; P=0.002 respectively). There were no deaths in either group. Conclusion We found that gender has no effect on early mortality rates of the coronary bypass surgery patients under 45 years. PMID:25714211

  8. Coronary artery bypass grafting in the octogenarians: should we intervene, or leave them be?

    PubMed Central

    Ozen, Anil; Unal, Ertekin Utku; Songur, Murat; Kocabeyoglu, Sinan Sabit; Hanedan, Onur; Yilmaz, Metin; Turkcan, Basak Soran; Cicekcioglu, Ferit; Kaplan, Sadi; Birincioglu, Cemal Levent

    2015-01-01

    Objective Coronary artery bypass grafting (CABG) is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between January 2002 and December 2011, a total of 101 consecutive patients at an age of 80 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ± 2.27 years. Sixty-four (63.4%) were males and 37 (36.6%) were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit (ICU) stay, inotropic support, intra aortic balloon pulsation application, amount of erythrocyte transfusion and fresh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass (CPB) was found to be an independent predictor of mortality (OR: 1.18, 95% CI 1.01?1.38, P = 0.034). The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio. PMID:25870618

  9. Who's next? A new process for creating points systems for prioritising patients for elective health services

    Microsoft Academic Search

    Alison Barber; Paul Hansen; Ray Naden; Franz Ombler; Ralph Stewart

    2011-01-01

    We describe a new process for creating points systems for prioritising patients for elective health services. Beginning in 2004, the authors were closely involved in a project to develop the process, initially for coronary artery bypass graft surgery and then successively for other elective services. The project was led by New Zealand's Ministry of Health in collaboration with the relevant

  10. Simultaneous coronary artery bypass grafting and carotid endarterectomy can be performed with low mortality rates

    PubMed Central

    Aydin, Ebuzer; Ozen, Yucel; Sarikaya, Sabit; Yukseltan, Ismail

    2014-01-01

    Summary Introduction There is controversy over the best approach for patients with concomitant carotid and coronary artery disease. In this study, we report on our experience with simultaneous carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) surgery in our clinic in the light of data in the literature. Methods Between January 1996 and January 2009, a total of 110 patients (86 males, 24 females; mean age 65.11 ± 7.81 years; range 44–85 years), who were admitted to the cardiovascular surgery clinic at our hospital, were retrospectively analysed. All patients underwent simultaneous CEA and CABG. Demographic characteristics of the patients and a history of previous myocardial infarction (MI), hypertension, diabetes mellitus, hyperlipidaemia, peripheral arterial disease and smoking were recorded. Results One patient (0.9%) with major stroke died due to ventricular fibrillation. Peri-operative neurological complications were observed in seven patients (6%). Complications were persistent in two patients. Four patients (3%) had postoperative major stroke, whereas three patients (2%) had transient hemiparesis. No peri-operative myocardial infarction was observed. Conclusion Simultaneous CEA and CABG can be performed with low rates of mortality and morbidity. PMID:25000443

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

    PubMed Central

    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

    Background The clinical benefits of the left internal thoracic artery–to–left anterior descending coronary artery graft are well established in coronary artery bypass graft surgery (CABG). However, limited data are available regarding the long?term outcome of the radial artery (RA) as a secondary conduit over the established standard of the saphenous venous graft. Methods and Results We compared the 12?year survival outcome in a set of propensity?matched CABG patients who received either the RA or the saphenous vein as a secondary conduit. A multivariable logistic regression that included 18 baseline characteristics was used to define the propensity of receiving an RA graft. The propensity model resulted in 260 matched pairs who underwent first?time isolated CABG from 1996 to 2001 with similar preoperative characteristics (C statistic=0.86). The cumulative 12?year survival estimated by use of the Kaplan–Meier method was higher for the RA graft patients (hazard ratio 0.76; P=0.03). This survival advantage was especially significant in diabetics (P=0.005), in women (P=0.02), and in the elderly (P=0.04.) The protective effect appeared beginning at year 5 post surgical intervention. Conclusion The RA as a secondary conduit provided superior long?term survival after CABG, especially in diabetic patients, women, and the elderly. This effect was most pronounced >5 years after surgery. PMID:23969224

  12. Can internal thoracic arteries be used for both coronary artery bypass and breast reconstruction?

    PubMed Central

    Currie, Maria E.; Fox, Stephanie A.; Greer-Bayramoglu, Rebecca J.; Fortin, Amanda J.; Chu, Michael W. A.

    2012-01-01

    OBJECTIVES Recently, the internal thoracic arteries have been preferentially used in autologous breast reconstruction at the levels of the third or fourth intercostal spaces. This may compromise future treatment of occult coronary disease. We hypothesized that internal thoracic artery length at the fourth intercostal space would allow both breast reconstruction and future coronary artery bypass grafting (CABG). METHODS Anatomic analysis of 20 female patients undergoing CABG was performed examining internal thoracic artery length from its origin to the third, fourth, fifth intercostal spaces and the left anterior descending (LAD) artery target. RESULTS The left internal thoracic artery was anastamosed to the LAD target at a mean length of 11.4 ± 1.4 cm. The mean lengths of the pedicled left internal thoracic artery from its origin to the third, fourth and fifth intercostal space were 8.5 ± 1.0, 10.9 ± 1.2 and 13.0 ± 1.4 cm, respectively. Therefore, the left internal thoracic artery length was adequate at the fourth intercostal space in 6 of 20 (30%) patients. CONCLUSIONS Dissection of the left internal thoracic artery to the fourth intercostal space would allow for concomitant use in CABG and breast reconstruction in one-third of cases. However, skeletonization of the internal thoracic artery at the level of the fourth intercostal space would be sufficient for CABG in all cases following autologous breast reconstruction. PMID:22899665

  13. Elective Cholecystectomy During Laparoscopic Roux-En-Y Gastric Bypass: Is it Worth the Wait?

    Microsoft Academic Search

    Giselle G. Hamad; Sayeed Ikramuddin; William F. Gourash; Philip R. Schauer

    2003-01-01

    Background: Combined gastric bypass and cholecystectomy have been advocated for open bariatric procedures. Our goal was to\\u000a evaluate the safety of this technique in laparoscopic bariatric surgery patients with gallstones diagnosed preoperatively.\\u000a Methods: 94 out of 556 consecutive morbidly obese patients (16.9%) underwent laparoscopic gastric bypass with simultaneous\\u000a cholecystectomy (LGBP\\/LC) for cholelithiasis. Results: 328 patients (59%) had a concomitant secondary

  14. TLR4 Expression Is Associated with Left Ventricular Dysfunction in Patients Undergoing Coronary Artery Bypass Surgery

    PubMed Central

    Avlas, Orna; Bragg, Arieh; Fuks, Avi; Nicholson, James D.; Farkash, Ariel; Porat, Eyal; Aravot, Dan; Levy-Drummer, Rachel S.; Cohen, Cyrille; Shainberg, Asher; Arad, Michael; Hochhauser, Edith

    2015-01-01

    Introduction Toll-like receptor 4 (TLR4) is an innate immune receptor expressed in immune cells and the heart. Activation of the immune system following myocardial ischemia causes the release of proinflammatory mediators that may negatively influence heart function. Aim The aim of this study is to determine whether TLR4 is activated in peripheral monocytes and heart tissue taken from patients with varying degrees of myocardial dysfunction caused by coronary artery diseases and scheduled for coronary artery bypass graft (CABG) surgery before 12 months following operation. Methods and Results Patients (n = 44) undergoing CABG surgery having left ventricular ejection fraction ? 45% (‘reduced EF’, n = 20) were compared to patients with preserved EF >45% (‘preserved EF’ group, n = 24). ‘Reduced EF’ patients exhibited increased TLR4 expression in monocytes (2.78±0.49 vs. 1.76±0.07 rMFI, p = 0.03). Plasma levels of C-reactive protein, microRNA miR-320a, brain natriuretic peptide (pro BNP) and NADPH oxidase (NOX4) were also significantly different between the ‘preserved EF’ and ‘reduced EF’groups. Elevated TLR4 gene expression levels in the right auricle correlated with those of EF (p<0.008), NOX4 (p<0.008) and miR320, (p<0.04). In contrast, no differences were observed in peripheral monocyte TLR2 expression. After CABG surgery, monocyte TLR4 expression decreased in all patients, reaching statistical significance in the ‘reduced EF’ group. Conclusion TLR4 is activated in peripheral monocytes and heart tissue obtained from patients with ischemic heart disease and reduced left ventricular function. Coronary revascularization decreases TLR4 expression. We therefore propose that TLR4 plays a pathogenic role and may serve as an additional marker of ischemic myocardial dysfunction. PMID:26030867

  15. Prognostic value of paraoxonase 1 in patients undergoing coronary artery bypass grafting surgery

    PubMed Central

    Wysocka, Anna; Cybulski, Marek; Berbe?, Henryk; Wysoki?ski, Andrzej; St??ka, Janusz; Zapolski, Tomasz

    2014-01-01

    Background The aim of this study was to evaluate whether –108C/T polymorphism of the paraoxonase 1 (PON1) gene and the plasma enzyme activity are risk factors for adverse cardiac events after coronary artery bypass grafting (CABG). Material/Methods Seventy-one patients with coronary heart disease (CHD) undergoing CABG were enrolled in the study. Genomic DNA was extracted from the venous blood using the Gen Elute™ Blood Genomic DNA kit (Sigma) according to the manufacturer’s instructions. PON1 activity was measured in 50 mM glycine/NaOH buffer (pH 10.5) containing 1.0 mM paraoxon, and 1.0mM CaCl2. Results The mean PON1 activity toward paraoxon and toward phenyl acetate was equal (166.5±86.9 U/ml and 96.0±47.2 U/ml, respectively) in patients with CHD. The –108C/T polymorphism of PON1 gene was tested. In CABG patients, PON1 activities in dependence on genotypes were significantly different and equalled 266.2±117.9 U/ml for CC, 178.8±64.7 U/ml for CT, and 98.9±59.2 U/ml for TT genotype. Patients with PON1 activity lower than 193.5 U/ml exhibited significantly increased risk of a serious cardiac event in comparison with patients with PON1 activity higher or equal to this value (p=0.03). Additionally, TT genotype was significantly associated with shorter time of event-free survival in comparison with CT and CC genotypes (p=0.009). Conclusions The PON1 polymorphism and enzyme plasma activity are associated with CHD occurrence. High PON1 activity connected with the presence of CC and CT genotypes decreases the recurrence of symptoms of coronary heart disease and improve prognosis after CABG. PMID:24721823

  16. 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

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

    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

  17. Totally minimally invasive cardiac surgery for coronary artery disease 1 Presented at the World Congress on Minimally Invasive Cardiac Surgery, under the auspices of the European Association of Cardiothoracic Surgery, Paris, May 30–31, 1997. 1

    Microsoft Academic Search

    Chi-Hsiao Yeh; Chau-Hsiung Chang; Pyng Jing Lin; Feng-Chun Tsai; Min-Wen Yang; Peter P. C Tan

    1998-01-01

    Objective: We report our experience using minimally invasive techniques both to perform coronary artery bypass and harvesting of saphenous vein grafts in 25 patients with left main or triple vessels disease. Methods: From March 1997 to June 1997, 25 patients received elective coronary artery bypass grafting using minimally invasive surgical techniques for left main or triple vessels disease. Saphenous vein

  18. Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial

    Microsoft Academic Search

    Vipin Zamvar; David Williams; Nicola Payne; Clare Cann; Karen Young; S Karthikeyan; John Dunne

    2002-01-01

    Objective To assess neurocognitive impairment after the off›pump and on›pump techniques for coronary artery bypass graft surgery in patients with triple vessel disease. Design Randomised controlled trial. Setting University Hospital of Wales, Cardiff. Participants 60 patients undergoing coronary artery bypass graft surgery for triple vessel disease prospectively randomised to the off›pump or on›pump technique. Main outcome measures Change in scores

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

    PubMed

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

    2002-01-01

    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

  20. The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons’ database

    Microsoft Academic Search

    Ganga Prabhakar; Constance K Haan; Eric D Peterson; Laura P Coombs; Jose L Cruzzavala; Gordon F Murray

    2002-01-01

    BackgroundObesity is epidemic in the United States and afflicts 97 million adults. Prior single center studies have been contradictory as to obese patients having higher risks with coronary artery bypass operations. Our objective was to assess the independent effect of both moderate (body mass index [BMI], 35 to 39.9) and extreme (BMI ? 40) obesity on bypass operation outcomes using

  1. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease and Diabetic Nephropathy: A Single Center Experience

    PubMed Central

    Bae, Ki Sun; Park, Hyeong Cheon; Kang, Byung Seung; Park, Jong Won; Chon, Nu Ri; Oh, Kyung Jin; Yoon, Young Won; Hong, You Sun

    2007-01-01

    Background Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD. Methods The clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed. Results The baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046). Conclusions The CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization. PMID:17939329

  2. Coronary artery bypass grafting or percutaneous revascularization in acute myocardial infarction?

    PubMed Central

    Perrier, Stéphanie; Kindo, Michel; Gerelli, Sébastien; Mazzucotelli, Jean-Philippe

    2013-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was as follows: is coronary artery bypass graft (CABG) surgery superior to percutaneous coronary intervention (PCI) in terms of in-hospital mortality and morbidity and long-term outcomes in patients with acute myocardial infarction (MI)? A total of 104 papers were returned using the selected search. Of these, six represented the best evidence to answer the clinical question. The selection criteria were comparative studies with only PCI and CABG groups in patients with acute MI. Case reports, reviews, recommendations and studies on a specific population or out of the context of acute MI were excluded. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Almost all PCI patients received stents. One study used drug-eluting stents (DES). Two randomized studies showed similar short- and mid-term morbidities and mortalities in patients with acute MI in the PCI and CABG groups but higher repeat revascularization rates after PCI. Three observational studies found comparable survival, but one of them found more periprocedural events with CABG and the other two found more recurrent ischaemia requiring repeat revascularization in the PCI group. In one cohort study, CABG appeared to be an independent risk factor for death in N-STEMI according to the European Society/American College of Cardiology 2000 definition. The results are strongly influenced by the definition of acute MI. In an institution offering the two techniques with an equivalent accessibility, the principal advantage of PCI is a lower incidence of periprocedural and short-term morbidities. CABG, on the other hand, offers a better durability with less mid-term repeat revascularization required, especially when compared with PCI with DES implantation. Choice had to weight up coronary artery anatomy, number and localization of coronary artery stenosis and accessibility of both PCI and CABG treatments. Medical and surgical discussion within the Heart Team is required to make the best medical decision for each patient. PMID:23962854

  3. The risk of death associated with delayed coronary artery bypass surgery

    PubMed Central

    Sobolev, Boris G; Levy, Adrian R; Kuramoto, Lisa; Hayden, Robert; Brophy, James M; FitzGerald, J Mark

    2006-01-01

    Background The detrimental effect of delaying surgical revascularization has been estimated in randomized trials and observational studies. It has been argued that the Kaplan-Meier method used in quantifying the hazard of delayed treatment is not appropriate for summarizing the probability of competing outcomes. Therefore, we sought to improve the estimates of the risk of death associated with delayed surgical treatment of coronary artery disease. Methods Population-based prospective study of 8,325 patients registered to undergo first time isolated coronary artery bypass grafting (CABG) in any of the four tertiary hospitals that provide cardiac care to adult residents of British Columbia, Canada. The cumulative incidence of pre-operative death, the cumulative incidence of surgery, and the probability that a patient, who may die or undergo surgery, dies if not operated by certain times over the 52-week period after the decision for CABG were estimated. The risks were quantified separately in two groups: high-severity at presentation were patients with either persistent unstable angina or stable angina and extensive coronary artery disease, and low-severity at presentation were stable symptomatic patients with limited disease. Results The median waiting time for surgery was 10 weeks (interquartile range [IQR] 15 weeks) in the high-severity group and 21 weeks (IQR 30 weeks) in the low-severity group. One percent of patients died before surgery: 54 in the high-severity and 26 in the low-severity group. For 58 (72.5%) patients, death was related to CVD (acute coronary syndrome, 33; chronic CVD, 16; other CVD, 4; and sudden deaths, 5). The overall death rate from all causes was 0.61 (95% CI 0.48-0.74) per 1,000 patient-weeks, varying from 0.62 (95% CI 0.45-0.78) in the high-severity group to 0.59 (95% CI 0.37-0.82) in the low-severity group. After adjustment for age, sex, and comorbidity, the all-cause death rate in the low-severity group was similar to the high-severity group (OR = 1.02, 95% CI 0.64-1.62). The conditional probability of death was greater in the high-severity group than in the low-severity group both for all-cause mortality (p = 0.002) and cardiovascular deaths (p <0.001). Conclusion The probability of death conditional on not having undergone a required CABG increases with time spent on wait lists. PMID:16822309

  4. Genome-Wide Assessment for Genetic Variants Associated with Ventricular Dysfunction after Primary Coronary Artery Bypass Graft Surgery

    Microsoft Academic Search

    Amanda A. Fox; Mias Pretorius; Kuang-Yu Liu; Charles D. Collard; Tjorvi E. Perry; Stanton K. Shernan; Philip L. de Jager; David A. Hafler; Daniel S. Herman; Steven R. Depalma; Dan M. Roden; Jochen D. Muehlschlegel; Brian S. Donahue; Dawood Darbar; J. G. Seidman; Simon C. Body; Christine E. Seidman; Holger K. Eltzschig

    2011-01-01

    BackgroundPostoperative ventricular dysfunction (VnD) occurs in 9–20% of coronary artery bypass graft (CABG) surgical patients and is associated with increased postoperative morbidity and mortality. Understanding genetic causes of postoperative VnD should enhance patient risk stratification and improve treatment and prevention strategies. We aimed to determine if genetic variants associate with occurrence of in-hospital VnD after CABG surgery.MethodsA genome-wide association study

  5. Peri-Operative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery as a Surgical Site Infection Prevention Strategy

    Microsoft Academic Search

    A. Bergstrom; J. Bruch; W. James; M. Bushey; D. Blackhurst

    2004-01-01

    ISSUE: Tight control of blood glucose levels in the peri-operative period appears to lead to fewer surgical site infections (SSI) in diabetic and non-diabetic patients. Individuals undergoing coronary artery bypass grafting (CABG) at Greenville Memorial Hospital (GMH) were found to have poor glucose control (6.7 percent of baseline had all glucose levels of less than 200 during the 48 hours

  6. Early postoperative outcome and medium-term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting

    Microsoft Academic Search

    Zoltán Szabó; Erik Håkanson; Rolf Svedjeholm

    2002-01-01

    Background. An increasing proportion of patients undergoing coronary artery bypass grafting (CABG) are diabetics. Patient characteristics, early postoperative outcome, and midterm survival in diabetic patients after CABG were investigated.Methods. A total of 2779 consecutive patients undergoing isolated CABG during 1995 to 1999 were studied, 19.4% of whom had diabetes mellitus. Demographic and peri-procedural data were registered prospectively in a computerized

  7. Coronary artery bypass grafting in chronic renal dialysis patients: intensive perioperative dialysis and extensive usage of arterial grafts

    Microsoft Academic Search

    T. Koyanagi; H. Nishida; M. Endo; H. Koyanagi

    1994-01-01

    Twenty-three chronic renal dialysis patients underwent coronary artery bypass grafting (CABG). Eigh- teen patients were maintained on hemodialysis and 5 patients received continuous ambulatory peritoneal dialysis. Eighteen patients (78%) had triple vessel disease or left main disease. The mean number of revascularized vessels was 2.2 kO.8, and the graft materials used were left internal thoracic artery (21), right internal thoracic

  8. Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women

    Microsoft Academic Search

    Viola Vaccarino; Jerome L. Abramson; Emir Veledar; William S. Weintraub

    2002-01-01

    Background—Data are conflicting over whether women have higher mortality than men after coronary artery bypass graft (CABG) surgery. Younger but not older women hospitalized for acute myocardial infarction have higher in-hospital mortality rates than men. We hypothesized that younger women also have higher in-hospital mortality rates after CABG. Methods and Results—We studied 51 187 patients (30% women) included in the

  9. Embracing the heart: Perioperative management of patients undergoing off-pump coronary artery bypass grafting using the octopus tissue stabilizer

    Microsoft Academic Search

    Arno P. Nierich; Jan Diephuis; Erik W. L. Jansen; Diederik van Dijk; Jaap R. Lahpor; Cornelius Borst; Johannes T. A. Knape

    1999-01-01

    Objective: To describe hemodynamic alterations during coronary artery bypass grafting (CABG) without extracorporeal circulation using the Octopus Tissue Stabilizer, and to describe the two anesthetic management protocols based on either general anesthesia with opioids (34 patients) or general anesthesia with high thoracic epidural anesthesia (TEA; 66 patients).Design: A prospective observational report.Setting: An academic university heart center.Participants: First 100 patients undergoing

  10. Local Generation of C-Reactive Protein in Diseased Coronary Artery Venous Bypass Grafts and Normal Vascular Tissue

    Microsoft Academic Search

    Wolfram J. Jabs; Elisabeth Theissing; Martin Nitschke; J. F. Matthias Bechtel; Michael Duchrow; Salah Mohamed; Bernhard Jahrbeck; Hans-Hinrich Sievers; Jürgen Steinhoff; Claus Bartels

    2010-01-01

    Background—Venous coronary artery bypass grafts (CABGs) are prone to accelerated atherosclerosis. In atherosclerotic diseases, serum C-reactive protein (CRP) levels have become an important diagnostic and prognostic marker. The origin of CRP in this setting remains to be elucidated. Methods and Results—Monoclonal anti-CRP identified CRP expression in medial and intimal -actin-positive smooth muscle cells (SMCs) of diseased CABGs with type V

  11. Clinical and angiographic outcomes in patients with previous coronary artery bypass graft surgery treated with primary balloon angioplasty for acute myocardial infarction

    Microsoft Academic Search

    Gregg W. Stone; Bruce R. Brodie; John J. Griffin; Lorelei Grines; Judith Boura; William W. O’Neill; Cindy L. Grines

    2000-01-01

    OBJECTIVESWe sought to characterize the presenting characteristics of patients with previous coronary artery bypass graft surgery (CABG) and acute myocardial infarction (AMI) and to determine the angiographic success rate and clinical outcomes of a primary percutaneous transluminal coronary angioplasty (PTCA) strategy.BACKGROUNDPatients who have had previous CABG and AMI comprise a high risk group with decreased reperfusion success and increased mortality

  12. Significance of off-pump coronary artery bypass grafting compared with percutaneous coronary intervention: a propensity score analysis

    PubMed Central

    Marui, Akira; Kimura, Takeshi; Tanaka, Shiro; Furukawa, Yutaka; Kita, Toru; Sakata, Ryuzo

    2012-01-01

    OBJECTIVE Although there have been several studies that compared the efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the impact of off-pump CABG (OPCAB) has not been well elucidated. The objective of the present study was to compare the outcomes after PCI, on-pump CABG (ONCAB), and OPCAB in patients with multivessel and/or left main disease. METHODS Among the 9877 patients undergoing first PCI using bare-metal stents or CABG who were enrolled in the CREDO-Kyoto Registry, 6327 patients with multivessel and/or left main disease were enrolled into the present study (67.9 ± 9.8 years old). Among them, 3877 patients received PCI, 1388 ONCAB, and 1069 OPCAB. Median follow-up was 3.5 years. RESULTS Comparing PCI with all CABG (ONCAB and OPCAB), propensity-score-adjusted all-cause mortality after PCI was higher than that CABG (hazard ratio (95% confidence interval): 1.37 (1.15–1.63), p < 0.01). The incidence of stroke was lower after PCI than that after CABG (0.75 (0.59–0.96), p = 0.02). CABG was associated with better survival outcomes than PCI in the elderly (interaction p = 0.04). Comparing OPCAB with PCI or ONCAB, propensity-score-adjusted all-cause mortality after PCI was higher than that after OPCAB (1.50 (1.20–1.86), p < 0.01). Adjusted mortality was similar between ONCAB and OPCAB (1.18 (0.93–1.51), p = 0.33). The incidence of stroke after OPCAB was similar to that after PCI (0.98 (0.71–1.34), p > 0.99), but incidence of stroke after ONCAB was higher than that after OPCAB (1.59 (1.16–2.18), p < 0.01). CONCLUSIONS In patients with multivessel and/or left main disease, CABG, particularly OPCAB, is associated with better survival outcomes than PCI using bare-metal stents. Survival outcomes are similar between ONCAB and OPCAB. PMID:21676626

  13. Extraanatomical coronary artery bypass grafting in patients with severely atherosclerotic (Porcelain) aorta

    PubMed Central

    2013-01-01

    Background Cannulation, cross clamping, or partial clamping of the aorta during a proximal anastomosis may cause embolic complications in patients with severely atherosclerotic (porcelain) aortas. These patients carry high morbidity and mortality risks due to intraoperative atheroembolism. Methods Between June 2008 and May 2010, 972 open heart surgery operations were performed in our department. In this group there were 41 patients who had severe atherosclerotic plaques in the aorta (porcelain aorta), and 9 of these underwent an extraanatomical coronary artery bypass grafting (CABG). These 9 patients were retrospectively analyzed and their demographic data, patient risk factors, and preferred surgical methods were reviewed. Results Seven patients underwent two-vessel CABG, while 2 underwent three-vessel CABG. Off-pump surgery was performed for 7 patients. CABG was performed with beating heart technique under cardiopulmonary bypass via femoral artery and right atrial cannulation without cross clamping in 2 of the patients. Postoperative course was uneventful in all patients. Mean length of stay in the intensive care unit was 2.11?±?0.78?days. Mean hospitalization was 7.22?±?0.97?days. Mean follow-up was 11.33?±?3.67?months, and no cerebrovascular events were observed during this period. Postoperative evaluation of the grafts by multislice computed tomography revealed sufficient patency in all patients. Conclusions Innominate artery is an alternative inflow source for the untouchable ascending aorta caused by severe atherosclerotic disease (porcelain aorta). In this group of patients, the risk of systemic embolisation and perioperative neurologic complications can be minimized by avoiding manipulation of the ascending aorta and using the innominate artery. PMID:23587129

  14. Relatively increased von Willebrand factor activity after off-pump coronary artery bypass graft surgery.

    PubMed

    Lo, Bernard; Nierich, Arno P; Kalkman, Cor J; Fijnheer, Rob

    2007-01-01

    High shear forces can induce structural changes in the shape of the von Willebrand factor (VWF) molecule, making it more sensitive for ADAMTS-13, a specific VWF protease. This leads to proteolysis of the highest-molecular-weight multimers, which are the most effective in platelet-mediated hemostasis under conditions of high shear stress. The use of cardiopulmonary bypass (CPB) is accompanied with high shear forces and could therefore lead to diminished VWF activity. Therefore, we studied VWF activity in patients undergoing myocardial revascularization. We enrolled 60 patients undergoing coronary artery bypass graft (CABG) surgery with and without CPB (30 in each group). ADAMTS-13 activity, VWF antigen (VWF:Ag) and propeptide levels were measured directly before and after the procedure. VWF activity was determined using both the ristocetin cofactor activity (VWF:Rcof) and collagen binding (VWF:CB) assays. VWF:Rcof and VWF:CB, both corrected for VWF:Ag, were significantly increased after the procedure in the off-pump group (p < 0.001 and p = 0.05, respectively), but not in the CPB group. Postoperative VWF:Ag and VWF-propeptide levels significantly increased in both groups. ADAMTS-13 activity increased after both types of surgery after correction for hemodilution. Postoperative VWF:Rcof levels correlated with postoperative D-dimer levels (p = 0.025) and were associated with early cognitive decline in the off-pump group (p = 0.025). Our data indicate that VWF activity is increased after off-pump CABG, but not after CABG with CPB. Since release of VWF is comparable in both groups, shear stress-induced proteolysis due to the use of CPB may be responsible for the decreased VWF activity. PMID:17200766

  15. Genome-wide association study of perioperative myocardial infarction after coronary artery bypass surgery

    PubMed Central

    Kertai, Miklos D; Li, Yi-Ju; Li, Yen-Wei; Ji, Yunqi; Alexander, John; Newman, Mark F; Smith, Peter K; Joseph, Diane; Mathew, Joseph P

    2015-01-01

    Objectives Identification of patient subpopulations susceptible to develop myocardial infarction (MI) or, conversely, those displaying either intrinsic cardioprotective phenotypes or highly responsive to protective interventions remain high-priority knowledge gaps. We sought to identify novel common genetic variants associated with perioperative MI in patients undergoing coronary artery bypass grafting using genome-wide association methodology. Setting 107 secondary and tertiary cardiac surgery centres across the USA. Participants We conducted a stage I genome-wide association study (GWAS) in 1433 ethnically diverse patients of both genders (112 cases/1321 controls) from the Genetics of Myocardial Adverse Outcomes and Graft Failure (GeneMAGIC) study, and a stage II analysis in an expanded population of 2055 patients (225 cases/1830 controls) combined from the GeneMAGIC and Duke Perioperative Genetics and Safety Outcomes (PEGASUS) studies. Patients undergoing primary non-emergent coronary bypass grafting were included. Primary and secondary outcome measures The primary outcome variable was perioperative MI, defined as creatine kinase MB isoenzyme (CK-MB) values ?10× upper limit of normal during the first postoperative day, and not attributable to preoperative MI. Secondary outcomes included postoperative CK-MB as a quantitative trait, or a dichotomised phenotype based on extreme quartiles of the CK-MB distribution. Results Following quality control and adjustment for clinical covariates, we identified 521 single nucleotide polymorphisms in the stage I GWAS analysis. Among these, 8 common variants in 3 genes or intergenic regions met p<10?5 in stage II. A secondary analysis using CK-MB as a quantitative trait (minimum p=1.26×10?3 for rs609418), or a dichotomised phenotype based on extreme CK-MB values (minimum p=7.72×10?6 for rs4834703) supported these findings. Pathway analysis revealed that genes harbouring top-scoring variants cluster in pathways of biological relevance to extracellular matrix remodelling, endoplasmic reticulum-to-Golgi transport and inflammation. Conclusions Using a two-stage GWAS and pathway analysis, we identified and prioritised several potential susceptibility loci for perioperative MI. PMID:25948407

  16. Impact of occult renal impairment on early and late outcomes following coronary artery bypass grafting

    PubMed Central

    Marui, Akira; Okabayashi, Hitoshi; Komiya, Tatsuhiko; Tanaka, Shiro; Furukawa, Yutaka; Kita, Toru; Kimura, Takeshi; Sakata, Ryuzo

    2013-01-01

    OBJECTIVES High serum creatinine is considered an independent risk factor for poor outcomes following coronary artery bypass grafting (CABG). However, the impact of occult renal impairment (ORI), defined as an impaired glomerular filtration rate (GFR) with a normal serum creatinine (SCr) level, remains unclear. Thus, we sought to investigate the impact of ORI on outcomes after CABG. METHODS Among patients undergoing their first percutaneous coronary intervention (PCI) or CABG enrolled in the CREDO-Kyoto Registry (a registry of first-time PCI and CABG patients in Japan), 1842 patients with normal SCr levels undergoing CABG were enrolled in the study. Patients were divided into two groups based on preoperative estimated GFR calculated by the Cockcroft–Gault equation: 1339 patients with estimated GFR of ?60 ml/min/1.73 m2 (normal group) and 503 with estimated GFR of <60 ml/min/1.73 m2 (ORI group). RESULTS Preoperative estimated GFR differed between the groups (51.3 ± 6.6 vs 85.8 ± 23.0 ml/min/1.73 m2, P < 0.01). ORI was associated with high in-hospital mortality (3.2 vs 1.0%, P < 0.01) and need for dialysis (2.0 vs 0.2%, P < 0.01). In terms of long-term outcomes, ORI was associated with high mortality compared with the normal (hazard ratio [95% confidence interval]: 1.72 [1.16–2.54], P < 0.01) and high incidence of composite cardiovascular events (death, stroke or myocardial infarction: 1.53 [1.16–2.02], P < 0.01). CONCLUSIONS ORI was an independent risk factor for early and late death as well as cardiovascular events in patients undergoing CABG with normal SCr levels. A more accurate evaluation of renal function through a combination of SCr and estimated GFR is needed in patients with normal SCr levels. PMID:23793709

  17. Potential Effect of L-Carnitine on the Prevention of Myocardial Injury after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Dastan, Farzaneh; Hajhossein Talasaz, Azita; Mojtahedzadeh, Mojtaba; Karimi, Abbasali; Salehiomran, Abbas; Bina, Payvand; Jalali, Arash; Aghaie, Zahra

    2015-01-01

    Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG) surgery. Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery) or a control group (n = 67). CK-MB (creatine kinase, muscle-brain subunits) and troponin T (TnT) levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively. Results: Our study included 134 patients (99 [73.8%] males) at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group) and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group) did not show any significant differences (p value=0.93 and 0.08, respectively). Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group), but the difference was not significant (p value = 0.28). TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34). Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels.

  18. Changes in the cardiac muscle electric activity as a result of Coronary Artery Bypass Graft operation

    NASA Astrophysics Data System (ADS)

    Grajek, Magdalena; Krzyminiewski, Ryszard; Kalawski, Ryszard; Kulczak, Mariusz

    2008-01-01

    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.

  19. The benefits of cognitive training after a coronary artery bypass graft surgery.

    PubMed

    de Tournay-Jetté, Emilie; Dupuis, Gilles; Denault, André; Cartier, Raymond; Bherer, Louis

    2012-10-01

    Cognitive deficits are frequent after coronary artery bypass graft surgery (CABG) in the elderly population. In fact, memory and attention deficits can persist several months after the surgery. Recent studies with healthy older adults have shown that memory and attention can be improved through cognitive training programs. The present study examined whether memory training (method of loci and story generation) and attentional training (dual-task computerized training) could improve cognitive functions in patients aged 65 years and older who underwent CABG surgery. Participants (n = 51) were assigned to one of three groups: (1) control group (tested at 1, 3 and 6 months after the surgery), (2) attention training followed by memory training, (3) memory training followed by attention training (groups 2 and 3: tested at 1, 2, 3 and 6 months after the surgery). The trainings took place between the 6th and 10th week following the surgery. The three groups were compared before and after each training program using attention and memory tests and neuropsychological tests. The results showed that attention and memory trainings lead to significant improvement in the cognitive domain that was trained. It thus seems that cognitive training can be a promising tool to enhance cognitive functions after a CABG surgery. PMID:22068879

  20. How Older Female Spouses Cope with Partners' Coronary Artery Bypass Graft Surgery

    PubMed Central

    Marnocha, Suzanne; Marnocha, Mark

    2013-01-01

    This research sought to better understand how older female spouses cope with a partner's coronary artery bypass graft surgery and to explore coping's relationships with life-change stress, cognitive appraisal, resilience, social support, and aspects of spouse's surgery. A sample of 96 women, aged from 55 to 81 years, completed surveys after their partner's surgery. Folkman and Lazarus' ways of coping (WCQ) scales yielded two factors in this sample—reactive coping and adaptive coping. Reactive coping, including more emotion-focused ways of coping from the WCQ, was associated only with more time spent anticipating spouses' surgeries. Women described the greatest use of ways of coping labeled adaptive, which in turn had significant relationships with greater resilience, social support, and positive appraisal of the surgical experience. Stepwise multiple regression found greater resilience, more frequent religious participation, and fewer children to be distinct predictors of adaptive coping. Nursing staff are encouraged to accept and normalize reactive coping, while facilitating adaptive coping with surgical stresses. PMID:23634299

  1. Gender differences in quality of life for post coronary artery bypass grafting patients in Taiwan.

    PubMed

    Tung, Heng-Hsin; Wei, Jen; Chang, Chung-Yi

    2007-12-01

    The purpose of this study was to investigate gender differences in quality of life for post Coronary Artery Bypass Grafting (CABG) patients in Taiwan. Cross-sectional survey research design and purposive sampling were used in this study, for which 100 subjects, including 50 males and 50 females, were recruited from a medical center in northern Taiwan. Quality of life was measured by Short Form 36, while gender role function and demographic data were collected using a demographic questionnaire. An Independent t test and one way ANOVA were employed to analyze data. Study results showed significant differences in quality of life between genders. There was a statistically significant difference in the physical component summary score, post-CABG, between males (M=45.5) and females (M=40.1, p< .05), which indicates that men demonstrated higher physical functioning than women. Within this component, the greatest difference between the genders was noted in sub-items related to physical functions. Men and women achieved mean scores of 42.2 and 37.9, respectively (p< .05). For the mental component summary section, sub-items related to vitality also demonstrated statistical significance; with men achieving a mean score of 49.6 and women a mean score of 45.2 (p< .05). Of interest, post-CABG patients who had greater role responsibilities, such as taking care of elderly or doing housework, obtained significantly higher quality of life scores. PMID:18080972

  2. Effect of gender and race on operative mortality after isolated coronary artery bypass grafting.

    PubMed

    Pollock, Benjamin; Hamman, Baron L; Sass, Danielle M; da Graca, Briget; Grayburn, Paul A; Filardo, Giovanni

    2015-03-01

    Studies examining outcomes after coronary artery bypass grafting (CABG) by gender and/or race have shown conflicting results. It remains to be determined if, or how, gender and race are independent risk factors for CABG operative mortality. Using all consecutive patients who underwent isolated CABG at Baylor University Medical Center in Dallas, Texas, from January 2004 to October 2011, the risk-adjusted associations between gender and race, respectively, and operative mortality were estimated using a generalized propensity approach, accounting for recognized Society of Thoracic Surgeons risk factors for mortality. Women were nearly 2 times more likely to die during or within 30 days of the operation than men (odds ratio 1.96, 95% confidence interval 1.44 to 2.66, p <0.0001), while no significant mortality differences were observed among races. In conclusion, these findings suggest that women face a significantly greater risk for operative death that should be taken into account during the treatment decision-making process but that race is not associated with CABG mortality and so should not be among the factors considered. PMID:25596952

  3. Hereditary spherocytosis in a patient undergoing coronary artery bypass grafting with cardiopulmonary bypass--a case report.

    PubMed

    Spegar, J; Riha, H; Kotulak, T; Vanek, T

    2015-01-01

    Hereditary spherocytosis is a genetically determined abnormality of red blood cells. It is the most common cause of inherited haemolysis in Europe and North America within the Caucasian population. We document a patient who underwent an aortocoronary bypass procedure on cardiopulmonary bypass. In view of the uncertain tolerance of the abnormal red cells in hereditary spherocytosis to cardiopulmonary bypass, we reviewed the patient's chart and analyzed recorded values of these parameters: free plasma haemoglobin, renal parameters, cystatin C, bilirubin, liver tests, urine samples. From the results, we can see that slight haemolysis-elevated bilirubin in the blood sample and elevated bilirubin and urobilinogen in the urine sample occurred on the first postoperative day. The levels of these parameters slowly decreased during the next postoperative days. There was no real clinical effect of this haemolysis on renal functions. PMID:24714521

  4. Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

    PubMed Central

    Stecher, David; Bronkers, Glenn; Noest, Jappe O.T.; Tulleken, Cornelis A.F.; Hoefer, Imo E.; van Herwerden, Lex A.; Pasterkamp, Gerard; Buijsrogge, Marc P.

    2014-01-01

    To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated. PMID:25490000

  5. Evaluation of a novel laser-assisted coronary anastomotic connector - the Trinity Clip - in a porcine off-pump bypass model.

    PubMed

    Stecher, David; Bronkers, Glenn; Noest, Jappe O T; Tulleken, Cornelis A F; Hoefer, Imo E; van Herwerden, Lex A; Pasterkamp, Gerard; Buijsrogge, Marc P

    2014-01-01

    To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated. PMID:25490000

  6. Metoprolol treatment for two years after coronary bypass grafting: effects on exercise capacity and signs of myocardial ischaemia.

    PubMed Central

    Sjöland, H.; Caidahl, K.; Lurje, L.; Hjalmarson, A.; Herlitz, J.

    1995-01-01

    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. PMID:7547016

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

    PubMed Central

    2013-01-01

    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. PMID:23971858

  8. A randomized study of coronary artery bypass surgery performed with the Resting Heart™ System utilizing a low vs a standard dosage of heparin

    PubMed Central

    Nilsson, Johan; Scicluna, Sara; Malmkvist, Gunnar; Pierre, Leif; Algotsson, Lars; Paulsson, Per; Bjursten, Henrik; Johnsson, Per

    2012-01-01

    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. PMID:22914806

  9. Predictors of stroke associated with coronary artery bypass grafting in patients with diabetes mellitus and multivessel coronary artery disease.

    PubMed

    Domanski, Michael J; Farkouh, Michael E; Zak, Victor; Feske, Steven; Easton, Donald; Weinberger, Jesse; Hamon, Martial; Escobedo, Jorge; Shrader, Peter; Siami, Flora S; Fuster, Valentin

    2015-05-15

    This study assesses demographic and clinical variables associated with perioperative and late stroke in diabetes mellitus patients after multivessel coronary artery bypass grafting (CABG). Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) is the largest randomized trial of diabetic patients undergoing multivessel CABG. FREEDOM patients had improved survival free of death, myocardial infarction, or stroke and increased overall survival after CABG compared to percutaneous intervention. However, the stroke rate was greater following CABG than percutaneous intervention. We studied predictors of stroke in CABG-treated patients analyzing separately overall, perioperative (?30 days after surgery), and late (>30 days after surgery) stroke. For long-term outcomes (overall stroke and late stroke), Cox proportional hazards regression was used, accounting for time to event, and logistic regression was used for perioperative stroke. Independent perioperative stroke predictors were previous stroke (odds ratio [OR] 6.96, 95% confidence interval [CI] 1.43 to 33.96; p = 0.02), warfarin use (OR 10.26, 95% CI 1.10 to 96.03; p = 0.02), and surgery outside the United States or Canada (OR 9.81, 95% CI 1.28 to 75.40; p = 0.03). Independent late stroke predictors: renal insufficiency (hazard ratio [HR] 3.57, 95% CI 1.01 to 12.64; p = 0.048), baseline low-density lipoprotein ?105 mg/dl (HR 3.28, 95% CI 1.19 to 9.02; p = 0.02), and baseline diastolic blood pressure (each 1 mm Hg increase reduces stroke hazard by 5%; HR 0.95, 95% CI 0.91 to 0.99; p = 0.03). There was no overlap between predictors of perioperative versus late stroke. In conclusion, late post-CABG strokes were associated with well-described risk factors. Nearly half of the strokes were perioperative. Independent risk factors for perioperative stroke: previous stroke, previous warfarin use, and CABG performed outside the United States or Canada. PMID:25824543

  10. The effect of total arterial grafting on medium-term outcomes following coronary artery bypass grafting

    PubMed Central

    Légaré, Jean-Francois; Hassan, Ansar; Buth, Karen J; Sullivan, John A

    2007-01-01

    Background While it is believed that total arterial grafting (TAG) for coronary artery bypass grafting (CABG) confers improved long-term outcomes when compared to conventional grafting with left internal mammary artery and saphenous vein grafts (LIMA+SVG), to date, this has not become the standard of care. In this study, we assessed the impact of TAG on medium-term outcomes after CABG. Methods Peri-operative data was prospectively collected on consecutive first-time, isolated CABG patients between 1995 and 2005. Patients were divided into two groups based on grafting strategy: TAG (all arterial grafts no saphenous veins) or LIMA+SVG. Patients who had an emergent status or underwent fewer than two distal bypasses were excluded. Medium term univariate and risk-adjusted comparisons between TAG and LIMA+SVG cases were performed. Results A total of 4696 CABG patients were included with 1019 patients undergoing TAG (22%). Unadjusted in-hospital mortality was 1.5% for TAG patients compared to 2.0% for LIMA+SVG (p = 0.31). The mean follow-up was 4.8 ± 2.0 years for TAG patients compared to 6.1 ± 3.0 years for LIMA+SVG patients (p < 0.0001). At follow-up total mortality (8% vs 19%; p < 0.0001), and the incidence of readmission to hospital for cardiac reasons (29% vs 38%; p < 0.0001) were significantly lower in TAG compared to LIMA+SVG patients. However, after adjusting for clinical covariates, TAG did not emerge as a significant independent predictor of long-term mortality (HR 0.92; CI 0.71–1.18), readmission to hospital (HR 1.02; CI 0.89–1.18) or the composite outcome of mortality and readmission (HR 1.00; CI 0.88–1.15). Risk adjusted survival was better than 88% in both TAG and LIMA-SVG patients at 5 years follow-up. Conclusion Patients undergoing TAG appear to experience lower rates of medium-term all-cause mortality and readmission to hospital for any cardiac cause when compared to patients undergoing LIMA+SVG. However, after adjusting for clinical variables, this difference no longer persists suggesting that at median follow-up there are no mortality or morbidity benefit based on the choice of conduit. PMID:17956634

  11. Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery.

    PubMed

    Ruiz, John M; Matthews, Karen A; Scheier, Michael F; Schulz, Richard

    2006-08-01

    Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient presurgical depressive symptoms and lower presurgical optimism contributed to greater caregiving burden. Relationship satisfaction moderated these effects. These results suggest that partners' personality traits are important determinants of both patients' and their caregiving spouses' well-being. PMID:16881763

  12. Vein Graft Preservation Solutions, Patency, and Outcomes After Coronary Artery Bypass Graft Surgery

    PubMed Central

    Harskamp, Ralf E.; Alexander, John H.; Schulte, Phillip J.; Brophy, Colleen M.; Mack, Michael J.; Peterson, Eric D.; Williams, Judson B.; Gibson, C. Michael; Califf, Robert M.; Kouchoukos, Nicholas T.; Harrington, Robert A.; Ferguson, T. Bruce; Lopes, Renato D.

    2015-01-01

    IMPORTANCE In vitro and animal model data suggest that intraoperative preservation solutions may influence endothelial function and vein graft failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical studies to validate these findings are lacking. OBJECTIVE To evaluate the effect of vein graft preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery. DESIGN, SETTING, AND PARTICIPANTS Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003, were used. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts. INTERVENTIONS Preservation of vein grafts in saline, blood, or buffered saline solutions. MAIN OUTCOMES AND MEASURES One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization. RESULTS Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. One-year VGF rates were much lower in the buffered saline group than in the saline group (patient-level odds ratio [OR], 0.59 [95% CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95% CI, 0.49-0.79; P < .001]) or the blood group (patient-level OR, 0.62 [95% CI, 0.46-0.83; P = .001]; graft-level OR, 0.63 [95% CI, 0.48-0.81; P < .001]). Use of buffered saline solution also tended to be associated with a lower 5-year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64-1.02; P = .08]) and blood (0.81 [0.63-1.03; P = .09]) solutions. CONCLUSIONS AND RELEVANCE Patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and trends toward better long-term clinical outcomes compared with patients whose grafts were preserved in saline- or blood-based solutions. PMID:25073921

  13. Prevalence and correlates of complicated grief in adults who have undergone a coronary artery bypass graft

    PubMed Central

    Ghesquiere, Angela; Shear, M. Katherine; Gesi, Camilla; Kahler, Julie; Belnap, Bea Herbeck; Mazumdar, Sati; He, Fanyin; Rollman, Bruce L.

    2012-01-01

    Background Complicated Grief (CG) is a recently described mental health condition that follows bereavement. CG is often comorbid with depression and may also be associated with poor health outcomes. However, CG has not been studied in depressed medically ill populations. This study examined the prevalence, correlates, and impact of CG in depressed post-coronary artery bypass graft surgery (CABG) patients. Methods A 5-item CG screen was administered to 302 depressed post-CABG patients participating in a comparative effectiveness intervention trial at 7 Pittsburgh-area hospitals from March 2004 to September 2007. Eligible patients were randomly assigned to either a telephone-delivered collaborative care intervention for depression or their primary care physicians’ usual care. Measures examined depression, physical and mental health-related quality of life, and physical functioning over 8 months. Results Compared to CG screen-negative patients, CG screen-positive patients were younger, more likely to: be female, non-White, have lost a partner or child, and to have used tobacco or antidepressants. At baseline, they had significantly higher depression and lower mental health scores. At 8 months, screen-positives had poorer physical functioning and marginally higher depression scores. Limitations The study lacked a definitive measure of CG. Moreover, the CG-positive group was relatively small, reducing the power to detect differences between groups or control for the possible influence of other variables on identified results. Conclusions CG in depressed post-CABG patients is associated with negative health and mental health outcomes. These results underscore the importance of identifying and treating CG in depressed medically ill populations. PMID:22209126

  14. Antioxidant supplementation attenuates oxidative stress in patients undergoing coronary artery bypass graft surgery.

    PubMed

    Stanger, Olaf; Aigner, Irene; Schimetta, Wolfgang; Wonisch, Willibald

    2014-01-01

    Ischemia-reperfusion has been reported to be associated with augmented oxidative stress in the course of surgery, which might be causally involved in the onset of atrial fibrillation (AF), the most common arrhythmia after cardiac surgery. We hypothesized that supplementation of antioxidants and n-3 polyunsaturated fatty acids (n-3 PUFAs) might lower the incidence of AF following coronary artery bypass graft (CABG) surgery. In the present study, by monitoring oxidative stress in the course of CABG surgery, we analyzed the efficacy of vitamins (ascorbic acid and ?-tocopherol) and/or n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid). Subjects (n = 75) were divided into 4 subgroups: control, vitamins, n-3 PUFAs, and a combination of vitamins and n-3 PUFAs. Fluorescent techniques were used to measure the antioxidative capacity, i.e. ability to inhibit oxidation. Total peroxides, endogenous peroxidase activity, and antibodies against oxidized LDL (oLAb) were used as serum oxidative stress biomarkers. Post-operative increase in oxidative stress was associated with the consumption of antioxidants and a simultaneous onset of AF. This was confirmed through an increased peroxide level and a decreased oLAb titer in control and n-3 PUFAs groups, indicating the binding of antibodies to oxidative modified epitopes. In both subgroups that were supplemented with vitamins, total peroxides decreased, and the maintenance of a constant IgG antibody titer was facilitated. However, treatment with vitamins or n-3 PUFAs was inefficient with respect to AF onset and its duration. We conclude that the administration of vitamins attenuates post-operative oxidative stress in the course of CABG surgery. PMID:24573122

  15. The improving outcomes of coronary artery bypass graft surgery in Ontario, 1981 to 1995

    PubMed Central

    Tu, J V; Wu, K

    1998-01-01

    BACKGROUND: There is continuing uncertainty over the relative contribution of outcomes monitoring to changes in surgical outcomes over time. The authors studied temporal trends in the clinical characteristics and short-term outcomes of patients who underwent coronary artery bypass grafting (CABG) in Ontario before and after the implementation, in 1993, of a province-wide program to provide feedback on cardiac surgery outcomes. METHODS: The authors analysed data from hospital discharge abstracts on the clinical characteristics and in-hospital death rates of all 67,784 patients who underwent isolated CABG in Ontario between Apr. 1, 1981, and Mar. 31, 1996. RESULTS: Death rates were relatively stable during the first half of the 1980s, then declined gradually in the second half of the decade; this decline continued into the first half of the 1990s. In the 1990s patients were older than those in the 1980s, and a higher proportion had coexisting diseases. Between 1986/87 and 1995/96 the unadjusted death rate decreased by 52% (5.0% v. 2.4%) (p < 0.001). The annual relative rate of decline was approximately 6% (95% confidence interval 5% to 7%) in the period before the outcomes feedback program was implemented and about 9% (95% confidence interval 7% to 11%) in the period after implementation. INTERPRETATION: Rates of death after CABG have been declining steadily in Ontario since the mid-1980s. Outcomes-based quality improvement interventions may facilitate; but are not a prerequisite for, improvements in the quality of surgical care. PMID:9724975

  16. Evaluation of taste sensitivity in patients undergoing coronary artery bypass graft surgery.

    PubMed

    Keith, Mary; Mokbel, Rose; San Emeterio, Mario; Song, Jacquelin; Errett, Lee

    2010-07-01

    Patients report changes in their perception of food tastes following cardiac surgery. This study was designed to explore changes in taste sensitivity following coronary artery bypass graft (CABG) surgery. Detection and recognition thresholds for sweet (sucrose), salty (sodium chloride), sour (citric acid), and bitter (quinine hydrochloride) were determined using the multiple forced-choice ascending concentration series method at baseline (presurgical), discharge, 5 weeks, and 16 weeks post-CABG. Demographic and gastrointestinal data were also obtained. Mixed-model analyses for repeated measures were performed using the baseline scores as reference. Thirty-three patients (mean age=61.8+/-8 years), consented to participate in the study between January 2003 and January 2006, with 13 completing all visits. Detection and recognition thresholds for sweet were significantly lower at discharge compared with baseline (1.7+/-1.2 vs 2.43+/-1.4 and 5.1+/-1.8 vs 5.5+/-1.3, respectively; P<0.05). This difference remained significant 4 months after surgery. Detection and recognition thresholds for salt also declined with time, with significant differences at 4 months post-surgery (2.3+/-2.0 vs 1.8+/-1.5; P<0.001 and 5.3+/-1.3 vs 4.2+/-2.2; P<0.05, respectively). The same trends were noted for the detection of sour and the recognition of bitter. Patients undergoing CABG demonstrated stable or improved taste sensitivity during the recovery period. Further studies aimed at clarifying the relationships between the biological state, taste sensitivity, reported taste changes, and food intake will help to clarify the clinical impact of taste changes and subsequently to guide clinical nutrition care. PMID:20630165

  17. Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting

    PubMed Central

    Ghotkar, Sanjay V; Grayson, Antony D; Fabri, Brian M; Dihmis, Walid C; Pullan, D Mark

    2006-01-01

    Objective Patients who have prolonged stay in intensive care unit (ICU) are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for prolonged ICU stay following coronary artery surgery (CABG). Methods 5,186 patients who underwent CABG between 1st April 1997 and 31st March 2002 were analysed in a development dataset. Logistic regression was used with forward stepwise technique to identify preoperative risk factors for prolonged ICU stay; defined as patients staying longer than 3 days on ICU. Variables examined included presentation history, co-morbidities, catheter and demographic details. The use of cardiopulmonary bypass (CPB) was also recorded. The prediction tool was tested on validation dataset (1197 CABG patients between 1st April 2003 and 31st March 2004). The area under the receiver operating characteristic (ROC) curve was calculated to assess the performance of the prediction tool. Results 475(9.2%) patients had a prolonged ICU stay in the development dataset. Variables identified as risk factors for a prolonged ICU stay included renal dysfunction, unstable angina, poor ejection fraction, peripheral vascular disease, obesity, increasing age, smoking, diabetes, priority, hypercholesterolaemia, hypertension, and use of CPB. In the validation dataset, 8.1% patients had a prolonged ICU stay compared to 8.7% expected. The ROC curve for the development and validation datasets was 0.72 and 0.74 respectively. Conclusion A prediction tool has been developed which is reliable and valid. The tool is being piloted at our institution to aid resource management. PMID:16737548

  18. Electrophysiological Changes Preceding the Onset of Atrial Fibrillation after Coronary Bypass Grafting Surgery

    PubMed Central

    Xiong, Feng; Yin, Yalin; Dubé, Bruno; Pagé, Pierre; Vinet, Alain

    2014-01-01

    Background The incidence of Post-CABG atrial fibrillation (AF) lies between 25% and 40%. It worsens morbidity and raises post-operative costs. Detection of incoming AF soon enough for prophylactic intervention would be helpful. The study is to investigate the electrophysiological changes preceding the onset of AF and their relationship to the preoperative risk. Methods and Results Patients were recorded continuously for the first four days after coronary artery bypass grafting surgery (CABG) with three unipolar electrodes sutured to the atria (AEG). The patients experiencing an AF lasting more than 10 minutes were selected and the two hours before the onset were analyzed. Four variables were found to show significant changes in the two hours prior to the first prolonged AF: increasing rate of premature atrial activation, increasing incidence of short transient arrhythmias, acceleration of heart rate, and rise of low frequency content of heart rate. The main contrast was between the first and last hour before AF onset. Preoperative risk was not predictive of the onset time of AF and did not correlate with the amplitude of changes prior to AF. Conclusions Post-CABG AF were preceded by electrophysiological changes occurring in the last hour before the onset of the arrhythmia, whereas none of these changes was found to occur in all AF patients. The risk was a weighted sum of factors related to the density of premature activations and the state of atrial substrate reflected by the sinus rhythm and its frequency content prior to AF. Preoperative risk score seems unhelpful in setting a detection threshold for the AF onset. PMID:25247814

  19. Use of Pulmonary Artery Catheter in Coronary Artery Bypass Graft. Costs and Long-Term Outcomes

    PubMed Central

    Xu, Fei; Wang, Qian; Zhang, Heng; Chen, Sipeng; Ao, Hushan

    2015-01-01

    Background Pulmonary artery catheters (PAC) are used widely to monitor hemodynamics in patients undergoing coronary bypass graft (CABG) surgery. However, recent studies have raised concerns regarding both the effectiveness and safety of PAC. Therefore, our aim was to determine the effects of the use of PAC on the short- and long-term health and economic outcomes of patients undergoing CABG. Methods 1361 Chinese patients who consecutively underwent isolated, primary CABG at the Cardiovascular Institute of Fuwai Hospital from June 1, 2012 to December 31, 2012 were included in this study. Of all the patients, 453 received PAC during operation (PAC group) and 908 received no PAC therapy (control group). Short-term and long-term mortality and major complications were analyzed with multivariate regression analysis and propensity score matched-pair analysis was used to yield two well-matched groups for further comparison. Results The patients who were managed with PAC more often received intraoperative vasoactive drugs dopamine (70.9% vs. 45.5%; P<0.001) and epinephrine (7.7% vs. 2.6%; P<0.001). In addition, costs for initial hospitalization were higher for PAC patients ($14,535 vs. $13,873, respectively, p = 0.004). PAC use was neither associated with the perioperative mortality or major complications, nor was it associated with long-term mortality and major adverse cardiac and cerebrovascular events. In addition, comparison between two well-matched groups showed no significant differences either in baseline characteristics or in short-term and long-term outcomes. Conclusions There is no clear indication of any benefit or harm in managing CABG patients with PAC. However, use of PAC in CABG is more expensive. That is, PAC use increased costs without benefit and thus appears unjustified for routine use in CABG surgery. PMID:25689312

  20. Insurance type and choice of hospital for coronary artery bypass graft surgery.

    PubMed Central

    Chernew, M; Scanlon, D; Hayward, R

    1998-01-01

    OBJECTIVE: To examine the effect of insurance type on the relationship between hospital attributes and patient flows, with particular attention to whether HMO enrollees are more or less likely than other patients to receive care at high-quality hospitals and whether HMO enrollees travel farther to receive care. DATA SOURCES/STUDY SETTING: Data on patient flows, taken from discharge abstracts compiled by the California Office of Statewide Health Planning and Development. Our sample consists of patients undergoing coronary artery bypass graft surgery (CABG) in 1991 who resided in three California markets. Only patients under the age of 65 and insured by HMOs, Blue Cross/Blue Shield, or other commercial insurance were included. Hospital quality is based on hospital-specific measures of excess mortality from CABG. Other hospital attributes were taken from American Hospital Association survey data. STUDY DESIGN: Conditional-choice models were used to estimate the probability that patients would receive care at any given hospital as a function of their insurance type and the hospital's attributes. PRINCIPAL FINDINGS: Patients were more likely to receive care from hospitals closer to their residence. However, HMO patient flows were less sensitive to proximity. In general, the likelihood that an HMO enrollee received care at a given hospital was positively related to hospital quality. Moreover, quality had a greater effect on patient flows for HMO enrollees than for non-HMO enrollees. However, the evidence suggests that the effect of quality on patient flows is neither uniform across markets nor across HMOs. CONCLUSIONS: HMOs do not appear to direct patients to low-quality hospitals. However, heterogeneity among HMOs and across markets suggests that buyers must recognize that choosing an HMO involves greater scrutiny than simply picking a plan labeled "HMO." PMID:9685117

  1. Outcomes of Transfemoral Transcatheter Aortic Valve Implantation in Patients With Previous Coronary Bypass.

    PubMed

    Leshem-Rubinow, Eran; Abramowitz, Yigal; Steinvil, Arie; Ben-Assa, Eyal; Chorin, Ehud; Shacham, Yacov; Yankelson, Lior; Konigstein, Maayan; Keren, Gad; Banai, Shmuel; Finkelstein, Ariel

    2015-08-01

    Patients with previous coronary artery bypass grafting (CABG) are considered to be at increased perioperative risk for a redo cardiac operation. In the era of transcatheter aortic valve implantation (TAVI), these patients constitute a considerable portion of those with severe aortic stenosis referred for TAVI. We evaluated the impact of previous CABG on transfemoral TAVI outcomes. Patients with severe symptomatic aortic stenosis (n = 515) who underwent transfemoral TAVI were divided according to the presence of history of CABG. Patients with previous valvular surgery were excluded (n = 12). TAVI clinical end points and adverse events were considered according to the Valve Academic Research Consortium 2 definitions. Survival was estimated using Cox regression models at the enter mode with the dependent variable defined as all-cause mortality. Of the total 503 patients who underwent TAVI, 91 (18.1%) had previous CABG. At baseline, patients with previous CABG were younger (80.8 vs 83.1 years, p <0.001), mostly men (85% vs 35%, p <0.001), had more cardiac and vascular co-morbidities, higher mean logistic EuroSCORE (32.8 vs 22; p <0.001), lower ejection fraction (53% vs 56%, p <0.001), and lower AV gradients and larger valve area. At a mean follow-up of 636 days, the overall Valve Academic Research Consortium 2-adjudicated end points did not differ. No differences in mortality were observed at 30 days, 6 months, and 1 year after TAVI (hazard ratio 1.34, p = 0.55, Cox regression). We conclude that patients with previous CABG who underwent TAVI do not have increased risk of periprocedural complications or mortality, although having distinct clinical features compared with the total TAVI population. PMID:26054290

  2. Trends in coronary artery bypass grafting in Ontario from 1981 to 1989.

    PubMed Central

    Ugnat, A M; Naylor, C D

    1993-01-01

    OBJECTIVES: To determine the trends in overall and age-specific rates of coronary artery bypass grafting (CABG) in Ontario from 1981 to 1989 and to assess whether relative resource scarcity, as manifested in waiting lists, resulted in obvious age-related or sex-related changes in utilization. DESIGN: Computerized compilation of hospital discharge abstracts from the Hospital Medical Records Institute. All separations for every other year from Apr. 1, 1981, to Mar. 31, 1990, were included. Procedures rather than patients were the unit of analysis (repeat procedures were double-counted if associated with separate hospital admissions). SETTING: Ontario acute care hospitals offering CABG. PATIENTS: People aged 20 years and over who underwent one or more CABG procedures. RESULTS: The overall rate of CABG increased by 31% in the study period, plateauing only between 1983 and 1985. By 1989-90 the rate was 66.03 per 100,000. The highest annual increase in the rate was among people aged 65 to 74 years, at 17.61 procedures per 100,000, as compared with 4.64 per 100,000 among people 75 years and over. In 1989-90 those aged 65 and over represented 37% of the total caseload. The overall male:female ratio did not change significantly throughout the study period. CONCLUSIONS: Since the CABG utilization rate continues to increase in Ontario, recent waiting lists must be due to a disproportionate growth in demand. There was no convincing evidence of age-related or sex-related discrimination in allocating this limited resource. Supply-demand mismatch was driven above all by the continued increase in CABG use among elderly people. PMID:8431818

  3. Coronary artery bypass grafting in Canada: What is its rate of use? Which rate is right?

    PubMed Central

    Naylor, C D; Ugnat, A M; Weinkauf, D; Anderson, G M; Wielgosz, A

    1992-01-01

    We reviewed recent reports from administrative databases and clinical registries addressing the utilization of coronary artery bypass grafting (CABG) in Canada. The Canadian CABG rate per 100,000 people increased from 31.1 to 43.2 between 1981-82 and 1986-87. Between 1981 and 1986 the rate in the United States increased from 69.9 to 95.3 per 100,000, consistently about two times the Canadian rate. Provincial data have shown particular growth in utilization among elderly people. However, in the United States the 1985 CABG rate was twice as high as the aggregated age-specific rates for Ontario and Manitoba among people 65 to 74 years of age and four times higher among those 75 years or more. Limited registry data suggest that the Canadian CABG case mix is similar to the case mix in major US centres and that, utilization growth notwithstanding, the procedure is largely applied to patients who should, in theory, benefit (i.e., those with severe angina, impaired left ventricular function and left main-stem or triple-vessel disease). However, chart audits and registry evaluations using explicit criteria are needed to compare the use of CABG in Canada and the United States. In addition, Canadian data show moderate regional and municipal variations, the 1986-87 rates per 100,000 population in major census metropolitan areas varying from 19.5 to 46.9. Areas with consistently low rates raise particular concerns about impaired access to CABG. Reasons for variations should therefore be a research priority. PMID:1544075

  4. Heart bypass surgery - minimally invasive

    MedlinePLUS

    Minimally invasive direct coronary artery bypass; MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery ... The surgeon will then find and prepare an artery on your chest wall to attach to your ...

  5. Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft

    PubMed Central

    dos Santos, Antônio Alceu; Sousa, Alexandre Gonçalves; Piotto, Raquel Ferrari; Pedroso, Juan Carlos Montano

    2013-01-01

    Introduction Transfusions of one or more packed red blood cells is a widely strategy used in cardiac surgery, even after several evidences of increased morbidity and mortality. The world's blood shortage is also already evident. Objective To assess whether the risk of mortality is dose-de>pendent on the number of packed red blood cells transfused after coronary artery bypass graft. Methods Between June 2009 and July 2010, were analyzed 3010 patients: transfused and non-transfused. Transfused patients were divided into six groups according to the number of packed red blood cells received: one, two, three, four, five, six or more units, then we assess the mortality risk in each group after a year of coronary artery bypass graft. To calculate the odds ratio was used the multivariate logistic regression model. Results The increasing number of allogeneic packed red blood cells transfused results in an increasing risk of mortality, highlighting a dose-dependent relation. The odds ratio values increase with the increased number of packed red blood cells transfused. The death's gross odds ratio was 1.42 (P=0.165), 1.94 (P=0.005), 4.17; 4.22, 8.70, 33.33 (P<0.001) and the adjusted death's odds ratio was 1.22 (P=0.43), 1.52 (P=0.08); 2.85; 2.86; 4.91 and 17.61 (P<0.001), as they received one, two, three, four, five, six or more packed red blood cells, respectively. Conclusion The mortality risk is directly proportional to the number of packed red blood cells transfused in coronary artery bypass graft. The greater the amount of allogeneic blood transfused the greater the risk of mortality. The current transfusion practice needs to be reevaluated. PMID:24598957

  6. Can local application of Tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial

    PubMed Central

    Fawzy, Hosam; Elmistekawy, Elsayed; Bonneau, Daniel; Latter, David; Errett, Lee

    2009-01-01

    Background Diffuse microvascular bleeding remains a common problem after cardiac procedures. Systemic use of antifibrinolytic reduces the postoperative blood loss. The purpose of this study was to examine the effectiveness of local application of tranexamic acid to reduce blood loss after coronary artery bypass grafting (CABG). Methods Thirty eight patients scheduled for primary isolated coronary artery bypass grafting were included in this double blind, prospective, randomized, placebo controlled study. Tranexamic acid (TA) group (19 patients) received 1 gram of TA diluted in 100 ml normal saline. Placebo group (19 patients) received 100 ml of normal saline only. The solution was purred in the pericardial and mediastinal cavities. Results Both groups were comparable in their baseline demographic and surgical characteristics. During the first 24 hours post-operatively, cumulative blood loss was significantly less in TA group (median of 626 ml) compared to Placebo group (median of 1040 ml) (P = 0.04). There was no significant difference in the post-op Packed RBCs transfusion between both groups (median of one unit in each) (P = 0.82). Significant less platelets transfusion required in TA group (median zero unit) than in placebo group (median 2 units) (P = 0.03). Apart from re-exploration for excessive surgical bleeding in one patient in TA group, no difference was found in morbidity or mortality between both groups. Conclusion Topical application of tranexamic acid in patients undergoing primary coronary artery bypass grafting led to a significant reduction in postoperative blood loss without adding extra risk to the patient. PMID:19538741

  7. Two-vessel off-pump coronary artery bypass grafting by left thoracotomy in a complex reoperative case.

    PubMed

    Unai, Shinya; Cook, Gary; Hirose, Hitoshi; Cavarocchi, Nicholas; Entwistle, John

    2014-04-01

    An 83-year-old male with a history of three prior sternotomies, including coronary artery bypass surgery (CABG), presented with unstable angina. Cardiac catheterization showed left main and triple-vessel disease. The saphenous vein graft (SVG) to the right coronary artery was diseased but patent, and the SVG to the left anterior descending artery (LAD) was occluded. Preoperative evaluation showed a heavily calcified ascending aorta and minimum disease on the descending aorta. He successfully underwent a left thoracotomy 2-vessel off-pump CABG using the descending aorta for the proximal anastomosis. The left thoracotomy approach is a useful alternative to avoid complications associated with resternotomy, especially in patients with a hostile chest, although visualization of the target vessels may be limited. PMID:24808445

  8. The paradox of excellent long-term survival and physical fitness after coronary artery bypass surgery despite suboptimal secondary prevention

    Microsoft Academic Search

    N. E. Hiemann; P. Zarubova; F. Dorbar; J. Vierecke; S. Konopelska; L. Krause; C. Egnell; C. Renner; M. Bauer; R. Hetzer

    2007-01-01

    \\u000a Abstract\\u000a \\u000a \\u000a Aims\\u000a   To evaluate current lifestyle, secondary medical prevention and objective physical abilities in long-term survivors after\\u000a coronary artery bypass grafting (CAGB).\\u000a \\u000a \\u000a \\u000a \\u000a Methods and results\\u000a   Data were collected by written questionnaires and telephone interviews in 476 (405 men, mean age 56 years) patients after\\u000a a median follow-up of 16.6 yrs (95% CI 16.5–16.7 yrs post-CABG). Triple-vessel coronary heart disease (CHD)

  9. Asymptomatic severe carotid stenosis undergoing staged carotid artery stent and coronary artery bypass grafting: decisive role of brain single photon emission computed tomography

    Microsoft Academic Search

    Min-Ho Song; Tomohiro Nakayama; Keisuke Hattori; Shigeru Miyachi

    2009-01-01

    Effort angina of a 70-year-old man was diagnosed as due to triple coronary vessel disease, and he was scheduled to undergo\\u000a coronary artery bypass surgery. Preoperative carotid duplex scan revealed more than 75% stenosis of the right internal carotid\\u000a artery, which was functionally proven to be significantly ischemic on brain single photon emission computed tomography. Although\\u000a he was neurologically asymptomatic,

  10. Post-mortem cast angiography in the diagnostics of graft complications in patients with fatal outcome following coronary artery bypass grafting (CABG)

    Microsoft Academic Search

    S. M. Weman; A. Penttilä; A. Männikkö; P. J. Karhunen

    1999-01-01

    The advantages and limitations of a novel post-mortem angiographic method using solidifying silicone rubber and lead oxide\\u000a as a contrast medium in detecting coronary artery graft complications on a routine basis were evaluated in a series of 223\\u000a consecutive patients with fatal outcome within 30 days following coronary artery bypass grafting (CABG). Of these patients,\\u000a 166 (74.4%) were male and

  11. Carotid Artery Stenosis Associated with Increased Mortality in Patients who Underwent Coronary Artery Bypass Grafting: A Single Center Experience

    PubMed Central

    da Rosa, Marcelo P.; Schwendler, Ricardo; Lopes, Rodrigo; Portal, Vera L.

    2013-01-01

    Background: Vascular disease resulting from arteriosclerosis is a severe worldwide health risk. Early diagnosis and intervention is important to control adverse cerebral and cardiovascular events. The aim of this study was to assess the potential predictors of mortality in patients submitted to coronary bypass surgery. Methods: Cohort study included asymptomatic cerebrovascular disease patients scheduled for coronary artery bypass grafting admitted to the cardiology reference center. All patients were submitted to carotid artery ultrasound assessment prior to surgery and were followed up during the entire in-hospital postoperative period. Carotid artery stenosis was considered clinically significant when cross sectional area ?50%. Significance was set at p <0.05. Logistic regression was used to identify independent predictors of mortality. Results: Of 455 patients with a mean age of 62.2 years 65.6% were males. The prevalence of carotid artery stenosis was 18.7%. It was absent in 3.6% of the patients, below 50% in 77.8%, between 50 and 69% in 11.6%, and between 70 and 99% in 6.9%. The carotid artery was occluded in 0.2% of the sample. An overall mortality of 12%, affecting 35 men (P=0.001) with stenosis ?50%. After logistic regression analysis, carotid artery stenosis ?50% was confirmed as being an independent predictor of mortality (P=0.005). Conclusion: In this series carotid artery stenosis showed a high prevalence in the sample assessed and was an independent predictor of mortality. PMID:24093050

  12. Prediction and monitoring of fluid responsiveness after coronary bypass surgery using the Initial Systolic Time Interval: Preliminary results

    NASA Astrophysics Data System (ADS)

    Smorenberg, A.; Lust, E. J.; Verdaasdonk, R. M.; Groeneveld, A. B. J.; Meijer, J. H.

    2010-04-01

    The objective of the study is to develop a non-invasive method to optimize the assessment of cardiac preload and therapeutic fluid administration after coronary artery bypass surgery. Previous studies have reported that the pre-ejection period (PEP), obtained from the electro-cardiogram (ECG) and from the invasively measured arterial pressure Pa, can be used for this assessment as it is dependent on the cardiac preload. The Initial Systolic Time Interval (ISTI), obtained non-invasively by simultaneous measurement of the Electro-CardioGram (ECG) and Impedance CardioGram (ICG), is expected to depend on the cardiac preload as well. 16 patients, admitted to the Intensive Care Unit after coronary artery bypass surgery and presumably hypovolaemic, were measured during administration of 2×250 ml of an isosmotic colloidal fluid solution. The parameters PEP and ISTI were determined before and after the administrations and compared with the change in cardiac output (CO), obtained by a thermodilution technique. Preliminary results show significant relationships between ISTI and CO and between changes in both of these variables before and after fluid administration.

  13. Variability in cost of coronary bypass surgery in New York State: Potential for cost savings

    Microsoft Academic Search

    Patricia A. Cowper; Elizabeth R. DeLong; Eric D. Peterson; Edward L. Hannan; Kevin T. Ray; Michael Racz; Daniel B. Mark

    2002-01-01

    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

  14. Impact of statins and beta-blocker therapy on mortality after coronary artery bypass graft surgery

    PubMed Central

    Blackstone, Eugene; Kapadia, Samir R.

    2015-01-01

    Background We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE). Methods We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad. Results We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period. Conclusions A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines. PMID:25774344

  15. Risk factors for endotracheal re-intubation following coronary artery bypass grafting

    PubMed Central

    2013-01-01

    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. PMID:24209453

  16. Elective preoperative use of intra aortic balloon counterpulsation in high risk group of coronary artery disease patients to facilitate off pump surgery

    Microsoft Academic Search

    Harinder Singh Bedi; Charanbir Singh Sohal; Bhupender Singh Sengar

    2007-01-01

    Background  To avoid the deleterious effects of cardio-pulmonary bypass, off pump coronary artery bypass graft surgery (OPCABG) is increasingly\\u000a the procedure of choice in the majority of patients needing myocardial revascularization. However patients at high operative\\u000a risk are sometimes not given the advantage of off pump surgery because of haemodynamic deterioration during displacement of\\u000a the heart to access the target vessels,

  17. Comparison of Five-Year Outcome of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Triple-Vessel Coronary Artery Disease (from the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2).

    PubMed

    Shiomi, Hiroki; Morimoto, Takeshi; Furukawa, Yutaka; Nakagawa, Yoshihisa; Tazaki, Junichi; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Shimamoto, Mitsuomi; Nishiwaki, Noboru; Komiya, Tatsuhiko; Kimura, Takeshi

    2015-07-01

    Studies evaluating long-term (?5 years) outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents compared with coronary artery bypass grafting (CABG) in patients with triple-vessel coronary artery disease (TVD) are still limited. We identified 2,978 patients with TVD (PCI: n = 1,824, CABG: n = 1,154) of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2. The primary outcome measure in the present analysis was a composite of death, myocardial infarction (MI), and stroke. Median follow-up duration for the surviving patients was 1,973 days (interquartile range 1,700 to 2,244). The cumulative 5-year incidence of death/MI/stroke was significantly higher in the PCI group than in the CABG group (28.2% vs 24.0%, log-rank p = 0.006). After adjusting for confounders, the excess risk of PCI relative to CABG for death/MI/stroke remained significant (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.13 to 1.68, p = 0.002). The excess risks of PCI relative to CABG for all-cause death, MI, and any coronary revascularization were also significant (HR 1.38, 95% CI 1.10 to 1.74, p = 0.006; HR 2.81, 95% CI 1.69 to 4.66, p <0.001; and HR 4.10, 95% CI 3.32 to 5.06, p <0.001, respectively). The risk for stroke was not significantly different between the PCI and CABG groups (HR 0.88, 95% CI 0.61 to 1.26, p = 0.48). There were no interactions for the primary outcome measure between the mode of revascularization (PCI or CABG) and the subgroup factors such as age, diabetes, and Synergy Between PCI With Taxus and Cardiac Surgery score. In conclusion, CABG compared with PCI was associated with better long-term outcome in patients with TVD. PMID:25956622

  18. Comparison between Drug-Eluting Stents and Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease: A Meta-Analysis of Two Randomized Trials and Thirteen Observational Studies

    Microsoft Academic Search

    Shuai Zheng; Zhe Zheng; Jianfeng Hou; Shengshou Hu

    2011-01-01

    Objective: The clinical outcomes for unprotected left main coronary artery (LMCA) between coronary artery bypass grafting (CABG) and drug-eluting stents (DES) are still controversial. The objective was to compare safety and efficacy between DES and CABG for unprotected LMCA. Methods: Electronic databases and article references were systematically searched (2000–2010) to access relevant studies. Results: Fifteen studies with 5,479 patients were

  19. The real-world outcomes of off-pump coronary artery bypass surgery in a public health care system

    PubMed Central

    Guru, Veena; Glasgow, Kevin W; Fremes, Stephen E; Austin, Peter C; Teoh, Kevin; Tu, Jack V

    2007-01-01

    BACKGROUND: The population-based results of off-pump coronary artery bypass surgery (OPCAB) in a public health care system have not been reported. OBJECTIVE: The study objective was to compare the one-year outcomes of OPCAB with those of the standard on-pump coronary artery bypass surgery (ONCAB) in the province of Ontario. METHODS: The present study was a retrospective, population-based study (n=15,172, with 1660 OPCAB patients) undertaken in fiscal years 2000 and 2001 using clinical and administrative data. Multivariate regression modelling for risk adjustment and propensity matching were used to compare OPCAB with ONCAB for one-year outcomes, including death, repeat revascularization and cardiac readmission. RESULTS: The rate of OPCAB was 11%, with institutional rates ranging from 3% to 51%. OPCAB patients were more likely to be female and older than 79 years of age, with peripheral vascular disease and higher socioeconomic status. OPCAB patients were less likely to have surgically significant coronary disease, poor left ventricular function, an urgent status, congestive heart failure and diabetes. The risk-adjusted one-year composite outcome was higher for OPCAB (11.8%, 95% CI 10.40% to 13.29%) than ONCAB (10.8%, 95% CI 10.23% to 11.27%); however, this difference was eliminated with propensity matching. OPCAB patients had shorter hospital lengths of stay and lower blood product transfusion rates than ONCAB patients. CONCLUSIONS: Despite the minimal use of OPCAB in Canada’s public health care system, outcome rates are similar to those of ONCAB. The benefits of OPCAB observed in randomized trials, including shorter hospital lengths of stay and lower transfusion rates, remained true in the investigators’ real-world experience. The results OPCAB were at least equivalent to those of ONCAB. PMID:17380221

  20. Relationship between Body Mass Index and Outcome of Elective Percutaneous Coronary Intervention

    PubMed Central

    Alidoosti, Mohammad; Salarifar, Mojtaba; Hajizeinali, Ali Mohammad; Kassaian, Seyed Ebrahim; Nematipour, Ebrahim; Aghajani, Hasan; Lotfi-Tokaldany, Masoumeh; Kazazi, Elham Hakki

    2015-01-01

    Abstract Background: Studies have shown controversial effects of obesity on major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). We sought to investigate the impact of the body mass index (BMI) on the mid-term outcome following successful PCI. Methods: Between March 2006 and August 2008, 3948 patients underwent successful elective PCI in Tehran Heart Center, Tehran, Iran, and were retrospectively included in this study. Patients who underwent PCI on the same day as the occurrence of myocardial infarction were excluded. The demographic, procedural, in-hospital, and follow-up information of these patients was extracted from the PCI Data Registry of our institution. The patients were divided into three groups: normal weight (No. 1058, BMI < 25 kg/m2 age = 58 ± 10 years); overweight (No. 1867, 25 ? BMI < 30 kg/m2, age = 57 ± 10 years); and obese (No. 1023, BMI ? 30 kg/m2, age = 56 ± 10 years). MACE included death, myocardial infarction, target vessel revascularization, and target lesion revascularization. Results: Compared with the other patients, the obese individuals were significantly younger and more frequently female, had a higher ejection fraction, and more frequently presented with hypertension, diabetes, and hyperlipidemia. There was no association between the BMI and the angiographic and procedural findings in the univariate analysis. While no difference was found in the rate of in-hospital death between the groups, the number of the obese patients undergoing emergent cardiac surgery was marginally different in the univariate analysis (p value = 0.06). At 9 months' follow-up, MACE had occurred in 92 (2.3%) patients and cardiac mortality was 9 (0.2%). After adjustments for confounders, no significant difference was observed in terms of MACE between the BMI groups. Conclusion: The BMI had no significant effect on the rate of MACE at 9 months' follow-up in our study population. Interventionists' recommendations for patients undergoing PCI should, therefore, not be significantly influenced by the BMI status. PMID:26157459

  1. The Impact of Newly Diagnosed Patent Foramen Ovale in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: Case Series of Eleven Patients

    Microsoft Academic Search

    M. R. Sukernik; B. Mets; B. Kachulis; M. C. Oz; E. Bennett-Guerrero

    2002-01-01

    The increased use of transesophageal echocardiogra- phy (TEE) by anesthesiologists may lead to an increase in the intraoperative detection of previously undiag- nosed patent foramen ovale (PFO). The impact of heart manipulation on interatrial shunting through a PFO during off-pump coronary artery bypass graft (CABG) has not been studied. We retrospectively studied 11 pa- tients with PFOs who underwent off-pump

  2. Assessment of Decline in Health-Related Quality of Life among Angina-Free Patients Undergoing Coronary Artery Bypass Graft Surgery

    Microsoft Academic Search

    Paul A. Pirraglia; Janey C. Peterson; Pamela Williams-Russo; Mary E. Charlson

    2003-01-01

    Purpose: Coronary artery bypass graft (CABG) surgery generally decreases symptoms and improves quality of life, but for those patients without angina, prolongation of life takes precedence. We used the SF-36 to assess changes in health-related quality of life (HRQOL) among patients who were angina free prior to CABG compared to those reporting angina. Methods: We combined data from two randomized

  3. Does Patient Gender Affect Outcomes after Concomitant Coronary Artery Bypass Graft and Aortic Valve Replacement? An Australian Society of Cardiac and Thoracic Surgeons Database Study

    Microsoft Academic Search

    Akshat Saxena; Chin-Leng Poh; Diem T. Dinh; Christopher M. Reid; Julian A. Smith; Gilbert C. Shardey; Andrew E. Newcomb

    2011-01-01

    Objectives: Women undergoing isolated coronary artery bypass graft (CABG) surgery have been previously shown to be at an independently increased risk for post-operative morbidity and mortality. However, there are considerably less data on whether this trend remains true in patients undergoing concomitant aortic valve replacement (AVR) and CABG surgery. The aim of our study was to investigate this pertinent issue.

  4. Preoperative 24-hour urine amount as an independent predictor of renal outcome in poor cardiac function patients after coronary artery bypass grafting

    Microsoft Academic Search

    Chun-Liang Lin; Kun-Ying Pan; Po-Yaur Hsu; Huan-Yu Yang; Huey-Liang Guo; Chiu-Ching Huang

    2004-01-01

    Purpose: To investigate the incidence and the main pre-operative risk factors for the development of acute renal failure (ARF) in triple vessels coronary artery bypass grafting (CABG) with special reference to a subset of patients with poor cardiac function (ejection fraction <50%).Patients: The study included the patients (n = 66) requiring CABG from January 1, 1995 to January 1, 2002

  5. Strict Thermoregulation Attenuates Myocardial Injury During Coronary Artery Bypass Graft Surgery as Reflected by Reduced Levels of Cardiac-Specific Troponin I

    Microsoft Academic Search

    Nahum Nesher; Eli Zisman; Tamir Wolf; Ram Sharony; Gil Bolotin; Miriam David; Gideon Uretzky; Reuven Pizov

    2003-01-01

    We assessed the cardioprotective effects of periopera- tive maintenance of normothermia by determining the perioperative profile of troponin I, a highly cardiac- specific protein important in risk stratification of pa- tients with acute ischemic events. Candidates for their primary coronary artery bypass grafting (CABG) were randomized into a new thermoregulation system group, Allon™ thermoregulation (AT; n 30), and a routine

  6. Gender as a Moderator between Having an Anxiety Disorder Diagnosis and Coronary Artery Bypass Grafting Surgery (CABG) Outcomes in Rural Patients

    ERIC Educational Resources Information Center

    Dao, Tam K.; Voelkel, Emily; Presley, Sherine; Doss, Brendel; Huddleston, Cashuna; Gopaldas, Raja

    2012-01-01

    Purpose: This paper examines gender as a moderating variable between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients. Methods: Using the 2008 Nationwide Inpatient Sample (NIS) database, 17,885 discharge records of patients who underwent a primary CABG surgery were identified.…

  7. Coronary flow and reactivity, but not arrhythmia vulnerability, are affected by cardioplegia during cardiopulmonary bypass in piglets

    PubMed Central

    2013-01-01

    Background Surgery under cardiopulmonary bypass (CPB) is still associated with significant cardiovascular morbidity in both pediatric and adult patients but the mechanisms are not fully understood. Abnormalities in coronary flow and function have been suggested to play an important role. Prior studies suggest protective effects on coronary and myocardial function by short intravenous (i.v.) infusion of cyclosporine A before CPB. Methods Barrier-bred piglets (10–12 kg, n=20) underwent CPB for 45 min, with or without antegrade administration of cardioplegic solution. Prior to CPB, half of the animals in each group received an i.v. infusion of 100 mg/kg cyclosporine A. The left anterior descending coronary flow velocity responses to adenosine, serotonin, and atrial pacing, as well as left ventricular function and postsurgical vulnerability to atrial fibrillation (Afib) were assessed by intracoronary Doppler, epicardial echocardiography, and in vivo electrophysiological study, before and 8 hours after surgery. Plasma C-reactive protein (CRP) and fibrinogen were measured at both time-points. Results Cyclosporine infusion did not influence any of the studied variables (p>0.4). Coronary peak flow velocity (cPFV) rose significantly after surgery especially in the cardioplegia group (p<0.01 vs. non-cardioplegia group and pre-surgery). cPFV responses to adenosine, but not to serotonin, tended to decrease (p=0.06) after surgery only in cardioplegia group (p=0.06; p=0.8 in non-cardioplegia group vs pre-surgery). Also, cPFV response to atrial pacing was lower in the cardioplegia than in the non-cardioplegia group (p=0.02). Neither vulnerability nor duration of induced Afib after CPB differed between groups (Chi-square p=0.4). Cyclosporine had no significant effect on coronary indexes or arrhythmia vulnerability (p>0.4). There was no difference in systolic myocardial function between groups at any time point. Conclusion In piglets, CPB with cardioplegia was associated with profound abnormalities in coronary vasomotor tone and receptor-related flow regulation, whereas arrhythmia vulnerability appeared to be comparable with that in non-cardioplegia group. In this study, preconditioning with cyclosporine had no detectable protective effect on coronary circulation or arrhythmia vulnerability after CPB. PMID:23777554

  8. Validation of coronary artery saphenous vein bypass graft diameter measurements using quantitative angiography

    Microsoft Academic Search

    Jacques Lespérance; Lucien Campeau; Johan H. C. Reiber; Marc Bois; Ihor Dyrda; Jean Laurier; Gilles Hudon

    1996-01-01

    The accepted value for reproducibility (true change) is two standard deviations (SD) of the differences between repeat measurements. It has been well established for coronary artery measurements using several different quantitative coronary angiography (QCA) systems, but it has not been well documented for saphenous vein grafts (SVG). The purpose of this study was to assess, using the Cardiovascular Measurement System

  9. The Prevalence of Risk Factors of Coronary Artery Disease in the Patients who Underwent Coronary Artery Bypass Graft, Shiraz, Iran: Suggesting a Model

    PubMed Central

    Ostovan, Mohammad Ali; Darvish, Negar; Askarian, Mehrdad

    2014-01-01

    Background: Cardiovascular diseases are the main cause of 40% of deaths in Iran annually. Many patients undergoing coronary artery bypass graft surgery have previous cardiovascular risk factors which could be prevented. Objectives: The present study aimed to assess the prevalence of cardiovascular risk factors in the patients undergoing coronary artery bypass graft surgery. Materials and Methods: In this cross-sectional (descriptive – analytical) study, a data collecting form was used. A total of 246 patients were selected from six hospitals of Shiraz using random stratification. Descriptive statistics were presented through figures and tables and t-test was used to analyze the continuous variables. All the statistical analyses were performed using the SPSS statistical software (version 15.0). Besides, P < 0.05 was considered as statistically significant. Results: Among the study patients, only 11.67% had no risk factors and 88.33% had one or more risk factors. The most common risk factors observed in the patients were hypertension, obesity and overweight, hyperlipidemia, and diabetes mellitus. The results showed a significant difference between males and females regarding the prevalence of hypertension (P = 0.001), diabetes (P = 0.028), hypercholesterolemia (P = 0.020), and cigarette smoking (P = 0.001). In addition, the patients' mean levels of cholesterol, LDL, triglyceride, and fasting blood sugar were higher than the acceptable level, while that of HDL was lower than the accepted level. Conclusions: These patients are recommended to be trained regarding lifestyle changes. Also, prevention strategies can play an important role in reducing patient morbidity and mortality. PMID:25614855

  10. Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement?

    PubMed Central

    Lee, Beom Jun; Herbison, Peter; Wong, Cheuk-Kit

    2014-01-01

    Several studies have shown that coronary artery bypass graft surgery (CABG) is superior to percutaneous coronary intervention (PCI) in patients with diabetes and multi-vessel disease. Whether this advantage of CABG over PCI is confined to diabetics who require insulin is unknown. We review the published literature comparing CABG with PCI in diabetics including 8 cohorts and 4,786 patients. There was a lower rate for all-cause mortality (Relative risk (RR): 0.78, 95% confidence interval (CI): 0.62–0.99), and for major adverse cardiac and cerebrovascular events (MACCE, RR: 0.59, 95% CI: 0.47–0.75) for CABG compared to PCI. Composite outcome of mortality, myocardial infarction and stoke was similar between CABG and PCI (RR: 0.87, 95% CI: 0.54–1.42). Visual inspection of the forest plots showed that in most analyses, the point estimates of the RR are similar between the insulin requiring group and non-insulin requiring group. On meta-regression, there was no interaction between status of insulin requirement and revascularization strategies (P > 0.05 for all). The presented data on the still unpublished analysis of the FREEDOM trial showed similar results. Thus, in the current era, CABG is superior to PCI with lower mortality and MACCE rates, but the state of insulin requirement had no effect on the outcomes from the two revascularization strategies. PMID:24748887

  11. Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement?

    PubMed

    Lee, Beom Jun; Herbison, Peter; Wong, Cheuk-Kit

    2014-03-01

    Several studies have shown that coronary artery bypass graft surgery (CABG) is superior to percutaneous coronary intervention (PCI) in patients with diabetes and multi-vessel disease. Whether this advantage of CABG over PCI is confined to diabetics who require insulin is unknown. We review the published literature comparing CABG with PCI in diabetics including 8 cohorts and 4,786 patients. There was a lower rate for all-cause mortality (Relative risk (RR): 0.78, 95% confidence interval (CI): 0.62-0.99), and for major adverse cardiac and cerebrovascular events (MACCE, RR: 0.59, 95% CI: 0.47-0.75) for CABG compared to PCI. Composite outcome of mortality, myocardial infarction and stoke was similar between CABG and PCI (RR: 0.87, 95% CI: 0.54-1.42). Visual inspection of the forest plots showed that in most analyses, the point estimates of the RR are similar between the insulin requiring group and non-insulin requiring group. On meta-regression, there was no interaction between status of insulin requirement and revascularization strategies (P > 0.05 for all). The presented data on the still unpublished analysis of the FREEDOM trial showed similar results. Thus, in the current era, CABG is superior to PCI with lower mortality and MACCE rates, but the state of insulin requirement had no effect on the outcomes from the two revascularization strategies. PMID:24748887

  12. A comparison of off-pump and on-pump coronary bypass surgery in patients with low EuroSCORE

    PubMed Central

    2014-01-01

    Background The aim of the present study was to evaluate and compare postoperative short-term, mid-term and long-term outcomes of coronary artery bypass surgery performed with or without cardiopulmonary bypass in patients with a low European System for Cardiac Operative Risk Evaluation score. Methods A retrospective analysis of 478 consecutive low risk patients undergoing coronary bypass surgery between January 2002 and December 2007 was performed. Of these patients, 83 cases had undergone on-pump and 395 cases had undergone off-pump coronary bypass surgery. The patients were assessed in terms peri-operative complications, survival, mortality due to cardiac events, need for rehospitalization and repeated coronary revascularization. Results There was no significant difference between the two groups in terms of preoperative characteristics, except for chronic obstructive pulmonary disease. The number of distal anastomosis per patient was significantly lower in the off-pump group than in the on-pump group (2.66?±?0.74 vs. 3.21?±?0.85, p?

  13. Change in the perioperative blood glucose and blood lactate levels of non-diabetic patients undergoing coronary bypass surgery.

    PubMed

    Shen, Chunjian; Gu, Tianxiang; Gu, Lili; Xiu, Zhongyi; Zhang, Zhiwei; Shi, Enyi; Zhang, Yuhai; Wang, Chun

    2013-11-01

    In the present study, a retrospective analysis of the trends and factors affecting blood glucose and blood lactate levels was carried out for non-diabetic adult patients who had undergone coronary artery bypass graft (CABG) surgery. Between October 2009 and October 2011, 200 non-diabetic adult patients undergoing CABG surgery were examined. Glucose and lactic acid levels were observed successively during surgery [following the induction of anesthesia, cardio-pulmonary bypass (CPB), aortic cross-clamping and aortic stop flow infusion], at the end of surgery and after surgery [1, 6, 12, 24 and 48 h after admission to the intensive care unit (ICU)]. The results of blood gas analyses and other related indicators for trend analysis were investigated. The peak blood glucose and blood lactate levels during CPB, as well as other CPB factors, were also analyzed. Following aortic cross-clamping, intraoperative blood glucose and blood lactate levels increased gradually with increasing operative time. Postoperatively, blood glucose and blood lactate levels continued to rise. Blood glucose and blood lactic acid levels during CPB were positively correlated. The blood glucose and blood lactate levels of non-diabetic adult patients undergoing CABG increased gradually with operative time following aortic cross-clamping. Moreover, blood glucose and blood lactate levels were positively correlated with the duration of CPB and duration of aortic cross-clamping. PMID:24223647

  14. Change in the perioperative blood glucose and blood lactate levels of non-diabetic patients undergoing coronary bypass surgery

    PubMed Central

    SHEN, CHUNJIAN; GU, TIANXIANG; GU, LILI; XIU, ZHONGYI; ZHANG, ZHIWEI; SHI, ENYI; ZHANG, YUHAI; WANG, CHUN

    2013-01-01

    In the present study, a retrospective analysis of the trends and factors affecting blood glucose and blood lactate levels was carried out for non-diabetic adult patients who had undergone coronary artery bypass graft (CABG) surgery. Between October 2009 and October 2011, 200 non-diabetic adult patients undergoing CABG surgery were examined. Glucose and lactic acid levels were observed successively during surgery [following the induction of anesthesia, cardio-pulmonary bypass (CPB), aortic cross-clamping and aortic stop flow infusion], at the end of surgery and after surgery [1, 6, 12, 24 and 48 h after admission to the intensive care unit (ICU)]. The results of blood gas analyses and other related indicators for trend analysis were investigated. The peak blood glucose and blood lactate levels during CPB, as well as other CPB factors, were also analyzed. Following aortic cross-clamping, intraoperative blood glucose and blood lactate levels increased gradually with increasing operative time. Postoperatively, blood glucose and blood lactate levels continued to rise. Blood glucose and blood lactic acid levels during CPB were positively correlated. The blood glucose and blood lactate levels of non-diabetic adult patients undergoing CABG increased gradually with operative time following aortic cross-clamping. Moreover, blood glucose and blood lactate levels were positively correlated with the duration of CPB and duration of aortic cross-clamping. PMID:24223647

  15. Growth Factors Serum Levels in Coronary Artery Disease Patients Scheduled for Bypass Surgery: Perioperative Dynamics and Comparisons with Healthy Volunteers

    PubMed Central

    Starkopf, Joel; Zilmer, Kersti; Zilmer, Mihkel

    2013-01-01

    Background. Vascular endothelial growth factors are important mediators for neovascularization of chronically ischemic adult heart, but their elevated values have also been connected with acute ischemia. Coronary artery bypass grafting (CABG) is associated with activation of inflammatory processes. We aimed to clarify whether the latter is also accompanied with acute changes in concentrations of vascular growth factors. Methods. Concentrations of growth factors VEGF and EGF, monocyte chemoattractant protein-1 (MCP-1), and a set of cytokines of 39 patients with stable coronary artery disease (CAD) were evaluated before and after CABG. Preoperative values were compared with data of healthy volunteers. Results. In comparison with CAD patients, healthy controls had significantly higher values of VEGF (15.5 (10.05–35.3) and 119.4 (55.7–136.9)?pg/mL, resp.), EGF (1.70 (1.14–3.18) and 37.3 (27.1–51.9)?pg/mL, resp.), and MCP-1 (111.6 (81.75–171.9) and 156.9 (134.7–241.3)?pg/mL, resp.). MCP-1, but not others, demonstrated a significant rise throughout the postoperative period. Proinflammatory interleukin-6 was significantly higher and anti-inflammatory IL-4 and IL-10 lower in patients with CAD. Conclusions. Patients with stable CAD have lower serum levels of growth factors than healthy volunteers. MCP-1, but not VEGF and EGF, becomes elevated immediately after CABG. Inflammatory status of CAD patients was drifted towards proinflammatory state. PMID:23984427

  16. Addressing the Potential Need for Coronary Artery Bypass Grafting After Free Tissue Transfer for Breast Reconstruction: An Algorithmic Approach.

    PubMed

    Maher, Janae L; Mahabir, Raman C; Roehl, Kendall R

    2015-08-01

    The number one cause of death in American women is heart disease. Studies have clearly shown the superiority of internal mammary artery (IMA) grafts for coronary revascularization over other conduits or intracoronary techniques. Our goal was to design an algorithm for recipient vessel selection in patients undergoing free tissue transfer breast reconstruction.A review of the literature was performed to identify potential evidence to contribute to a best-practice guideline. The lack of high-level evidence led us to create a guideline based on a workgroup consensus, expert opinion, cadaveric studies, and case reports.As we operate on older patient populations, the need for IMA use for coronary artery bypass grafting (CABG) after autologous breast reconstruction may arise more frequently. We discuss the current literature regarding recipient vessel choices and level of recipient vessel harvest in free flap breast reconstruction to help continually evolve the practices of our specialty to the potential future needs of our patients. We also present a best-practice decision algorithm for vessel selection and harvest, as well as a sample case of CABG using the left IMA 35 days after previous autologous breast reconstruction using the left IMA.As the number of patients we operate on who may later require their IMA for CABG increases, so too must our understanding of the implications of our selection of recipient vessels for free autologous breast reconstruction. PMID:26165568

  17. Minimally invasive coronary artery bypass grafting using the inferior J-shaped ministernotomy in high-risk patients.

    PubMed

    Del Giglio, Mauro; Dell'Amore, Andrea; Aquino, Tommaso; Calvi, Simone; Calli, Morena; Marri, Claudio; Boni, Francesco; Lamarra, Mauro

    2008-05-01

    In the last years the population of patients referred for coronary surgery has changed toward a high-risk profile. In selected cases minimally invasive approach could be a good option to reduce mortality and morbidity. Between September 2005 and September 2007, twenty-one consecutive patients underwent minimally invasive bypass surgery using the J-shaped inferior mini-sternotomy approach. All patients had a EuroSCORE higher than 6. The operative mortality was 0%. Conversion to on-pump surgery was not necessary. The mean operation time was 89+/-18 min, the mean ventilation time was 2.4+/-2.2 h, the mean intensive care unit stay was 47.2+/-36.5 h. In four patients a hybrid approach to achieve a complete revascularization was used. After six months from the operation the graft patency was evaluated with the 64-slice computed tomography. In high-risk coronary patients the use of the minimally invasive technique appeared a good option to achieve low morbidity and mortality. Through a mini-sternotomy approach, single- or double-vessel revascularization can be performed safely off-pump even in high-risk patients without compromising the accuracy of the anastomosis. Nevertheless, a further investigation is required to evaluate the long-term results in a larger cohort of patients. PMID:18276661

  18. The biocompound method in coronary artery bypass operations: surgical technique and 3-year patency

    Microsoft Academic Search

    Heinz Robert Zurbrügg; Friedrich Knollmann; Michele Musci; Markus Wied; Matthias Bauer; Tito Chavez; Andreas Krukenberg; Roland Hetzer

    2000-01-01

    Background. Complete arterial revascularization may be unsafe in patients with a high operative risk. In patients with varicose ectatic veins, the biocompound technique, which uses unsuitable autologous veins, enables the surgeon to influence the bypass graft wall stress levels and diameter. This report summarizes the 3-year patency of 53 patients, the survival rate of 200 patients, and operative technical considerations.Methods.

  19. Segmental myocardial wall motion during minimally invasive coronary artery bypass grafting using open and endoscopic surgical techniques.

    PubMed

    Mierdl, S; Byhahn, C; Lischke, V; Aybek, T; Wimmer-Greinecker, G; Dogan, S; Viehmeyer, S; Kessler, P; Westphal, Klaus

    2005-02-01

    Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass (CPB) via mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB) with CPB. Both procedures are associated with potential myocardial stress before revascularization, such as single-lung ventilation (SLV), temporary coronary artery occlusion, cardiac luxation, intrathoracic carbon dioxide insufflation, and extended CPB and operating time. In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB surgery and to identify factors affecting SWMA. Forty-six patients with single-vessel coronary artery disease were studied. Sixteen patients were operated using the MIDCAB technique and 30 patients with TECAB. In both groups sequential transesophageal echocardiograms were recorded during the entire procedure. Hemodynamic data and oxygenation variables were acquired simultaneously. In both groups, mild but obvious perioperative SWMA were identified and noted to increase during the course of the operation. These SWMA were more pronounced in the TECAB group. Independent of operating time, these changes disappeared completely after revascularization. No significant hemodynamic compromise was observed. We conclude that MIDCAB and TECAB techniques are associated with significant perioperative SWMA. The appearance of more profound SWMA in the TECAB group compared with the MIDCAB patients might have been the result of intrathoracic CO(2) insufflation, as SLV was used in both groups. No persistent SWMA or post-CPB SWMA were apparent in either group. More extensive intraoperative ventricular SWMA was detected in the TECAB group, suggesting that a more frequent risk for right ventricular dysfunction may exist during TECAB procedures. PMID:15673848

  20. Noninvasive testing of cerebral perfusion reserve prior to coronary artery bypass graft surgery

    SciTech Connect

    Levine, R.L.; Lagreze, H.L.; Berkoff, H.A.; Turnipseed, W.D.; Hanson, J.M.; Sunderland, J.J.; Nickles, R.J.; Rowe, B.R.

    1988-05-01

    Cerebral perfusion reserve testing using fluorine-18-fluoromethane and positron emission tomographic brain scanning to define cerebral blood flow abnormalities was performed in 5 patients being considered for combined coronary and carotid reconstructive surgery. Blood flow testing during normocapnia and following hypercapnia was utilized in these patients to determine the hemodynamic significance of known extracranial carotid artery occlusive lesions. Reserve diminution in 2 of these patients prompted combined surgery, whereas normal reserve values in the other 3 prompted coronary surgery alone. Results obtained in this preliminary series show how preoperative noninvasive testing of cerebral perfusion reserve adds to the diagnostic evaluation of patients with widespread vascular disease.

  1. Reduced albumin-cobalt binding with transient myocardial ischemia after elective percutaneous transluminal coronary angioplasty: A preliminary comparison to creatine kinase-MB, myoglobin, and troponin I

    Microsoft Academic Search

    David Bar-Or; James V. Winkler; Karyl VanBenthuysen; Lisbeth Harris; Edward Lau; Fred W. Hetzel

    2001-01-01

    Background Previous reports suggest that ischemic conditions rapidly reduce the capacity of human albumin to bind exogenous cobalt. A new assay based on human albumin-cobalt binding (ACB) may help detect early myocardial ischemia. We investigated altered ACB during the first 24 hours after transient ischemia induced during elective percutaneous transluminal coronary angioplasty (PTCA). We then compared ACB assay results with

  2. Efficacy of short-term cordyceps sinensis for prevention of contrast-induced nephropathy in patients with acute coronary syndrome undergoing elective percutaneous coronary intervention.

    PubMed

    Zhao, Kai; Lin, Yu; Li, Yong-Jian; Gao, Sheng

    2014-01-01

    Contrast-induced nephropathy (CIN) is one of the major causes of hospital-acquired acute renal failure. The pathophysiological mechanism of CIN remains unknown. There has been little evidence regarding the effects of Traditional Chinese Medicine (TCM) on CIN. Cordyceps sinensis (CS), a traditional Chinese herb, has been widely used clinically for the prevention of the progression of renal failure. We performed a prospective, randomized controlled trial to investigate the role of CS in the prevention of CIN in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI). The 150 ACS patients were randomly assigned to three groups, basic treatment group (n=51), standard CS therapy group (n=49, corbrin capsule 2 g, 3 times/d were used 3 days before and after angiography), and intensive CS therapy group (n=50, corbrin capsule 3 g, 3 times/d were used 3 days before and after angiography). Renal function was assessed at the time of hospital admission and on days 1, 2, and 3 after PCI. CIN occurred in 13 of 150 patients (8.67%). The incidence of CIN was lower in the CS treatment groups than in the basic treatment group (P<0.05), and a significant decrease in the incidence of CIN in the intensive CS therapy group was shown (P<0.01). In conclusion, prophylactic treatment with CS during the peri-procedural stage in ACS patients undergoing elective PCI has a preventive role against CIN, and intensive CS therapy could be more effective. PMID:25664103

  3. A large dissecting sub-epicardial hematoma and cardiac tamponade following elective percutaneous coronary intervention.

    PubMed

    Kashiwase, Kazunori; Ueda, Yasunori; Ogasawara, Nobuyuki; Oyabu, Jyota; Okada, Katsuki; Murakawa, Tomokazu; Hirayama, Atsushi; Kodama, Kazuhisa

    2008-10-01

    A 70-year-old woman was performed percutaneous coronary intervention at the stenotic lesion of the 1st diagonal branch. Soon after stenting, cardiac tamponade occurred and emergent cardiac surgery was performed. A large epicardial hematoma was observed in the antero-lateral wall that was compressing the distal diagonal branch. The patient died of multi-organ failure 3 days after surgery. An autopsy of her heart revealed an extensive intramural hematoma in the left ventricular wall. There was no evidence of perforation of the stented lesion. The suspected cause was neither coronary perforation nor coronary rupture of target lesion. PMID:18922392

  4. A surgical gauze appearing as a retrocardiac mass in a patient after coronary artery bypass surgery

    Microsoft Academic Search

    Martin Unverdorben; Udo Bauer; Hartmut Oster; Hellmuth Kraska; Christian Vallbracht

    1999-01-01

    Five years after open chest surgery because of three vessel coronary artery disease a patient was referred for progressing dyspnea and recent onset of atrial fibrillation. A retrocardiac mass was detected on chest X-ray and echocardiography. On CT-scan, the inhomogenous tumor made the diagnosis of a retained surgical gauze likely. Through a left incision the sponge was removed uneventfully and

  5. Effect of Aspirin on Postoperative Bleeding in Coronary Artery Bypass Grafting

    Microsoft Academic Search

    Muhammad Kamran; Ali Ahmed; Mudassir Iqbal Dar; Abdul Bari Khan

    Purpose: It is not uncommon for aspirin therapy to be withheld before coronary artery by- pass grafting (CABG) because it is thought to increase the risk of postoperative bleeding. Many studies have shown that continued aspirin therapy reduces postoperative myocardial infarction and increases survival. The purpose of this study is to analyze the effect of preop- erative aspirin on postoperative

  6. Simultaneous carotid endarterectomy and coronary artery bypass grafting in 313 patients

    Microsoft Academic Search

    N Evagelopoulos; M. T Trenz; A Beckmann; A Krian

    2000-01-01

    The coincidence of coronary and carotid artery disease (uni- or bilateral, with or without involvement of the supra-aortic branch) is still a problem with regards to surgical strategy. Since the opening of the Heart Centre Duisburg in 1989 the authors have favoured a simultaneous approach to lesions in both arterial systems in order to avoid myocardial infarction or stroke. The

  7. Coronary artery bypass grafting in a patient with situs inversus totalis and dextrocardia

    Microsoft Academic Search

    Eduardo Keller SAADI; Luis Henrique DUSSIN; Alvaro NICOLAO; Alcides José ZAGO

    2007-01-01

    Situs inversus totalis is a rar e congenital anomaly . We report a case of a 78-year-old woman with this condition and ischemic coronary artery disease who underwent myocardial revascularizatio n. The cardiac catheterism showed severe proximal stenosis with aneurysms in the anterior interventricular branch, diagonal ar tery, and right cor onar y artery . The pr ocedur e was

  8. Oral d,l sotalol reduces the incidence of postoperative atrial fibrillation in coronary artery bypass surgery patients: a randomized, double-blind, placebo-controlled study

    Microsoft Academic Search

    J. Anthony Gomes; John Ip; Francesco Santoni-Rugiu; Davendra Mehta; Arisan Ergin; Steven Lansman; Elena Pe; Teri Takle Newhouse; Sally Chao

    1999-01-01

    OBJECTIVESThe purpose of this prospective, randomized, double-blind, placebo-controlled study was to assess the efficacy of preoperatively and postoperatively administered oral d,l sotalol in preventing the occurrence of postoperative atrial fibrillation (AF).BACKGROUNDAtrial fibrillation is the most common arrhythmia following coronary artery bypass surgery (CABG). Its etiology, prevention and treatment remain highly controversial. Furthermore, its associated morbidity results in a prolongation of

  9. A case of coronary artery bypass grafting for effort angina in a patient with post skin grafting for an extramammary Paget’s desease

    Microsoft Academic Search

    Kensuke Kobayashi; Masahiro Endo; Hiroshi Nishida; Yasuko Tomizawa; Hiroaki Satoh; Hitoshi Koyanagi

    1998-01-01

    The extramammary Paget’s disease of anogenital area is rare, and is seen as a precancerous lesion or carcinoma in situ. In\\u000a most cases, surgical treatment including dissection of regional lymph nodes, skin resection and grafting should be considered\\u000a first. A 74-year-old male suffered from effort angina and underwent triple coronary artery bypass grafting (CABG) including\\u000a saphenous vein graft (SVG) harvested

  10. Level of perioperative B-type natriuretic peptide associates with heart function after on-pump coronary artery bypass graft surgery on a beating heart

    PubMed Central

    Wang, Baocai; Cheng, Zhaoyun; Ge, Zhenwei; Peng, Bangtian; Zhao, Ziniu; Quan, Xiaoqiang

    2015-01-01

    Objective: To explore the relationship of the perioperative B-type natriuretic peptide (BNP) level with heart function among patients undergoing on-pump coronary artery bypass graft surgery on a beating heart. Methods: Total 90 patients expected to undergo coronary artery bypass graft surgery were selected and their left ventricular ejection fraction (LVEF) were examined before operation. Patients with LVEF greater than or equal to 50% were selected as the A group (n=46), and those less than 50% formed the B group (n=44). BNP levels of the patients were examined and its relationship with cardiac function was analyzed. Results: BNP levels of group A was lower than that in group B pre-and post-operatively (until 7 days after the surgery), the difference is statistically significant (p<0.05). Pearson analysis showed that the BNP level was negatively correlated with the LVEF (r = 0.767, p< 0.05). The area under the Roc curve is 0.865. Conclusion: BNP level was negatively correlated with the LVEF. Perioperative BNP level can be used as the prediction for heart function of patients with on-pump coronary artery bypass graft surgery on a beating heart.

  11. Comparing the Effects of Morphine Sulfate and Diclofenac Suppositories on Postoperative Pain in Coronary Artery Bypass Graft Patients

    PubMed Central

    Imantalab, Vali; Mirmansouri, Ali; Sedighinejad, Abbas; Naderi Nabi, Bahram; Farzi, Farnoush; Atamanesh, Hadi; Nassiri, Nassir

    2014-01-01

    Background: Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care. Objectives: This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management. Patients and Methods: In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 ?g/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 ?g/kg/min, fentanyl 1-2 ?g/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients. Results: No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ? 0.05). Total dosage of used morphine was 22 ± 8.3 mg in each patient and total dosage of used diclofenac was 94 ± 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ? 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023). Conclusions: Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery. PMID:25346897

  12. Acute Compartment Syndrome of the Lower Leg after Coronary Artery Bypass Grafting: A Silent but Dangerous Complication.

    PubMed

    Te Kolste, Henryk Jan; Balm, Ron; de Mol, Bas

    2015-06-01

    Background?Acute compartment syndrome (ACoS) is a serious, limb-threatening condition, but ACoS after coronary artery bypass grafting (CABG) is rare. ACoS is diagnosed with the help of typical symptoms, but due to the use of analgesics in a postoperative setting, these symptoms may vary. Identifying risk factors for ACoS after CABG could reduce the risk of developing this complication. Methods?We describe the clinical presentation, diagnosis, and management of five cases of ACoS arising from CABG procedures at our institution during the last 5 years. We also review all cases found in literature about this complication. Discussion?Both systemic and local factors may contribute to ACoS of the lower leg. These factors include increased microvascular permeability caused by cardiopulmonary bypass (CPB), the use of cardiac-assist devices causing arterial occlusion and reperfusion injury, diminished arterial blood flow in patients with peripheral vascular disease due to lithotomy position and the use of elastic bandages and local trauma and hematoma formation due to the harvesting of the greater saphenous vein (GSV). Conclusion?To prevent this serious complication, we advise to pay extra attention to the patients with a greater risk. Hemostasis after venectomy in CABG surgery is mandatory, especially in the endoscopic harvesting of the GSV. Elastic bandages should be applied after weaning from CPB. Elevated creatine phosphokinase values may indicate ACoS. When suspicion arises, intracompartmental pressure measurement is the preferred tool for early recognition and diagnosis. To prevent irreversible, extensive tissue damage and permanent disability fasciotomy must be performed immediately after the diagnosis is made. PMID:25602845

  13. Clinical Characteristics and Outcomes of Patients with Acute Coronary Syndrome and Prior Coronary Artery Bypass Grafting in a Large Middle Eastern Cohort

    PubMed Central

    Alanbaei, Muath; Alsheikh-Ali, Alawi A; Aleinati, Tareq; Zubaid, Mohammad; Ridha, Mustafa; Alenezi, Fahad; Al-Mahmeed, Wael; Sulaiman, Kadhim; Al-Lawati, Jawad; Amin, Haitham; Al Suwaidi, Jassim; Al-Motarreb, Ahmed

    2011-01-01

    Background: Acute Coronary Syndrome (ACS) can occur in patients with prior coronary artery bypass grafting (CABG). In the Gulf Registry of acute coronary events (Gulf RACE), we identified the clinical characteristics and in-hospital outcomes of these patients. Methods: Clinical characteristics and in-hospital outcomes for 461 ACS patients with prior CABG are compared to 7715 ACS patients without prior CABG enrolled from 64 hospitals in 6 Gulf countries over a 6-month period. Results: The overall incidence of ACS with prior CABG was 5.6% out of 8176 patients. The ACS with prior CABG were older (63 vs 55 years, P<0.0001), had more history of diabetes (62.3 vs 37.6%, P <0.0001), dyslipidemia (70.3 vs 29.5%, P<0.0001), and hypertension (75.7 vs 47.8%, P<0.0001) compared with the non-CABG group. They presented more frequently with dyspnea (14.8 vs 9.5%, P<0.0005), non-ST segment elevation myocardial infarction (41.4 vs 31.6%, P<0.0001) and echocardiographic evidence of left ventricular dysfunction (49.4 vs 29.8%, P<0.0001) than ACS without prior CABG. They had a complicated in-hospital course with more recurrent ischemia (13.9 vs 9.3%, P=0.0011), heart failure (24.1 vs 15.7%), and stroke (2.2 vs 0.6%) compared with those without CABG. The in-hospital mortality rate was 5.6% in the CABG group compared with 3.5% in the ACS without prior CABG group. After adjusting for confounders, prior CABG was independently associated with recurrent ischemia and shock, more in patients presenting with ST elevation than non-ST elevation ACS. Conclusions: Patients with ACS and prior CABG are a high-risk group with poor outcomes irrespective of their older age and comorbidities. They should be identified and treated differently to improve their outcomes. PMID:21915225

  14. A surgical gauze appearing as a retrocardiac mass in a patient after coronary artery bypass surgery.

    PubMed

    Unverdorben, M; Bauer, U; Oster, H; Kraska, H; Vallbracht, C

    1999-03-01

    Five years after open chest surgery because of three vessel coronary artery disease a patient was referred for progressing dyspnea and recent onset of atrial fibrillation. A retrocardiac mass was detected on chest X-ray and echocardiography. On CT-scan, the inhomogenous tumor made the diagnosis of a retained surgical gauze likely. Through a left incision the sponge was removed uneventfully and the dyspnea resolved. PMID:10399616

  15. Triple coronary artery bypass graft in a 10-year-old child with familial hypercholesterolemia

    Microsoft Academic Search

    Mohammad Hassan Nemati; Behrooz Astaneh; Afshad Joubeh

    2009-01-01

    Familial hypercholesterolemia is a genetic disorder caused by a mutation in the low density lipoprotein (LDL) receptor gene.\\u000a The homozygous type of the disease is rare and causes tendon xanthomas and coronary artery disease during the early years\\u000a of life. Herein we present a 10-year-old child with familial hypercholesterolemia who had three-vessel disease and was a candidate\\u000a for liver transplantation.

  16. Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting

    PubMed Central

    Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

    2014-01-01

    Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602

  17. Sudden cardiac death after coronary artery bypass grafting is not predicted by signal-averaged ECG

    Microsoft Academic Search

    Christoph Scharf; Hermann Redecker; Firat Duru; Reto Candinas; Hans Peter Brunner-La Rocca; Andreas Gerber; Osmund Bertel; Marko I Turina; Wolfgang Kiowski

    2001-01-01

    Background. Sudden cardiac death (SCD) is a major cause of death despite successful revascularization in patients with coronary artery disease. The signal-averaged ECG (SAECG) is a sensitive predictor of SCD and could be used in the screening strategy to select patients for prophylactic cardioverter implantation.Methods. The SAECG was recorded in 561 patients (mean age: 60 ± 8.8 years) within 10

  18. Modifiable risk factors remain significant causes of medium term mortality after first time Coronary artery bypass grafting

    PubMed Central

    Kunadian, Babu; Dunning, Joel; Millner, Russell WJ

    2007-01-01

    Background Whilst there is much current data on early outcomes after Coronary artery bypass grafting(CABG), there is relatively little data on medium term outcomes in the current era. The purpose of this study is to present a single surgeon series comprising of all first time CABG patients operated on with the technique of cross clamp fibrillation from Feb-1996 to through to Jan-2003, and to seek risk factors for medium term mortality in these patients. Methods Data was collected from Hospital Episode Statistics and departmental patient administration and tracking systems and cross checked using database techniques. Patient outcomes were searched using the National Health Service strategic tracing service. Results Mean follow up was 5.3 years(0–9.4 years) and was complete for all patients. 30-day survival was 98.4%, 1-year survival 95% and 8-year survival 79%. Cox-regression analysis revealed that several modifiable pre-operative risk factors remain significant predictors of medium term mortality, including Diabetes(Hazard Ratio(HR) 1.73, 95%CI 1.21–2.45), Chromic obstructive pulmonary disease(HR 2.02, 95%CI 1.09–3.72), Peripheral vascular disease(HR 1.68, 95%CI 1.13–2.5), Body mass index>30(HR 1.54, 95%CI 1.08–2.20) and current smoker at operation(HR 1.67, 95%CI 1.03–2.72). However hypertension(HR 1.31, 95%CI 0.95–1.82) and Hypercholestrolaemia(HR 0.81, 95%CI 0.58–1.13) were not predictive which may reflect adequate post-operative control. Conclusion Coronary artery bypass surgery using cross clamp fibrillation is associated with a very low operative mortality. Medium term survival is also good but risk factors such as smoking at operation, Chronic obstructive pulmonary disease, obesity and diabetes negatively impact this survival and should be aggressively treated in the years post-surgery. PMID:18053186

  19. Outcomes of Off-Pump Coronary Bypass Grafting with the Bilateral Internal Thoracic Artery for Left Ventricular Dysfunction

    PubMed Central

    Chung, Suryeun; Jeong, Dong Seop; Lee, Jaejin; Lee, Young Tak

    2014-01-01

    This study evaluated the outcomes of off-pump coronary artery bypass surgery (OPCAB) with severe left ventricular dysfunction using composite bilateral internal thoracic artery grafting. From January 2001 to December 2008, 1,842 patients underwent primary isolated OPCAB with composite bilateral internal thoracic artery grafting. A total of 131 of these patients were diagnosed with a severely depressed preoperative left ventricle ejection fraction (LVEF) (?0.35). These patient outcomes were compared with the outcomes of 830 patients that had mildly or moderately depressed LVEF (0.36 to 0.59) and 881 patients with normal LVEF (>0.6). The early mortality for patients with severe LVEF was 2.3%. The 3-yr and 7-yr survival rate for patients with severe LV dysfunction was 86.0% and 82.8%, respectively. Multivariate analysis showed that severe LV dysfunction EF increased the risk of all-cause death (P=0.012; hazard ratio [HR],2.14; 95% confidence interval [CI],1.19-3.88) and the risk of cardiac-related death (P=0.008; HR,3.38; 95% CI, 1.37-8.341). The study identified positive surgical outcomes of OPCAB, although severe LVEF was associated with two-fold increase in mortality risk compared with patients who had normal LVEF. PMID:24431908

  20. Incidental moderate mitral regurgitation in patients undergoing coronary artery bypass grafting: update on guidelines and key randomized trials.

    PubMed

    Ramakrishna, Harish; Ghadimi, Kamrouz; Augoustides, John G T

    2014-02-01

    Incidental moderate mitral regurgitation (MR) in patients presenting for coronary artery bypass grafting (CABG) is not only common but also probably adversely affects clinical outcome. The echocardiographic evaluation of incidental MR must be comprehensive and integrated, as it remains a cornerstone in management decisions. Current guidelines support surgical mitral intervention in this setting as a reasonable option, reflecting clinical equipoise towards moderate MR in the setting of planned CABG. There are currently 2 major randomized trials in progress that will test whether surgical correction of moderate MR combined with CABG improves major clinical outcomes as compared to CABG alone. These landmark trials will be completed in the near future. In the interim, significant progress in the fields of cardiac resynchronization therapy, transcatheter mitral valve intervention, and minimally invasive mitral valve surgery promise to affect the management alternatives for moderate MR in patients undergoing CABG regardless of operative risk. It is likely that in the coming decade there will be less tolerance for incidental moderate MR given its already known outcome effects and the multimodal interventions that continue to mature with better safety profiles. PMID:24440010

  1. Cooling device for bradycardia based on Peltier element for accurate anastomosis of off-pump coronary artery bypass grafting.

    PubMed

    Kuniyoshi, Yukio; Koja, Kageharu; Miyagi, Kazufumi; Shimoji, Mituyoshi; Uezu, Tooru; Arakaki, Katuya; Yamashiro, Satoshi; Mabuni, Katuhito; Senaha, Shigenobu

    2002-10-01

    Upon introducing off-pump coronary artery bypass grafting (CABG), the indications for CABG were expanded to include patients who previously had no operative indications. For accurate anastomosis, various devices and methods have been developed. Bradycardia is easily induced by drug administration. However, this method of achieving bradycardia also has adverse effects on cardiac function. We have developed a new device to decrease the heart rate by regional cooling of the sino-atrial node. The new device is incorporated with Peltier's element, which uses an electric charge to create a temperature gradient on both of its surfaces. In terms of the cooling ability of this device, its cooling surface is chilled from 25 degrees C to 0 degrees C within 30 s. During in vivo animal experiments, this device has been shown to decrease the myocardial temperature around the sino-atrial node to 15 degrees C and suppress sino-atrial node activity, resulting in bradycardia to 60 beats/min level. In summary, the simple and easily applicable device for local cooling in combination with the application of diltiazem for effective heart rate reduction may be very helpful for the surgeon and may avoid disadvantages for critically ill patients. PMID:12296920

  2. NURSES' PERCEPTIONS OF QUALITY NURSING CARE PROVIDED TO POST PROCEDURE ELECTIVE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY PATIENTS

    Microsoft Academic Search

    Sonja Cleary; Sansnee Jirojwong; Sandra Walker

    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

  3. Accuracy of serial myocardial perfusion scintigraphy with /sup 201/Tl for prediction of graft patency early and late after coronary artery bypass surgery. A controlled prospective study

    SciTech Connect

    Pfisterer, M.; Emmenegger, H.; Schmitt, H.E.; Mueller-Brand, J.; Hasse, J.; Graedel, E.; Laver, M.B.; Burckhardt, D.; Burkart, F.

    1982-11-01

    To assess the accuracy of serial myocardial perfusion scintigraphy with /sup 201/Tl to predict graft patency early and late coronary artery bypass surgery, rest and exercise /sup 201/Tl and coronary arteriography were performed preoperatively and 2 weeks and 1 year after operation. The scintigraphic results were compared with graft patency, symptoms, left ventricular function and physical work capacity in a consecutive series of 55 patients with a total of 154 grafts. Serial /sup 201/Tl had an 80% sensitivity, 88% specificity and 86% overall accuracy in detecting or excluding graft occlusion, which was predicted by reversible ischemia as well as persistent new scar segments. Occluded grafts were correctly localized by /sup 201/Tl scintigraphy in 61%. Postoperative apical /sup 201/Tl defects were frequent (two-thirds of cases), and were the result of intraoperative transapical venting of the left ventricle. After coronary bypass graft surgery, ejection fraction at rest was unchanged. Left ventricular end-diastolic pressure and physical work capacity improved significantly. In the presence of new perfusion defects detected postoperatively, physical work capacity was reduced significantly. New /sup 201/Tl defects in addition to typical or atypical angina provided a high probability of graft occlusion, while in the absence of new /sup 201/Tl defects all grafts were patent in more than 90% of patients, all of whom had no or only atypical chest pain. We conclude that serial /sup 201/Tl imaging after coronary artery bypass surgery is an accurate noninvasive method that can be used routinely to assess graft function, to localize spatially occluded grafts and to identify patients with a high likelihood of graft occlusion who may need invasive studies.

  4. The utility of lung epithelium specific biomarkers in cardiac surgery: a comparison of biomarker profiles in on- and off-pump coronary bypass surgery

    PubMed Central

    2013-01-01

    Background Despite continuous improvements in materials and perfusion techniques, cardiac surgery still causes lung injury and a delay of pulmonary recovery. Currently, there is no gold standard for quantifying cardiac surgery induced lung injury and dysfunction. Adding objective measures, such as plasma biomarkers, could be of great use here. In this study the utility of lung epithelium specific proteins as biomarkers for lung dysfunction was evaluated. Methods Serial measurements of plasma concentrations of Clara cell 16 kD (CC16) protein, Surfactant protein D (SP-D), Elastase and Myeloperoxidase were performed on blood samples from 40 patients who underwent coronary artery bypass grafting with cardiopulmonary bypass (CABG, n?=?20) or without cardiopulmonary bypass (OPCAB, n?=?20). Results The increase of SP-D and CC16 between pre-operative concentrations and concentrations at the end of cardiopulmonary bypass, correlated with the Aa-O2 gradient at 1?hour on the ICU (Rs?=?0.409, p?=?.016 and Rs?=?0.343, p?=?.043, respectively). Furthermore, SP-D and CC16 were higher in CABG than in OPCAB at the end of surgery [8.96 vs. 4.91?ng/mL, p?=?.042 and 92 vs. 113%, p?=?.007, respectively]. After 24?h both biomarkers returned to their baseline values. Conclusions Our results show that increases in plasma of SP-D and CC16 correlate with clinical lung injury after coronary artery bypass surgery. Therefore, lung epithelium specific proteins seem to be a useful biomarker for measuring lung injury in the setting of cardiac surgery. PMID:23302601

  5. Changes in Heart Rate Variability Parameters after Elective Percutaneous Coronary Intervention

    PubMed Central

    Abrootan, Saeed; Yazdankhah, Saeed; Payami, Babak; Alasti, Mohammad

    2015-01-01

    Background: Patients with chronic stable angina often have a state of sympathetic hyperactivity. It is considered associated with myocardial ischemia and disappears after ischemia elimination. The aim of this study was to investigate the changes in heart rate variability parameters, a noninvasive technique for the evaluation of the autonomic nervous system activity, after successful revascularization in these patients to evaluate this theory. Methods: The patients were enrolled among those who underwent successful percutaneous coronary intervention. Short-term heart rate variability analyses of all the patients were obtained, and time-domain indices (standard deviation of normal-to-normal intervals [SDNN], standard deviation of differences of successive R-R intervals [SDSD], root-mean square differences of successive R-R intervals [rMSSD], percentage of R-R intervals differing > 10 ms from the preceding one [PNN10], percentage of R-R intervals differing > 20 ms from the preceding one [PNN20], percentage of R-R intervals differing > 30 ms from the preceding one [PNN30], percentage of R-R intervals differing > 40 ms from the preceding one [PNN40], percentage of R-R intervals differing > 50 ms from the preceding one [PNN50], percentage of R-R intervals differing > 60 ms from the preceding one [PNN60], and percentage of R-R intervals differing > 70 ms from the preceding one [PNN70]) were analyzed. All the measurements were made before and after percutaneous coronary intervention. Results: This study included 64 patients, comprising 27 men and 37 women at a mean age of 56.8 ± 9.1 years. There was a significant difference only between pre- and post-revascularization SDNN (27.5 ± 19.72 vs. 41 ± 41.4; p value = 0.013). The other parameters showed no significant differences after successful coronary intervention. Conclusion : Our data indicate that the increase in SDNN in patients with stable angina pectoris undergoing percutaneous coronary intervention seems to be prominent.

  6. Patient and Spouse Perceived Quality of Life Five Years After Coronary Artery Bypass Graft Surgery

    PubMed Central

    Lee, G.A

    2008-01-01

    Health-related quality of life (HRQoL) was examined in patients’ and their respective spouses’ perspectives five years after cardiac bypass surgery. Participants completed the Short-Form 36 (SF-36) which consists of eight domains and two component summary scores measuring physical and mental HRQoL (PCS and MCS respectively). Paired t tests were used to compare couples responses (n=56 pairs) with spouses recording higher (i.e. better scores) in the physical-related domains although differences were not significant. Statistically significant results were found between patients and spouses in emotional role, mental health, social functioning, energy/vitality and general health perceptions (p< 0.001). The PCS were very similar for both the patient and spouses sample (45.9 v. 45.8 respectively, p = .829) and the MCS was significantly higher in the patients compared to the spouses (54.8 v. 47.7, p < .001). The results demonstrated that spouses could accurately report the physical aspects of HRQoL but not the mental health of their partner. PMID:19319222

  7. Prognostic value of myocardial perfusion abnormalities for long-term prognosis in patients after coronary artery bypass grafting

    PubMed Central

    Milvidaite, Irena; Kulakiene, Ilona; Vencloviene, Jone; Kinduris, Sarunas; Jurkiene, Nemira; Grizas, Vytautas; Navickas, Ramunas; Slapikas, Rimvydas

    2014-01-01

    Aims: The objective was to evaluate the prognostic value of exercise myocardial perfusion scintigraphy (MPS) in patients who underwent coronary artery bypass grafting (CABG). Subjects and Methods: A retrospective, one-center study of 361 patients with multivessel coronary artery disease was carried out. All the patients underwent MPS after CABG due to worsened health status. MPS was performed at 4.5 years standard deviation (SD: 0.2), based on symptoms. MPS was carried out using Tc-99m methoxy isobutyl isonitrile and following a 1-day protocol (stress-rest). The end points were analyzed at 6.5 years (SD: 3.3) after MPS, on the average. Statistical Analysis Used: SPSS software for Windows, version 13.0. The t-test or the ?2-test was used. Survival times were calculated. A multivariate Cox proportional hazards model was developed. Results: During the follow-up, death occurred in 54 patients, and 37 patients experienced major adverse cardiovascular events (MACE). In the multivariate analysis, advanced age hazard ratio (HR: 1.45; 95% confidence interval [CI]: 1.4–2.02; P = 0.027), previous myocardial infarction (HR: 3.17; 95% CI: 1.22–8.2; P = 0.018), left ventricular ejection fraction of <40% (HR: 2.16; 95% CI: 1.2–3.89; P = 0.01), and the summed stress score (SSS) of ?4 (HR: 1.87; 95% CI: 1.02–3.41; P = 0.04) were independent predictors of all-cause death. The summed difference score (SDS) was the only independent predictor of MACE (HR: 1.26; 95% CI: 1.06–1.48; P = 0.034). Conclusions: The parameters of MPS were found to have prognostic value in the long-term period after CABG. Advanced age, previous myocardial infarction, decreased left ventricular ejection fraction, and the abnormal SSS were associated with an increased risk of all-cause death. The SDS was found to be the only significant risk factor for MACE. PMID:25400360

  8. Perioperative dexmedetomidine improves mortality in patients undergoing coronary artery bypass surgery

    PubMed Central

    Fuhai, Ji; Zhongmin, Li; Nilas, Young; Peter, Moore; Hong, Liu

    2015-01-01

    Objective This study aimed to retrospectively investigate the effect of dexmedetomidine on outcomes of patients undergoing CABG surgery. Design Retrospective investigation Setting Patients from a single tertiary medical center. Participants 724 patients undergoing CABG surgery met the inclusion criteria were categorized into two groups: 345 in the dexmedetomidine group (DEX) and 379 in the non-dexmedetomidine group (Non-DEX). Interventions Perioperative dexmedetomidine use was defined as an intravenous infusion (0.24 to 0.6mcg/kg/hr) initiated after cardiopulmonary bypass and continued for less than 24 hours postoperatively in the intensive care unit. Measurements and Main Results Major outcome measures of this study were inhospital, 30-day and 1-year all cause mortality, delirium and major adverse cardiocerebral events. Perioperative dexmedetomidine infusion was associated with significant reduction in in-hospital, 30-day and 1-year mortalities, compared to the patients who did not received dexmedetomidine. In-hospital, 30-day and 1-year mortalities were 1.5% and 4.0% (adjusted Odds Ratio [OR], 0.332; 95% CI, 0.155 to 0.708; p = 0.0044), 2.0% and 4.5% (adjusted OR, 0.487; 95%CI, 0.253 to 0.985; p = 0.0305), 3.2% and 6.9% (adjusted OR 0.421; 95%CI, 0.247 to 0.718, p = 0.0015). Perioperative dexmedetomidine infusion was associated with a reduced risk of delirium from 4.6% to 7.9% (adjusted OR, 0.431; 95% CI, 0.265–0.701; P= 0.0007). Conclusion Dexmedetomidine infusion during CABG surgery was more likely to achieve improved in-hospital, 30-day and 1-year survival rates, and a significant lower incidence of delirium. PMID:24182835

  9. Poor Sleep Quality in Patients after Coronary Artery Bypass Graft Surgery: An Intervention Study Using the PRECEDE-PROCEED Model

    PubMed Central

    Ranjbaran, Soheila; Dehdari, Tahereh; Sadeghniiat-Haghighi, Khosro; Majdabadi, Mahmood Mahmoodi

    2015-01-01

    Abstract Background: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG. Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points. Results: The mean age of the patients in the intervention (24% women) and control (24% women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention. Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients.

  10. Disparities in race/ethnicity and gender in in-hospital mortality rates for coronary artery bypass surgery patients.

    PubMed Central

    Becker, Edmund R.; Rahimi, Ali

    2006-01-01

    BACKGROUND: While dramatic progress has been made lowering in-hospital mortality for coronary artery bypass graft surgery (CABG), few comprehensive studies have been done that include Caucasian, African-American, Hispanic and Asian-American/Pacific-Islander CABG inpatients and simultaneously evaluate the influence of gender. This study, analyzing five years of national data for 1.2 million CABG admissions, examines trends in in-hospital CABG mortality rates for gender and four racial/ethnic categories for CABG patients. METHODS: Using data from the Health Care Utilization Project (HCUP) for 1998-2002, 1.2 million CABG admissions were analyzed using descriptive and logistic regression analyses to evaluate the extent of the disparities in in-hospital CABG mortality rates. HCUP is a sample of nearly 1,000 hospitals from 35 states designed by the Agency for Healthcare Research and Quality (AHRQ) to approximate a 20% stratified sample of the nation's community hospitals: approximately 94% of all hospital discharges in the United States. RESULTS: Although significant progress has been made in recent years in lowering in-hospital CABG mortality, after controlling for relevant patient and socioeconomic factors, female CABG patients, regardless of their racial/ethnic group, still experience significantly higher in-hospital mortality rates than their male counterparts. Additionally, among these racial and ethnic groups, black CABG patients, whether male or female, continue to experience significantly worse in-hospital mortality rates than other races/ethnicities. CONCLUSIONS: The declines in CABG in-hospital mortality rates have not been equal across race/ethnicity and gender. PMID:17128680

  11. Long-term influence of mild or moderate ischemic mitral regurgitation after off-pump coronary artery bypass surgery

    PubMed Central

    Hong, Jong-Myeon; Cartier, Raymond; Pellerin, Michel; Demers, Philippe; Bouchard, Denis; Couture, Pierre

    2010-01-01

    BACKGROUND: The issue of mild to moderate ischemic mitral regurgitation (IMR) is controversial after conventional surgery, and has not been specifically studied after off-pump coronary artery bypass graft (OPCAB) surgery. OBJECTIVE: To review the influence of mild or moderate IMR on long-term survival and recurrent cardiac events after OPCAB surgery. METHODS: A total of 1000 consecutive and systematic OPCAB patients who underwent operations between September 1996 and March 2004 were prospectively followed. Sixty-seven patients (6.7%) had mild to moderate IMR at the time of surgery. Operative mortality, actuarial survival and major adverse cardiac event-free survival were studied to assess the effect of IMR. RESULTS: The mean (± SD) follow-up period was 66±22 months and was completed in 97% of the cohort. IMR patients were older (P<0.001), and had lower ejection fractions (P<0.001) and more comorbidities. More female patients presented with IMR (P=0.002). Operative mortality (P=0.25) and prevalence of perioperative myocardial infarction (P=0.25) were comparable for both groups. Eight-year survival was decreased in IMR patients (P<0.001), but after adjusting for risk factors in the Cox regression model, mild to moderate IMR was not found to be a significant risk factor of long-term mortality (P=0.42). Major adverse cardiac event-free survival at eight years was significantly lower in IMR patients (P<0.001) and, more specifically, in patients with 2+ IMR. After adjusting for risk factors, IMR remained a significant cause of poor outcome (hazard ratio 2.09), especially for recurrent congestive heart failure and myocardial infarction. CONCLUSIONS: OPCAB patients with preoperative mild or moderate IMR had a higher prevalence of preoperative risk factors than those without IMR. They had comparable perioperative mortality and morbidity but, over the long term, were found to be at risk for recurrent cardiac events. PMID:20386769

  12. Sternal Healing after Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Arteries: Assessment by Computed Tomography Scan

    PubMed Central

    Shin, Yoon Cheol; Kim, Sue Hyun; Kim, Dong Jung; Kim, Dong Jin; Kim, Jun Sung; Lim, Cheong; Park, Kay-Hyun

    2015-01-01

    Background This study aimed to investigate sternal healing over time and the incidence of poor sternal healing in patients undergoing coronary artery bypass graft (CABG) surgery using bilateral internal thoracic arteries. Methods This study enrolled 197 patients who underwent isolated CABG using skeletonized bilateral internal thoracic arteries (sBITA) from 2006 through 2009. Postoperative computed tomography (CT) angiography was performed on all patients at monthly intervals for three to six months after surgery. In 108 patients, an additional CT study was performed 24 to 48 months after surgery. The axial CT images were used to score sternal fusion at the manubrium, the upper sternum, and the lower sternum. These scores were added to evaluate overall healing: a score of 0 to 1 reflected poor healing, a score of 2 to 4 was defined as fair healing, and a score of 5 to 6 indicated complete healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results Three to six months after surgery, the average total score of sternal healing was 2.07±1.52 and 68 patients (34.5%) showed poor healing. Poor healing was most frequently found in the manubrium, which was scored as zero in 72.6% of patients. In multivariate analysis, the factors associated with poor early healing were shorter post-surgery time, older age, diabetes mellitus, and postoperative renal dysfunction. In later CT images, the average sternal healing score improved to 5.88±0.38 and complete healing was observed in 98.2% of patients. Conclusion Complete sternal healing takes more than three months after a median sternotomy for CABG using sBITA. Healing is most delayed in the manubrium. PMID:25705595

  13. The Impact of Peplau's Therapeutic Communication Model on Anxiety and Depression in Patients Candidate for Coronary Artery Bypass

    PubMed Central

    Zarea, Kourosh; Maghsoudi, Solmaz; Dashtebozorgi, Bahman; Hghighizadeh, Mohammad Hossin; Javadi, Mostafa

    2014-01-01

    Background and Objective: Anxiety and depression are among the psychological disorders in heart surgeries. Establishing a simple communication is essential to reduce anxiety and depression. Hence, the objective of the present studywas to examine the impact of Peplau therapeutic communication model on anxiety and depression in patients, who were candidate for coronary artery bypass in Al-Zahra Heart Hospital, Shiraz during 2012-2013. Methods: This is a clinical trial in which 74 patients were randomly divided into intervention and control groups, each consisted of 37 patients. Anxiety and depression levels were assessed before, and two and four months after intervention using the Hospital Anxiety and Depression Scale (HADS). Seven therapeutic communication sessions were held in four stages. Data were analyzed with the SPSS (version 16) using analysis of covariance. Results: The mean anxiety and depression levels decreased in the intervention group after the therapeutic communication (p<0.01). Anxiety scores in the intervention group before and after intervention were 10.23 and 9.38, respectively. While the corresponding scores in the control group were 10.26 and 11.62, respectively. Depression scores in the intervention group before and after intervention were 11 and 9.13, respectively. The corresponding scores in the control group were 11.30 and 12.08, respectively. Conclusion: The results demonstrated the positive role of therapeutic communication in reducing anxiety and depression of the patients. Therefore, the therapeutic communication is recommended as a simple, cost effective and efficient method in this area. PMID:25505931

  14. Food pattern and quality of life in metabolic syndrome patients who underwent coronary artery bypass grafting in Taiwan.

    PubMed

    Tung, Heng-Hsin; Tseng, Li-Hua; Wei, Jeng; Lin, Cheng-Hsin; Wang, Tsae-Jyy; Liang, Shu-Yuan

    2011-12-01

    Metabolic syndrome is associated with poor operative outcomes of coronary artery bypass grafting surgery (CABG). A healthy food pattern for metabolic syndrome patients is necessary not only in the initial stage to prevent cardiovascular disease but for those who experience cardiovascular problems and undergo heart surgery. Empirical studies that explore food pattern and quality of life metabolic syndrome patients who undergo CABG are lacking. Therefore, the objectives of this study are to explore the food pattern and quality of life of metabolic syndrome patients who undergo CABG and to examine the relationship between these two variables. A descriptive, correlational and cross section design was conducted. Through convenience sampling, 104 patients were recruited. Data were collected through three instruments: a demographic questionnaire; the Chinese Food Frequency Questionnaire-Short Form (Short C-FFQ), used to assess food pattern; and the Taiwanese version of the Medical Outcomes Study Short Form 36-Health Survey (SF-36), used to assess quality of life. Descriptive analysis, one-way analysis of variance (ANOVA) and Pearson correlation were used to analyze the data. The results indicated that patients who ate fruit more frequently tended to have a better quality of life, while the intake of fried food was more frequently associated with a poor quality of life. The use of these data gives the health care provider a better understanding of food pattern and their impact on quality of life in this population. Such an understanding can be used to develop targeted interventions to promote health in this and in other populations. PMID:20609630

  15. Hand Grip Strength and Myocardial Oxygen Consumption Index among Coronary Artery Bypass Grafting Patients

    PubMed Central

    Sokran, Siti Nur Baait Biniti Mohd; Mohan, Vikram; Kamaruddin, Kamaria; Sulaiman, Mohd Daud; Awang, Yahya; Othman, Ida Rosmini Binti; Victor, Smiley Jesu Priya

    2015-01-01

    Background Hand grip strength (HGS) is a reliable indicator of peripheral muscle strength. Although, numerous studies have investigated the strength of hand grip; little attention has been given to coronary artery disease (CAD) patients, exploring the relationship between HGS and myocardial oxygen consumption (MVO2) index. The current study aimed to evaluate the interaction between HGS and MVO2 index findings before and after cardiac surgery. Methods Twenty-seven patients with CAD had HGS were assessed using handheld dynamometer. HGS for each hand were documented. MVO2 index was assessed using rate pressure product (RPP), which is the product of the heart rate (HR) and systolic blood pressure (SBP). Repeated measures MANOVA were carried out to estimate the interaction between both hands HGS and MVO2 index before and after surgery. Results There was significant interactions (P<0.001) for both HGS dominant and non-dominant with large effect sizes (HGS dominant×MVO2 index: hp2=0.44; HGS dominant×RPP: hp2=0.49). This signifies that peripheral muscle strength of the upper limb (HGS dominant and non-dominant) had different effects on MVO2 index before and after surgery. The interaction graph shows that the increase in MVO2 index after surgery was significantly greater for peripheral muscle strength of the dominant hand when compared to non-dominant.  Conclusion Patients with CAD had interactions between HGS and oxygen consumption before and after surgery. Hence, HGS might be used as a predictor to assess oxygen consumption among cardiac patients.

  16. Successful use of the Impella Recover LP 5.0 device for circulatory support during off-pump coronary artery bypass grafting

    PubMed Central

    Pepino, Paolo; Coronella, Germano; Oliviero, Piermario; Monaco, Mario; Schiavone, Vincenzo; Finizio, Filippo; Biondi-Zoccai, Giuseppe; Frati, Giacomo; Giordano, Arturo

    2014-01-01

    INTRODUCTION Surgical coronary revascularization is being performed with ever increasing frequency in patients at high surgical risk. Off-pump coronary artery bypass grafting (OPCABG) is particularly appealing in such subjects, but may limit the options for concomitant mechanical circulatory support. PRESENTATION OF CASE We hereby report an original case of mechanical circulatory support with the Impella Recover LP 5.0 device during OPCABG in a 61-year-old gentleman with multiple comorbidities and severe left ventricular systolic dysfunction. Specifically, the soft tipped device did not impede surgical manipulation of the heart during the surgical procedure, providing uninterrupted circulatory support to the patient. DISCUSSION This clinical vignette supports the feasibility, safety and efficacy of the Impella Recover LP 5.0 device in patients undergoing OPCABG. CONCLUSION Pending further studies, use of the Impella Recover LP 5.0 device can be envisioned safely for OPCABG. PMID:25305600

  17. [Is aortocoronary bypass indicated in patients with lesions of the common trunk of the left coronary artery incapable of complete revascularization?].

    PubMed

    Barboso, G; Saccani, S; Busi, M; Fesani, F

    1980-01-01

    Obstructive lesions of the left common coronary trunk need surgery if our operability criteria: possibility of at least making a by-pass on the left descending anterior coronary branch and a not seriously compromised miocardial contractility exist. Of the 25 patients operated, there was a mortality of 8% and 3 intra-and post-operatory infarcts; two other patients died after some time (one for extracardiac causes). Other infarcts were not observed. 48% of the patients had incomplete riva-scolarization which after some time had an effect on the objective state of the patients but not on their survival. The authors conclude their studies by affirming that total surgical correction is indicated even on non susceptible patients on the basis of coronarography. PMID:6971115

  18. Coronary bypass graft fate and patient outcome: Angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years

    Microsoft Academic Search

    Gerald M. Fitzgibbon; Henryk P. Kafka; Alan J. Leach; Wilbert J. Keon; G. David Hooper; Jeffrey R. Burton

    1996-01-01

    Objectives. We sought to examine, angiographically, the long-term fate of a large number of mainly venous coronary bypass grafts and to correlate graft patency and disease with patient survival and reoperation.Background. Much is known about bypass graft patency and disease, but the precise relation between graft fate and patient outcome has not been substantiated and documented.Methods. A total of 1,388

  19. Comparison of 30-day and 5-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients aged?50 years (the Coronary aRtery diseAse in younG adultS Study).

    PubMed

    Biancari, Fausto; Gudbjartsson, Tomas; Heikkinen, Jouni; Anttila, Vesa; Mäkikallio, Timo; Jeppsson, Anders; Thimour-Bergström, Linda; Mignosa, Carmelo; Rubino, Antonino S; Kuttila, Kari; Gunn, Jarmo; Wistbacka, Jan-Ola; Teittinen, Kari; Korpilahti, Kari; Onorati, Francesco; Faggian, Giuseppe; Vinco, Giulia; Vassanelli, Corrado; Ribichini, Flavio; Juvonen, Tatu; Axelsson, Tomas A; Sigurdsson, Axel F; Karjalainen, Pasi P; Mennander, Ari; Kajander, Olli; Eskola, Markku; Ilveskoski, Erkki; D'Oria, Veronica; De Feo, Marisa; Kiviniemi, Tuomas; Airaksinen, K E Juhani

    2014-07-15

    Data on the outcome of young patients after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are scarce. Data on 2,209 consecutive patients aged?50 years who underwent CABG or PCI were retrospectively collected from 15 European institutions. PCI and CABG had similar 30-day mortality rates (0.8% vs 1.4%, p=0.27), late survival (at 5 years, 97.8% vs 94.9%, p=0.082), and freedom from stroke (at 5 years, 98.0% and 98.0%, p=0.731). PCI was associated with significantly lower freedom from major adverse cardiac and cerebrovascular events (at 5 years, 73.9% vs 85.0%, p<0.0001), repeat revascularization (at 5 years, 77.6% vs 92.5%, p<0.0001), and myocardial infarction (at 5 years, 89.9% vs 96.6%, p<0.0001) compared with CABG. These findings were confirmed in propensity score-adjusted and matched analyses. Freedom from major adverse cardiac and cerebrovascular events after PCI was particularly low in diabetics (at 5 years, 58.0% vs 75.9%, p<0.0001) and in patients with multivessel disease (at 5 years, 63.6% vs 85.1%, p<0.0001). PCI in patients with ST elevation myocardial infarction was associated with significantly better 5-year survival (97.5% vs 88.8%, p=0.001), which was driven by its lower 30-day mortality rate (1.5% vs 6.0%, p=0.017). In conclusion, patients aged?50 years have an excellent immediate outcome after either PCI or CABG with similar long-term survival when used according to the current clinical practice. PCI was associated with significantly lower freedom from myocardial infarction and repeat revascularization. PMID:24878127

  20. Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts

    PubMed Central

    Frauenfelder, Thomas; Boutsianis, Evangelos; Schertler, Thomas; Husmann, Lars; Leschka, Sebastian; Poulikakos, Dimos; Marincek, Borut; Alkadhi, Hatem

    2007-01-01

    Purpose Coronary artery bypass graft (CABG) surgery represents the standard treatment of advanced coronary artery disease. Two major types of anastomosis exist to connect the graft to the coronary artery, i.e., by using an end-to-side or a side-to-side anastomosis. There is still controversy because of the differences in the patency rates of the two types of anastomosis. The purpose of this paper is to non-invasively quantify hemodynamic parameters, such as mass flow and wall shear stress (WSS), in end-to-side and side-to-side anastomoses of patients with CABG using computational fluid dynamics (CFD). Methods One patient with saphenous CABG and end-to-side anastomosis and one patient with saphenous CABG and side-to-side anastomosis underwent 16-detector row computed tomography (CT). Geometric models of coronary arteries and bypasses were reconstructed for CFD analysis. Blood flow was considered pulsatile, laminar, incompressible and Newtonian. Peri-anastomotic mass flow and WSS were quantified and flow patterns visualized. Results CFD analysis based on in-vivo CT coronary angiography data was feasible in both patients. For both types of CABG, flow patterns were characterized by a retrograde flow into the native coronary artery. WSS variations were found in both anastomoses types, with highest WSS values at the heel and lowest WSS values at the floor of the end-to-side anastomosis. In contrast, the highest WSS values of the side-to-side anastomosis configuration were found in stenotic vessel segments and not in the close vicinity of the anastomosis. Flow stagnation zones were found in end-to-side but not in side-to-side anastomosis, the latter also demonstrating a smoother stream division throughout the cardiac cycle. Conclusion CFD analysis of venous CABG based on in-vivo CT datasets in patients was feasible producing qualitative and quantitative information on mass flow and WSS. Differences were found between the two types of anastomosis warranting further systematic application of the presented methodology on multiple patient datasets. PMID:17897460

  1. Performance of EuroSCORE in CABG and off-pump coronary artery bypass grafting: single institution experience and meta-analysis

    PubMed Central

    Parolari, Alessandro; Pesce, Lorenzo L.; Trezzi, Matteo; Loardi, Claudia; Kassem, Samer; Brambillasca, Claudio; Miguel, Bruno; Tremoli, Elena; Biglioli, Paolo; Alamanni, Francesco

    2009-01-01

    Aims To assess EuroSCORE performance in predicting in-hospital mortality in on-pump coronary artery bypass grafting (CABG) and off-pump coronary artery bypass grafting (OPCAB). Methods and results Additive and logistic EuroSCORE were computed for consecutive patients undergoing CABG (n = 3440, 75%) or OPCAB (n = 1140, 25%) at our hospital from 1999 to September 2007. The areas under the receiver operating characteristic (ROC) curves (AUCs) were used to describe performance and accuracy. No difference in performance between CABG and OPCAB and between additive and logistic EuroSCORE (additive EuroSCORE AUCs of 0.808 and 0.779 for CABG and OPCAB, respectively; logistic EuroSCORE AUCs of 0.813 and of 0.773 for CABG and OPCAB, respectively) was found, although a marked tendency to overpredict mortality by both models was evident. A meta-analysis of previously published data was done, and a total of eight studies representing 19 212 and 5461 patients undergoing CABG and OPCAB, respectively, met inclusion criteria. Meta-analysis confirmed similar performance of EuroSCORE in CABG and OPCAB: estimated AUCs were 0.767 and 0.766 for CABG and OPCAB, respectively, with an estimated difference of 0.001 (95% CI ?0.061 to 0.063). Conclusion Additive and logistic EuroSCORE algorithms performed similarly, and cumulative evidence suggests comparable performance in CABG and OPCAB procedures; both risk models, however, significantly overestimated mortality. PMID:19141560

  2. Return to work after rehabilitation in coronary bypass patients. Role of the occupational medicine specialist during rehabilitation.

    PubMed

    Monpere, C; Francois, G; Rondeau du Noyer, C; Phan Van, J

    1988-11-01

    The aim of the study was to assess the role of the occupational medicine specialist in improving return to work (RTW) after coronary bypass graft (CABG) surgery, with an early intervention in the rehabilitation programme of the patients. There were 57 patients (56 male, 1 female, mean age was 50.7 years), sent for rehabilitation 22 days after surgery (49% of them had a prior myocardial infarction, and the ejection fraction (EF) was greater than or equal to 0.55 in 67%, 0.30 less than EF less than 0.55 in 25%, or less than or equal to 0.30 in 8%; myocardial revascularization was complete in 47% of the patients). Jobs required a high level of physical activity in 52.5% of the patients, a medium or low level in 44% and 3.5% of the patients were unemployed. At 7 months follow-up, 73.2% out of the 56 alive patients had returned to work with a mean delay of 109.9 +/- 84 days after surgery. The causes of non-return to work were social and economical factors (46.6%), psychological factors (40%) and medical reasons (13.4%). No clinical data were correlated with return to work (age, EF, extent of revascularization, or results of the stress tests), but return to work varied with the energy requirement in jobs with 97.3% return to work in case of low physical level, and 46.7% in case of high physical level (P less than 0.001). The comparison with a previous study performed in 1984 in 45 rehabilitation patients (with non-systematic vocational counselling), showed an increase in return to work in cardiac patients from 51% to 78% (P less than 0.05) after intervention of the occupational physician. So, the different ways of improving return to work in post-CABG patients are complementary: exercise training and secondary prevention are important, but must be completed with individual vocational counselling that should be included in every rehabilitation programme. PMID:3266597

  3. Impact of admission serum glucose level on in-hospital outcomes following coronary artery bypass grafting surgery

    PubMed Central

    Imran, Syed Ali; Ransom, Thomas PP; Buth, Karen J; Clayton, Dale; Al-Shehri, Bandar; Ur, Ehud; Ali, Imtiaz S

    2010-01-01

    OBJECTIVE: The impact of admission serum glucose (SG) level on outcomes in coronary artery bypass grafting (CABG) surgery is unknown. The present study sought to determine whether elevated admission SG level is associated with adverse outcomes following CABG surgery. METHODS: Patients undergoing CABG surgery between January 2000 and December 2005 at a single centre were identified (n=2856). Admission SG levels of less than 9.2 mmol/L and 9.2 mmol/L or greater were chosen to divide patients into two groups based on the 75th percentile of SG distribution. A logistic regression model was generated to determine the impact of admission SG level on a composite outcome of any one or more of in-hospital mortality, stroke, perioperative myocardial infarction, sepsis, deep sternal wound infection, renal failure, requirement for postoperative inotropes and prolonged ventilation. RESULTS: In total, 76.3% of patients had an admission SG level of less than 9.2 mmol/L (group A) and 23.7% had an admission SG level of 9.2 mmol/L or greater (group B). Group B patients were more likely to be female, have diabetes, have preoperative renal failure, have an ejection fraction of less than 40%, experience myocardial infarction within 21 days before surgery, and have triple vessel or left main disease (P<0.05). Univariate analysis revealed no difference in in-hospital mortality between group A (2.2%) and group B (3.2%) (P=0.12); however, the composite outcome was more likely to occur in group B (40.8%) versus group A (27.9%) (P=0.0001). After multivariable adjustment, admission SG level of 9.2 mmol/L or greater remained an independent predictor of composite outcome (OR=1.3, 95% CI 1.0 to 1.7, P=0.02, receiver operating characteristic = 78%). CONCLUSION: Admission SG level of 9.2 mmol/L or greater is associated with significant morbidity in patients undergoing CABG surgery. PMID:20352135

  4. The Effects of Propofol Cardioplegia on Blood and Myocardial Biomarkers of Stress and Injury in Patients With Isolated Coronary Artery Bypass Grafting or Aortic Valve Replacement Using Cardiopulmonary Bypass: Protocol for a Single-Center Randomized Controlled Trial

    PubMed Central

    Plummer, Zoe E; Baos, Sarah; Rogers, Chris A; Suleiman, M-Saadeh; Bryan, Alan J; Angelini, Gianni D; Hillier, James; Downes, Richard; Nicholson, Eamonn

    2014-01-01

    Background Despite improved myocardial protection strategies, cardioplegic arrest and ischemia still result in reperfusion injury. We have previously published a study describing the effects of propofol (an anesthetic agent commonly used in cardiac surgery) on metabolic stress, cardiac function, and injury in a clinically relevant animal model. We concluded that cardioplegia supplementation with propofol at a concentration relevant to the human clinical setting resulted in improved hemodynamic function, reduced oxidative stress, and reduced reperfusion injury when compared to standard cardioplegia. Objective The Propofol cardioplegia for Myocardial Protection Trial (ProMPT) aims to translate the successful animal intervention to the human clinical setting. We aim to test the hypothesis that supplementation of the cardioplegic solution with propofol will be cardioprotective for patients undergoing isolated coronary artery bypass graft or aortic valve replacement surgery with cardiopulmonary bypass. Methods The trial is a single-center, placebo-controlled, randomized trial with blinding of participants, health care staff, and the research team. Patients aged between 18 and 80 years undergoing nonemergency isolated coronary artery bypass graft or aortic valve replacement surgery with cardiopulmonary bypass at the Bristol Heart Institute are being invited to participate. Participants are randomly assigned in a 1:1 ratio to either cardioplegia supplementation with propofol (intervention) or cardioplegia supplementation with intralipid (placebo) using a secure, concealed, Internet-based randomization system. Randomization is stratified by operation type and minimized by diabetes mellitus status. Biomarkers of cardiac injury and metabolism are being assessed to investigate any cardioprotection conferred. The primary outcome is myocardial injury, studied by measuring myocardial troponin T. The trial is designed to test hypotheses about the superiority of the intervention within each surgical stratum. The sample size of 96 participants has been chosen to achieve 80% power to detect standardized differences of 0.5 at a significance level of 5% (2-tailed) assuming equal numbers in each surgical stratum. Results A total of 96 patients have been successfully recruited over a 2-year period. Results are to be published in late 2014. Conclusions Designing a practicable method for delivering a potentially protective dose of propofol to the heart during cardiac surgery was challenging. If our approach confirms the potential of propofol to reduce damage during cardiac surgery, we plan to design a larger multicenter trial to detect differences in clinical outcomes. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 84968882; http://www.controlled-trials.com/ISRCTN84968882/ProMPT (Archived by WebCite at http://www.webcitation.org/6Qi8A51BS). PMID:25004932

  5. Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial

    Microsoft Academic Search

    L. P Perrault; H Jeanmart; L Bilodeau; J Lespérance; J.-F Tanguay; D Bouchard; P Pagé; M Carrier

    2004-01-01

    ObjectiveEndoscopic saphenectomy is associated with a decreased incidence of wound complications without an increase in histologic trauma or endothelial dysfunction in published reports. Concern remains about the patency of saphenous vein grafts harvested endoscopically and the development of early intimal hyperplasia. The purpose of this study was to compare early quantitative coronary analysis of saphenous vein grafts used for coronary

  6. A decade of change—risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990–1999: a report from the STS National Database Committee and the Duke Clinical Research Institute

    Microsoft Academic Search

    T. Bruce Ferguson; Bradley G Hammill; Eric D Peterson; Elizabeth R DeLong; Frederick L Grover

    2002-01-01

    Background. The Society of Thoracic Surgeons National Adult Cardiac Database is the largest voluntary clinical database in medicine. Using this database we examined changes in the risk profile of patients undergoing isolated coronary artery bypass grafting (CABG) and their outcomes during the decade 1990 to 1999.Methods. Trends in 23 preoperative risk factors were tracked for CABG cases during this decade.

  7. AntiC5a monoclonal antibody reduces cardiopulmonary bypass and cardioplegia-induced coronary endothelial dysfunction

    Microsoft Academic Search

    Motohisa Tofukuji; Gregory L. Stahl; Azin Agah; Caroline Metais; Michael Simons; Frank W. Sellke

    1998-01-01

    Objective: Because C5a induces tissue injury by activating polymorphonuclear leukocytes, the hypothesis was that inhibition of C5a activity would reduce cardioplegia-related injury. Methods: Pigs were placed on cardiopulmonary bypass. The hearts were arrested for 1 hour with hyperkalemic cardioplegia. Pigs were then separated from bypass, and the hearts were reperfused for 2 hours. Anti-porcine C5a monoclonal antibody (1.6 mg\\/kg, intravenously;

  8. The effect of lavender essential oil on anxiety level in patients undergoing coronary artery bypass graft surgery: A double-blinded randomized clinical trial

    PubMed Central

    Seifi, Zahra; Beikmoradi, Ali; Oshvandi, Khodayar; Poorolajal, Jalal; Araghchian, Malihe; Safiaryan, Reza

    2014-01-01

    Background: Open heart surgery can cause high levels of anxiety in patients. Nowadays, lavender essential oil is widely used in medical research. This study was conducted with an aim to investigate the effects of lavender essential oil to reduce the anxiety of patients after coronary artery bypass surgery. Materials and Methods: This research is double-blinded randomized controlled trial on 60 patients who had undergone coronary artery bypass surgery in a 2-day intervention targeting reduction of anxiety. This study was conducted in Ekbatan Therapeutic and Educational Center, Hamadan city, Iran, in 2013. The patients in the inhalation aromatherapy group inhaled two drops of 2% lavender essential oil and those in the control group inhaled two drops of distilled water as placebo for 20 min on the 2nd and 3rd days after surgery. The level of anxiety was evaluated by Spielberger's State Anxiety questionnaire before and after intervention and the vital signs were documented as well. Data were analyzed using Stata 11 (Stata Corp., College Station, TX, USA) by independent t-test for continuous variables and Chi-square test for categorical variables. Results: The mean score of anxiety in the aromatherapy group was 48.73 ± 5.08 and in the control group was 48 ± 6.98 before the intervention (P = 0.64), which reduced after the intervention to 42.6 ± 5.44 and 42.73 ± 7.30, respectively. On the 3rd day after surgery, the mean score of anxiety in the aromatherapy group was 46.76 ± 4.07 and in the control group was 46.53 ± 7.05 before the intervention, which reduced to 41.33 ± 3.65 and 41.56 ± 6.18, respectively, after the intervention. However, there was no statistically significant difference in the mean scores of anxiety between the aromatherapy and control groups. Conclusions: Lavender essential oil has no significant effect on anxiety in patients after coronary artery bypass surgery, although it decreased the level of anxiety in the patients. PMID:25558253

  9. Myocardial revascularization in patients with end-stage renal disease: Comparison of percutaneous transluminal coronary angioplasty and coronary artery bypass grafting

    Microsoft Academic Search

    K. Ivens; F. Gradaus; P. Heering; F. C. Schoebel; M. Klein; H. D. Schulte; B. E. Strauer; B. Grabensee

    2001-01-01

    Background: Ischemic heart disease is the major cause of death inpatients with end-stage renal disease. The high prevalence of coronary\\u000a artery disease results in a rising number of dialysis patients requiring myocardial revascularisation. Objective: The objective of this study was to compare the outcomes of recurrent angina, myocardial infarction, rate of reinterventions\\u000a and cardiovascular death following percutaneous coronary angioplasty (PTCA)

  10. Comparing mortality and myocardial infarction between coronary artery bypass grafting and drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis

    PubMed Central

    Qi, Xiaolong; Xu, Mingxin; Yang, Haitao; Zhou, Lin; Mao, Yu; Song, Haoming; Li, Quan

    2014-01-01

    Introduction We aim to compare the midterm outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients who had multivessel coronary artery diseases (CAD). Material and methods A comprehensive literature search was conducted to identify the related clinical studies with a follow-up for 1 year at least. The endpoints were death, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE). Results Finally, the analysis of ten studies involving 5,264 patients showed that patients with CABG had worse baseline characteristics, a higher rate of stable angina pectoris, a higher percentage of triple-vessel disease, higher incidence of chronic total occlusion and a higher SYNTAX score. However, there was no significant difference in mortality between the two groups. Additionally, the rates of myocardial infarction and MACCE were markedly decreased in the CABG group. Conclusions The strategy of CABG is better than PCI for diabetic patients with multivessel CAD. The CABG can significantly reduce the rates of myocardial infarction and MACCE and is comparable in mortality despite the worse baseline characteristics. PMID:25097568

  11. Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

    PubMed Central

    Guizilini, Solange; Viceconte, Marcela; Esperança, Gabriel Tavares da M.; Bolzan, Douglas W.; Vidotto, Milena; Moreira, Rita Simone L; Câncio, Andréia Azevedo; Gomes, Walter J

    2014-01-01

    Objective To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. Methods A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27) - pleural drain in intercostal space; SI group (n=29) - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second) were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5) was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1. Results In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second) until POD5 (P<0.05). However, when compared, SI group presented less decrease in these parameters (P<0.05). Pulmonary shunt fraction was significantly lower in SI group (P<0.05). Respiratory events, pain score, orotracheal intubation time and postoperative length of hospital stay were lower in the SI group (P<0.05). Conclusion Subxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting. PMID:25714214

  12. Preoperative atrial fibrillation is an independent risk factor for mid-term mortality after concomitant aortic valve replacement and coronary artery bypass graft surgery

    PubMed Central

    Saxena, Akshat; Dinh, Diem; Dimitriou, Jim; Reid, Christopher; Smith, Julian; Shardey, Gilbert; Newcomb, Andrew

    2013-01-01

    OBJECTIVES Preoperative atrial fibrillation (PAF) has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery. Few studies, however, have evaluated the impact of PAF on early and mid-term outcomes after concomitant aortic valve replacement and coronary aortic bypass graft (AVR-CABG) surgery. METHODS Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program was retrospectively analysed. Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded. Demographic and operative data were compared between patients undergoing concomitant AVR-CABG who presented with PAF and those who did not using chi-square and t-tests. The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression, respectively. RESULTS Concomitant AVR-CABG surgery was performed in 2563 patients; 322 (12.6%) presented with PAF. PAF patients were generally older (mean age 76 vs 74 years; P < 0.001) and presented more often with comorbidities including congestive heart failure, chronic pulmonary disease and cerebrovascular disease (all P < 0.05). PAF was associated with 30-day mortality on univariate analysis (P = 0.019) but not multivariate analysis (P = 0.53). The incidence of early complications was not significantly higher in the PAF group. PAF was independently associated with reduced mid-term survival (HR, 1.58; 95% CI, 1.14–2.19; P = 0.006). CONCLUSIONS PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery. Patients with PAF undergoing AVR-CABG should be considered for a concomitant surgical ablation procedure. PMID:23287590

  13. Short-Term Complications and Resource Utilization in Matched Subjects After On-Pump or Off-Pump Primary Isolated Coronary Artery Bypass

    PubMed Central

    Hravnak, Marilyn; Hoffman, Leslie A.; Saul, Melissa I.; Zullo, Thomas G.; Cuneo, Julie F.; Pellegrini, Ronald V.

    2013-01-01

    Background Studies suggest that patients who undergo off-pump coronary artery bypass grafting (OPCABG) have fewer short-term complications and use fewer inpatient resources than do patients who undergo standard coronary artery bypass grafting (CABG) with extracorporeal circulation. However, dissimilarity between groups in risk factors for complications has hindered interpretation of results. Objectives To compare the prevalence of selected complications (atrial fibrillation, stroke, reoperation, and bleeding) and inpatient resource utilization (length of stay, discharge disposition, total charges) between subjects undergoing primary isolated CABG or OPCABG who were matched with respect to key risk factors. Methods Retrospective, causal-comparative survey conducted in 1 center for 18 months. Patients who underwent primary isolated CABG or OPCABG were matched for sex, age (within 2 years), left ventricular ejection fraction (within 0.05), and graft-patient ratio (exact match) and compared for prevalence of new-onset atrial fibrillation, stroke, reoperation within 24 hours, and bleeding. Statistical analysis included Wilcoxon and t tests for paired comparisons. Results The sample (107 matched pairs) was 63% male, with a mean age of 66 (SD 9.5) years, a mean left ventricular ejection fraction of 0.51 (SD 0.13), and a mean graft-patient ratio of 3.41 (SD 0.74). The 2 groups did not differ significantly in New York Heart Association class (P=.43), Acute Physiology and Chronic Health Evaluation III score (P=.22), postoperative ?-blocker use (P=.73), or comorbid conditions. None of the complications examined differed significantly between pairs. Conclusion Patients with comparable risk profiles have similar prevalences of selected complications after CABG and OPCABG. PMID:15568655

  14. Frequency Rate of Atelectasis in Patients Following Coronary Artery Bypass Graft and Its Associated Factors at Mazandaran Heart Center in 2013-2014

    PubMed Central

    Esmaeili, Ravanbakhsh; Nasiri, Ebrahim; Ghafari, Rahman; Mousavinasab, Seyed Nouraddin; Saffari, Neshat Hasan Niyayeh

    2015-01-01

    Background and aim: As the most common postoperative pulmonary complication after cardiac surgery, atelectasis is one of the most important and serious early postoperative complications and one of the most important causes of prolonged hospitalization, increased costs, and mortality rise. Therefore, the present study was aimed at specifying the frequency of atelectasis in patients following coronary artery bypass graft and its associated factors in Mazandaran Heart Center in 2013-2014. Materials and methods: The present investigation was a descriptive cross-sectional study in which sequential sampling was used. It was conducted on 375 patients whose coronary artery bypass graft had been performed by the same surgeon and anesthesiologist. For data collection, first the patients’ demographic variables and the information of their surgery were retrieved through their profiles, direct observation, patient inquiry, and the collected data were recorded in the data collection forms. Then, atelectasis was measured before the surgery and on the first and second days after it by taking CXR whose results were checked by two radiologists who were not aware of the previous observations. Data were analyzed through t-test, Pearson test, and Chi-square test using SPSS 16.0. Results: The results of the present study indicated that, 123 out of 375 patients (32.8%) were diagnosed with at least one type of tattletales during the first three days after the surgery. The mean age of the patients who were diagnosed with atelectasis was 62.9±9 and most of them were female. The results also showed that there was a significant relationship between postoperative frequency of atelectasis and the patients’ pulmonary diseases and underlying diseases like diabetes and hyperlipidemia, smoking and alcohol use before the surgery, and transfusion of 4 units of packed red blood cells during the surgery (p<0.05). Conclusion: Atelectasis is the most common postoperative complication which emerges more in patients with pulmonary and underlying diseases than other patients. PMID:26005251

  15. Better Outcome for Women Compared With Men Undergoing Coronary Revascularization A Report From the Bypass Angioplasty Revascularization Investigation (BARI)

    Microsoft Academic Search

    Alice K. Jacobs; Sheryl F. Kelsey; Maria Mori Brooks; David P. Faxon; Bernard R. Chaitman; Vera Bittner; Michael B. Mock; Bonnie H. Weiner; Larry Dean; Carla Winston; Laura Drew; George Sopko

    Background—Numerous studies have shown that women undergoing coronary revascularization procedures do so at a higher risk for an adverse outcome compared with men. However, the impact of advances in technology and improvements in techniques on in-hospital and long-term outcome after revascularization in women is unclear. Methods and Results—We evaluated 1829 patients with symptomatic multivessel coronary disease randomized to CABG or

  16. Study of levosimendan during off-pump coronary artery bypass grafting in patients with LV dysfunction: A double-blind randomized study

    PubMed Central

    Shah, B.; Sharma, P.; Brahmbhatt, A.; Shah, R.; Rathod, B.; Shastri, Naman; Patel, J.; Malhotra, A.

    2014-01-01

    Objectives: Levosimendan is a calcium sensitizer drug which has been used in cardiac surgery for the prevention of postoperative low cardiac output syndrome (LCOS) and in difficult weaning from cardiopulmonary bypass (CPB). This study aims to evaluate perioperative hemodynamic effects of levosimendan pretreatment in patients for off-pump coronary artery bypass graft (OPCABG) surgery with low left ventricular ejection fractions (LVEF < 30%). Materials and Methods: Fifty patients undergoing OPCABG surgery with low LVEF (<30%) were enrolled in the study. Patients were randomly divided in two groups: Levosimendan pretreatment (Group L) and placebo pretreatment (Group C) of 25 each. Group L, patients received levosimendan infusion 200 ?g/kg over 24 h and in Group C Patients received placebo. The clinical parameters measured before and after the drug administration up to 48 h were heart rate (HR; for the hour after drug infusion), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP). The requirement of inotropes, intraaortic balloon pump (IABP), CPB, intensive care unit (ICU) stay, and hospital stay were also measured. Results: The patients in group L exhibited higher CI and PCWP during operative in early postoperative period as compared to control group C. Group L also had a less requirement for inotropes, CPB support and IABP with shorter ICU stay as well as hospital stay. Conclusion: Levosimendan pretreatment (24 h infusion) in patient for OPCABG with poor LVEF shows better outcomes and hemodynamics in terms of inotropes, CPB and IABP requirements. It also reduces ICU stay. PMID:24550581

  17. Ginkgo biloba Extract (EGb 761) Pretreatment Limits Free Radical Oxidative Stress in Patients Undergoing Coronary Bypass Surgery

    Microsoft Academic Search

    Sylvia Pietri; Jacques R. Séguin; Pierre d'Arbigny; Katy Drieu; Marcel Culcasi

    1997-01-01

    A growing body of evidence supports the trigger role of free radicals in the delayed functional and metabolic myocardial recovery following cardiopulmonary bypass (CPB) in humans, thus opening the field to specific therapies. This clinical study was designed to evaluate, in 15 patients undergoing aortic valve replacement, whether the extent of CPB- and reperfusion-induced lipid peroxidation, ascorbate depletion, tissue necrosis,

  18. The role of combined carotid endarterectomy and coronary artery bypass grafting in the era of carotid stenting in view of long-term results

    PubMed Central

    Levy, Eli; Yakubovitch, Dimtry; Rudis, Ehud; Anner, Haim; Landsberg, Giora; Berlatzky, Yaakov; Elami, Amir

    2012-01-01

    OBJECTIVES The management of concomitant coronary and carotid artery disease is still in evolution. The surgical options are staged approach—carotid endarterectomy (CEA), followed by coronary artery bypass grafting (CABG) or a reversed-staged approach, or combined approach—CEA and CABG under the same anaesthesia. In view of the percutaneous carotid artery stenting option, we have reviewed our short- and long-term experience with combined CEA and CABG to define the role of this procedure. METHODS From January 1992 to December 2006, we operated on 80 patients performing combined carotid endarterctomy and myocardial revascularization. Short- and long-term results were reviewed. RESULTS Operative mortality was 3.7%. Perioperative cerebrovascular accident (CVA) occurred in 2 patients (2.5%). Perioperative myocardial infarction (MI) occurred in 3 patients (3.7%). Combined complications of death + MI + CVA = 10%. During the mean follow-up of 10 ± 3.2 years (1–14 years), 6 patients (7.6%) had neurological events. Freedom from neurological events for 10 years was 92 ± 4%. Nearly 17 (21.5%) had cardiac events. The 5-year and 10-year survival rates were 74 ± 5 and 62 ± 6%, respectively. CONCLUSIONS Although the short-term results of the non-surgical carotid therapeutic alternative is similar to our surgical results, there are limitations to carotid artery stenting: the need for aggressive antiplatelets therapy, and the haemodynamic changes during the procedure that may be unacceptable for patients with unstable coronary artery disease. Therefore, there is still a role for concomitant surgical CEA and CABG to the results of which the other options should be compared. PMID:22968959

  19. Intraoperative Color Doppler Ultrasound Assessment of LIMA-to-LAD Anastomoses in Off-Pump Coronary Artery Bypass Grafting

    Microsoft Academic Search

    Rune Haaverstad; Nicola Vitale; Ole Tjomsland; Arve Tromsdal; Hans Torp; Stein O. Samstad

    Background. Although techniques for off-pump coro- nary artery bypass grafting (CABG) are continually being refined, angiographic follow-up studies have indicated a higher rate of anastomoses-related stenoses than ex- pected after traditional on-pump CABG. This study was performed to evaluate the use of intraoperative epicar- dial color Doppler ultrasound to quality-assess left inter- nal mammary artery (LIMA) to left anterior descending

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

    Microsoft Academic Search

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

    2002-01-01

    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

  1. End-tidal CO2 for prediction of cardiac output following weaning from cardiopulmonary bypass.

    PubMed

    Baraka, Anis S; Aouad, Marie T; Jalbout, Maya I; Kaddoum, Roland N; Khatib, Mohammad F; Haroun-Bizri, Sania T

    2004-09-01

    This prospective study included 32 patients undergoing cardiopulmonary bypass (CPB) for elective coronary artery bypass grafting correlates the respiratory end-tidal CO2 (ETCO2) during partial separation from CPB with cardiac output (CO) following weaning from CPB. After induction of general anesthesia, a pulmonary artery catheter was inserted for measurement of cardiac output by thermodilution. Patients were monitored using a 5-lead ECG, pulse oximeter, invasive blood pressure monitoring, rectal temperature probe, and end-tidal capnography. At the end of surgery, patients were weaned from CPB in a stepwise fashion. Respiratory ETCO2 and in-line venous oximetry were continuously monitored during weaning. The ETCO2 was recorded at quarter pump flow and after complete weaning from CPB. Following weaning from CPB, CO was measured by thermodilution. The CO values were correlated with the ETCO2 during partial bypass and following weaning from bypass. Regression analysis of ETCO2 at quarter-flow and post-bypass CO showed significant correlation (r = 0.57, p < .001). Also, regression analysis of ETCO2 after complete weaning from bypass and post-bypass CO showed significant correlation (r = 0.6, p = .002). The correlation between ETCO2 and CO showed that an ETCO2 >30 mm Hg during partial CPB will always predict an adequate CO following weaning from CPB. An ETCO2 <30 mm Hg may denote either a low or a normal cardiac output and hence other predictive parameters such as SvO2 must be added. PMID:15559744

  2. The effects of tranexamic acid and 6% hydroxyethyl starch (HES) solution (130/0.4) on postoperative bleeding in coronary artery bypass graft (CABG) surgery

    PubMed Central

    Yanartas, M; Baysal, A; Ayd?n, C; Ay, Y; Kara, ?; Ayd?n, E; Cevirme, D; Köksal, C; Sunar, H

    2015-01-01

    Background: The addition of 6% hydroxyethyl starch (HES) into Ringer lactate priming solution may have adverse effects on hemostasis in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) with or without the use of tranexamic acid. Methods: In a prospective, randomized clinical trial, 132 patients were assigned to receive 20 ml/kg of Ringer priming solution with or without tranexamic acid (TA) (Group RS-TA, n=34 and Group RS-noTA, n=32) or 10 ml/kg of 6% HES plus 10 ml/kg of RS priming solution with or without intravenous tranexamic acid (Group HES-TA, n=35 and Group HES-noTA, n=31). Estimated blood loss, chest tube drainage, amount of blood products, hemoglobin, hematocrit, platelet and coagulation parameters were examined before and 24 hour after surgery. Results: For Group HES with tranexamic acid, when compared to other groups, estimated blood loss, postoperative 24 hour drainage loss and blood product transfusions were less (P=0.023; P=0.003; P=0.001; respectively) and hemoglobin, hematocrit values at 12 and 24 hours after surgery increased in comparison to other groups (P=0.041, P=0.034, P=0.004, P=0.001; respectively). Platelet concentrations were similar between groups (P>0.05). Conclusions: In CABG, the administration of tranexamic acid in HES 130/0.4 prime solution study group decreased estimated blood loss and chest tube drainage in comparison to patients receving Ringer prime solution with or without tranexamic acid postoperatively however, no effects on renal functions or postoperative complications were shown.

  3. Coronary artery bypass graft surgery: socioeconomic inequalities in access and in 30 day mortality. A population-based study in Rome, Italy

    PubMed Central

    Ancona, C.; Agabiti, N.; Forastiere, F.; Arca, M.; Fusco, D.; Ferro, S.; Perucci, C.

    2000-01-01

    OBJECTIVES—To evaluate whether coronary artery bypass graft (CABG) surgery is equally provided among different socioeconomic status (SES) groups in accordance with need. To estimate the association between SES and mortality occurring 30 days after CABG surgery.?DESIGN—Individual socioeconomic index assigned with respect to the characteristics of the census tract of residence (level I = highest SES; level IV = lowest SES). Comparison of age adjusted hospital admission rates of ischaemic heart disease (IHD) and CABG surgery among four SES groups. Retrospective cohort study of all patients who underwent CABG surgery during 1996-97.?SETTING—Rome (2 685 890 inhabitants) and the seven cardiac surgery units in the city.?PARTICIPANTS—All residents in Rome aged 35 years or more. A cohort of 1875 CABG patients aged 35 years or more.?MAIN OUTCOME MEASURES—Age adjusted hospitalisation rates for CABG and IHD and rate of CABG per 100 IHD hospitalisations by SES group, taking level I as the reference group. Odds ratios of 30 day mortality after CABG surgery, adjusted for age, gender, illness severity at admission, and type of hospital where CABG was performed.?RESULTS—People in the lowest SES level experienced an excess in the age adjusted IHD hospitalisation rates compared with the highest SES level (an excess of 57% among men, and of 94% among women), but the rate of CABG per 100 IHD hospitalisations was lower, among men, in the most socially disadvantaged level (8.9 CABG procedures per 100 IHD hospital admissions in level IV versus 14.1 in level I rate ratio= 0.63; 95% CI 0.44, 0.89). The most socially disadvantaged SES group experienced a higher risk of 30 day mortality after CABG surgery (8.1%) than those in the highest SES group (4.8%); this excess in mortality was confirmed even when initial illness severity was taken into account (odds ratio= 2.89; 95% CI 1.44, 5.80).?CONCLUSIONS—The universal coverage of the National Health Service in Italy does not guarantee equitable access to CABG surgery for IHD patients. Factors related to SES are likely to influence poor prognosis after CABG surgery.???Keywords: coronary artery bypass graft; ischaemic heart disease; socioeconomic status PMID:11076990

  4. On-versus Off-Pump Coronary Artery Bypass Grafting: No Difference in Early Postoperative Kidney Function Based on TNF-? or C-Reactive Protein

    PubMed Central

    Nezami, Nariman; Djavadzadegan, Hassan; Tabatabaie-Adl, Haleh; Hamdi, Amir; Ghobadi, Kazem; Ghorashi, Sona; Hajhosseini, Babak

    2012-01-01

    Background/Aims There are controversial data about renal function following off-pump coronary artery bypass grafting (CABG). The present study aimed to evaluate renal function changes 24 h after on- and off-pump CABG, as well as renal function correlated with high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-? (TNF-?). Methods Ninety patients with coronary artery disease referred to our center for CABG from July 2006 to November 2007 were enrolled in the study. Patients were equally and randomly divided in two groups, on- and off-pump. Serum levels of creatinine (Cr), blood urea nitrogen, creatinine clearance (CrCl), hs-CRP, and TNF-? were determined immediately before and 24 h after surgery. Results Cr and CrCl changes after surgery were not significantly different between the two groups; however, blood urea nitrogen levels after surgery were significantly higher in the on-pump group (p = 0.035). No statistically significant difference was noted between the two groups in terms of changes in levels of hs-CRP and TNF-? (p = 0.350 and 0.805, respectively). The changes in CrCl levels had no significant correlation with hs-CRP and TNF-?. Conclusions The early Cr and CrCl levels after surgery are not significantly different in on- and off-pump groups. The early renal function after on- or off-pump CABG is not correlated with the levels of inflammatory markers including hs-CRP and TNF-?. PMID:22969775

  5. Coronary artery surgery: indications and recent experience.

    PubMed Central

    Robinson, P. S.; Coltart, D. J.; Jenkins, B. S.; Webb-Peploe, M. M.; Braimbridge, M. V.; Williams, B. T.

    1978-01-01

    The comprehensive experience of coronary artery surgery in a Cardiothoracic Unit over a 31-month period is reviewed. Hospital mortality for elective bypass grafting was 3.9% overall and 2.5% in those with good pre-operative left ventricular function. Major influences on hospital mortality were pre-operative left ventricular function, extent of coronary artery disease and extent of the surgical procedure undertaken in terms of number of aortocoronary grafts inserted, coronary endarterectomy and particularly concomitant valve surgery or aneurysm resection. Follow-up experience shows 74% of grafted patients to be symptom-free and 85% symptomatically improved one year after surgery with 70% symptom-free and 80% improved at two years. Early post-operative deaths appear related to early graft closure and recurrence of symptoms postoperatively to late graft closure or progression of coronary disease in the native circulation. The study provides a guide to the relative risks of coronary artery surgery for symptomatic coronary artery disease and expected symptomatic results in the early follow-up period. PMID:310999

  6. A comparative analysis of saphenous vein conduit harvesting techniques for coronary artery bypass grafting--standard bridging versus the open technique.

    PubMed

    Khan, Ursalan A; Krishnamoorthy, Bhuvaneswari; Najam, Osman; Waterworth, Paul; Fildes, James E; Yonan, Nizar

    2010-01-01

    Coronary artery bypass graft (CABG) surgery involves harvesting the great saphenous vein (GSV) using the traditional open technique (TOT). This can be associated with significant leg morbidity and patient dissatisfaction. Alternatively, the standard bridging technique (SBT) is a minimally invasive procedure of vein retrieval that uses smaller frequent incisions along the length of the leg and may reduce postoperative complications. This study was designed to compare the success of SBT in reducing leg morbidity and increasing patient satisfaction. One hundred patients were recruited into the study and computer randomised into two groups of 50 undergoing SBT or TOT. Leg morbidity and patient satisfaction were analysed by assessment of pain scores, wound development and scar formation. Closure and harvesting time were also compared between the two groups. SBT was associated with better wound development (P<0.001) and a significantly higher patient satisfaction (P<0.001). Leg pain was significantly reduced amongst SBT group at rest and with movement (P<0.001). There was also a reduction in saphenous neuropathy with the use of SBT (P<0.001). No difference in closure or harvesting time was demonstrated (P=0.26 and P=0.23, respectively). This study demonstrates that harvesting the GSV by the minimally invasive SBT reduces postoperative leg morbidity and increases patient satisfaction without the need of costly equipment. SBT represents a safe, effective and financially viable technique for vein harvesting. PMID:19696051

  7. Comparison of the Complications between Left Side and Right Side Subclavian Vein Catheter Placement in Patients Undergoing Coronary Artery Bypass Graft Surgery

    PubMed Central

    Tarbiat, Masoud; Manafi, Babak; Davoudi, Maryam; Totonchi, Ziae

    2014-01-01

    Introduction: Percutaneous subclavian vein catheterization is one of the most common invasive procedures performed in cardiac surgery. The aim of this study was to compare left and right subclavian vein catheter placement via the infraclavicular approach in patients who undergo coronary artery bypass graft (CABG) surgery. Methods: This prospective, randomized clinical trial was performed in193 patients. The technique applied for cannulation was infraclavicular approach for both the right and the left sides. Subclavian vein of other side was attempted only when catheterization at initial side was unsuccessful at two attempts. The success and complication rates were compared for the two sides. Results: On193 patients, catheterization attempts were performed. Overall 177 catheterizations (91.7%) were successful during the first attempt, 105 (92.1%) on the right side and 72 (91.1%) on the left side. There was no significant difference between success rate and side of catheterization. Malposition of the catheter tip on the right side (9.6%) was significantly more than the left side (0%) (P= 0.003). The differences in other complications on two sides were statistically insignificant. Conclusion: Compared with the right side, insertion of the cannula on the left side resulted in fewer catheter tip misplacements. Incidence of cannulation failure and other complications were similar on both sides. PMID:25320661

  8. Optimism measured pre-operatively is associated with reduced pain intensity and physical symptom reporting after coronary artery bypass graft surgery

    PubMed Central

    Ronaldson, Amy; Poole, Lydia; Kidd, Tara; Leigh, Elizabeth; Jahangiri, Marjan; Steptoe, Andrew

    2014-01-01

    Objective Optimism is thought to be associated with long-term favourable outcomes for patients undergoing coronary artery bypass graft (CABG) surgery. Our objective was to examine the association between optimism and post-operative pain and physical symptoms in CABG patients. Methods We assessed optimism pre-operatively in 197 adults undergoing CABG surgery, and then followed them up 6–8 weeks after the procedure to measure affective pain, pain intensity, and physical symptom reporting directly pertaining to CABG surgery. Results Greater optimism measured pre-operatively was significantly associated with lower pain intensity (? = ? 0.150, CI = ? 0.196 to ? 0.004, p = .042) and fewer physical symptoms following surgery (? = ? 0.287, CI = ? 0.537 to ? 0.036, p = .025), but not with affective pain, after controlling for demographic, clinical and behavioural covariates, including negative affectivity. Conclusions Optimism is a modest, yet significant, predictor of pain intensity and physical symptom reporting after CABG surgery. Having positive expectations may promote better recovery. PMID:25129850

  9. Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass

    Microsoft Academic Search

    Luiz A Brasil; Walter J Gomes; Reinaldo Salomão; Enio Buffolo

    1998-01-01

    Background. Tumor necrosis factor-? has been implicated in complications seen after cardiac operations with cardiopulmonary bypass. The release of tumor necrosis factor-? and its possible effects were studied in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass.Methods. Twenty patients were studied, 10 with (group 1) and 10 without cardiopulmonary bypass (group 2). Serial blood samples were obtained

  10. No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis

    Microsoft Academic Search

    Silvana F. Marasco; Lisa N. Sharwood; Michael J. Abramson

    2010-01-01

    Summary The popularity of off-pump (beating heart) coronary artery bypass grafting (CABG) was initially stimulated by numerous theoretical benefits includinglowerincidenceof strokeandneurocognitivedysfunction.Witha postoperativestroke rateofless than1%for electiveCABG, ithas been very difficult to demonstrate any significant differences in this outcome between techniques. However, changes in neurocognitive function are more common in the postoperative setting and thus provide greater power for demonstrating improvement with

  11. Assessment of Perfusion toward the Aortic Valve Using the New Dispersion Aortic Cannula during Coronary Artery Bypass Surgery

    PubMed Central

    Grooters, Ronald K.; Thieman, Kent C.; Schneider, Robert F.; Nelson, Mark G.

    2000-01-01

    When there is an echocardiographic diagnosis of severe mobile atherosclerotic plaque in the aortic arch or descending aorta, perfusion toward the aortic arch during cardiopulmonary bypass may create a high risk of embolic neurologic injury. Other perfusion methods, such as cannulation of the femoral or axillary arteries, are not always possible, due to atherosclerosis. The ascending aorta may be an alternative site for perfusion, since it is less frequently diseased. We assessed a new technique of perfusion toward the aortic valve using a new cannula designed for this purpose (Dispersion aortic cannula). Our study included 100 consecutive patients, 72 men and 28 women, with an average age of 68 ± 1.0 years (range, 39–89 years). There were no complications related to insertion of the cannula or perfusion. The ascending aorta could be cross-clamped and side-clamped without perfusion problems. Three deaths occurred; none was related to the cannulation technique. No intra-operative stroke occurred. Two patients suffered neurologic events, one on day 1 and the other on day 6; both had been fully alert after surgery. Perfusion toward the aortic valve appears to be safe and hemodynamically effective. This cannulation technique appears to be an acceptable alternative to present methods. Comparative studies will be needed to determine whether this alternative technique is effective in patients with severe aortic arch disease. PMID:11198309

  12. The platelet-to-lymphocyte ratio as a predictor of all-cause mortality in patients with coronary artery disease undergoing elective percutaneous coronary intervention and stent implantation

    PubMed Central

    Osadnik, Tadeusz; Wasilewski, Jaros?aw; Lekston, Andrzej; Strzelczyk, Joanna; Kurek, Anna; Gonera, Ma?gorzata; Gawlita, Marcin; Regu?a, Rafa?; Bujak, Kamil; Szygu?a-Jurkiewicz, Bo?ena; Wiczkowski, Andrzej; Polo?ski, Lech

    2015-01-01

    Background There is no data regarding the association between the platelet-to-lymphocyte ratio (PLR) and long-term mortality in patients with stable coronary artery disease (SCAD). The aim of this study is to evaluate the utility of the pre-procedural PLR for predicting long-term, all-cause mortality in patients with SCAD undergoing percutaneous coronary intervention (PCI) and stent implantation. Methods We analyzed a total of 2959 consecutive patients with SCAD who underwent PCI (balloon angioplasty followed by stent implantation or direct stenting) between July 2006 and December 2011 at our institution. The patients were stratified into tertiles according to their admission PLR. The association between the PLR value and the outcomes was assessed using Cox proportional regression analysis after adjusting for clinical angiographic and laboratory data. Results During median follow-up of 1124 days, mortality was highest in patients with PLR within the 3rd tertile as compared to the 2nd and the 1st tertile (11.0% vs 8.7% vs. 9.6%, respectively, p = 0.03). PLR remained associated with mortality in multivariable analysis including clinical variables, ejection fraction and angiographic parameters HR (per 10 units increase) = 1.02 [95%CI,1.01 ÷ 1.04, p = 0.006]. After adjustment for the eGFR and hemoglobin levels, PLR was however no longer significantly associated with mortality. Conclusion PLR has potential predictive value in patients with SCAD, which has not been reported previously, but statistical significance disappears after adjusting for estimated glomerular filtration rate (eGFR) and hemoglobin levels as a potential confounding variable.

  13. Efficacy of Long-Term ?-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Zhang, Heng; Yuan, Xin; Zhang, Haibo; Chen, Sipeng; Zhao, Yan; Hua, Kun; Rao, Chenfei; Wang, Wei; Sun, Hansong; Hu, Shengshou

    2015-01-01

    Background— Conflicting results from recent observational studies have raised questions concerning the benefit of ?-blockers for patients undergoing coronary artery bypass grafting (CABG). Furthermore, the efficacy of long-term ?-blocker therapy in CABG patients after hospital discharge is uncertain. Methods and Results— The study included 5926 consecutive patients who underwent CABG and were discharged alive. The prevalence and consistency of ?-blocker use were determined in patients with and without a history of myocardial infarction (MI). ?-Blockers were always used in 1280 patients (50.9%) with and 1642 patients (48.1%) without previous MI after CABG. Compared with always users (n=2922, 49.3%), the risk of all-cause death was significantly higher among inconsistent ?-blocker users (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.50–2.57), and never using ?-blockers was associated with increased risk of both all-cause death (HR, 1.42; 95% CI, 1.01–2.00) and the composite of adverse cardiovascular events (HR, 1.29; 95% CI, 1.10–1.50). In the cohort without MI, the HR for all-cause death was 1.70 (95% CI, 1.17–2.48) in inconsistent users and 1.23 (95% CI, 0.76–1.99) in never users. In the MI cohort, mortality was higher for inconsistent users (HR, 2.14; 95% CI, 1.43–3.20) and for never users (HR, 1.59; 95% CI, 1.07–2.63). Consistent results were obtained in equivalent sensitivity analyses. Conclusions— In patients with or without previous MI undergoing CABG, the consistent use of ?-blockers was associated with a lower risk of long-term mortality and adverse cardiovascular events. Strategies should be developed to understand and improve discharge prescription of ?-blockers and long-term patient adherence. PMID:25908770

  14. Comparing the impact of supine and leg elevation positions during coronary artery bypass graft on deep vein thrombosis occurrence: a randomized clinical trial study.

    PubMed

    Ayatollahzade-Isfahani, Farah; Pashang, Mina; Omran, Abbas Salehi; Saadat, Soheil; Shirani, Shapour; Fathollahi, Mahmood Sheikh

    2013-06-01

    Deep vein thrombosis (DVT) is a common preoperative complication that occurs in patients who undergoing coronary artery bypass grafting surgery (CABG). Early ambulation, elastic stockings, intermittent pneumatic compression, and leg elevation, before and after surgery, are among preventative interventions. The goal of the study was to compare the effect of supine position with that of leg elevation on the occurrence of DVT during CABG and after, until ambulation. Between October, 2008, and May, 2011, a total of 185 eligible CABG patients admitted to the Cardiac Surgery Unit were randomly assigned to groups designated as the supine group (n = 92) or the leg-elevation group (n = 93). Of this total, 92 patients were assigned to the supine group and 93 to the leg-elevation group. Doppler ultrasonography of the superficial and deep veins in the lower extremities was performed for each patient before and after surgery. Logistic regression analysis was conducted to investigate the possible independent factors associated with DVT. DVT was detected in 25 (13.5%) patients: 17 (18.4%) patients in the supine position group and 8 (8.6%) in the leg-elevation group (P value = .065). After adjustment for confounding factors there was no effect of position on the presence of DVT (P = .126).Clots were often localized in legs ipsilateral to the saphenous vein harvest. The authors conclude that a positive, albeit not statistically significant, trend was evident toward higher incidence of silent DVT in supine position during and after CABG in comparison with leg elevation. Future studies with larger sample sizes are required to confirm this result. PMID:23683764

  15. Storage of saphenous vein grafts prior to coronary artery bypass grafting: is autologous whole blood more effective than saline in preserving graft function?

    PubMed Central

    Tsakok, Maria; Montgomery-Taylor, Sarah; Tsakok, Teresa

    2012-01-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: ‘Is storage of saphenous vein grafts in autologous whole blood prior to coronary artery bypass grafting (CABG) more effective than storage in saline in preserving graft function?’ Altogether more than 580 papers were found using the reported search, of which, 10 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Preservation of the vein graft endothelium during graft preparation is of well-recognized importance in forestalling graft occlusion and saphenous vein graft disease following CABG, however, the different preservation capabilities of saline vs autologous whole blood are not well validated. Although there is a complete lack of randomized clinical trials addressing this issue, some studies using basic in vitro techniques and animal models can be extrapolated to answer the clinical question in hand. All are consistent in demonstrating the detrimental effects of saline on vascular endothelium and therefore graft patency, but there is some disagreement in the literature as to whether autologous whole blood is superior as a storage medium. Though three well-designed studies suggest preserved endothelial function when saphenous vein grafts are stored in saline compared with storage in autologous whole blood, data from other studies are unimpressive, with two studies showing no difference. Furthermore, two elegant experiments that seek to mimic in vivo conditions by comparing outcomes postarterialization show no benefit of prior storage in autologous whole blood, despite the initial better-preserved endothelium. Instead, some notice should be taken of alternative storage solutions such as the University of Wisconsin solution, as some early studies suggest that it may be advantageous over both blood and crystalloid solution. PMID:22753436

  16. Intermediate and high peri-operative cardiac enzyme release following isolated coronary artery bypass surgery are independently associated with higher one-year mortality

    PubMed Central

    Newall, N; Oo, AY; Palmer, ND; Grayson, AD; Hine, TJ; Stables, RH; Fabri, BM; Ramsdale, DR

    2006-01-01

    Background The relationship between cardiac enzyme (CE) release following coronary artery bypass surgery (CABG) and medium term outcome is unclear. We sought to determine the relationship between post-operative CE release and one-year survival following isolated CABG. Methods Over three years 3,024 consecutive patients underwent isolated CABG. Patient characteristics were prospectively recorded in a cardiac surgical database. CE release, taken as the highest single measurement recorded in the first 24 hours post-op, was abstracted from an electronic archive. All cause mortality was taken from a national registry of deaths. Results Data were complete for 2,860 (94.6%) patients. CK-MB isoenzyme (reference range 5–24 U/l) was recorded in 2,568 (89.8%), total CK in 292 (10.2%). CE release three or more times the upper limit of the reference range (ULR) were recorded in 498 (17.4%) patients, 163 (5.7%) patients had CE more than six times ULR. There were 122 deaths (4.3%). Cox proportional hazards analysis showed that CE release 3–6 times ULR (adjusted HR 2.1 [95% CI: 1.6 to 2.6], p = 0.002) and CE release six or more times the ULR (adjusted HR 5.0 [95% CI: 4.5 to 5.4], p < 0.001) were independently associated with increased one-year mortality. Conclusion Cardiac enzyme release following CABG is associated with increased one-year all-cause mortality. The definition of peri-operative myocardial infarction following CABG should include elevation of CK-MB three or more times the upper limit of normal. PMID:16911773

  17. The protective effect of topical rifamycin treatment against sternal wound infection in diabetic patients undergoing on-pump coronary artery bypass graft surgery

    PubMed Central

    Aygun, Fatih; Kuzgun, Ahmet; Ulucan, Seref; Keser, Ahmet; Akpek, Mahmut; Kaya, Mehmet G

    2014-01-01

    Summary Objectives The aim of this study was to investigate the protective effect of topical rifamycin SV treatment against sternal wound infection (SWI) in diabetic patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods One hundred and fifty-nine diabetic patients who were scheduled to undergo isolated on-pump CABG surgery were included. Eight were excluded for various reasons. Of the 151 patients, 51 were on insulin therapy and 100 were on oral anti-diabetics. The risk of mediastinitis was assessed using the American College of Cardiology/American Heart Association 2004 guideline update for CABG surgery. According to the risk scores, patients were divided into two comparable groups: the rifamycin group (n = 78) received topical rifamycin treatment after on-pump CABG surgery, and the control group (n = 73) received no topical treatment. Results Deep sternal wound infection (mediastinitis) was not observed in either group (0/78 vs 0/73, p = 1.0). No superficial sternal wound infection was observed in the rifamycin group, however, it did occur in one patient in the control group (0/78 vs 1/73, p = 0.303). Wound culture was performed and coagulase-negative staphylococci were observed. The infection regressed on initiation of antibiotic therapy against isolated bacteria and the patient was discharged after a full recovery. Conclusion Although the difference in rate of superficial sternal wound infection (SSWI) in the rifamycin and control groups was not statistically significant, locally applied rifamycin SV during closure of the sternum in the CABG operation may have had a protective affect against SWI. PMID:24687038

  18. Comparison of Outcome of Transcatheter Aortic Valve Implantation With Versus Without Previous Coronary Artery Bypass Grafting (from the FRANCE 2 Registry).

    PubMed

    Castellant, Philippe; Didier, Romain; Bezon, Eric; Couturaud, Francis; Eltchaninoff, Hélène; Iung, Bernard; Donzeau-Gouge, Patrick; Chevreul, Karine; Fajadet, Jean; Leprince, Pascal; Leguerrier, Alain; Lievre, Michel; Prat, Alain; Teiger, Emmanuel; Laskar, Marc; Boschat, Jacques; Gilard, Martine

    2015-08-01

    Previous coronary artery bypass grafting (CABG) increases operative risk in conventional valve replacement. Transcatheter aortic valve implantation (TAVI) has been shown to be successful in high-risk patient subgroups. The present study compared outcome and overall survival in patients who underwent TAVI with and without history of CABG. From January 2010 to December 2011, 683 of the 3,761 patients selected for TAVI in 34 French centers (18%) had a history of CABG. Outcomes (mortality and complications) were collected prospectively according to the Valve Academic Research Consortium (VARC) criteria. Patients with previous CABG were younger, with higher rates of diabetes and vascular disease and higher logistic European System for Cardiac Operative Risk Evaluation (29.8 ± 16.4 vs 20.1 ± 13.0, p <0.001) but lower rates of pulmonary disease. Two types of valve (Edwards SAPIEN and Medtronic CoreValve) were implanted in equal proportions in the 2 groups. The 30-day and 1-year mortality rates from all causes on Kaplan-Meier analysis (9.2% vs 9.7%, p = 0.71; and 19.0% vs 20.2%, p = 0.49, respectively) did not differ according to the history of CABG. There were no significant differences in the Valve Academic Research Consortium complications (myocardial infarction, stroke or vascular, and bleeding complications). On multivariate analysis, CABG was not associated with greater 1-year post-TAVI mortality. In conclusion, previous CABG did not adversely affect outcome in patients who underwent TAVI, which may be an alternative to surgery in high-risk patients with severe aortic stenosis and history of CABG. PMID:26071993

  19. Rosiglitazone and Outcomes for Patients with Diabetes and Coronary Artery Disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

    PubMed Central

    Bach, Richard G.; Brooks, Maria Mori; Lombardero, Manuel; Genuth, Saul; Donner, Thomas W.; Garber, Alan; Kennedy, Laurence; Monrad, E. Scott; Pop-Busui, Rodica; Kelsey, Sheryl F.; Frye, Robert L.

    2013-01-01

    Background Rosiglitazone improves glycemic control for patients with type 2 diabetes, but there remains controversy regarding an observed association with cardiovascular hazard. The cardiovascular effects of rosiglitazone for patients with coronary artery disease (CAD) remain unknown. Methods and Results To examine any association between rosiglitazone use and cardiovascular events among patients with diabetes and CAD, we analyzed events among 2368 patients with type 2 diabetes and CAD in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Total mortality, composite death, myocardial infarction (MI), and stroke, and individual incidence of death, MI, stroke, congestive heart failure (CHF) and fractures, were compared during 4.5 yrs of follow-up among patients treated with rosiglitazone vs. patients not receiving a thiazolidinedione using Cox proportional hazards and Kaplan-Meier analyses including propensity matching. After multivariable adjustment, among patients treated with rosiglitazone, mortality was similar (HR 0.83; 95% CI, 0.58 to 1.18) while there was a lower adjusted incidence of composite death, MI, and stroke (hazard ratio (HR) 0.72; 95% confidence interval (CI), 0.55 to 0.93) and stroke (HR 0.36, 95% CI 0.16 to 0.86), and a higher incidence of fractures (HR 1.62, 95% CI 1.05 to 2.51); the incidence of MI (HR 0.77; 95% CI, 0.54 to 1.10) and CHF (HR 1.22, 95%CI, 0.84 to 1.82) were not significantly different. Among propensity matched patients rates of major ischemic cardiovascular events and CHF were not significantly different. Conclusions Among patients with type 2 diabetes and CAD in the BARI 2D trial, neither on-treatment nor propensity matched analysis supported an association of rosiglitazone treatment with an increase in major ischemic cardiovascular events. PMID:23857320

  20. Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: A prospective randomized study

    Microsoft Academic Search

    Raimondo Ascione; Simon Williams; Clinton T. Lloyd; Thiagarajamirthy Sundaramoorthi; Antonis A. Pitsis; Gianni D. Angelini

    2001-01-01

    Objective: Coronary artery bypass grafting on the beating heart through median sternotomy is a relatively new treatment, which allows multiple revascularization without the use of cardiopulmonary bypass. A prospective randomized study was designed to investigate the effect of coronary bypass with or without cardiopulmonary bypass on postoperative blood loss and transfusion requirement. Methods: Two hundred patients with coronary artery disease

  1. Coronary fistula between the left anterior descending coronary artery and the pulmonary artery: Two case reports

    PubMed Central

    Ibrahim, Mohamed F.; Sayed, Sameh; Elasfar, Abdelfatah; Sallam, Ayman; Fadl, Mazin; Al Baradai, Abdulaziz

    2012-01-01

    Coronary artery fistulae are rare congenital or acquired connections between the coronary vessels and the cardiac chambers or other vascular structures. We present two consecutive cases of coronary fistulae between the proximal left anterior descending artery (LAD) and the main pulmonary artery. Both cases where admitted with history of acute coronary syndromes and had multivessel coronary disease along with coronary pulmonary fistulae. The two cases were managed by coronary artery bypass grafting (CABG) and repair of the fistulae. PMID:24174833

  2. Yoga based cardiac rehabilitation after coronary artery bypass surgery: One-year results on LVEF, lipid profile and psychological states – A randomized controlled study

    PubMed Central

    Raghuram, Nagarathna; Parachuri, Venkateshwara Rao; Swarnagowri, M.V.; Babu, Suresh; Chaku, Ritu; Kulkarni, Ravi; Bhuyan, Bhagavan; Bhargav, Hemant; Nagendra, Hongasandra Ramarao

    2014-01-01

    Objective To compare the long term effects of yoga based cardiac rehabilitation program with only physiotherapy based program as an add-on to conventional rehabilitation after coronary artery bypass grafting (CABG) on risk factors. Methods In this single blind prospective randomized parallel two armed active control study, 1026 patients posted for CABG at Narayana Hrudayalaya Institute of Cardiac Sciences, Bengaluru (India) were screened. Of these, 250 male participants (35–65 years) who satisfied the selection criteria and consented were randomized into two groups. Within and between group comparisons were done at three points of follow up (i.e. 6th week, 6th month, and 12th month) by using Wilcoxon's signed ranks test and Mann Whitney U test respectively. Results Yoga group had significantly (p = 0.001, Mann Whitney) better improvement in LVEF than control group in those with abnormal baseline EF (<53%) after 1 year. There was a better reduction in BMI in the yoga group (p = 0.038, between groups) in those with high baseline BMI (?23) after 12 months. Yoga group showed significant (p = 0.008, Wilcoxon's) reduction in blood glucose at one year in those with high baseline FBS ?110 mg/dl. There was significantly better improvement in yoga than the control group in HDL (p = 0.003), LDL (p = 0.01) and VLDL (p = 0.03) in those with abnormal baseline values. There was significantly better improvement (p = 0.02, between groups) in positive affect in yoga group. Within Yoga group, there was significant decrease in perceived stress (p = 0.001), anxiety (p = 0.001), depression (p = 0.001), and negative affect (p = 0.03) while in the control group there was reduction (p = 0.003) only in scores on anxiety. Conclusion Addition of yoga based relaxation to conventional post-CABG cardiac rehabilitation helps in better management of risk factors in those with abnormal baseline values and may help in preventing recurrence. PMID:25443601

  3. Epicardial and Subcutaneous Adipose Tissue Fatty Acids Profiles in Diabetic and Non-Diabetic Patients Candidate for Coronary Artery Bypass Graft

    PubMed Central

    Pezeshkian, Masood; Mahtabipour, Mohammad-Reza

    2013-01-01

    Introduction: We have recently shown that in high cholesterol-fed rabbits, the sensitivity of epicardial adipose tissue to changes in dietary fat is higher than that of subcutaneous adipose tissue. Although the effects of diabetes on epicardial adipose tissue thickness have been studied, the influence of diabetes on profile of epicardial free fatty acids (FFAs) has not been studied. The aim of this study is to investigate the effect of diabetes on the FFAs composition in serum and in the subcutaneous and epicardial adipose tissues in patients undergoing coronary artery bypass graft (CABG). Methods: Forty non-diabetic and twenty eight diabetic patients candidate for CABG with >75% stenosis participated in this study. Fasting blood sugar (FBS) and lipid profiles were assayed by auto analyzer. Phospholipids and non-estrified FFA of serum and the fatty acids profile of epicardial and subcutaneous adipose tissues were determined using gas chromatography method. Results: In the phospholipid fraction of diabetic patients’ serum, the percentage of 16:0, 18:3n-9, 18:2n-6 and monounsaturated fatty acids (MUFAs) was lower than the corresponding values of the non-diabetics; whereas, 18:0 value was higher. A 100% increase in the amount of 18:0 and 35% decrease in the level of 18:1n-11 was observed in the diabetic patients’ subcutaneous adipose tissue. In epicardial adipose tissue, the increase of 18:0 and conjugated linolenic acid (CLA) and decrease of 18:1n-11, w3 (20:5n-3) and 22:6n-3 were significant; but, the contents of arachidonic acid and its precursor linoleic acid were not affected by diabetes. Conclusion: The fatty acids’ profile of epicardial and subcutaneous adipose tissues is not equally affected by diabetes. The significant decrease of 16:0 and w3 fatty acids and increase of trans and conjugated fatty acids in epicardial adipose tissue in the diabetic patients may worsen the formation of atheroma in the related arteries. PMID:23878791

  4. Flow capacity of skeletonized versus pedicled internal thoracic artery in coronary artery bypass graft surgery: systematic review, meta-analysis and meta-regression.

    PubMed

    Sá, Michel Pompeu Barros Oliveira; Cavalcanti, Paulo Ernando Ferraz; Santos, Henrique José de Andrade Costa; Soares, Artur Freire; Miranda, Rodrigo Gusmão Albuquerque; Araújo, Mayara Lopes; Lima, Ricardo Carvalho

    2015-07-01

    Many surgeons are concerned about the flow capacity of a skeletonized internal thoracic artery (ITA) in comparison with a pedicled ITA used during coronary artery bypass graft (CABG). This work aims to summarize the evidence comparing the flow capacity of a skeletonized versus pedicled ITA during CABG. We performed systematic review and meta-analysis according to the PRISMA statement based on a search in MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and reference lists of relevant articles. Studies included were original studies whose populations comprised patients undergoing CABG; compared outcomes between skeletonized versus pedicled ITA; the outcomes included data regarding intraoperative flow capacity of the grafts; the studies were prospective or retrospective or non-randomized or randomized controlled trials. In total, eight studies were identified and reviewed for eligibility and data were extracted. Forest plots and the summarized difference in means including 95% confidence intervals (CIs) were estimated and meta-regressions were performed. There was a statistically significant difference in favour of the skeletonized ITA compared with the pedicled ITA in terms of flow capacity (random-effect model: additional 20.8 ml/min, 95% CI 6.6-35.0, P = 0.004), being the summary measures under the influence of heterogeneity of the effects, but free from publication bias. We observed a difference with regard to the type of study, since non-randomized studies together demonstrated the superiority of a skeletonized ITA (random-effect model: additional 32.3 ml/min, 95% CI 21.0-43.6, P < 0.001), but the randomized studies together did not show it (random-effect model: additional 13.2 ml/min, 95% CI -1.1 to 27.6, P = 0.071). Meta-regression demonstrated some modulation influence by female gender, age and diabetes on the flow capacity of grafts. In summary, in terms of flow capacity, a skeletonized ITA appears to be superior in comparison with a pedicled ITA during CABG. PMID:25228742

  5. Safety and efficacy of one stage off-pump coronary artery operation and carotid endarterectomy

    Microsoft Academic Search

    Zile Singh Meharwal; Anil Mishra; Naresh Trehan

    2002-01-01

    Background. Patients with concomitant occlusive disease of coronary and carotid arteries remain at high risk of perioperative stroke and myocardial infarction. Combined coronary artery bypass grafting on cardiopulmonary bypass and carotid endarterectomy has been shown to give good results for this category of patients. In the present study, we analyzed our results of off-pump coronary artery bypass grafting and carotid

  6. Conduits for Coronary Bypass: Strategies

    PubMed Central

    2013-01-01

    Strategic planning is integral to any operation but complexity varies immensely and therefore the effort necessary to create the optimal plan. The previous three reports have discussed individual conduits and herein is an attempt to present approaches to common situations which the author favors. Although much has been learned over 45 years about use and subsequent behavior of venous and arterial grafts we continue to learn and, as a result, evolve new strategies or modify those now popular. Thus the reader must recognize that in spite of trying to be balanced and inclusive all surgeons have personal opinions and also prejudices which influence the approach taken and which may not be the optimal one for others or for the patient. PMID:24175266

  7. Effect of Hypertonic Saline Infusion versus Normal Saline on Serum NGAL and Cystatin C Levels in Patients Undergoing Coronary Artery Bypass Graft

    PubMed Central

    Yousefshahi, Fardin; Bashirzadeh, Mona; Abdollahi, Mohammad; Mojtahedzadeh, Mojtaba; Salehiomran, Abbass; Jalali, Arash; Mazandarani, Mahnaz; Zaare, Elmira; Ahadi, Mehdi

    2013-01-01

    Background: Acute kidney injury (AKI) is a common and life-threatening complication following coronary artery bypass graft (CABG). Neutrophil gelatinase-associated lipocalin (NGAL) and Cystatin C have shown to be good predictive factors for AKI. Recently, there has been a growing interest in the use of hypertonic saline in cardiac operations. The purpose of this study was to evaluate the prophylactic anti-inflammatory effect of hypertonic saline (Group A) infusion versus normal saline (Group B) on serum NGAL and Cystatin C levels as the two biomarkers of AKI in CABG patients. Methods: This randomized double-blinded clinical trial recruited 40 patients undergoing CABG in Tehran Heart Center, Tehran, Iran. After applying exclusion criteria, the effects of preoperative hypertonic saline (294 meq Na) versus normal saline (154 meq Na) infusion on serum NGAL and Cystatin C levels were investigated in three intervals: before surgery and 24 and 48 hours postoperatively. The probable intraoperative or postoperative confounders, including pump time, cross-clamp time, heart rate, systolic and diastolic blood pressures, central venous pressure, arterial pH, partial pressure of arterial oxygen, fraction of inspired oxygen, blood sugar, Na, K, Mg, hemoglobins, white blood cells, hematocrits, and platelets, were recorded and compared between the two groups of study. Results: The study population comprised 40 patients, including 25 (62.5%) males, at a, mean age ± SD of 61.75 ± 8.13 years. There were no statistically significant differences between the patients’ basic, intraoperative, and postoperative characteristics, including intraoperative and postoperative hemodynamic variables and supports such as inotropic use. Intra-aortic balloon pump use and mortality were not seen in our cases. Three patients in the normal saline group and one patient in the hypertonic saline group had serum NGAL levels greater than 400 ng/ml. Moreover, 10 patients in Group A and 17 patients in group B showed a rise in serum Cystatin C levels above 1.16 mg/dl. Patients with AKI had significantly elevated NGAL and Cystatin C levels (p value < 0.001), but there were no significant differences in the decrease in the NGAL level in the hypertonic saline group versus the normal saline group (230.91 ± 92.68 vs. 239.74 ± 116.58 ng/ml, respectively; p value = 0.792), or in the decrease in the Cystatin C level in the hypertonic saline group versus the normal saline group (1.05 ± 0.26 vs. 1.06 ± 0.31, respectively; p value = 0.874). Conclusion: Pre-treatment of CABG patients with hypertonic saline had no significant effect on serum NGAL and Cystatin C levels compared to the normal saline-receiving group. Our present data, albeit promising, have yet to fully document outcome differences. PMID:23646044

  8. Coronary artery ectasia in Egyptian patients with coronary artery disease.

    PubMed Central

    Waly, H M; Elayda, M A; Lee, V V; el-Said, G; Reul, G J; Hall, R J

    1997-01-01

    We conducted a retrospective study of 45 Egyptian patients with coronary artery ectasia who underwent coronary bypass grafting at our institution between 1980 and 1995. We examined the anatomic distribution and type of coronary ectasia and its association with coronary risk factors in these patients, and evaluated the severity of their coronary artery disease. We compared these findings with those from a group of 230 Egyptian patients who did not have coronary ectasia. These patients also underwent coronary artery bypass grafting between 1980 and 1995 at our institution. Obesity was present in 60% of the patients who had coronary artery ectasia, compared with 42% of patients who did not have ectasia (P < 0.01). Coronary artery ectasia was not related to any coronary risk factors other than obesity. However, patients who had ectasia did have a higher rate of triple-vessel coronary artery disease than did patients without ectasia (82% vs 67%, P < 0.05). Of the coronary vessels affected by ectasia, 43% were left anterior descending arteries. Diffuse disease was noted in 84% of all ectatic segments. We conclude that in this patient population, 2 conditions had a positive correlation with coronary ectasia: obesity and the severity of coronary artery disease. Images PMID:9456489

  9. Facilitated coronary anastomosis using a nitinol U-Clip device: Bovine model

    Microsoft Academic Search

    Arthur C. Hill; Timothy P. Maroney; Renu Virmani

    2001-01-01

    Objective: The coronary anastomosis is the most difficult part of the coronary bypass procedure, particularly when using a minimally invasive technique. Methods to facilitate coronary anastomosis will make the minimally invasive approach to coronary bypass feasible. We sought preclinical validation and testing of the design and efficacy of a self-closing penetrating clip that can be used to facilitate the creation

  10. 21 CFR 870.5100 - Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...balloon dilatation of a hemodynamically significant coronary artery or bypass graft stenosis in patients evidencing coronary...intended for the treatment of hemodynamically significant coronary artery stenosis for the purpose of improving myocardial...

  11. 21 CFR 870.5100 - Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...balloon dilatation of a hemodynamically significant coronary artery or bypass graft stenosis in patients evidencing coronary...intended for the treatment of hemodynamically significant coronary artery stenosis for the purpose of improving myocardial...

  12. 21 CFR 870.5100 - Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...balloon dilatation of a hemodynamically significant coronary artery or bypass graft stenosis in patients evidencing coronary...intended for the treatment of hemodynamically significant coronary artery stenosis for the purpose of improving myocardial...

  13. 21 CFR 870.5100 - Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...balloon dilatation of a hemodynamically significant coronary artery or bypass graft stenosis in patients evidencing coronary...intended for the treatment of hemodynamically significant coronary artery stenosis for the purpose of improving myocardial...

  14. Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease

    Microsoft Academic Search

    Marc L. Ladenheim; Brad H. Pollock; Alan Rozanski; Daniel S. Berman; Howard M. Staniloff; James S. Forrester; George A. Diamond

    1986-01-01

    The ability of exercise-induced myocardial hypoperfusion on thallium scintigraphy to predict coronary events was assessed in 1,689 patients with symptoms suggestive of coronary artery disease but without prior myocardial infarction or coronary artery bypass surgery. A total of 74 patients had a coronary event in the year after testing (12 cardiac deaths, 20 nonfatal infarctions and 42 referrals for bypass

  15. Election Day

    NSDL National Science Digital Library

    University of Washington

    Election Day teaches how elections work in the United States. Players learn about political parties, public opinion, campaign financing, election law, political marketing, strategic planning, and the media. The game is well-suited for high-school and college students.

  16. Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 levels predict percutaneous coronary intervention-related periprocedural myocardial infarction in stable patients undergoing elective native single-vessel PCI.

    PubMed

    Balin, Mehmet; Celik, Ahmet; Kobat, M Ali; Baydas, Adil

    2012-11-01

    Percutaneous coronary intervention-related periprocedural myocardial infarction (PCI-RPMI) has now been definitively linked in large data sets to long-term adverse outcomes. It is more likely that the relationship is caused by the underlying predisposing factors that led to the PCI-RPMI, such as plaque vulnerability. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is involved in multiple phases of vascular dysfunction, including atherosclerotic plaque formation and/or vulnerability. The purpose of this study was to determine whether soluble LOX-1 (sLOX-1) is associated with myocardial necrosis in elective native single-vessel PCI (NSV-PCI). From January 2010 to January 2012, 214 consecutive stable patients undergoing elective NSV-PCI were enrolled. Troponin T, CK and CK-MB were performed to screen for PCI-induced myocardial necrosis after the procedure, and PCI-RPMI was defined as three times the ULN of CK, which was confirmed by the elevation of the CK-MB and troponin T. According to the cardiac biomarkers result, patients were divided into two groups [PCI-RPMI(+) and PCI-RPMI(-)]. sLOX-1 levels were measured in serum by ELISA. Of the 214 patients who underwent NSV-PCI, 33 (15.4 %) patients developed PCI-RPMI. The results of this study showed that among patients undergoing elective NSV-PCI, those with PCI-RPMI had significantly higher circulating sLOX-1 levels than those without (167 ± 89 vs. 99 ± 68 pg/mL; p < 0 0.001). There were high correlations between sLOX-1 levels and CK and CK-MB values (r = 0.677 and r = 0.682, respectively; p < 0.001). Our study demonstrated that circulating sLOX-1 levels were associated with PCI-RPMI, which might predict periprocedural myocardial necrosis in elective NSV-PCI. Importantly, the study speculates that the level of sLOX-1 may help to identify patients at risk for PCI-RPMI before the procedure. sLOX-1 may provide new insights into not only risk stratification, but also therapeutic strategies for elective PCI. PMID:22797935

  17. Evaluation of quality of life among patients with ischemic heart disease who practiced self-care activities at home after elective percutaneous coronary intervention.

    PubMed

    Takematsu, Yuriko; Hasebe, Yukari; Moriwaki, Yoshimi; Kotera, Naomi; Yamada, Chie; Nakagami, Tomoko; Shinoda, Kozo; Furubayashi, Akira; Kato, Sayoko; Sugimoto, Ikuko; Shibayama, Kenzo

    2015-04-01

    The present study compares health-related QOL between patients who practiced self-care activities comprising exercise and diet at home for at least 6 months (SA group; n = 84) after elective PCI and those who did not (NA group; n = 54). Health-related (HR) QOL was measured using the SF-36 questionnaire. Scores for two mental and three physical parameters of the HRQOL were increased in the SA, but not in the NA group. These findings indicated that the QOL was far superior among patients who exercised and consumed an appropriate diet at home for at least 6 months after elective PCI compared with those who did not. PMID:25154402

  18. Case report - Vascular thoracic Aorta non-touch coronary artery bypass grafting after total arch replacement for acute type A aortic dissection

    Microsoft Academic Search

    Yosuke Takahashi; Yasushi Tsutsumi; Osamu Monta; Hirokazu Ohashi

    We report successful surgical treatment of coronary artery disease (CAD) in a 53-year-old man. The man was admitted to our hospital due to severe anterior chest pain. He had a surgical history of total arch replacement for acute type A dissection 10 years previously. Angiography showed triple-vessel disease and partial dissection of the descending aorta. To avoid excessive excision and

  19. Do patients after off-pump coronary artery bypass grafting need the intensive care unit? A prospective audit of 85 patients.

    PubMed

    Noiseux, Nicolas; Bracco, David; Prieto, Ignacio; Hemmerling, Thomas M

    2008-02-01

    With limited resources, cardiac surgery is frequently cancelled due to lack of ICU beds. Immediate postoperative extubation (UFT) is performed in our hospital setting. The aim of the present study is to report patients undergoing off-pump aortocoronary bypass grafting (OPCABG) with immediate extubation and no ICU stay. Eighty-five patients undergoing OPCABG were included. UFT analgesia consisted of high thoracic epidural analgesia (n=65), or PCA morphine (n=20). Discharge criteria from PACU to cardiac ward were: alert, cooperative patient, respiratory rate <25/min, PaO(2)>80 mmHg and PaCO(2)<45 mmHg, temperature >36 degrees C, hemodynamic stability, no bleeding, no ischemia, and sufficient analgesia. More males (71/14) were included. Mean age was 63.4 years, NYHA class III, ejection fraction 59.4. Three grafts were performed in 119 min. Patients were extubated 12+/-2 min after closure. After 428 min in PACU, four patients did not meet ward criteria; three bradycardia requiring pacing, one elevated CK-MB. Two patients returned to the ICU, one for hypertension, and one for hypovolemia. Cardiac complications were: atrial fibrillation (29%), MI=2, bradycardia=3. During the same period, 304 OR-extubated patients spent 21+/-6 h in the ICU. The cost from leaving the OR until the patient reached the cardiac ward was 1265$ for ICU bypass patients vs. 6405$ for ICU patients, the difference representing 5140$ per patient. ICU bypass after OPCABG is safe. By avoiding ICU, this protocol reduces costs, improves resource utilization and may reduce OR cancellation due to ICU bed shortages. PMID:18024492

  20. Usefulness of single nucleotide polymorphism in chromosome 4q25 to predict in-hospital and long-term development of atrial fibrillation and survival in patients undergoing coronary artery bypass grafting.

    PubMed

    Virani, Salim S; Brautbar, Ariel; Lee, Vei-Vei; Elayda, Macarthur; Sami, Shehzad; Nambi, Vijay; Frazier, Lorraine; Wilson, James M; Willerson, James T; Boerwinkle, Eric; Ballantyne, Christie M

    2011-05-15

    We aimed to determine whether polymorphisms in chromosome 4q25 are associated with postoperative atrial fibrillation (AF), long-term AF, postoperative or long-term stroke, and long-term survival after coronary artery bypass grafting. We performed genotyping for rs2200733 and rs10033464 in white participants (n = 1,166) from the TexGen genetic registry. The development of postoperative or long-term AF, postoperative or long-term stroke, and long-term mortality were ascertained. Both rs2200733 and rs10033464 were associated with postoperative AF (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.04 to 1.91, and OR 1.47, 95% CI 1.05 to 2.06, respectively). Carriers of the risk allele (T) had an increased risk of postoperative AF with preoperative ? blocker (BB) (for rs2200733, OR 1.47, 95% CI 1.004 to 2.16 for those taking a BB, and OR 1.13, 95% CI 0.73 to 1.73 for those not taking a BB; for rs10033464, OR 1.89, 95% CI 1.22 to 2.93 for those taking preoperative a BB, and OR 1.04, 95% CI 0.65 to 1.65 for those not taking a BB). Both rs2200733 and rs10033464 were also associated with long-term AF (hazard ratio 1.32, 95% CI 1.05 to 1.67, and hazard ratio 1.28, 95% CI 1.00 to 1.66, respectively). Carriers of rs2200733 had increased long-term mortality (hazard ratio 1.57, 95% CI 1.10 to 2.24). These variants were not associated with postoperative or long-term stroke. In conclusion, variants in 4q25 are associated with an increased risk of postoperative or long-term AF and, possibly, mortality in whites undergoing coronary artery bypass grafting, and could potentially affect the choice of therapy used to decrease postoperative AF. PMID:21414601

  1. Staged carotid and coronary surgery for concomitant carotid and coronary artery disease

    Microsoft Academic Search

    Pedro E. Antunes; Gabriel Anacleto; J. M. Ferrão de Oliveira; Lu??s Eugénio; Manuel J. Antunes

    2002-01-01

    Objective: To demonstrate that staged, consecutive, carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are safe, perhaps preferable, alternative for the treatment of patients with severe carotid and coronary artery disease. Methods: During an 8-year period ending December 1999, 77 (2.1%) of 3633 consecutive patients who were referred for isolated coronary surgery were found to have significant carotid disease

  2. Staged carotid and coronary surgery for concomitant carotid and coronary artery disease

    Microsoft Academic Search

    Pedro E. Antunes; Gabriel Anacleto; J. M. Ferrao; Manuel J. Antunes

    2010-01-01

    Objective: To demonstrate that staged, consecutive, carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are safe, perhaps preferable, alternative for the treatment of patients with severe carotid and coronary artery disease. Methods: During an 8-year period ending December 1999, 77 (2.1%) of 3633 consecutive patients who were referred for isolated coronary surgery were found to have significant carotid disease

  3. Off-pump bypass graft operation significantly reduces oxidative stress and inflammation

    Microsoft Academic Search

    Bashir M Matata; Andrzej W Sosnowski; Manuel Galiñanes

    2000-01-01

    Background. This study investigated whether off-pump coronary bypass graft operations on the beating heart under normothermic conditions reduces the systemic oxidative stress and inflammatory reaction seen in patients operated under cardiopulmonary bypass (CPB).Methods. A cardiac stabilizer (Octopus Tissue Stabilizer; Medtronic Inc, Minneapolis, MN) was used to perform the coronary anastomoses on the normothermic beating heart with or without CPB. Serial

  4. Refractory angina pectoris in end-stage coronary artery disease: Evolving therapeutic concepts

    Microsoft Academic Search

    Frank C. Schoebel; O. Howard Frazier; Gilian A. J. Jessurun; Mike J. L. De Jongste; Kamuran A. Kadipasaoglu; Thomas W. Jax; Matthias P. Heintzen; Denton A. Cooley; Bodo E. Strauer; Matthias Leschke

    1997-01-01

    Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortocoronary bypass grafting must be excluded on the basis of a recent coronary angiogram. This coronary syndrome, which represents end-stage coronary artery

  5. Congenital coronary artery fistulae: a rare cause of heart failure in adults

    PubMed Central

    2014-01-01

    Coronary artery fistulae are uncommon, reported in 0.25% of patients undergoing coronary angiography. Two patients with congenital coronary artery fistula and coronary artery disease who presented with symptoms of exacerbated congestive heart failure out of proportion to their atherosclerotic burden were successfully treated by epicardial fistula ligation and coronary artery bypass grafting with marked improvement in functional status. PMID:24886594

  6. Impact of Early Discharge After Coronary Artery Bypass Graft Surgery on Rates of Hospital Readmission and Death fn1 fn1 This study was supported by Research Grants HS06503 and HS08805-02 from the Agency for Health Care Policy and Research, Rockville, Maryland and was presented in part at the 45th Annual Scientific Session of the American College of Cardiology, Orlando, Florida, March 1996

    Microsoft Academic Search

    Patricia A. Cowper; Eric D. Peterson; Elizabeth R. DeLong; James G. Jollis; Lawrence H. Muhlbaier; Daniel B. Mark

    1997-01-01

    Objectives. This study examined the impact of early hospital discharge on short-term clinical outcomes of elderly patients treated with coronary artery bypass graft surgery (CABG) in the United States in 1992.Background. Protocols that encourage earlier discharge of patients who have had CABG have been implemented across the country. Although delivery of efficient care benefits both patients and providers, premature discharge

  7. Sensitivity Analysis and Parameter Estimation of a Coronary Circulation Model for Triple-Vessel

    E-print Network

    Paris-Sud XI, Université de

    measurements acquired during coronary artery bypass graft (CABG) surgery. Although some efforts towards ischemia or infarction. In the case of triple-vessel disease, the right coronary artery is completely angioplasty or coronary artery bypass graft (CABG) surgery [1]. *D. Ojeda is with INSERM, UMR 1099, Rennes, F

  8. Off-pump coronary surgery: Effect on early mortality and stroke

    Microsoft Academic Search

    Wen Cheng; Timothy A. Denton; Gregory P. Fontana; Sharo Raissi; Carlos Blanche; Robert M. Kass; Kathy E. Magliato; James Mirocha; Alfredo Trento

    2002-01-01

    Background: Avoiding cardiopulmonary bypass in coronary artery bypass grafting is thought to reduce early mortality and morbidity. Methods: We used our prospective database to compare all patients having off-pump coronary surgery (n = 389) with those having on-pump coronary surgery (n = 2412) between March 15, 1995, and November 1, 2000. Patients were grouped by age (years) in decades (>90,

  9. Similar neurobehavioral outcome after valve or coronary artery operations despite differing carotid embolic counts

    Microsoft Academic Search

    Michael J. Neville; John Butterworth; Robert L. James; John W. Hammon; David A. Stump

    2001-01-01

    Objectives: The interrelationships among coronary and valvular operations, microemboli, and neurobehavioral outcome are unclear. We hypothesized that adult patients undergoing cardiac valve operations would have more total emboli delivered to the brain than patients undergoing coronary artery bypass grafting and that this would associate with worse neurobehavioral outcomes. Methods: One hundred ninety-three patients undergoing coronary artery bypass grafting and 73

  10. The impact of uncertainty on shape optimization of idealized bypass graft models in unsteady flow

    E-print Network

    Marsden, Alison L.

    idealized numerical examples, an end-to-side anastomosis, and a bypass graft around a stenosis, demonstrate graft can result in localized, un- steady, and turbulent flow depending on the size of stenosis that is bypassed. Bypass grafts are used in both coronary artery disease and peripheral vascular disease

  11. A loss of taurine and other amino acids from ventricles of patients undergoing bypass surgery

    Microsoft Academic Search

    M S Suleiman; H C Fernando; W C Dihmis; J A Hutter; R A Chapman

    1993-01-01

    OBJECTIVE--To study the changes in amino acid content of left ventricles of patients during cardiac surgery that involves cardiopulmonary bypass and cold cardioplegia. DESIGN--Biopsy specimens (up to 10 mg wet weight) from the left ventricle of 30 patients undergoing coronary artery bypass graft and valve replacement surgery on cardiopulmonary bypass (protected by cold cardioplegia with St Thomas' solution) were taken

  12. Tissue Factor Expression in Coronary Circulation as a Prognostic Factor for Late Restenosis after Coronary Angioplasty

    Microsoft Academic Search

    Osamu Mizuno; Uichi Ikeda; Yukihiro Hojo; Hideyuki Fujikawa; Taka-aki Katsuki; Kazuyuki Shimada

    2001-01-01

    We investigated changes in blood coagulation in the coronary circulation after percutaneous transluminal coronary angioplasty (PTCA) and its clinical significance. We examined 43 patients with ischemic heart disease who underwent elective PTCA of isolated stenotic lesions in the left coronary artery. Ten patients underwent PTCA alone, 15 received percutaneous transluminal rotational atherectomy (PTRA) and 18 stent implantation. Blood samples were

  13. New Technologies in Coronary Artery Surgery

    PubMed Central

    Taggart, David; Nir, Rony-Reuven; Bolotin, Gil

    2013-01-01

    Coronary artery disease remains the leading cause of death in developed countries. Major recent studies such as SYNTAX and FREEDOM have confirmed that coronary artery bypass grafting (CABG) remains the gold standard treatment in terms of survival and freedom from myocardial infarction and the need for repeat revascularization. The current review explores the use of new technologies and future directions in coronary artery surgery, through 1) stressing the importance of multiple arterial conduits and especially the use of bilateral mammary artery; 2) discussing the advantages and disadvantages of off-pump coronary artery bypass; 3) presenting additional techniques, e.g. minimally invasive direct coronary artery bypass grafting, hybrid, and robotic-assisted CABG; and, finally, 4) debating a novel external stenting technique for saphenous vein grafts. PMID:23908868

  14. New technologies in coronary artery surgery.

    PubMed

    Taggart, David; Nir, Rony-Reuven; Bolotin, Gil

    2013-07-01

    Coronary artery disease remains the leading cause of death in developed countries. Major recent studies such as SYNTAX and FREEDOM have confirmed that coronary artery bypass grafting (CABG) remains the gold standard treatment in terms of survival and freedom from myocardial infarction and the need for repeat revascularization. The current review explores the use of new technologies and future directions in coronary artery surgery, through 1) stressing the importance of multiple arterial conduits and especially the use of bilateral mammary artery; 2) discussing the advantages and disadvantages of off-pump coronary artery bypass; 3) presenting additional techniques, e.g. minimally invasive direct coronary artery bypass grafting, hybrid, and robotic-assisted CABG; and, finally, 4) debating a novel external stenting technique for saphenous vein grafts. PMID:23908868

  15. Endarterectomy and surgical angioplasty without cardiopulmonary bypass.

    PubMed

    Sai Krishna, Cheemalapati; Naresh Kumar, Palli Venkata; Ramesh Babu, Vedangi; Ram Mohan, Kanteti

    2008-01-01

    Surgical angioplasty for ostial stenosis of the major coronary arteries is a well-established treatment modality. Management of discrete stenoses of distal coronary arteries in the presence of mild proximal disease is a challenging task. Percutaneous intervention or grafting beyond the diseased segment may be limited by size of the target vessel, whereas endarterectomy followed by graft placement may result in graft occlusion due to competitive native flow. Patch angioplasty with or without endarterectomy is an effective option in this setting, which can be performed without cardiopulmonary bypass in the appropriate group of patients. A patient with triple vessel coronary artery disease and a discrete lesion in the posterior descending artery underwent off-pump endarterectomy with vein patch angioplasty in combination with bypass grafting to left anterior descending and obtuse marginal arteries. Operative technique and intraoperative strategies are discussed. PMID:18384576

  16. Usefulness of Single Nucleotide Polymorphism in Chromosome 4q25 to Predict In-Hospital and Long Term Development of Atrial Fibrillation and Survival in Patients Undergoing Coronary Artery Bypass Grafting

    PubMed Central

    Virani, Salim S.; Brautbar, Ariel; Lee, Vei-Vei; Elayda, MacArthur; Sami, Shehzad; Nambi, Vijay; Frazier, Lorraine; Wilson, James M; Willerson, James T; Boerwinkle, Eric; Ballantyne, Christie M

    2011-01-01

    We aimed to determine whether polymorphisms in chromosome 4q25 are associated with postoperative atrial fibrillation (AF), long term AF, postoperative or long term stroke, and long term survival after coronary artery bypass grafting (CABG). We performed genotyping for rs2200733 and rs10033464 in Caucasian participants (n=1,166) of TexGen genetic registry. Development of postoperative or long term AF, postoperative or long term stroke, and long term mortality were ascertained. Both rs2200733 and rs10033464 were associated with postoperative AF (odds ratio [OR]=1.41, 95% confidence interval [CI]; 1.04–1.91, and OR=1.47, 95% CI; 1.05–2.06, respectively). Carriers of the risk allele (T) had an increased risk of postoperative AF with preoperative beta blocker (BB) (for rs2200733: OR=1.47, 95% CI; 1.004–2.16 for those on BB, and OR=1.13, 95% CI; 0.73–1.73 for those not on BB; for rs10033464: OR=1.89, 95% CI; 1.22–2.93 for those on pre-operative BB, and OR=1.04, 95% CI; 0.65–1.65 for those not on BB). Both rs2200733 and rs10033464 were also associated with long term AF (hazards ratio [HR]=1.32, 95% CI; 1.05–1.67, and HR=1.28, 95% CI; 1.00–1.66, respectively). Carriers of rs2200733 had increased long term mortality (HR=1.57, 95% CI; 1.10–2.24). These variants were not associated with postoperative or long term stroke. In conclusion, variants in 4q25 are associated with an increased risk of postoperative or long term AF, and possibly mortality in Caucasians undergoing CABG, and could potentially affect the choice of therapy used to decrease postoperative AF. PMID:21414601

  17. Concomitant Brachiocephalic and Coronary Artery Disease: Outcome and Decision Analysis

    Microsoft Academic Search

    Thomas J. Takach; George J. Reul; J. Michael Duncan; Zvonimir Krajcer; James J. Livesay; Igor D. Gregoric; Roberto D. Cervera; David A. Ott; O. Howard Frazier; Denton A. Cooley

    2005-01-01

    Background. In patients with coronary artery disease, concomitant brachiocephalic disease may affect outcome and influence decision making regarding operative stag- ing, technique, and choice of conduit. Methods. Eighty consecutive patients (mean age, 59.3 years; 60.0% male) with concomitant brachiocephalic and coronary artery disease were identified either before (group A, n 48) or after (group B, n 32) coronary artery bypass

  18. Election 2012

    NSDL National Science Digital Library

    Cade

    2012-10-15

    Understanding the Electoral College: Making predictions for 2012 With the election coming fast we better make sure we understand the Electoral College and how it works. After our classroom explanation of the Electoral College you will be assigned to argue for or against using the Electoral College for future elections. Use the following resources to form your argument. Pros and Cons of Electoral College More Pros and Cons Electoral Map ...

  19. Aneurysm of main left coronary artery.

    PubMed Central

    Kessler, M; Hamby, R I; Hilsenrath, J

    1980-01-01

    A 57-year-old man presented with exertional chest pain, and was found to have a saccular, lobulated aneurysm of the left main coronary artery associated with severe atherosclerotic vascular disease. This is the third similar case reported and the first case of atherosclerotic origin. All symptoms were relieved by coronary artery bypass surgery. Images PMID:7426179

  20. Concomitant Cerebral and Coronary Subclavian Steal

    Microsoft Academic Search

    Thomas J Takach; Martin L Beggs; Verlyn J Nykamp; George J Reul

    1997-01-01

    We report the unusual presentation of simultaneous coronary and cerebrovascular insufficiency secondary to subclavian steal in a patient previously treated with coronary artery bypass grafting. Movement of the arm produced reversal of flow (“steal”) in both the left vertebral and left internal thoracic arteries and resulted in the onset of angina and neurologic symptoms.