Sample records for elective coronary bypass

  1. Coronary Artery Bypass Surgery

    MedlinePLUS

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  2. 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

  3. Acute Effect of Intravenous Administration of Magnesium Sulfate on Serum Levels of Interleukin-6 and Tumor Necrosis Factor-? in Patients Undergoing Elective Coronary Bypass Graft With Cardiopulmonary Bypass

    PubMed Central

    Aryana, Parastou; Rajaei, Samira; Bagheri, Abdolhamid; Karimi, Forouzan; Dabbagh, Ali

    2014-01-01

    Background: Cardiovascular problems are among the most common health issues. A considerable number of cardiac patients undergo cardiac surgery, and coronary artery disease patients constitute about two-thirds of all these surgeries. The application of cardiopulmonary bypass (CBP) usually results in some untoward effects. Objectives: Studies have suggested magnesium sulfate (MgSO4) as an anti-inflammatory agent in a coronary artery bypass graft (CABG). This study aimed to assess the effect of an IV MgSO4 infusion during elective CABG (with CBP) on the blood levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-?). Materials and Methods: During a 12 month period, after review board approval and based on inclusion and exclusion criteria, 90 patients were selected and entered randomly into one of the two study groups (MgSO4 or placebo). Anesthesia, surgery and CBP were performed in exactly the same way, except for the use of MgSO4 or a placebo. Both preoperative and postoperative plasma levels of IL-6 and TNF-? were checked and compared between the two groups using an ELISA. Results: There was no difference found between the two groups with regard to; gender, basic variables, Ejection Fraction (EF), CBP time and aortic cross-clamp time. The preoperative levels of IL-6 and TNF-? were not different; however, their postoperative levels were significantly higher in the placebo group (P value = 0.01 for IL-6 and 0.005 for TNF-?). Conclusions: This study showed that MgSO4 infusion could suppress part of the inflammatory response after CABG with CBP. This was demonstrated by decreased levels of interleukin-6 and TNF-? in postoperative serum levels in elective CABG with CBP. PMID:25237633

  4. Coronary Artery Bypass Graft

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program explains the benefits and risks of coronary artery bypass graft surgery for the treatment of coronary arteriosclerosis. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary

  5. 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 ...

  6. 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,

  7. 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.

  8. Types of Coronary Artery Bypass Grafting

    MedlinePLUS

    ... best option for you based on your needs. Traditional Coronary Artery Bypass Grafting Traditional CABG is used when at least one major ... Grafting This type of CABG is similar to traditional CABG because the chest bone is opened to ...

  9. Improvement of outcomes after coronary artery bypass: A randomized trial comparing intraoperative high versus low mean arterial pressure

    Microsoft Academic Search

    Jeffrey P. Gold; Mary E. Charlson; Pamela Williams-Russo; Ted P. Szatrowski; Janey C. Peterson; Paul A. Pirraglia; Gregg S. Hartman; Fun Sun F. Yao; James P. Hollenberg; Denise Barbut; Joseph G. Hayes; Stephen J. Thomas; Mary Helen Purcell; Steven Mattis; Larry Gorkin; Martin Post; Karl H. Krieger; O. Wayne Isom

    1995-01-01

    Background The objective of this randomized clinical trial of elective coronary artery bypass grafting was to investigate whether intraoperative mean arterial pressure below autoregulatory limits of the coronary and cerebral circulations was a principal determinant of postoperative complications. The trial compared the impact of two strategies of hemodynamic management during cardiopulmonary bypass on outcome. Patients were randomized to a low

  10. On-Pump versus Off-Pump Coronary-Artery Bypass Surgery

    Microsoft Academic Search

    A. Laurie Shroyer; Frederick L. Grover; Brack Hattler; Joseph F. Collins; Gerald O. McDonald; Elizabeth Kozora; John C. Lucke; Janet H. Baltz; Dimitri Novitzky

    2009-01-01

    BACKGROUND Coronary-artery bypass grafting (CABG) has traditionally been performed with the use of cardiopulmonary bypass (on-pump CABG). CABG without cardiopulmonary bypass (off-pump CABG) might reduce the number of complications related to the heart-lung machine. METHODS We randomly assigned 2203 patients scheduled for urgent or elective CABG to either on-pump or off-pump procedures. The primary short-term end point was a composite

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. Systemic pattern of free radical generation during coronary bypass surgery.

    PubMed Central

    Davies, S W; Underwood, S M; Wickens, D G; Feneck, R O; Dormandy, T L; Walesby, R K

    1990-01-01

    Diffuse impairment of ventricular function after cardiac surgery may be related to the generation during reperfusion of the myocardium of free radicals derived from oxygen. Fifteen patients undergoing elective coronary bypass surgery were studied by previously described assays for peroxidised lipids and for isomerised lipids which were used as indices of free radical activity. Serial blood samples were obtained from systemic arterial, mixed venous, and coronary sinus catheters before, during, and after the ischaemic period. The patients underwent coronary artery surgery on cardiopulmonary bypass with a membrane oxygenator, relative hypothermia 30-34 degrees C, and intermittent cross-clamping of the aorta. During the ischaemic periods there were no significant changes in the indices of free radical activity. During the reperfusion phase there was a significant increase in free radical indices in arterial and mixed venous blood. A small rise in free radical indices in coronary venous blood was not statistically significant. These data indicate that free radical activity is increased in patients shortly after the cessation of cardiopulmonary bypass. The pattern of distribution between the different sampling sites suggests that much of the observed increase in isomerised and peroxidised lipids originates from tissues other than the myocardium. PMID:2223301

  17. Do Coronary Artery Bypass Operations Prolong Life?

    PubMed Central

    Carr, Kenneth W.; Engler, Robert L.; Ross, John

    1982-01-01

    Coronary artery bypass operations improve survival in patients with symptomatic left main coronary artery stenosis, but whether or not longevity is improved in other patients has been controversial. Small clinical studies, even when randomized, have not sufficiently controlled for the heterogeneous distribution of risk factors in patient cohorts treated medically and surgically. The first randomized study large enough to overcome such problems, the Veterans Administration Cooperative Study, showed that coronary artery bypass procedures prolonged survival only in the high-risk subgroup. The surgically treated patients suffered more perioperative morbidity and mortality and had worse long-term survival than similar patients operated on in more recent years. The European Coronary Surgery Study Group recently reported that the three-year to five-year survival of symptomatic patients with triple-vessel disease and normal left ventricular function was better if patients were randomly assigned to surgical therapy. The third and by far the largest randomized study, the Coronary Artery Surgery Study (CASS), has not yet reported long-term follow-up results. Large clinical studies, both randomized and nonrandomized, that have subgrouped patients by the number of diseased coronary arteries and by the degree of left ventricular dysfunction all show that survival with single-vessel disease is excellent and not improved by operation. Medically treated patients with double- and triple-vessel disease who have good left ventricular function generally now have a five-year survival greater than 85 percent and only two of the major studies suggest that it is improved by operation. The results of most studies, however, suggest that bypass operation prolongs survival in symptomatic patients when left ventricular dysfunction coexists with double- and triple-vessel disease. Continually improving surgical techniques may potentiate the small survival differences that are now apparent, but until then, because the survival differences are so small, it is recommended that limiting anginal symptoms remain the primary indication for a coronary bypass procedure for an individual patient. PMID:7046257

  18. 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

  19. Outcome of Coronary Bypass Surgery Versus Coronary Angioplasty in Diabetic Patients With Multivessel Coronary Artery Disease

    Microsoft Academic Search

    William S Weintraub; Bernardo Stein; Andrzej Kosinski; John S Douglas; Ziyad M. B Ghazzal; Ellis L Jones; Douglas C Morris; Robert A Guyton; Joseph M Craver; Spencer B King

    1998-01-01

    Objectives. This study sought to compare the outcome of percutaneous transluminal coronary angioplasty (PTCA) (n = 834) and coronary artery bypass graft surgery (CABG) (n = 1805) in diabetic patients with multivessel coronary disease from an observational database.Background. There is concern about selection of revascularization in diabetic patients with multivessel coronary artery disease.Methods. Data were collected prospectively and entered into

  20. Off-pump versus on-pump coronary artery bypass grafting: oxidative stress and renal function

    Microsoft Academic Search

    W. B. M Gerritsen; W. J. P van Boven; A. H. G Driessen; F. J. L. M Haas; L. P. H. J Aarts

    2001-01-01

    Objectives: Oxidative stress and renal dysfunction occur in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass (on-pump CABG). Whether the same adverse effects also occur during off-pump CABG is the question in this study. Methods: Forty patients, 27 men and 13 women, undergoing elective CABG were included; 20 patients underwent on-pump CABG and 20 patients underwent off-pump CABG. Renal

  1. Pre-operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery.

    ClinicalTrials.gov

    2015-04-16

    Patients Waiting for Elective Isolated Coronary Artery Bypass Grafting (CABG); Patients Waiting for Aortic Valve Repair/Replacement for Moderate Aortic Stenosis or Severe Regurgitation; Patients Waiting for Mitral Valve Repair/Replacement for Moderate Stenosis or Severe Regurgitation; Patients Waiting for Combined CABG/Valve Procedures.

  2. Increases in P-Wave Dispersion Predict Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

    Microsoft Academic Search

    Joby Chandy; Toshiko Nakai; Randall J. Lee; Wayne H. Bellows; Samir Dzankic; Jacqueline M. Leung

    2004-01-01

    Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. In this study we examined the effect of surgery on atrial elec- trophysiology as measured by P-wave characteristics and to determine the potential predictive value of P-wave characteristics on the incidences of postopera- tive AF in patients undergoing CABG surgery. Patients undergoing elective CABG surgery were

  3. Clinical Features of Elderly Patients Submitted to Coronary Artery Bypass Graft

    Microsoft Academic Search

    Franklin Santana Santos; Irineu Tadeu Velasco

    2005-01-01

    Objective: To describe the clinical features as well as morbidity and mortality of elderly patients submitted to coronary artery bypass graft (CABG). Design: Randomized, single-center, observational study. Methods: A prospective study was carried out in a tertiary referral teaching hospital (Heart Institute-Brazil). A total of 220 inpatients submitted to elective CABG were evaluated and data collected from the pre-, intra-

  4. What to Expect during Coronary Artery Bypass Grafting

    MedlinePLUS

    ... from traditional surgery to newer, less-invasive methods. Traditional Coronary Artery Bypass Grafting This type of surgery ... arteries being bypassed. Many steps take place during traditional CABG. You'll be under general anesthesia (AN- ...

  5. Safety of low dose heparin in elective coronary angioplasty.

    PubMed Central

    Koch, K. T.; Piek, J. J.; de Winter, R. J.; David, G. K.; Mulder, K.; Tijssen, J. G.; Lie, K. I.

    1997-01-01

    OBJECTIVES: To evaluate the safety of a low dose of heparin in consecutive stable patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA). DESIGN: Open prospective study in a single centre. PATIENTS: 1375 consecutive patients had elective PTCA (1952 lesions: type A 11%, B1 34%, B2 36%, and C 19%). There were no angiographic exclusion criteria. INTERVENTIONS: A bolus of 5000 IU heparin was used as the standard anticoagulation regimen during PTCA. The sheaths were removed immediately after successful completion of the procedure. Prolongation of heparin treatment was left to the operator's discretion. MAIN OUTCOME MEASURES: Procedural success was defined as < 50% residual stenosis without death from any cause, acute myocardial infarction, urgent coronary bypass surgery, or repeat angioplasty within 48 hours for acute recurrent ischaemia; the need for prolonged heparinisation; and the occurrence of puncture site complications. RESULTS: Procedural success without clinical events was achieved in 90% of patients. Mortality was 0.3%; coronary bypass surgery was performed in 1.7% of the procedures. The rate of myocardial infarction was 3.3%; repeat angioplasty within 48 hours was carried out in 0.7% of patients. A total of 89.1% of the patients were treated according to the protocol. Prolonged treatment with heparin was considered necessary in 123 patients (8.9%). Repeat angioplasty for abrupt closure was performed in two patients shortly after sheath removal and in two during prolonged heparinisation. Puncture site complications occurred in 2.1% of patients (low dose heparin 1.9% and prolonged heparinisation 4.9%). CONCLUSION: Elective PTCA can be safely performed using a low dose of heparin, with a negligible risk for subacute closure. Low dose heparin may reduce the incidence of puncture site complications, shorten hospitalisation, and enable out-patient angioplasty. PMID:9227294

  6. 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

  7. 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

  8. 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

  9. Awake coronary artery bypass grafting: utopia or reality?

    Microsoft Academic Search

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

    2003-01-01

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

  10. Lowest Hematocrit on Bypass and Adverse Outcomes Associated With Coronary Artery Bypass Grafting

    Microsoft Academic Search

    Gordon R. DeFoe; Cathy S. Ross; Elaine M. Olmstead; Stephen D. Surgenor; Mary P. Fillinger; Robert C. Groom; Richard J. Forest; John W. Pieroni; Craig S. Warren; Mary E. Bogosian; Charles F. Krumholz; Cantwell Clark; Robert A. Clough; Paul W. Weldner; Stephen J. Lahey; Bruce J. Leavitt; Charles A. S. Marrin; David C. Charlesworth; Peter Marshall; Gerald T. O'Connor

    2010-01-01

    Background. Cardiac surgery patients' hematocrits fre- quently fall to low levels during cardiopulmonary bypass. Methods. We investigated the association between na- dir hematocrit and in-hospital mortality and other ad- verse outcomes in a consecutive series of 6,980 patients undergoing isolated coronary artery bypass graft surgery. The lowest hematocrit during cardiopulmonary bypass was recorded for each patient. Patients were divided into

  11. Ultrasonic Evaluation of Graft Anastomoses During Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass

    Microsoft Academic Search

    Yoshihiro Suematsu; Toshiya Ohtsuka; Takeshi Miyairi; Noboru Motomura; Shinichi Takamoto

    2010-01-01

    Performance of the graft-to-coronary anastomosis in cor- onary artery bypass grafting without cardiopulmonary bypass is more difficult than conventional coronary ar- tery bypass grafting. We report a new method that uses high-frequency epicardial echocardiography to detect technical errors and inadequacies in graft anastomoses. This method improves the operative outcome and en- ables detection of septal perforator branches and deeply embedded

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

    Microsoft Academic Search

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

    2011-01-01

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

  13. 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

  14. 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

    2010-01-01

    Background. We sought to investigate the effect of multiple coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) on the perioper- ative inflammatory response. Methods. Sixty patients undergoing CABG were ran- domly 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

  15. Coronary Bypass Surgery with or without Surgical Ventricular Reconstruction

    Microsoft Academic Search

    Robert H. Jones; Eric J. Velazquez; Robert E. Michler; George Sopko; Jae K. Oh; Christopher M. O'Connor; James A. Hill; Lorenzo Menicanti; Zygmunt Sadowski; Patrice Desvigne-Nickens; Jean-Lucien Rouleau; Kerry L. Lee

    2009-01-01

    Background Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address the question of whether surgical ventricular recon- struction added to coronary-artery bypass grafting (CABG) would decrease the rate of death or hospitalization for cardiac causes, as compared with CABG alone.

  16. Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients

    Microsoft Academic Search

    Mitchell J. Magee; Kathleen A. Jablonski; Sotiris C. Stamou; Albert J. Pfister; Todd M. Dewey; Mercedes K. C. Dullum; James R. Edgerton; Syma L. Prince; Tea E. Acuff; Paul J. Corso; Michael J. Mack

    2002-01-01

    Background. Coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (CPB) is currently increasing in clinical practice. Decreased morbidity associated with off-pump (OP) CABG in selected risk groups examined in relatively small, single institution groups has been the focus of most recent studies. The purpose of this study was to determine the independent impact of CPB on early survival

  17. Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass

    Microsoft Academic Search

    J. Reis; J. C. MotaSUPbSU; P. Ponce; A. Costa-Pereira; M. Guerreiro

    2002-01-01

    Background: With the evolution of anesthesia and surgical procedures, fast track extubation has gained an increased interest, mainly based on the possibility of reducing health costs seemingly without compromising patient care. Aim: To compare two groups of patients submitted to a non-fast track extubation and a fast track extubation protocol after coronary artery bypass graft surgery with cardiopulmonary bypass, regarding

  18. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting

    Microsoft Academic Search

    Gordon R DeFoe; Cathy S Ross; Elaine M Olmstead; Stephen D Surgenor; Mary P Fillinger; Robert C Groom; Richard J Forest; John W Pieroni; Craig S Warren; Mary E Bogosian; Charles F Krumholz; Cantwell Clark; Robert A Clough; Paul W Weldner; Stephen J Lahey; Bruce J Leavitt; Charles A. S Marrin; David C Charlesworth; Peter Marshall; Gerald T O’Connor

    2001-01-01

    Background. Cardiac surgery patients’ hematocrits frequently fall to low levels during cardiopulmonary bypass.Methods. We investigated the association between nadir hematocrit and in-hospital mortality and other adverse outcomes in a consecutive series of 6,980 patients undergoing isolated coronary artery bypass graft surgery. The lowest hematocrit during cardiopulmonary bypass was recorded for each patient. Patients were divided into categories based on their

  19. Hyperbaric oxygen preconditioning improves myocardial function, reduces length of intensive care stay, and limits complications post coronary artery bypass graft surgery

    Microsoft Academic Search

    Jeysen Zivan Yogaratnam; Gerard Laden; Levant Guvendik; Mike Cowen; Alex Cale; Steve Griffin

    2010-01-01

    ObjectiveThe objective of this study was to determine whether preconditioning coronary artery disease (CAD) patients with HBO2 prior to first-time elective on-pump cardiopulmonary bypass (CPB) coronary artery bypass graft surgery (CABG) leads to improved myocardial left ventricular stroke work (LVSW) post CABG. The primary end point of this study was to demonstrate that preconditioning CAD patients with HBO2 prior to

  20. Refractory vascular spasm associated with coronary bypass grafting.

    PubMed

    Kim, Young Sam; Yoon, Yong Han; Kim, Jeoung Taek; Shinn, Helen Ki; Woo, Seong Ill; Baek, Wan Ki

    2014-10-01

    Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management. PMID:25346903

  1. Refractory Vascular Spasm Associated with Coronary Bypass Grafting

    PubMed Central

    Kim, Young Sam; Yoon, Yong Han; Kim, Jeoung Taek; Shinn, Helen Ki; Woo, Seong Ill; Baek, Wan Ki

    2014-01-01

    Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management. PMID:25346903

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

    Microsoft Academic Search

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

    1995-01-01

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

  3. [Cerebral dysfunction after coronary artery bypass graft surgery with cardiopulmonary bypass].

    PubMed

    Tsygan, I V

    2013-11-01

    The cardiac surgery is accompanied by multifactorial alteration of the brain, which can present in different clinical types of postoperative cerebral dysfunction. A stroke was diagnosed only after coronary artery bypass graft surgery with cardiopulmonary bypass. Postoperative cognitive dysfunction (including acute cognitive dysfunction and deferred cognitive impairment) was significantly more frequent after surgery with cardiopulmonary bypass. The preoperative use of complex cytoprotective medication Cytoflavin decreased the severity of the deferred cognitive impairment. The data show the prospects of the pharmacological neuroprotection in cardiac surgery with cardiopulmonary bypass. PMID:24611306

  4. Nonembolic Predictors of Stroke Risk in Coronary Artery Bypass Patients

    Microsoft Academic Search

    Giulio Pompilio; Attilio A. Lotto; Marco Agrifoglio; Carlo Antona; Francesco Alamanni; Rita Spirito; Paolo Biglioli

    1999-01-01

    .   The aim of this study was to identify and stratify the most important nonembolic risk factors for stroke after coronary bypass\\u000a grafting. From June 1994 to June 1997 a series of 1532 patients (pts) underwent isolated myocardial revascularization on cardiopulmonary\\u000a bypass (CPB). A retrospective chart review selected 1417 pts in whom the presence of aortic calcification or left ventricular

  5. [Off-pump coronary artery bypass grafting in Japan].

    PubMed

    Kobayashi, Junjiro

    2006-01-01

    The number of coronary artery bypass grafting (CABG) procedures has reached more than 20,000 per year in Japan, and the operative mortality rate has decreased to less than 1.5% including emergent surgery. The mortality and morbidity rates of CABG are still high in patients with risk factors such as cerebrovascular disease, chronic renal failure on hemodialysis, atheromatous and calcified ascending aorta, and older age when cardiopulmonary bypass is used. Minimally invasive direct coronary bypass on a beating heart through a small left lateral anterior thoracotomy, in which the left internal thoracic artery (LITA) is used to revascularize the left anterior descending artery, was introduced for high-risk patients with single-vessel disease in the mid-1990s, although is not widely performed at present. Since the late 1990s off-pump coronary artery bypass grafting (OPCAB) has been widely performed as a treatment for multivessel disease through a median sternotomy with the evolution of stabilizers and apical suction devices, refined anesthetic management, and sophisticated surgical techniques. In 2004, 60% of all CABG procedures in Japan were performed without cardiopulmonary bypass. Due to competition from percutaneous coronary intervention with drug-eluting stents and better long-term outcomes, CABG with arterial grafts alone was carried out in 52% of total cases and in 66% of OPCAB cases. OPCAB is becoming the standard CABG in Japan. PMID:16482890

  6. 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\\

  7. [Off-pump coronary artery bypass grafting using graft to coronary shunt for acute coronary syndrome].

    PubMed

    Iida, H; Mori, H; Yamada, Y; Eda, K; Inoue, Y; Mochizuki, Y

    2005-06-01

    We developed graft to coronary shunt during off-pump anastomosis. Proximal anastomosis of saphenous vein graft (SVG) was done formerly, and vinyl chloride tube, 5 cm long and 2 mm in diameter, was inserted into SVG. Another end was inserted into coronary artery, and continuous suture around the tube was performed before removing the tube. This technique is fit to use for the anastomosis between SVG and #3. Because the tube is easily inserted into those parts without injury of intima, and distal right coronary artery needs enough blood supply. After the revascularization of left anterior descending artery and #3, the heart can be displaced to expose circumflex artery. We adopted this technique to 3 patients with acute coronary syndrome (ACS). Though this technique is not adopted for the patients having stenosis on #4, we conclude that SVG to coronary shunt could be a important part of the strategies of off-pump coronary artery bypass grafting (OPCAB) for ACS patients. PMID:15957421

  8. 010. Coronary artery bypass in prior left pneumonectomy postoperative use of iloprost

    PubMed Central

    Ignatiadis, Agisilaos; Ampatzidou, Fotini; Kechagioglou, George; Antoniou, Konstantinos; Michail, Nikolaos; Karaiskos, Theodoros; Sileli, Maria; Drossos, George

    2015-01-01

    Background The rare procedure of coronary artery bypass in a prior left pneumonectomy patient characterized by postoperative cardiopulmonary complications. Acute right heart failure due to anatomic and physiologic changes because of pneumonectomy is the most serious complication. It is very helpful to prevent this condition by reducing pulmonary vascular resistance index which represents the right heart afterload. In our case we have recorded the favorable hemodynamic effects of inhaled Iloprost. Methods A 60-year-old man presented to our department with acute coronary syndrome. He had undergone a left pneumonectomy nine years ago because of bronchial carcinoma. Coronary angiography, which was performed during acute coronary syndrome, revealed left main disease (70% stenosis) and 50% stenosis in right coronary artery. Pulmonary function tests revealed severe restrictive disease: forced vital capacity (FVC): 1.47 L (30% of predicted) and forced expiratory volume (FEV) 1: 1.41 L (25% of predicted). Coronary artery bypass surgery (CABG) procedure was successfully completed with cardiopulmonary bypass (CPB) and patient was transferred in ICU. Patient’s inotropic support was 0.1 ?g/kg/min Epinephrine and 0.06 ?g/kg/min Noradrenaline. In the ICU, in order to avoid RV dysfunction the patient was ventilated with low tidal volume, Vt 6 mL/kg and with low positive end-expiratory pressure (PEEP). He was under careful fluid balance. Hemodynamic profile revealed high values of PVRI. This undesirable high RV afterload was managed with inhaled Iloprost (prostacyclin analogue) because of its elective pulmonary vessels dilator properties. Results The patient was extubated 5 hours postoperatively. Postoperative vigorous chest physiotherapy and bronchodilation due to transient brochospasm contributed to the uncomplicated respiratory function. The patient discharged on 7th postop day. Conclusions CABG in postpneumonectomy patients is a challenging procedure. The use of selective pulmonary vasodilators could offer better postoperative conditions in order to overcome the possible cardiorespiratory complications in this group of patients.

  9. 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

  10. Coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty. Twenty-year clinical outcome

    Microsoft Academic Search

    R. T. van Domburg; D. P. Foley; A. Breeman; L. A. van Herwerden; P. W. Serruys

    2002-01-01

    Aims The purpose of this study is to compare the long-term outcome (up to 20 years) of coronary artery bypass surgery (CABG) with percutaneous transluminal coronary angio- plasty (PTCA) in a consecutive patient series at a single centre. Survival is similar after CABG and PTCA up to 8 years follow-up in patients with multivessel disease, with a reduced need for

  11. 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

  12. 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.

  13. Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized study

    Microsoft Academic Search

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

    1999-01-01

    Background. Emphasis on cost containment in coronary artery bypass surgery is becoming increasingly important in modern hospital management. The revival of interest in off-pump (beating heart) coronary artery bypass surgery may influence the economic outcome. This study examines these effects.Methods. Two hundred patients undergoing first-time coronary artery bypass surgery were prospectively randomized to either conventional cardiopulmonary bypass and cardioplegic arrest

  14. Neurologic outcomes after coronary artery bypass grafting with and without cardiopulmonary bypass

    Microsoft Academic Search

    John E. Scarborough; William White; Frantz E. Derilus; Joseph P. Mathew; Mark F. Newman; Kevin P. Landolfo

    2003-01-01

    Neurologic injury, in the form of either stroke or more subtle neurocognitive impairment, is a frequent and potentially devastating complication of coronary artery bypass grafting (CABG). The etiology of CABG-associated neurologic injury is likely multifactorial, with the phenomena of cerebral hypoperfusion and embolism being the major contributors. Several perioperative strategies have been developed in an effort to reduce the incidence

  15. TECAB - Totally Endoscopic Coronary Artery Bypass

    MedlinePLUS

    ... for entry. And the bypass vessel is the so-called “internal mammary artery.” That’s an artery, as opposed ... for the second stitch here. This is a so-called hat there’s no tremor at all. That is ...

  16. 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

  17. 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,

  18. 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

  19. [Surgical therapy of coronary disease: aortocoronary bypass. Risks and complications].

    PubMed

    Unger, F; Knapp, E; Mühlberger, V; Scharfetter, H; Schistek, R

    1985-10-31

    The aorto-coronary bypass surgery is a well established method for treating patients with coronary artery disease. In the last five years at the University Clinic in Innsbruck 417 operations have been performed. The operation letality decreased down to 0.66%, whereby the mean revascularisation rate increased to 2.8. The specific aim of this paper is to show the benefits and the risks of this operation to validate and to verify the benefits in regard to the risks, which could be kept very low. PMID:3878043

  20. [Coronary artery bypass grafting for cardiovascular sequelae in Kawasaki disease].

    PubMed

    Maruyama, Yuji; Ochi, Masami

    2014-09-01

    There are several issues regarding surgical revascularization for Kawasaki coronary disease including (1) the choice of conduits and (2) the optimal timing and correct indication for coronary artery bypass grafting(CABG). The internal thoracic artery(ITA) is the best conduit in terms of growth potential for pediatric CABG and for excellent long-term patency. The use of saphenous vein graft should be avoided unless an ITA is unavailable. The indication of CABG for Kawasaki coronary disease has not been established. In principle, coronary aneurysms should be observed continuously for 1 to 2 years under restrictive anticoagulation therapy, because regression of coronary aneurysm often occurs in 50 % within 1 to 2 years. The presence of severe ischemia in giant coronary aneurysms involving either the left main trunk or left anterior descending coronary artery is an absolute indicator for CABG. In addition, giant aneurysms with recurrent thrombosis under restrictive anticoagulation therapy or with severe delayed flow without significant localized stenosis may be an indication for CABG. PMID:25518421

  1. 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

  2. Endoscopic vein harvesting in coronary artery bypass surgery

    Microsoft Academic Search

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

    2007-01-01

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

  3. 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

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

    SciTech Connect

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

    1987-02-01

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

  5. On-pump versus off-pump coronary artery bypass graft surgery. What do the evidences show?

    PubMed Central

    Rodrigues, Alfredo José; Évora, Paulo Roberto Barbosa; Tubino, Paulo Victor Alves

    2013-01-01

    The main purpose of the off-pump coronary artery bypass surgery is to reduce morbidity and mortality due cardiopulmonary bypass. However, even though many studies have shown that off-pump coronary artery bypass is feasible and provides hospital morbidity and mortality similar to the on-pump coronary artery bypass graft surgery, probably better in some aspects, its long-term results have been questioned, since some trials have shown reduced survival with off-pump coronary artery bypass. It is likely that incomplete revascularization and/or poor graft patency with off-pump coronary artery bypass probably are responsible for such unfavorable outcome. PMID:24598960

  6. Does off-pump coronary artery bypass surgery reduce secretion of plasminogen activator inhibitor-1?

    PubMed

    Ozkara, C; Guler, N; Batyraliev, T; Okut, H; Agirbasli, M

    2007-05-01

    Prior studies showed that postoperative increase in plasminogen activator inhibitor-1 (PAI-1) levels is associated with an increased risk of graft occlusion after coronary artery bypass surgery (CABG). This prospective study aimed to compare the changes of PAI-1 antigen levels after off-pump and on-pump CABG. Forty-four patients admitted for elective CABG were randomised to on-pump (n=22) or off-pump (n=22) surgery. Serum samples were collected for estimation of PAI-1 and tissue plasminogen activator (t-PA) antigen levels preoperatively and 2 h after the operation. The groups were similar in terms of age, weight, gender ratio and extent of coronary disease, left ventricular function and number of grafts per patient. Fibrinogen and t-PA levels increased postoperatively in both the groups when compared with baseline values. After operation, statistical analysis revealed that increase of PAI-1 values was higher in off-pump group (44.1+/-9.1 vs. 25.3+/-6.9) than on-pump group (37.2+/-5.5 vs. 27.3+/-7.8, p=0.002). This study shows that increase in PAI-1 antigen values in patients who undergo off-pump (beating heart) CABG is significantly higher than in those who undergo conventional CABG with cardiopulmonary bypass. PMID:17343662

  7. 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

  8. Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting

    Microsoft Academic Search

    Carlos A Estrada; James A Young; L Wiley Nifong; W. Randolph Chitwood

    2003-01-01

    BackgroundThe association between perioperative hyperglycemia and outcomes in patients with and without diabetes mellitus undergoing coronary artery bypass grafting is not well defined. We measured the association between perioperative hyperglycemia and outcomes among patients undergoing coronary artery bypass grafting.

  9. Intermittent Cold-Blood Cardioplegia and Its Impact on Myocardial Acidosis during Coronary Bypass Surgery.

    PubMed

    Borowski, Andreas; Godehardt, Erhard; Paprotny, Gerrit; Kurt, Muhammed

    2014-11-25

    Background?The purpose of the study was to assess the degree of myocardial acidosis in patients undergoing elective coronary bypass surgery, in whom intermittent cold-blood cardioplegia (ICBC) was used for myocardial protection. The results of this study are presented in comparison to those of a previous trial conducted by the same investigators, using a similar methodology, but with intermittent warm-blood cardioplegia (IWBC). Patients and Methods?In 15 patients undergoing elective myocardial revascularization with ICBC for myocardial protection, metabolic changes of global ischemia indicators, lactate and pH values (measured simultaneously in coronary sinus and arterial blood) were analyzed. Lactate concentrations and pH values were measured at the beginning and the end of each cardioplegia administration, and the change-overtime analysis of the values was performed. For comparison with the results of the previous study (IWBC method) consisting of 12 patients, the analysis of variance with repeated measurements, including tests for a crossover, group, and time effect were used. Results?Using the ICBC method, as compared with IWBC, no significant difference in the lactate production was observed during the first two successive cardioplegia administrations. During the third and fourth administrations, especially at the end of reperfusions, ICBC patients had a significantly lower lactate release and higher pH values, as compared with IWBC patients. Conclusion?Our results suggest that ICBC has an inhibiting effect on potentially progressive myocardial acidosis during cross-clamp period. PMID:25423313

  10. Massive intracardiac thrombosis during coronary artery bypass grafting surgery

    PubMed Central

    Bhandary, Sujatha P; Papadimos, Thomas J; Essandoh, Michael K; Apostolakis, John

    2015-01-01

    Thrombosis is a potential life-threatening complication in patients undergoing cardiac surgery. Various clinical and heritable conditions, like cancer, trauma, immobilization, the presence of factor V Leiden or prothrombin 20210A, deficiency of or resistance to the inhibitor proteins C, S, or antithrombin, elevated levels of coagulation proteins, antiphospholipid antibody syndrome, pregnancy, and the use of exogenous hormones, may contribute to catastrophic thrombosis. Massive thrombi with cerebrovascular and cardiovascular events develop in patients with polycythemia vera (PV). However, thrombus formation in the cardiac chambers is extremely rare. We report a case of massive intracardiac thrombosis in a patient undergoing coronary artery bypass grafting.

  11. Endoscopic radial artery harvesting procedure for coronary artery bypass grafting

    PubMed Central

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

    2013-01-01

    Development and adoption of endoscopic minimally invasive saphenous vein harvesting prompted its application to the radial artery in an effort to minimize surgical trauma. Recently, we reported that endoscopic radial artery harvesting was associated with better wound appearance and it proved to be safe and effective, with less pain and fewer wound complications than the open surgical technique. Based on this positive experience, our institution adopted endoscopic radial artery harvesting, hence the aim of this manuscript is to describe the minimally invasive endoscopic radial artery harvesting for coronary artery bypass grafting. PMID:23977636

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

    Microsoft Academic Search

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

    2000-01-01

    OBJECTIVESWe sought to evaluate immediate and late outcomes after stenting for left main coronary artery (LMCA) stenosis.BACKGROUNDConventional percutaneous transluminal coronary angioplasty (PTCA), for which coronary artery bypass grafting (CABG) has been the gold standard therapy for years, has yielded poor results in unprotected LMCA lesions. The development of coronary stents, together with their dramatic patency improvement provided by new antiplatelet

  13. Intraoperative graft assessment during coronary artery bypass surgery.

    PubMed

    Fukui, Toshihiro

    2015-03-01

    Coronary artery bypass grafting (CABG) is an established revascularization method for treating multivessel coronary artery disease. The goal of CABG is to achieve complete revascularization with a durable, patent graft without reintervention. However, early graft failure, including that associated with technical errors, has been reported. This makes intraoperative verification of graft patency one of the most important ways in which surgeons can reduce the rate of early graft failure. Conventional angiography is considered the gold standard for graft assessment. However, because it is invasive and inconvenient, several alternatives to intraoperative graft assessment have become available that help reduce early graft failure by allowing revision of the anastomosis intraoperatively. The aim of this article is to review the advantages and disadvantages of several intraoperative graft assessment methods for CABG. PMID:25556862

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

    Microsoft Academic Search

    Cornelius Borst; Erik W. L. Jansen; Cornelis A. F. Tulleken; Paul F. Grundeman; Hendricus J. Mansvelt Beck; Jeroen W. F. van Dongen; Kees C. Hodde; Jaap J. Bredée

    1996-01-01

    Objective. This study assessed the feasibility of coronary artery bypass grafting on the beating heart without interruption of native coronary blood flow using a novel anastomosis site restraining device.Background. Recently, an end-to-side bypass technique was described that does not require interruption of flow in the recipient artery.Methods. By means of a suction device (“Octopus”), in 31 pigs the epicardium was

  15. 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,

  16. Outcome and Graft Patency in Coronary Artery Bypass Grafting with Coronary Endarterectomy

    PubMed Central

    Nemati, Mohammad Hassan; Astaneh, Behrooz; Khosropanah, Shahdad

    2015-01-01

    Background Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE. Methods This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After follow-up at 9.66±3.65 months post-surgery, 28 patients from the CE+ group underwent angiography to evaluate the patency of grafts and native coronary vessels. Results Patients in the CE+ group had a more prevalent history of diabetes (48% vs. 36%) and number of diseased vessels (2.88±0.39 vs. 2.70±0.85). The overall hospital mortality was 1.8%, and no significant difference was observed between the two groups. In the 28 patients who underwent reangiography, 113 vessels were bypassed and 29 endarterectomies were performed, mostly on the left anterior descending artery (12 endarterectomies) and the right coronary artery (8 endarterectomies). In the endarterectomized vessels, a 66% patency rate was found in both the grafts and the native vessels. The native coronary vessels were more likely to be patent when the left internal mammary artery was used as a conduit than when a saphenous vein bypass graft was used. Conclusion The lack of a significant difference in postoperative complications in patients who underwent CABG with or without CE may indicate that CE does not expose patients to a higher risk of complications. Since most of the endarterectomized vessels were shown to be patent during the follow-up period, we propose that endarterectomy is a viable option for patients with severely diseased vessels. PMID:25705593

  17. A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes

    Microsoft Academic Search

    Stephen G. Pauker; Deeb N. Salem

    2003-01-01

    ObjectivesWe performed a meta-analysis of randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous transluminal coronary angioplasty (PTCA) for the treatment of coronary artery disease, incorporating new trials and examining long-term outcomes.

  18. 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

  19. Slow-flow phenomenon after elective percutaneous coronary intervention of computed tomography-detected vulnerable coronary lesion.

    PubMed

    Wolny, Rafa?; D?bski, Artur; Kruk, Mariusz; K?pka, Cezary

    2014-01-01

    No-reflow or slow-flow phenomenon is one of the serious complications of percutaneous coronary interventions (PCI) in acute myocardial infarction, as well as during elective procedures, and is an independent predictor of myocardial infarction, and in-hospital and long-term mortality. We present a case of an elective PCI of native coronary artery lesion that was assessed to be vulnerable based on coronary computed tomography angiography, complicated with slow-flow phenomenon. PMID:25489304

  20. Slow-flow phenomenon after elective percutaneous coronary intervention of computed tomography-detected vulnerable coronary lesion

    PubMed Central

    Wolny, Rafa?; D?bski, Artur; Kruk, Mariusz

    2014-01-01

    No-reflow or slow-flow phenomenon is one of the serious complications of percutaneous coronary interventions (PCI) in acute myocardial infarction, as well as during elective procedures, and is an independent predictor of myocardial infarction, and in-hospital and long-term mortality. We present a case of an elective PCI of native coronary artery lesion that was assessed to be vulnerable based on coronary computed tomography angiography, complicated with slow-flow phenomenon. PMID:25489304

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

    PubMed Central

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

    2013-01-01

    Background Atelectasis is a major cause of hypoxemia after coronary artery bypass grafting (CABG) and is commonly ascribed to general anesthesia, high inspiratory oxygen concentration and cardiopulmonary bypass (CPB). The objective of this study was to evaluate the role of heart-induced pulmonary compression after CABG with CPB. Methods Seventeen patients without pre-operative cardiac failure who were scheduled for coronary artery bypass graft underwent pre- and postoperative thoracic computed tomography. The cardiac mass, the pressure exerted on the lungs by the right and left heart and the fraction of collapsed lower lobe segments below and outside of the heart limits were evaluated on a computed tomography section 1 cm above the diaphragmatic cupola. Results In the postoperative period, cardiac mass increased by 32% (117±31 g versus 155±35 g, p<0.001), leading to an increase in the pressure that was exerted on the lungs by the right (2.2±0.6 g.cm?2 versus 3.2±1.2 g.cm?2, p<0.05) and left heart (2.4±0.7 g.cm?2 versus 4.2±1.8 g.cm?2, p<0.001). The proportion of collapsed lung segments beneath the heart markedly increased [from 6.7% to 32.9% on the right side (p<0.001) and from 6.2% to 29% on the left side (p<0.001)], whereas the proportion of collapsed lung segments outside of the heart limits slightly increased [from 0.7% to 10.8% on the right side (p<0.001) and from 1.5% to 12.6% on the left side (p<0.001)]. Conclusion The pressure that is exerted by the heart on the lungs increased postoperatively and contributed to the collapse of subjacent pulmonary segments. PMID:24244331

  2. Triage of patients for short term observation after elective coronary angioplasty

    PubMed Central

    Koch, K; Piek, J; Prins, M; de Winter, R J; Mulder, K; Lie, K; Tijssen, J

    2000-01-01

    OBJECTIVE—To evaluate triage of patients for short term observation after elective percutaneous transluminal coronary angioplasty (PTCA), as appropriate selection of patients for short term observation after angioplasty may facilitate early discharge.?METHODS—1015 consecutive patients scheduled for elective PTCA were prospectively included for short term observation. Patients with unstable angina Braunwald class III were excluded. There were no angiographic exclusion criteria. Patients were discharged from the interventional centre when considered stable during 4 hours of observation after PTCA. It was left to the operator's discretion whether to prolong the observation period. Procedural complications were defined as death, coronary bypass surgery, early repeat PTCA, and myocardial infarction.?OUTCOME MEASURES—The need for prolonged observation (> 4 hours) and the occurrence of complications. Predictors for prolonged observation and the occurrence of complications after the 4 hours observation were assessed by univariate and multivariate analysis.?RESULTS—Two patients died, including one of six patients who underwent emergency bypass surgery. In all, 922 patients (90.8%) were triaged to short term observation and had an uncomplicated three day follow up. Observation was prolonged in 87 patients (8.6%), and 40 patients had a complicated course. Independent predictors of procedural complications were acute closure (odds ratio (OR) 9.7; 95% confidence interval 4.4 to 21.4), side branch occlusion (OR 8.9; 3.4 to 23.7), no angiographic success (OR 5.1; 2.4 to 11.0), female sex (OR 3.1, 1.7 to 5.7), any unplanned stent (OR 2.8, 1.4 to 5.9), and ostial lesion (OR 2.2, 1.0 to 4.7).?CONCLUSIONS—A 4 hour observation period is safe after elective coronary angioplasty. As procedural variables are the strongest predictors of postprocedural complications, the immediate procedural results allow effective triage of patients for short term or prolonged observation in order to anticipate complications.???Keywords: angioplasty; triage; interventional cardiology PMID:10768908

  3. 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.

  4. 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

  5. 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

  6. 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

  7. Beating heart versus conventional single-vessel reoperative coronary artery bypass

    Microsoft Academic Search

    Sotiris C Stamou; Albert J Pfister; George Dangas; Mercedes K. C Dullum; Steven W Boyce; Ammar S Bafi; Jorge M Garcia; Paul J Corso

    2000-01-01

    Background. Reoperative (redo) coronary artery bypass grafting (CABG) with cardiopulmonary bypass (on-pump) is associated with a higher morbidity and mortality than first-time CABG. It is unknown, however, whether CABG without cardiopulmonary bypass (off-pump) may yield an improved clinical outcome over conventional on-pump redo CABG.Methods. We compared the perioperative outcomes of patients with single-vessel disease who underwent on-pump (n = 41)

  8. Single proximal anastomosis for multiple vein coronary artery bypasses in diseased ascending aorta.

    PubMed

    Cebi, N; Walterbusch, G

    2008-02-01

    Minimization of the manipulation of the diseased ascending aorta has been shown to be associated with a reduced risk of postoperative stroke during coronary artery bypass surgery. We describe in this paper a novel method in which a single proximal anastomosis has been performed in the same ostium on the ascending aorta for multiple coronary artery vein grafts. PMID:18212698

  9. 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)

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

    Microsoft Academic Search

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

    1989-01-01

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

  11. Outcome after combined carotid endarterectomy and coronary artery bypass is related to patient selection

    Microsoft Academic Search

    James M. Estes; Kamal R. Khabbaz; Marcos Barnatan; Philip Carpino; William C. Mackey

    2001-01-01

    Objective: The optimal management of patients with significant coronary and carotid artery disease remains controversial. Since reporting on a series of 100 patients undergoing combined carotid endarterectomy and coronary artery bypass (CEA\\/CAB) 4 years ago, we have liberalized our selection criteria for combined operation. We sought to compare outcomes of the recent cohort of 74 patients and the previous group.

  12. Factors predicts skin ulcer following coronary artery bypass

    PubMed Central

    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. Abbreviations: electrocautery sore = ES, pressure sore = PS, electrocautery ulcer = EU, pressure ulcer = PU, activated clotting time = ACT

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

    PubMed Central

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

    2014-01-01

    Background There are several modalities of coronary artery revascularization for multivessel coronary artery disease. Hybrid coronary revascularization (HCR) with minimally invasive direct coronary artery bypass grafting was introduced for high-risk patients, and recently, many centers have been using it. Limited incisional full sternotomy coronary artery bypass (LIFCAB) involves left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis through a sternotomy with a minimal skin incision; it could be considered another technique for minimally invasive LITA-to-LAD anastomosis. Our center has performed HCR using LIFCAB, and in this paper, we report our short-term results, obtained in the past 3 years. Methods The medical records of 38 patients from May 2010 to June 2013 were analyzed retrospectively. The observation period after HCR was 1 to 37 months (average, 18.3±10.3 months). The patency of revascularization was confirmed with postoperative coronary angio-computerized tomography or coronary angiography. Results There were 3 superficial wound complications, but no mortalities. All the LITA-to-LAD anastomoses were patent in the immediate postoperative and follow-up studies, but stenosis was detected in 3 cases of percutaneous coronary intervention. Conclusion HCR using LIFCAB is safe and yields satisfactory results from the viewpoint of revascularization for multivessel disease. PMID:24782958

  14. 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

  15. Prevalence of Delirium in Opium Users after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Eizadi-Mood, Nastaran; Aghadavoudi, Omid; Najarzadegan, Mohammad Reza; Fard, Masoud Mozhdehi

    2014-01-01

    Background: Postoperative cognitive dysfunction, especially delirium commonly occurs after cardiac surgery. Clinical evidences suggest an increase in delirium in opium abusers after Coronary Artery Bypass Graft (CABG) surgery. In this study, the prevalence of delirium in addict (opium user) and nonaddict patients after CABG were compared. Methods: In a cross-sectional study after obtaining institutional approval and informed consent, 325 patients candidate for elective CABG were included in the study. All patients with history of opium abuse met the criteria for opioid dependence using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition definitions. Delirium after CABG was assessed in addict (opium user) and nonaddict patients up to a maximum of 5 days after surgery with the Intensive Care Delirium Screening Checklist. Results: A total of 325 patients were evaluated (208 without and 117 with a history of opium abuse). Postoperative delirium occurred within 72 h after surgery in 44.31% of all patients. There was a significant difference in the prevalence of postoperative delirium between the opium users (80.7%) and nonaddict patients (25%) in the intensive care unit (P < 0.001). Opium addiction was a risk factor for postoperative delirium after CABG Surgery. Conclusions: Delirium after CABG surgery is more prevalent in opium users compared with nonaddict patients. Therefore, opium abuse is a possible risk factor for postoperative delirium in cardiac surgical patients. PMID:25105003

  16. Premedication With Oral Pregabalin for the Prevention of Acute Postsurgical Pain in Coronary Artery Bypass Surgery

    PubMed Central

    Ziyaeifard, Mohsen; Mehrabanian, Mohammad Javad; Faritus, Seyedeh Zahra; Khazaei Koohpar, Mehrdad; Ferasatkish, Rasool; Hosseinnejad, Heidar; Mehrabanian, Mohammadreza

    2015-01-01

    Background: For coronary artery bypass grafting (CABG) sternotomy should be performed. The pain after surgery is severe and requires medical intervention. Use of the analgesics is limited by their side effects and studies suggest that prevention with some medications before surgery is effective in controlling the postoperative pain. Objectives: We investigated the efficacy of pregabalin administration before surgery in the treatment of acute postoperative pain after CABG surgery. Patients and Methods: Sixty patients indicated for elective CABG surgery were randomly allocated to two groups. One group received placebo and the other received 150 mg of oral pregabalin before surgery. Heart rates, blood pressure, respiratory rate, intensive care unit (ICU) stay duration, morphine consumption, and pain score according to the visual analog scale (VAS) were measured and recorded at 4, 12, and 24 hours of surgery. Results: Pregabalin consumption did not alter hemodynamic parameters and was safe in patients after CABG. Its consumption was associated with significant reduction in the pain score (P values were 0.035, 0.026, and 0.047 respectively at 4, 12, and 24 hours of surgery). Its use was not associated with changes in the morphine consumption at 4, 12, and 24 hours of surgery (P > 0.05). Conclusions: Premedication with studied dose of pregabalin is effective for the prevention of postoperative pain in patients after CABG and has no adverse effects. Trials with other treating schedule and doses of the drug should be performed to determine the best treatment plan.

  17. Coronary Arteries Bypass Grafting Surgery in Elderly Patients

    PubMed Central

    Sabzi, Feridoun; Kazerani, Hashem; Jalali, Arash; Samadi, Mojgan; Ghasemi, Fahime

    2013-01-01

    Background: The incidence of coronary artery bypass grafting surgery (CABG) in elderly patients has been increasing. There are contradictory reports on the early outcome of elderly coronary artery patients as compared with their young counterparts. We designed this retrospective study to address this issue. Methods: We retrospectively analyzed the results of 1489 on–pump CABG cases performed at our hospital during a 4.5-year period. Perioperative data such as demographic, medical, clinical, operative, and postoperative variables were collected and compared between patients 70 years old or younger (Group A, n = 1164) and patients above 70 years of age (Group B, n = 325). Statistical analysis was performed using the t-test for the continuous and the X2 tests for the categorical variables. Significant variables according to the univariate analysis (X2 and t-test) were further analyzed using multivariate logistic regression analysis. Results: The variables of weight (P value < 0.001), preoperative PO2 (P value = 0.005), ejection fraction > 30% (P value = 0.001), body surface area (P value = 0.003), and hypercholesterolemia (P value = 0.007) were higher in Group A, whereas preoperative myocardial infarction (P value < 0.001), postoperative low cardiac output syndrome (P value = 0.019), emergent surgery (P value = 0.003), inotropic drug use (P value < 0.001), preoperative heparin use (P value < 0.001), re-exploration for bleeding (P value = 0.015), hospital stay (P value < 0.001), low ejection fraction (? 30%) (P value = 0.001), preoperative creatinine > 1.5 mg/dl (P value < 0.001), chronic obstructive pulmonary disease (P value < 0.001), intra-aortic balloon pump use (P value < 0.001), infection (P value < 0.001), pulmonary complications (P value < 0.001), atrial fibrillation (P value < 0.001), postoperative renal complications (P value < 0.001), and death (P value = 0.012) were more frequent in Group B. Conclusion: CABG in the elderly patients had certain surgical risks such as chronic obstructive pulmonary disease, preoperative myocardial infarction, emergent surgery, and death. Also, postoperative complications such as pulmonary complications, inotropic drug use, intra-aortic balloon pump use, and infection were more frequent in the elderly than in the younger patients. PMID:23967029

  18. 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

  19. Video-assisted limited anterior thoracotomy approach for lingular segmentectomy and left anterior descending coronary artery bypass

    Microsoft Academic Search

    Toshiya Ohtsuka; Jun Matsumoto; Jun Nakajima; Shinichi Takamoto

    Minimally invasive cardiothoracic combined surgery was performed successfully in an octogenerian with left anterior descending coronary artery disease and concurrent adenocarcinoma in the lingular segment of emphysematous lung. Through a limited anterior 4th intercostal thoracotomy, left anterior descending coronary artery bypass grafting without cardiopulmonary bypass was carried out using the left internal thoracic artery (LITA) and the interposed vein graft,

  20. Variation in patients’ perceptions of elective percutaneous coronary intervention in stable coronary artery disease: cross sectional study

    PubMed Central

    Jones, Philip G; Buchanan, Donna M; Abdallah, Mouin S; Spertus, John A

    2014-01-01

    Objectives To assess the perceptions of patients with stable coronary artery disease of the urgency and benefits of elective percutaneous coronary intervention and to examine how they vary across centers and by providers. Design Cross sectional study. Setting 10 US academic and community hospitals performing percutaneous coronary interventions between 2009 and 2011. Participants 991 patients with stable coronary artery disease undergoing elective percutaneous coronary intervention. Main outcome measures Patients’ perceptions of the urgency and benefits of percutaneous coronary intervention, assessed by interview. Multilevel hierarchical logistic regression models examined the variation in patients’ understanding across centers and operators after adjusting for patient characteristics, using median odds ratios. Results The most common reported benefits from percutaneous coronary intervention were to extend life (90%, n=892; site range 80-97%) and to prevent future heart attacks (88%, n=872; site range 79-97%). Although nearly two thirds of patients (n=661) reported improvement of symptoms as a benefit of percutaneous coronary intervention (site range 52-87%), only 1% (n=9) identified this as the only benefit. Substantial variability was noted in the ways informed consent was obtained at each site. After adjusting for patient and operator characteristics, the median odds ratios showed significant variation in patients’ perceptions of percutaneous coronary intervention across sites (range 1.4-3.1) but not across operators within a site. Conclusion Patients have a poor understanding of the benefits of elective percutaneous coronary intervention, with significant variation across sites. No sites had a high proportion of patients accurately understanding the benefits. Coupled with the wide variability in the ways in which hospitals obtain informed consent, these findings suggest that hospital level interventions into the structure and processes of obtaining informed consent for percutaneous coronary intervention might improve patient comprehension and understanding. PMID:25200209

  1. 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

  2. Penetration of cefuroxime in subcutaneous tissue during coronary artery bypass grafting surgery

    Microsoft Academic Search

    Jorge Willian Leandro Nascimento; Maria José Carvalho Carmona; Tânia Mara Varejão Strabelli; José Otávio Costa Auler Jr; Sílvia Regina Cavani Jorge Santos

    2009-01-01

    A sensitive and rapid HPLC assay for determining cefuroxime penetration in the subcutaneous tissue near to surgical incision of patients submitted to coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) was performed. Blood and subcutaneous tissue samples were collected from 14 patients, in four periods during surgery. The analytical method presented linearity from 0.5 to 100?g\\/g, LOQ=0.50?g\\/g,

  3. [Coronary artery bypass with extracorporeal circulation in a patient with hemophilia B].

    PubMed

    Bukowski, J G; De Brux, J L; Ganascia, B; Cottineau, C; Jacob, J P

    1996-01-01

    A 64-year-old patient with factor IX deficiency (Christmas disease) underwent quadruple coronary bypass grafting for angina pectoris. Excessive bleeding was prevented by infusion of factor IX concentrates from one day before surgery until the 19th postoperative day. The surgical procedure and the cardiopulmonary bypass were carried out in the same manner as in patients without any haemorrhagic disorder. No haemorrhagic complication occurred, neither during nor after the operation. PMID:8758585

  4. 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.

  5. Circumflex Coronary Artery Bypass via the Posterior Interatrial Sulcus and under the Venae Cavae

    PubMed Central

    Cebi, Niyazi; Walterbusch, Gerhard

    2008-01-01

    During coronary artery bypass grafting, the length of the graft to the circumflex coronary artery or its end branches can be underestimated because of the posterior location of the circumflex. Herein, we describe a new bypass route—which we consider the shortest—to the ascending aorta. In 2 patients, during proximal anastomosis of the saphenous vein bypass graft (via a route either anterior to the pulmonary artery or the transverse sinus) from the circumflex to the ascending aorta, the vein graft (approximately 5–6 cm in length) proved too short. We performed bypass in a new direction—from the circumflex coronary artery to the right side of the ascending aorta, under the inferior and superior venae cavae and along the interatrial groove—without the need for graft lengthening. To our knowledge, the bypass route to the circumflex system described herein is new. This new route can be successfully used when the bypass conduit is too short to follow the conventional route. Our 2 patients benefited from this approach and were in Canadian Cardiovascular Society Class l two years after the surgical procedure. PMID:18612494

  6. Circumflex coronary artery bypass via the posterior interatrial sulcus and under the venae cavae.

    PubMed

    Cebi, Niyazi; Walterbusch, Gerhard

    2008-01-01

    During coronary artery bypass grafting, the length of the graft to the circumflex coronary artery or its end branches can be underestimated because of the posterior location of the circumflex. Herein, we describe a new bypass route--which we consider the shortest--to the ascending aorta. In 2 patients, during proximal anastomosis of the saphenous vein bypass graft (via a route either anterior to the pulmonary artery or the transverse sinus) from the circumflex to the ascending aorta, the vein graft (approximately 5-6 cm in length) proved too short. We performed bypass in a new direction--from the circumflex coronary artery to the right side of the ascending aorta, under the inferior and superior venae cavae and along the interatrial groove--without the need for graft lengthening. To our knowledge, the bypass route to the circumflex system described herein is new. This new route can be successfully used when the bypass conduit is too short to follow the conventional route. Our 2 patients benefited from this approach and were in Canadian Cardiovascular Society Class l two years after the surgical procedure. PMID:18612494

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

    PubMed

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

    2014-03-01

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

  8. Blood levels of corticosteroid-binding globulin, total cortisol and unbound cortisol in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass

    Microsoft Academic Search

    Leif Dibbelt; Peter Schmucker

    2000-01-01

    Previous studies have demonstrated a persistent rise in serum cortisol concentrations after cardiac surgery. To further investigate this finding and to evaluate the effect of hemodilution that occurs with the onset of cardiopulmonary bypass (CPB), concentrations of cortisol-binding globulin (CBG), total and unbound cortisol, and packed cell volume (PCV) were studied in 28 patients undergoing coronary artery bypass graft surgery.

  9. 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

  10. Comparative effectiveness of coronary artery bypass grafting and percutaneous coronary intervention for multivessel coronary disease in a community-based population with chronic kidney disease

    PubMed Central

    Chang, Tara I.; Leong, Thomas K.; Kazi, Dhruv S.; Lee, Hon S.; Hlatky, Mark A.; Go, Alan S.

    2014-01-01

    Background Randomized clinical trials comparing coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) have largely excluded patients with chronic kidney disease (CKD), leading to uncertainty about the optimal coronary revascularization strategy. We sought to test the hypothesis that an initial strategy of CABG would be associated with lower risks of long-term mortality and cardiovascular morbidity compared with PCI for the treatment of multivessel coronary heart disease in the setting of CKD. Methods We created a propensity score–matched cohort of patients aged ?30 years with no prior dialysis or renal transplant who received multivessel coronary revascularization between 1996 and 2008 within a large integrated health care delivery system in northern California. We used extended Cox regression to examine death from any cause, acute coronary syndrome, and repeat revascularization. Results Coronary artery bypass grafting was associated with a significantly lower adjusted rate of death than PCI across all strata of estimated glomerular filtration rate (eGFR) (in mL/min per 1.73 m2): the adjusted hazard ratio (HR) was 0.81, 95% CI 0.68 to 1.00 for patients with eGFR ?60; HR 0.73 (CI 0.56–0.95) for eGFR of 45 to 59; and HR 0.87 (CI 0.67–1.14) for eGFR <45. Coronary artery bypass grafting was also associated with significantly lower rates of acute coronary syndrome and repeat revascularization at all levels of eGFR compared with PCI. Conclusions Among adults with and without CKD, multivessel CABG was associated with lower risks of death and coronary events compared with multivessel PCI. PMID:23622918

  11. Rationale, design and methodology for a Prospective Randomized Study of graft patency in Off-pump and On-pump MultI-Vessel coronary artery bypasS Surgery (PROMISS) using multidetector computed tomography

    Microsoft Academic Search

    Miguel Sousa Uva; Fernando Matias; Sara Cavaco; Manuel Pedro Magalhães

    2008-01-01

    BACKGROUND: Off-pump coronary artery bypass grafting has been accused of possibly compromising graft patency. Sixteen slice computed tomography has shown good diagnostic accuracy in the assessment of coronary bypass graft patency when compared with conventional coronary artery angiography and is less invasive. The study hypothesis is that coronary artery bypass grafting (CABG) performed without cardiopulmonary bypass (Off-Pump) has equivalent early

  12. Clinical markers, management, and long-term follow-up of early ischemia after coronary artery bypass grafting

    Microsoft Academic Search

    Carlos X. Pimentel; Srinivas N. Paranandi; David M. Goodhart; Shelly K. Sapp; Bruce W. Lytle; Conrad C. Simpfendorfer

    1995-01-01

    In summary, cardial infarction within 1 year after coronary bypass is associated with a high incidence of significant angiographic abnormalities. Early angiography is necessary to identify high-risk patients who could undergo revascularization. Patients with other markers of ischemia should have a noninvasive approach (stress imaging test) as initial evaluation, before coronary angiography is considered. When technically feasible, coronary angioplasty can

  13. The psychosocial and physical impact of exercise rehabilitation following coronary artery bypass surgery

    Microsoft Academic Search

    A. B. Ross; E. E. Brodie; D. Carroll; C. A. Niven

    2000-01-01

    A number of studies attest to the physical and psychosocial benefits of exercise rehabilitation following myocardial infarction (MI). There is substantially less evidence for rehabilitation following coronary artery bypass (CAB) surgery. In the present study CAB patients were allocated either to a comprehensive ten week exercise based rehabilitation programme or to a routine care condition; psychological well being, psychosocial adjustment

  14. 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

  15. 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…

  16. Previous Coronary Artery Bypass Grafting Is Not a Risk Factor for Aortic Valve Replacement

    Microsoft Academic Search

    Thoralf M Sundt; Suzan F Murphy; Benico Barzilai; Richard B Schuessler; Eric N Mendeloff; Charles B Huddleston; Michael K Pasque; William A Gay

    1997-01-01

    Background. The risk of aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG) is controversial. Its magnitude influences the threshold for recommending this procedure and has been cited in arguments regarding the optimal management of mild aortic stenosis at primary CABG. We therefore reviewed our experience with reoperative AVR ± CABG and the primary combined procedure.Methods. Between January

  17. Patient-Specific Multiscale Modeling of Blood Flow for Coronary Artery Bypass Graft Surgery

    E-print Network

    Marsden, Alison L.

    the pathlines. Using this framework, we quantify wall shear stress, wall shear stress gradients and oscillatory. Keywords--Hemodynamics, Bypass graft, Wall shear stress, Coronary artery, Multiscale modeling. INTRODUCTION environment, and structural properties of the walls. It is known that arterial grafts such as internal mammary

  18. Giant left atrial thrombus formation in patient with a previous coronary artery bypass grafting.

    PubMed

    Erdil, N; Disli, O M; Yagmur, J; Secici, S; Donmez, K; Akca, B; Battaloglu, B

    2013-09-15

    Free-floating left atrial ball thrombus is a rare condition. We report a giant left atrial ball thrombus which was removed under surgery uneventfully, in a 48-year-old male patient with the presence of sinus rhythm and no valvular disease with previous off-pump coronary artery bypass surgery. PMID:24146694

  19. Atherosclerosis after Coronary Artery Bypass Surgery: Results of Recent Studies and Recommendations Regarding Prevention

    Microsoft Academic Search

    Martial G. Bourassa; Lucien Campeau; Jacques Lespérance; Charles Solymoss

    1986-01-01

    Atherosclerosis is the most frequent cause of occlusion of aortocoronary saphenousvein grafts between 5 and 10 years after coronary artery bypass surgery. The typical atherosclerotic plaque appears between 1 and 3 years after operation and, at a mean of 5 years, histologic changes of atherosclerosis are present in 21 % of grafts and in 27% of patients. Only approximately 60%

  20. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery

    Microsoft Academic Search

    John C. Y Lu; Antony D Grayson; Pankaj Jha; Arun K Srinivasan; Brian M Fabri

    2003-01-01

    Objective: To identify risk factors for sternal wound infection following coronary artery bypass surgery (CABG), and to compare early and mid-term survival outcome. Methods: Data were prospectively collected for 4228 patients who underwent CABG surgery between April 1997 and March 2001. One hundred and nine (2.6%) patients developed sternal wound infection. We used logistic regression to identify independent risk factors

  1. 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

  2. Predictors of Outcome After Coronary Bypass Surgery in Patients with Left Ventricular Dysfunction

    Microsoft Academic Search

    Fatih Islamolu; Ziya Apaydin; Mustafa Özbaran; Münevver Yüksel; Ali Telli; Isa Durmaz

    Objective: The aim of this study was to determine the risk factors affecting the mortality and morbidity af- ter coronary artery bypass grafting (CABG) in patients with LV dysfunction and without any viability assess- ment. Methods: The preoperative, perioperative, and postoperative early and mid-term follow-up data of 252 pa- tients with left ventricular ejection fraction (LVEF) of ?30% who underwent

  3. Sexual quality of life in patients undergoing coronary artery bypass graft surgery

    Microsoft Academic Search

    Jennifer Barsky Reese; Rebecca A. Shelby; Kathryn L. Taylor

    2011-01-01

    Objectives: Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients.Methods: Participants completed a survey assessing sexual activity, mental health and physical health at baseline

  4. Sexual quality of life in patients undergoing coronary artery bypass graft surgery

    Microsoft Academic Search

    Jennifer Barsky Reese; Rebecca A. Shelby; Kathryn L. Taylor

    2012-01-01

    Objectives: Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients.Methods: Participants completed a survey assessing sexual activity, mental health and physical health at baseline

  5. Quality of Life and Coping Following Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Surgery

    Microsoft Academic Search

    J. Wray; S. Al-Ruzzeh; W. Mazrani; K. Nakamura; S. George; C. Ilsley; M. Amrani

    2004-01-01

    Minimally invasive direct coronary artery bypass (MIDCAB) surgery has been shown to be a promising technique for surgical treatment of single or double vessel disease. However, little is known about quality of life, mood state or coping in this group of patients. The records of 55 consecutive patients who underwent MIDCAB surgery at Harefield Hospital between April 1999 and May

  6. 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,

  7. Intra- and Postoperative Predictors of Stroke After Coronary Artery Bypass Grafting

    Microsoft Academic Search

    Donald S. Likosky; Bruce J. Leavitt; Charles A. S. Marrin; David J. Malenka; Alexander G. Reeves; Ronald M. Weintraub; Louis R. Caplan; Yvon R. Baribeau; David C. Charlesworth; Cathy S. Ross; John H. Braxton; Felix Hernandez; Gerald T. O'Connor

    2010-01-01

    Background. Stroke is a devastating complication of coronary artery bypass graft surgery. An individual's risk of stroke is based in part on preoperative characteristics but also on intra- and postoperative factors. We devel- oped a risk prediction model for stroke based on factors in intra- and postoperative care, after adjusting for a patient's preoperative risk. Methods. We conducted a regional

  8. Pleural Effusions Following Cardiac Injury and Coronary Artery Bypass Graft Surgery

    Microsoft Academic Search

    Richard W. Light

    2001-01-01

    This article discusses the pleural effusions that occur with the post-cardiac in- jury (Dressler's) syndrome (PCIS) and those that occur after coronary artery bypass graft (CABG) surgery. The PCIS can occur after any type of cardiac injury and is thought to be due to antimyocardial antibodies. The primary symptoms are fever and chest pain, and pericarditis is frequently present. Pleural

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

    PubMed

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

    2014-07-15

    Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery-to-left anterior descending coronary artery grafting with percutaneous coronary intervention of non-left anterior descending coronary arteries. The safety and efficacy of HCR in patients?65 years of age is unknown. In this study, patients aged?65 years were included who underwent HCR at an academic center from October 2003 to September 2013. These patients were matched 1:4 to similar patients treated with coronary artery bypass grafting (CABG) using a propensity-score matching algorithm. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between HCR and CABG, and 30-day major adverse cardiovascular and cerebrovascular events (a composite of mortality, myocardial infarction, and stroke), periprocedural complications, and 3-year all-cause mortality. Of 715 patients (143 of whom underwent HCR and 572 CABG) in the propensity score-matched cohort, rates of 30-day major adverse cardiovascular and cerebrovascular events were comparable after HCR and CABG (5.6% vs 3.8%, odds ratio 1.46, 95% confidence interval 0.65 to 3.27, p=0.36). Compared with CABG, HCR resulted in fewer procedural complications (9.1% vs 18.2%, p=0.018), fewer blood transfusions (28.0% vs 53.3%, p<0.0001), less chest tube drainage (838±484 vs 1,100±579 cm3, p<0.001), and shorter lengths of stay (<5 days: 45.5% vs 27.4%, p=0.001). Over a 3-year follow-up period, mortality rates were similar after HCR and CABG (13.2% vs 16.6%, hazard ratio 0.81, 95% confidence interval 0.46 to 1.43, p=0.47). Subgroup analyses in high-risk patients (Charlson index?6, age?75 years) rendered similar results. In conclusion, although the present data are limited, we found that in older patients, the use of HCR is safe, has fewer procedural complications, entails less blood product use, and results in faster recovery with similar longitudinal outcomes relative to conventional CABG. PMID:24878119

  10. 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

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

    MedlinePLUS

    ... specialist (cardiologist). Follow-up care is of great importance since people who have had bypass surgery have ... Patient information: Aspirin in the primary prevention of cardiovascular disease and cancer (Beyond the Basics) Patient information: ...

  12. Influence of left ventricular aneurysm on survival following the coronary bypass operation.

    PubMed Central

    Jones, E L; Craver, J M; Hurst, J W; Bradford, J A; Bone, D K; Robinson, P H; Cobbs, B W; Thompkins, T R; Hatcher, C R

    1981-01-01

    Patients having coronary bypass and aneurysm resection (N = 40) or aneurysm plication (N = 32) were compared with patients having coronary bypass without aneurysm (N = 2782). Unlike other series, the primary indication for surgery in the aneurysm patients was angina pectoris, with heart failure playing a secondary role. Multivessel disease was present in 83% of the patients with aneurysm. Total occlusion of the anterior descending coronary artery was more prevalent in the group of patients who had aneurysmectomy (75%) than in rhe group of patients who had plication (38%), and more grafts/patient could be performed in the plication group (2.6 vs 2.0). Location of the aneurysm was most often anteroapical (N = 55) and infrequently inferior (N = 6). Septal wall motion was akinetic or aneurysmal in 47% of the aneurysmectomy group, and 10% of the plication group. Postoperative requirements for inotropes or intra-aortic balloon assist was much higher in the aneurysm group (aneurysmectomy or plication) than in patients without aneurysm having bypass. Hospital mortality for aneurysm patients was 2.7% versus 1.4% in patients without aneurysms having coronary bypass. The actuarial survival rate at 42 months for all aneurysm patients was 90%. Improvement in anginal symptoms after plication and coronary bypass (96%) was more frequent than with aneurysmectomy and coronary bypass (76%) and this was attributed to larger viable muscle mass and greater revascularization. Although two-thirds of patients having surgery for aneurysms had improvement in heart failure symptoms after operation, 30% of those having aneurysmectomies and 35% of those having plications said they were unimproved after surgery. However, this could be explained by the finding that a significant number (35% of the aneurysmectomy and 45% of the plication group) were in heart failure Class I prior to operation. Hospital mortality has been progressively reduced and late survival increased by the surgical treatment of left ventricular aneurysm, primarily through early operation at a time when coronary bypass can be used as an adjunct to aneurysm resection or plication. PMID:6972744

  13. 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

  14. Increasing Severity of Aortic Atherosclerosis in Coronary Artery Bypass Grafting Patients Evaluated by Transesophageal Echocardiography

    PubMed Central

    Denny, John T.; Pantin, Enrique; Chiricolo, Antonio; Tse, James; Denny, Julia E.; Mungekar, Sagar S.; Chyu, Darrick; Solina, Alann

    2015-01-01

    Background Atherosclerotic disease in coronary artery bypass grafting (CABG) patients is a potential contributor to complications in the perioperative periods. This study was undertaken to better define how the frequency of aortic atheromatous disease among patients coming for CABG has evolved over the last decade. Methods Data from elective patients coming for CABG who underwent transesophageal echocardiography (TEE) examinations following induction of anesthesia were obtained for the years 2002 and 2009. Aortas were graded according to the method of Kronzon, with the following interpretations: normal = grade I, intimal thickening = 2, atheroma of less than 5 mm = 3, atheroma of > 5 mm = 4, and any mobile atheroma = 5. The data of 124 patients who underwent comprehensive exam of the aorta by one cardiac anesthesiologist were gathered and assigned into two groups based on the year TEE was done. Student’s t-test was used for statistical analysis. A P value < 0.05 was considered significant. The data were presented as mean ± SD. Results There was significant difference between group 2002 (2.05 ± 1.28) and group 2009 (2.59 ± 1.11) in atheroma grade (P = 0.013). Conclusions Patients coming for CABG in group 2009 exhibited significantly higher grades of aortic atheroma on TEE, compared to group 2002. Understanding the risk of atheroma in the elderly CABG population may help in altering surgical approaches to lessen the risk of catastrophic stroke. Potential options needing further study include the off-pump approach and modification of cross-clamp site and technique as well as other modalities. PMID:25379067

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

    PubMed Central

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

    2005-01-01

    Background: Studies of neuropsychological outcome following coronary artery bypass graft surgery (CABG) have traditionally dichotomised patients as "impaired" or "unimpaired". This conceals the potential heterogeneity of deficits due to different mechanisms and sites of brain injury. Objectives: To explore neuropsychological outcome following CABG and determine to what extent it conforms to prototypic cortical and/or subcortical neurobehavioral syndromes and whether different intraoperative physiologic measures are associated with different subtypes of neuropsychological outcome. Methods: Neuropsychological tests were administered to 85 patients before and after elective CABG and to 50 matched normal control subjects. Pre- to postoperative change scores were computed using standardised regression based norms. Change scores on selected memory measures were subjected to cluster analysis to identify qualitatively distinct subtypes of memory outcome. Emergent clusters were compared on non-memory measures, intraoperative physiologic measures, and demographic variables. Results: Three subtypes of memory outcome were identified: memory spared (48% of patients), retrieval deficit (35%), and encoding/storage deficit (17%). Contrary to expectation, the subgroups were indistinguishable on measures of confrontation naming and manual dexterity and on intraoperative cardiac surgical physiologic measures and demographic variables. The encoding/storage deficit subgroup exhibited executive dysfunction. Conclusions: Heterogeneous profiles of neuropsychological dysfunction were found following CABG although they did not tightly conform to prototypic cortical and subcortical neurobehavioral syndromes. This challenges the value and appropriateness of the common practice of collapsing individual test scores to arrive at a single figure to define "impairment". Whether different subtypes of neuropsychological outcome are caused by different pathophysiologic mechanisms remains unknown. PMID:16024891

  16. Prevention of Edema After Coronary Artery Bypass Graft Surgery by Compression Stockings

    PubMed Central

    Alizadeh-Ghavidel, Alireza; Ramezannejad, Parisa; Mirmesdagh, Yalda; Sadeghpour-Tabaei, Ali

    2014-01-01

    Background: Lower limb edema may occur after removal of the saphenous veins in coronary artery bypass graft (CABG) surgery. Compression therapy is often used to prevent postoperative edema. Objectives: The objective of this study was to evaluate the efficacy of medical compression stockings (TED) on the prevention of donor limbs edema and wound complications after CABG surgery. Patients and Methods: In this prospective cohort study, we enrolled 100 patients who underwent elective CABG surgery at Rajaie Cardiovascular Medical and Research Center. The patients were divided into two groups; group A who applied TED stockings regularly (exposure group) and group B who did not apply TED stockings at all or apply it irregularly (no exposure group). The degree of donor limb edema and the differences of the peripheries of calf and thigh before and after the surgery (in 1, 2 and 4 weeks) were recorded and analyzed statistically. Results: The patients' weight (P = 0.02) and the degree of their daily activity (P = 0.002) were the significant factors for the incidence of the donor limbs edema. The incidence and degree of lower limb edema were significantly lower in exposure group 4 weeks after the surgery (P < 0.001). The differences of the periphery of the calf before (at admission time) and after the surgery (in 1, 2 and 4 weeks) between two groups were also statistically significant (P = 0.41, P = 0.39, P = 0.40, respectively). Lower limb wound complications was higher in patients who have peripheral edema in the 4th week of post-CABG (P = 0.09). Conclusions: Regular use of TED stockings may have positive effects on the prevention of donor limb edema (especially higher degrees of edema) and wound complications after CABG surgery. PMID:25478535

  17. Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting

    Microsoft Academic Search

    John Sampalis; Stella Boukas; Moishe Liberman; Tracey Reid; Gilles Dupuis

    Background: A lack of resources has created waiting lists for many elective surgical procedures within Canada's universal health care system. Coronary artery by- pass grafting (CABG) for the treatment of atherosclerotic ischemic heart disease is one of these affected surgical procedures. We studied the impact of waiting times on the quality of life of patients awaiting CABG. Methods: A prospective

  18. Thoracic epidural analgesia for off-pump coronary artery bypass surgery in patients with chronic obstructive pulmonary disease.

    PubMed

    Mehta, Yatin; Vats, Mayank; Sharma, Munish; Arora, Reetesh; Trehan, Naresh

    2010-01-01

    The benefits of thoracic epidural analgesia in patients undergoing coronary artery bypass grafting are well documented. However, the literature available on the role of high thoracic epidural analgesia (HTEA) in patients with chronic obstructive pulmonary disease undergoing off-pump coronary artery bypass graft (OPCAB) surgery is scarce. We conducted a randomized clinical trial to establish whether HTEA is beneficial in patients with chronic obstructive pulmonary disease undergoing elective OPCAB surgery. After institutional ethics board approval and informed consent, 62 chronic obstructive pulmonary disease patients undergoing elective OPCAB were randomly grouped into two (n = 31 each). Both groups received general anesthesia (GA), but in the HTEA group patients, TEA was also administered. Standardized surgical and anesthetic techniques were used for both the groups. Pulmonary function tests were performed pre-operatively, 6 h and 24 h post-extubation and on days 2, 3, 4 and 5 along with arterial blood gas analysis (ABG) analysis. Time for extubation (h) and time for oxygen withdrawal (h) were recorded. Pain score was assessed by the 10-cm visual analogue scale. All hemodynamic/oxygenation parameters were noted. Any complications related to the TEA were also recorded. Patients in the HTEA group were extubated earlier (10.8 h vs. 13.5 h, P < 0.01) and their oxygen withdrawal time was also significantly lower (26.26 h vs. 29.87 h, P < 0.01). The VAS score, both at rest and on coughing, was significantly lower in the HTEA group at all times, post-operatively (P < 0.01). The forced vital capacity improved significantly at 6 h post-operatively in the HTEA group (P = 0.026) and remained significantly higher thereafter. A similar trend was observed in forced expiratory volume in the first second on day 2 in the HTEA group (P = 0.024). We did not observe any significant side-effects/mortality in either group. In chronic obstructive pulmonary disease patients undergoing elective OPCAB surgery, HTEA is a good adjunct to GA for early extubation, faster recovery of pulmonary function and better analgesia. PMID:20826963

  19. 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).

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

    PubMed Central

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

    2014-01-01

    Background Randomized trials of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) suggest that patient characteristics modify the effect of treatment on mortality. Objective To assess whether clinical characteristics modify the comparative effectiveness of CABG versus PCI in an unselected, general patient population. Design Observational treatment comparison using propensity score matching and Cox proportional hazards models. Setting United States, 1992 to 2008. Patients Medicare beneficiaries aged 66 years or older. Intervention Multivessel CABG or multivessel PCI. Measurements The CABG–PCI hazard ratio (HR) for all-cause mortality, with prespecified treatment-by-covariate interaction tests, and the absolute difference in life-years of survival in clinical subgroups after CABG or PCI, both over 5 years of follow-up. Results Among 105 156 propensity score–matched patients, CABG was associated with lower mortality than PCI (HR, 0.92 [95% CI, 0.90 to 0.95]; P < 0.001). Association of CABG with lower mortality was significantly greater (interaction P ? 0.002 for each) among patients with diabetes (HR, 0.88), a history of tobacco use (HR, 0.82), heart failure (HR, 0.84), and peripheral arterial disease (HR, 0.85). The overall predicted difference in survival between CABG and PCI treatment over 5 years was 0.053 life-years (range, ?0.017 to 0.579 life-years). Patients with diabetes, heart failure, peripheral arterial disease, or tobacco use had the largest predicted differences in survival after CABG, whereas those with none of these factors had slightly better survival after PCI. Limitation Treatments were chosen by patients and physicians rather than being randomly assigned. Conclusion Multivessel CABG is associated with lower long-term mortality than multivessel PCI in the community setting. This association is substantially modified by patient characteristics, with improvement in survival concentrated among patients with diabetes, tobacco use, heart failure, or peripheral arterial disease. Primary Funding Source National Heart, Lung, and Blood Institute. PMID:23609014

  1. Coronary artery bypass grafting in a patient with pituitary adenoma: can alertness prevent tragedy?

    PubMed

    Shah, Shitalkumar; Hrabovsky, Derek

    2014-09-01

    Pituitary apoplexy is a rare, life-threatening complication that may occur after coronary artery bypass graft surgery for patients with pituitary adenomas. The dynamics of cardiopulmonary bypass may contribute to a sudden expansion of silent pituitary adenomas and result in the compression of surrounding structures. A range of clinical features have been described, and the condition requires prompt diagnosis and treatment to prevent further complications. Herein, we present an uncomplicated case highlighting the importance of diagnosing pituitary apoplexy, ensuring high alertness to the condition, so as to prevent life-threatening tragedy due to missed diagnosis. PMID:25273945

  2. 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

  3. Morpho-functional features of the radial artery: implications for use as a coronary bypass conduit.

    PubMed

    Gaudino, Mario; Crea, Filippo; Cammertoni, Federico; Mazza, Andrea; Toesca, Amelia; Massetti, Massimo

    2014-11-01

    Since its reintroduction in the early 1990s the radial artery has gained a major role in coronary surgery, currently representing a valid alternative to the right internal thoracic artery as a second arterial graft. However, its peculiar morphologic and functional features have both surgical and clinical critical implications that must be taken into account. In this review we summarize the current totality of evidence on the biologic characteristics of the radial artery, such as its histopathology, vasoreactivity, and remodeling, and discuss their potential implications for use as a coronary bypass conduit. PMID:25258159

  4. Current Outcomes of Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Graft Surgery in North America

    Microsoft Academic Search

    Sunil M. PrasadShuang; Shuang Li; J. Scott Rankin; Sean M. O’Brien; James S. Gammie; John D. Puskas; David M. Shahian; Edgar G. Chedrawy; Malek G. Massad

    2010-01-01

    Objective  Management of patients with concomitant carotid and coronary artery disease has been controversial. Divergent strategies have\\u000a been employed, including simultaneous carotid endarterectomy and coronary bypass (SCC) versus various staged procedures. Although\\u000a no strict comparison group is available, this study defines current outcomes of SCC, compared qualitatively to two reference\\u000a categories.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Utilizing the STS database from 2003 to 2007, patients who

  5. Atrial fibrillation after coronary artery bypass grafting: does the type of procedure influence the early postoperative incidence?

    Microsoft Academic Search

    J Siebert; L Anisimowicz; R Lango; J Rogowski; R Pawlaczyk; M Brzezinski; S Beta; M Narkiewicz

    2001-01-01

    Objective: Atrial fibrillation (AF), the common postoperative complication, has been observed after coronary artery bypass grafting (CABG) in 7–40% of patients. Cardiopulmonary bypass (CPB), eliminated in off-pump operations (OPCABG) may decrease the incidence of AF, whereas the combination of CABG with heart valve replacement may result in more frequent postoperative atrial fibrillation. The aim of our study was to compare

  6. Cognitive self-assessment one year after on-pump and off-pump coronary artery bypass grafting

    Microsoft Academic Search

    Annemieke M. A Keizer; Ron Hijman; Diederik van Dijk; Cor J Kalkman; René S Kahn

    2003-01-01

    BackgroundCoronary artery bypass grafting (CABG) is associated with significant cerebral morbidity. This is usually manifested as cognitive decline and may be caused by cardiopulmonary bypass. The primary objective of this study was to explore whether patients report more cognitive failures 1 year after CABG than preoperatively. Secondary objectives were to evaluate whether there is a difference in reported cognitive failures

  7. Impact of gender on coronary bypass operative mortality

    Microsoft Academic Search

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

    1998-01-01

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

  8. Coronary arteriography and coronary bypass survey among whites and other racial groups relative to hospital-based incidence rates for coronary artery disease: findings from NHDS.

    PubMed Central

    Ford, E; Cooper, R; Castaner, A; Simmons, B; Mar, M

    1989-01-01

    To assess racial differences in health care utilization for coronary artery disease (CAD) the data of the National Hospital Discharge Survey (NHDS) from 1979-84 were examined. Discharge rates for acute myocardial infarction (AMI) were utilized as a measure of hospital-based incidence and relative need for the designated cardiac procedures. Although 35-74 year old Black men had discharge rates of AMI that were 77 per cent of those observed for White men, they underwent coronary arteriography half as often and were only a third as likely to have coronary artery bypass graft (CABG) surgery. Black women in this age range were hospitalized at a slightly higher rate than White women for AMI, yet experienced a 19 per cent lower rate of coronary arteriography and a 52 per cent lower rate of CABG surgery. These data suggest a racial bias in the pattern of care delivered for CAD in US hospitals at the present time. PMID:2784635

  9. Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery

    Microsoft Academic Search

    Dena M. Bravata; Allison L. Gienger; Kathryn M. McDonald; Vandana Sundaram; Marco V. Perez; Robin Varghese; John R. Kapoor; Reza Ardehali; Douglas K. Owens; Mark A. Hlatky

    2007-01-01

    Background: The comparative effectiveness of coronary artery by- pass graft (CABG) surgery and percutaneous coronary intervention (PCI) for patients in whom both procedures are feasible remains poorly understood. Purpose: To compare the effectiveness of PCI and CABG in pa- tients for whom coronary revascularization is clinically indicated. Data Sources: MEDLINE, EMBASE, and Cochrane databases (1966-2006); conference proceedings; and bibliographies of

  10. Simultaneous carotid endarterectomy and coronary bypass: Perioperative risk and long-term survival

    Microsoft Academic Search

    William C. Mackey; Kamal Khabbaz; Robert Bojar; Thomas F. O'Donnell

    1996-01-01

    Purpose: The purpose of this article is to examine the outcome of simultaneous coronary bypass-carotid endarterectomy (CABG-CEA) and to compare it with the outcome of endarterectomy alone (CEA alone) in patients at high cardiac risk.Methods: A retrospective review of the records and follow-up data for 100 consecutive patients who had undergone CABG-CEA and were at high risk and 114 patients

  11. Impact of coronary artery bypass grafting on various aspects of quality of life

    Microsoft Academic Search

    Helén Sjöland; Kenneth Caidahl; Ingela Wiklund; Maria Haglid; Marianne Hartford; Björn W Karlson; Thomas Karlsson; Johan Herlitz

    1997-01-01

    Objective: To prospectively study the improvement in quality of life (QoL) after coronary artery bypass surgery (CABG). Patients and Methods: Consecutive patients (n=2121) who underwent CABG at Sahlgrenska University Hospital between 1988 and 1991 received 3 questionnaires for the study of QoL: the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-being Index, which were responded both

  12. Impact of coronary artery bypass grafting on various aspects of quality of life

    Microsoft Academic Search

    Helen Sjoland; Kenneth Caidahl; Ingela Wiklund; Maria Haglid; Marianne Hartford; Bjorn W. Karlson; Thomas Karlsson; Johan Herlitz; Astra Hassle AB

    Objective: To prospectively study the improvement in quality of life (QoL) after coronary artery bypass surgery (CABG). Patients and Methods: Consecutive patients (n2121) who underwent CABG at Sahlgrenska University Hospital between 1988 and 1991 received 3 questionnaires for the study of QoL: the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-being Index, which were responded both

  13. Piracetam Prevents Cognitive Decline in Coronary Artery Bypass: A Randomized Trial Versus Placebo

    Microsoft Academic Search

    Ildikó Szalma; Ágnes Kiss; László Kardos; Géza Horváth; Erika Nyitrai; Zita Tordai; László Csiba

    2010-01-01

    Background. Coronary artery bypass grafting (CABG) can be associated with postoperative cognitive impair- ment and ischemic stroke. No effective treatment is currently available. The aim of this study was to evaluate the effectiveness of piracetam to treat the cognitive im- pairment after CABG in an investigator-initiated, dou- ble-blind, placebo-controlled, randomized clinical trial. Methods. Patients undergoing CABG (n 98) were randomized

  14. Predictors of preoperative depressive risk in patients undergoing coronary artery bypass graft surgery

    Microsoft Academic Search

    Anne Dunkel; Friederike Kendel; Elke Lehmkuhl; Birgit Babitsch; Sabine Oertelt-Prigione; Roland Hetzer; Vera Regitz-Zagrosek

    2009-01-01

    Aims  Depression is highly prevalent among patients undergoing coronary artery bypass graft (CABG) surgery and represents a significant\\u000a risk factor for longer hospitalization, increasing health costs and worse outcomes. Nonetheless, preoperative depression is\\u000a rarely assessed in clinical practice, limiting the possibilities for effective prevention and care. Thus, we sought to develop\\u000a risk models to determine the depressive risk before CABG based

  15. Impact of kidney function on plasma troponin concentrations after coronary artery bypass grafting

    Microsoft Academic Search

    Kurt Hannemann-Pohl; Reinhard Ziebig; Herko Grubitzsch; Berthold Hocher; Ortrud Vargas-Hein; Andreas Lun; Ingolf Schimke; Lutz Liefeldt

    2008-01-01

    Background. To date, there have been no studies reliably showing an influence of the kidney on the concentration of troponins. We therefore analysed the concentration curves in patients after coronary artery bypass grafting (CABG) according to their dependence on renal function. Methods. We determined cardiac troponin I (cTnI), cardiac troponin T (cTnT) and creatinine in plasma in 28 patients after

  16. The effect of total arterial grafting on medium-term outcomes following coronary artery bypass grafting

    Microsoft Academic Search

    Jean-Francois Légaré; Ansar Hassan; Karen J Buth; John A Sullivan

    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:

  17. Effects of minimal-dose aprotinin on coronary artery bypass grafting

    Microsoft Academic Search

    Nobuhiko Hayashida; Tadashi Isomura; Tohru Sato; Hiroshi Maruyama; Kenichi Kosuga; Shigeaki Aoyagi

    1997-01-01

    Objective: To evaluate the effects of minimal-dose aprotinin in patients undergoing coronary artery bypass grafting, we conducted a prospective randomized study. Methods: A total of 167 patients were randomized to receive no aprotinin treatment (control, n = 57), minimal-dose aprotinin (1.0 × 106 KIU; n = 55), or low-dose aprotinin (2.7 ± 0.5 × 106 KIU; n = 55). Blood

  18. Graft-to-coronary-artery shunt during off-pump coronary artery bypass grafting.

    PubMed

    Iida, Hiroshi; Mori, Hideaki; Sudo, Yoshio; Yamada, Yasuyuki; Eda, Kunihiro; Inoue, Yuho

    2006-09-01

    We have developed a simple technique for temporary shunt from the saphenous vein graft to the coronary artery during off-pump coronary anastomosis. The ends of a 2-mm diameter tube were inserted into the distal end of the saphenous vein graft in which proximal anastomosis had been established and into the right coronary artery crux. Blood flow sufficient to maintain adequate hemodynamics was obtained through the shunt tube while suturing around the tube. We successfully employed this technique in 5 patients with acute coronary syndrome. We suggest that this technique may represent an addition to the armamentarium for off-pump anastomosis to the right coronary artery. PMID:16928480

  19. Emergency coronary artery bypass grafting in patients with acute myocardial infarction treated with glycoprotein IIb\\/IIIa receptor inhibitors

    Microsoft Academic Search

    Marco De Carlo; Daniele Maselli; Bernardo Cortese; Nicola Ciabatti; Roberto Gistri; Maurizio Levantino; Alberto Balbarini; Raffaele De Caterina; Anna Sonia Petronio

    2008-01-01

    Glycoprotein (GP) IIb\\/IIIa receptor inhibitors before primary angioplasty in patients with ST-elevation acute myocardial infarction (STEMI) are recommended by current guidelines. Thus, an increasing number of patients receive these drugs before coronary angiography, particularly if a between-hospital transfer is needed. However, when coronary anatomy is unsuitable for angioplasty, emergency coronary artery bypass grafting (CABG) under GP IIb\\/IIIa inhibitor treatment may

  20. Use of extracorporeal life support for emergency coronary artery bypass grafting.

    PubMed

    Panda, Biswa Ranjan; Prabhu, Anil; Provenzano, Sylvio; Karl, Tom

    2013-06-01

    A 14-year old boy was admitted with an anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva, with an interarterial course of the narrow proximal segment. He underwent coronary ostial augmentation and main pulmonary artery translocation to the left pulmonary artery. In the post-cardiopulmonary bypass (CPB) period, he developed thrombotic occlusion of the RCA resulting in arrhythmia and ventricular dysfunction, requiring extracorporeal life support (ECLS) in the form of extracorporeal membrane oxygenation rather than CPB. After confirming this complication by cardiac catheterization, the right coronary artery territory was revascularized with a pedicled right internal thoracic artery graft. The entire procedure was performed on a beating heart using a stabilizer during ECLS. This strategy may be useful in situations with unstable haemodynamics and a low risk of blood loss. PMID:23478345

  1. Prevalence of periodontal pathogens in coronary atherosclerotic plaque of patients undergoing coronary artery bypass graft surgery

    Microsoft Academic Search

    Jaideep Mahendra; Little Mahendra; V. M. Kurian; K. Jaishankar; R. Mythilli

    2009-01-01

    Background  Chronic bacterial infections have been associated with an increased risk for atherosclerosis and coronary artery disease.\\u000a The ability of oral pathogens to colonize in coronary atheromatous plaque is well known. The aim of our study was to detect\\u000a the presence of four common periodontal pathogens in coronary plaques. We detected the presence of 16S rRNA of Treponema denticola, Eikenella Corrodens,

  2. Patient-specific multiscale modeling of blood flow for coronary artery bypass graft surgery.

    PubMed

    Sankaran, Sethuraman; Esmaily Moghadam, Mahdi; Kahn, Andrew M; Tseng, Elaine E; Guccione, Julius M; Marsden, Alison L

    2012-10-01

    We present a computational framework for multiscale modeling and simulation of blood flow in coronary artery bypass graft (CABG) patients. Using this framework, only CT and non-invasive clinical measurements are required without the need to assume pressure and/or flow waveforms in the coronaries and we can capture global circulatory dynamics. We demonstrate this methodology in a case study of a patient with multiple CABGs. A patient-specific model of the blood vessels is constructed from CT image data to include the aorta, aortic branch vessels (brachiocephalic artery and carotids), the coronary arteries and multiple bypass grafts. The rest of the circulatory system is modeled using a lumped parameter network (LPN) 0 dimensional (0D) system comprised of resistances, capacitors (compliance), inductors (inertance), elastance and diodes (valves) that are tuned to match patient-specific clinical data. A finite element solver is used to compute blood flow and pressure in the 3D (3 dimensional) model, and this solver is implicitly coupled to the 0D LPN code at all inlets and outlets. By systematically parameterizing the graft geometry, we evaluate the influence of graft shape on the local hemodynamics, and global circulatory dynamics. Virtual manipulation of graft geometry is automated using Bezier splines and control points along the pathlines. Using this framework, we quantify wall shear stress, wall shear stress gradients and oscillatory shear index for different surgical geometries. We also compare pressures, flow rates and ventricular pressure-volume loops pre- and post-bypass graft surgery. We observe that PV loops do not change significantly after CABG but that both coronary perfusion and local hemodynamic parameters near the anastomosis region change substantially. Implications for future patient-specific optimization of CABG are discussed. PMID:22539149

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

    PubMed Central

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

    2014-01-01

    Objectives To identify the pattern of prevalence of risk factors in patients presenting for coronary artery bypass grafting at a single center in Oman. Methods All patients who had coronary artery bypass grafting between March 2008 to March 2010 were included and data were obtained from history and laboratory investigations. The prevalence rates of eight conventional risk factors are presented as a retrospective single center observational study. Results Out of 146 total patients, 107 (73.29%) were male. The age ranged from 31 to 87 years old. The mean age was 58.18 ± 10.08 years (males = 56.81 ± 10.42, females = 61.95 ± 7.97). Hypertension was present in 119 patients (81.51%), 115 patients (78.77%) had dyslipidemia, 107 patients (73.29%) were male, 79 patients (54.11%) had diabetes mellitus, 70 patients (47.95%) were over the age of 60 years, 41 patients (28.08%) gave a history of smoking, 31 patients (21.23%) were obese, and 19 patients (13.01%) gave a positive family history. Conclusions The most common risk factor was hypertension, followed by dyslipidemia, male gender, diabetes mellitus, old age, smoking, obesity and positive family history; 87.7% had three or more risk factors. The females in this study were older than the males and had more risk factors at presentation. The most common combination of factors seen together was diabetes, hypertension, dyslipidemia and male gender. PMID:24936271

  4. Sympathetic nervous system tonicity and post-coronary artery bypass hypertension.

    PubMed

    Pratilas, V; Pratila, M G; Vlachakis, N D; Owitz, S; Dimich, I

    1980-01-01

    To elucidate the pathogenesis of hypertension following coronary bypass surgery, blood pressure and plasma catecholamine concentration were measured in 28 patients with coronary artery disease who were undergoing myocardial revascularization procedures. Measurements were obtained on arrival in the operating room and 1 and 4 h after surgery. One hour after surgery, plasma norepinephrine (NE) increased significantly by 495 +/- 108 pg/ml (P less than 0.001) in the coronary artery disease group which developed hypertension, but the increase was not significant in the coronary artery patients who remained normotensive after surgery. However, 4 h after surgery, plasma NE increased significantly and to the same extent in both coronary artery disease groups, regardless of the change in blood pressure. Plasma epinephrine (E) also increased significantly 1 and 4 h after surgery in both groups. The observed change in plasma catecholamine concentration is direct evidence that the stress of surgery is a potent adrenergic stimulus, but the hemodynamic significance of the plasma catecholamine change remains unclear. PMID:6990676

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

    PubMed Central

    2013-01-01

    In this paper, coronary arterial bypass grafting hemodynamics and anastomosis designs are reviewed. The paper specifically addresses the biomechanical factors for enhancement of the patency of coronary artery bypass grafts (CABGs). Stenosis of distal anastomosis, caused by thrombosis and intimal hyperplasia (IH), is the major cause of failure of CABGs. Strong correlations have been established between the hemodynamics and vessel wall biomechanical factors and the initiation and development of IH and thrombus formation. Accordingly, several investigations have been conducted and numerous anastomotic geometries and devices have been designed to better regulate the blood flow fields and distribution of hemodynamic parameters and biomechanical factors at the distal anastomosis, in order to enhance the patency of CABGs. Enhancement of longevity and patency rate of CABGs can eliminate the need for re-operation and can significantly lower morbidity, and thereby reduces medical costs for patients suffering from coronary stenosis. This invited review focuses on various endeavors made thus far to design a patency-enhancing optimized anastomotic configuration for the distal junction of CABGs. PMID:24330653

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

    PubMed

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

    2000-03-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2011-11-01

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

  8. Comparison of inflammatory response following coronary revascularization with or without cardiopulmonary bypass

    PubMed Central

    Gasz, Balázs; Benkö, László; Jancsó, Gábor; Lantos, János; Szántó, Zalán; Alotti, Nasri; Röth, Erzsébet

    2004-01-01

    BACKGROUND: It is well known that conventional coronary revascularization is associated with a pronounced systemic inflammatory response due to the application of cardiopulmonary bypass (CPB). OBJECTIVE: To compare the effects of coronary artery bypass grafting (CABG) with (on-pump) or without (off-pump) extra-corporeal circulation observing certain inflammatory response parameters. METHODS: Twenty patients undergoing CABG with (CPB group: 10 patients) or without (off-pump coronary artery bypass grafting [OPCAB] group: 10 patients) CPB were enrolled in this prospective, randomized study. Blood samples were collected three times during the operation and on postoperative days 1, 2, 3 and 7. The plasma level of proinflammatory cytokine tumor necrosis factor (TNF)-alpha was measured by enzyme-linked immunosorbent assay method following stimulation, and the expression of adhesion molecules (CD11, CD18) of leukocytes were determined by flow cytometry. Furthermore, white blood cell (WBC) and neutrophil count were carried out. RESULTS: The WBC and neutrophil counts rose markedly in both groups following the operation and remained at this increased level during the observation period. There was a significant difference in WBC and neutrophil counts between the two groups of patients on postoperative day 7. A significant difference in the level of TNF-alpha was found between the two groups on postoperative day 2 (P<0.05). An intense increase was observed with CPB, which significantly exceeded the values of the OPCAB group without extracorporeal circulation in the early postoperative period. The CD11a and CD18 expression of leukocytes decreased during the operation and on postoperative day 1; thereafter, it increased markedly. There was a significant difference in adhesion molecule expression between the two groups on postoperative day 2. CONCLUSION: The investigation revealed that inflammatory response reactions following extracorporeal circulation could be reduced significantly using the off-pump technique. PMID:19641693

  9. Minimally Invasive Single-Vessel Coronary Artery Bypass With the Internal Thoracic Artery and Early Postoperative Angiography: Midterm Results of a Prospective Study in 120 Consecutive Patients

    Microsoft Academic Search

    Sergio A. Oliveira; Luiz Augusto; F. Lisboa; Luõ ´ s; Alberto O. Dallan; Salomon O. Rojas; Luiz F. Poli de Figueiredo

    2010-01-01

    Background. This prospective study was undertaken to determine the role of the minimally invasive direct coronary artery bypass with early postoperative angiog- raphy and midterm follow-up in 120 consecutive patients with single-vessel coronary artery disease. Methods. Minimal access (6 to 10 cm), without com- plete sternotomy and no cardiopulmonary bypass, was used. The lesions were located at the proximal left

  10. Hematocrit value on intensive care unit entry influences the frequency of Q-wave myocardial infarction after coronary artery bypass grafting

    Microsoft Academic Search

    Bruce D. Spiess; Catherine Ley; Simon C. Body; Lawrence C. Siegel; E. Price Stover; Rosemarie Maddi; Michael D'Ambra; Uday Jain; Fong Liu; Ahvie Herskowitz; Dennis T. Mangano; Jack Levin

    1998-01-01

    Objectives: No data exist regarding “the best” hematocrit value after coronary artery bypass graft surgery. Transfusion practice varies, because neither an optimal hematocrit value nor a uniform transfusion trigger criterion has been determined. Methods: To investigate the optimal hematocrit value, we studied 2202 patients undergoing coronary bypass. The hematocrit value on entry into the intensive care unit (IHCT) was categorized

  11. A serious game for off-pump coronary artery bypass surgery procedure training.

    PubMed

    Cowan, Brent; Sabri, Hamed; Kapralos, Bill; Moussa, Fuad; Cristancho, Sayra; Dubrowski, Adam

    2011-01-01

    We have begun development of an interactive, multi-player serious game for the purpose of training cardiac surgeons, fellows, and residents the series of steps comprising the Off-Pump Coronary Artery Bypass grafting (OPCAB) surgical procedure. It is hypothesized that by learning the OPCAB procedure in a "first-person-shooter gaming environment", trainees will have a much better understanding of the procedure than by traditional learning modalities. The serious game will allow for simulation parameters related to levels of fidelity to be easily adjusted so that the effect of fidelity on knowledge transfer can be examined. PMID:21335779

  12. Technical issues in the use of the radial artery as a coronary artery bypass conduit.

    PubMed

    Gaudino, Mario; Crea, Filippo; Cammertoni, Federico; Mazza, Andrea; Toesca, Amelia; Massetti, Massimo

    2014-12-01

    The clinical and angiographic benefits related to the use of the radial artery (RA) as a bypass conduit have extensively been proven. However, due to its morpho-functional features and its anatomic position, successful use of the RA requires careful consideration of several technical issues. We herein summarize the current evidence on all the technical aspects related to the RA use in coronary surgery such as the preoperative evaluation of ulnar compensation, the different means of intraoperative vasodilatation, and the various harvesting techniques. PMID:25443025

  13. Coronary Artery Bypass Graft Surgery: The Past, Present, and Future of Myocardial Revascularisation

    PubMed Central

    Chedrawy, Edgar G.

    2014-01-01

    The development of the heart-lung machine ushered in the era of modern cardiac surgery. Coronary artery bypass graft surgery (CABG) remains the most common operation performed by cardiac surgeons today. From its infancy in the 1950s till today, CABG has undergone many developments both technically and clinically. Improvements in intraoperative technique and perioperative care have led to CABG being offered to a more broad patient profile with less complications and adverse events. Our review outlines the rich history and promising future of myocardial revascularization. PMID:25374960

  14. Usefulness of perioperative blood glucose control in patients undergoing off-pump coronary artery bypass grafting

    Microsoft Academic Search

    Takeshiro Fujii; Yoshinori Watanabe; Noritsugu Shiono; Muneyasu Kawasaki; Hiroki Yokomuro; Tsukasa Ozawa; Satoshi Hamada; Hiroshi Masuhara; Nobuya Koyama

    2007-01-01

    Objective  We investigated the usefulness of perioperative blood glucose control in patients undergoing coronary artery bypass grafting\\u000a (CABG).\\u000a \\u000a \\u000a \\u000a Methods  DM patients were aggressively treated with intensive insulin therapy to achieve a preoperative fasting blood glucose level\\u000a of 140?mg\\/dl and a postoperative level of 200?mg\\/dl. For comparison, patients were divided as follows: (1) DM group vs. non-DM\\u000a group, and (2) for mean blood

  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. Is a strategy of intended incomplete percutaneous transluminal coronary angioplasty revascularization acceptable in nondiabetic patients who are candidates for coronary artery bypass graft surgery?

    Microsoft Academic Search

    Martial G Bourassa; Kevin E Kip; Alice K Jacobs; Robert H Jones; George Sopko; Allan D Rosen; Barry L Sharaf; Leonard Schwartz; Bernard R Chaitman; Edwin L Alderman; David R Holmes; Gary S Roubin; Katherine M Detre; Robert L Frye

    1999-01-01

    OBJECTIVESOur objective was to determine whether a strategy of intended incomplete percutaneous transluminal coronary angioplasty revascularization (IR) compromises long-term patient outcome.BACKGROUNDComplete angioplasty revascularization (CR) is often not planned nor attempted in patients with multivessel coronary disease, and the extent to which this influences outcome is unclear.METHODSBefore randomization, in the Bypass Angioplasty Revascularization Investigation, all angiograms were assessed for intended CR

  17. Effects of Angiotensin-Converting Enzyme Inhibition in Low-Risk Patients Early After Coronary Artery Bypass Surgery

    Microsoft Academic Search

    Jean L. Rouleau; Wayne J. Warnica; Richard Baillot; Pierre J. Block; Sidney Chocron; David Johnstone; Martin G. Myers; Cristina-Dana Calciu; Pierre Martineau; Christine Mormont; Wiek H. van Gilst

    2010-01-01

    Background—Early after coronary artery bypass surgery (CABG), activation of numerous neurohumoral and endogenous vasodilator systems occurs that could be influenced favorably by angiotensin-converting enzyme inhibitors. Methods and Results—The Ischemia Management with Accupril post-bypass Graft via Inhibition of the coNverting Enzyme (IMAGINE) trial tested whether early initiation (7 days) of an angiotensin-converting enzyme inhibitor after CABG reduced cardiovascular events in stable

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

    SciTech Connect

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

    1985-12-01

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

  19. Nurse led shared care for patients on the waiting list for coronary artery bypass surgery: a randomised controlled trial

    Microsoft Academic Search

    F McHugh; G M Lindsay; P Hanlon; I Hutton; M R Brown; C Morrison; D J Wheatley

    2001-01-01

    OBJECTIVETo evaluate the effectiveness of a nurse led shared care programme to improve coronary heart disease risk factor levels and general health status and to reduce anxiety and depression in patients awaiting coronary artery bypass grafting (CABG).DESIGNRandomised controlled trial.SETTINGCommunity, January 1997 to March 1998.STUDY GROUPS98 (75 male) consecutive patients were recruited to the study within one month of joining the

  20. Minimally invasive single-vessel coronary artery bypass with the internal thoracic artery and early postoperative angiography: midterm results of a prospective study in 120 consecutive patients

    Microsoft Academic Search

    Sérgio A Oliveira; Luiz Augusto F Lisboa; Lu??s Alberto O Dallan; Salomon O Rojas; Luiz F Poli de Figueiredo

    2002-01-01

    Background. This prospective study was undertaken to determine the role of the minimally invasive direct coronary artery bypass with early postoperative angiography and midterm follow-up in 120 consecutive patients with single-vessel coronary artery disease.Methods. Minimal access (6 to 10 cm), without complete sternotomy and no cardiopulmonary bypass, was used. The lesions were located at the proximal left anterior descending coronary

  1. Impact of Metabolic Syndrome on Mortality and Morbidity After Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Ardeshiri, Maryam; Faritus, Zahra; Ojaghi-Haghighi, Zahra; Bakhshandeh, Hooman; Kargar, Faranak; Aghili, Rokhsareh

    2014-01-01

    Background: The prevalence of Metabolic syndrome (MetS) has been increased in Asian countries. It represents a cluster of cardiovascular risk factors including obesity, insulin resistance, lipid abnormality and hypertension. Objectives: The purpose of this study was to assess the association between MetS and outcome in patients undergoing coronary artery bypass grafting surgery (CABG). Patients and Methods: This prospective study was performed on patients scheduled for coronary artery bypass grafting surgery (CABG). All the patients were followed up in hospital and three months afterward. Patients were excluded if they were younger than 18 years or had severe comorbidities, a history of valvular heart disease, and low ejection fraction. Results: A total of 235 patients (135 women) with a mean age of 59 ± 9.3 years were included. MetS was more prevalent in women (P < 0.001). The most prevalent complications were bleeding [20 (8.5%)] and dysrhythmia [18 (7.7%)]. At three months follow-up, the frequency rates of readmission [24 (10.2%)] and mediastinitis [9 (3.8%)] were higher than other complications. Diabetes and MetS were risk factors for a long ICU stay (> 5 days) and atelectasia (P < 0.05). Significant associations were observed between diabetes and pulmonary embolism (P = 0.025) and mediastinitis (P = 0.051). Conclusions: Identification of MetS before CABG can predict the surgery outcome. Patients with MetS have increased risks for longer ICU stay and atelectasia. PMID:25478548

  2. Haemostatic factors and inhibitors and coronary artery bypass grafting: preoperative alterations and relations to graft occlusion.

    PubMed

    Moor, E; Hamsten, A; Blombäck, M; Herzfeld, I; Wiman, B; Rydén, L

    1994-09-01

    Graft closure remains a major problem after coronary artery bypass surgery. While a number of graft characteristics influencing the risk of occlusion have been defined, the role of haemostatic factors and inhibitors has not been studied in detail. The present study examined the time course of changes in blood coagulation and fibrinolytic function after coronary artery bypass grafting in 20 consecutive patients. Pre- and postoperative determinations of haemostatic factors and inhibitors were also related to the presence of graft occlusion assessed by angiography at three months after surgery. A broad panel of haemostatic tests was used preoperatively, on the first, third and eight postoperative days, and at three months after surgery. A particular emphasis was placed on fibrinogen, factor VII activity, von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1) activity, anticoagulant proteins C and S, thrombin-antithrombin complex and D-dimer. A marked activation of the coagulation cascade was noted postoperatively along with enhanced degradation of cross-linked fibrin. The degree of activation of blood coagulation and fibrinolysis differed widely between individuals and appeared to relate only partly to the acute phase reaction produced by the surgical trauma. Preoperative values of haemostatic factors and inhibitors showed fairly weak associations with the levels of postoperative determinations.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7531874

  3. [Regional differences in access to coronary bypass surgery in Brazil, 2002-2010].

    PubMed

    Viacava, Francisco; Porto, Silvia; Laguardia, Josué; Moreira, Rodrigo da Silva; Ugá, Maria Alícia Dominguez

    2012-11-01

    The hospitalization rates for angioplasty and coronary bypass surgery have been used as proxies for access to highly specialized services. The scope of this study is to analyze the evolution of these rates and discuss what are the possible causes associated with regional inequalities. Standardized rates of angioplasty and coronary bypass surgery by age and sex per 100,000 inhabitants aged 20 and over, in the period from 2002 to 2010 were calculated. Comparison with international data shows that Brazil has lower rates than those observed in OECD countries. In Brazil, the standardized rates of hospitalization for angioplasty in the population aged 20 and over showed an upward trend, rising from 27.5 per 100,000 in 2002 to 39 in 2010. When mortality rates by age and sex from different geographical regions were compared, besides the marked differences in the north - south axis, what is notable is the maintenance of a stable pattern of these rates and regional differences over the period analyzed. The definition of regional health care networks for cardiac surgery is an important strategy to ensure the quality of care, optimization of operating costs and reduction of inequalities in access to healthcare between Brazilian regions. PMID:23175303

  4. Overcoming aspirin resistance with loading clopidogrel earlier in elective percutaneous coronary intervention.

    PubMed

    Ozcan, Ozgur Ulas; Tutar, Eralp; Candemir, Basar; Ustun, Elif Ezgi; Erol, Cetin

    2015-03-01

    We aimed to analyze the clinical effect of clopidogrel loading time on adverse cardiovascular events among patients with aspirin resistance. Recurrent adverse events may still occur despite dual antiplatelet therapy after coronary stenting. Aspirin resistance is one of the possible reasons of this trouble. Optimal antiplatelet strategy for coronary stenting is unknown among patients with aspirin resistance. A total of 980 patients scheduled for elective coronary stenting were enrolled and allocated into two groups according to the loading time of clopidogrel more or less than 6 hours before coronary intervention (early- or late-loaded groups, respectively). Aspirin resistance was determined according to the urinary levels of 11-dehydrothromboxane B2. Overall 240 patients who were allocated to early- and late-loaded groups were identified as aspirin resistant according to the urinary levels of 11-dehydrothromboxane B2. After a follow-up period of 12 months major adverse cardiac events were observed among 16 patients (13.9%) in the early-loaded group and 30 patients (25.8%) in the late-loaded group (p?=?0.02). Early loading of clopidogrel was an independent predictor of lower rate of cardiac events (hazard ratio?=?0.46 [0.32-0.76, 95% confidence interval], p?=?0.001). The rates of bleeding events and periprocedural myocardial infarction were similar in early- and late-loaded groups. The current study demonstrated that loading of clopidogrel earlier than 6 hours before elective coronary stenting among aspirin-resistant patients was associated with increased benefits for ischemic events with similar bleeding rates. PMID:25780324

  5. 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.

  6. Haemostasis alterations in coronary artery bypass grafting: comparison between the off-pump technique and a closed coated cardiopulmonary bypass system

    PubMed Central

    Scrascia, Giuseppe; Rotunno, Crescenzia; Guida, Piero; Conte, Manuela; Amorese, Lillà; Margari, Vito; Schinosa, Luigi de Luca Tupputi; Paparella, Domenico

    2013-01-01

    OBJECTIVES To compare coagulation and fibrinolysis activation in off-pump coronary artery bypass operation and in patients in whom a closed phosphorylcoline-coated cardiopulmonary bypass system was applied. Cardiopulmonary bypass induces activation of coagulative and fibrinolytic systems, which together with intraoperative haemodilution augment the risk of postoperative bleeding and transfusion of blood products. METHODS Thirty-six off-pump coronary artery bypass and 36 coronary artery bypass grafting patients in whom a closed, phosphorylcholine-coated cardiopulmonary bypass system with a closed-collapsible venous reservoir (Physio group) was used were prospectively enrolled. Activation of coagulation and fibrinolytic systems was assessed evaluating the release of prothrombin fragment 1.2 and plasmin–antiplasmin complex preoperatively (T0), 30 min after heparin administration (T1), 15 min after protamin administration (T2), 3 h after protamin administration (T3) and on postoperative days 1 (T4) and 5 (T5). Platelet function was evaluated through Platelet Function Analyzer 100®. RESULTS During the operation, prothrombin fragment 1.2 and plasmin–antiplasmin levels were slightly higher in the Physio group, the difference being not statistically significant. In the off-pump coronary artery bypass group, prothrombin fragment 1.2 was significantly higher at T3 (618.7 ± 282.7 vs 416.6 ± 250.2 pmol/l; P = 0.006), T4 (416.7 ± 278.8 vs 310.2 ± 394.6 pmol/l; P < 0.001) and T5 (629.3 ± 295.2 vs 408.4 ± 409.7 pmol/l; P = 0.002), and plasmin–antiplasmin was significantly higher at T4 (731.1 ± 790 vs 334 ± 300.8 ng/ml; P = 0.019) and T5 (1744.4 ± 820.7 vs 860.1 ± 488.4 ng/ml; P = 0.003). Platelet Function Analyzer 100® closure time values were significantly higher in the Physio group patients at T3 (131.3 ± 105.7 vs 215.6 ± 58.9 s; P = 0.002). The off-pump coronary artery bypass patients had greater chest tube drainage (874.3 ± 371.5 vs 629.1 ± 334.5 ml; P = 0.005). The mean priming volume was 1240 ± 215 ml in the Physio group. Much more Physio patients received red blood cell transfusions (14 vs 25 patient; P = 0.009), because of higher intraoperative transfusion rates (6 vs 15 patients; P = 0.016). Despite similar preoperative haemoglobin levels (13 ± 1.2 vs 12.6 ± 1.4 g/dl; P = 0.2), postoperative haemoglobin levels were significantly lower in the Physio group. CONCLUSIONS The Physio cardiopulmonary bypass approach does not significantly alter haemostasis during the operation compared with off-pump coronary artery bypass providing a reduced activation in the postoperative period reducing also chest tube drainage. However, further priming volume reduction is required to decrease intraoperative red blood cell transfusion. PMID:23335652

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

    Microsoft Academic Search

    Doron Aronson; Elazer R. Edelman

    2010-01-01

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

  8. 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

  9. 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)

  10. CARDIOVASCULAR RISK FACTORS AND IN-HOSPITAL MORTALITY IN 1258 CASES OF CORONARY ARTERY BYPASS SURGERY IN TEHRAN HEART CENTER

    Microsoft Academic Search

    M. H. Mandegar; M. Marzban; A. H. Lebaschi; P. Ghaboussi; A. R. Alai-Alamooti; A. Ardalan

    Coronary artery bypass grafting (CABG) surgery is being performed increasingly in Iran. So far, no large-scale report has described characteristics and risk factor profile and in-hospital mortality of patients undergoing this procedure in Iran. We conducted this study to address these topics in order to help clarify Iran's current state of CABG and to provide assistance in planning combat against

  11. Implementation of an antibiotic nomogram improves postoperative antibiotic utilization and safety in patients undergoing coronary artery bypass grafting

    Microsoft Academic Search

    Thomas J Papadimos; Jennifer L Grabarczyk; Daniel F Grum; James P Hofmann; Alan P Marco; Sadik A Khuder

    2007-01-01

    BACKGROUND: Routine, initial, empiric vancomycin dosing by clinicians in postoperative coronary artery bypass grafting (CABG) patients was identified as a potential patient safety issue in the Cardiovascular Intensive Care Unit (CVICU) because the rate of postoperative acute renal insufficiency (ARI) and average patient Body Mass Index (BMI) > 35 kg\\/m2 were significantly higher in our institution than those of the

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

    Microsoft Academic Search

    Robert H. Jones; Edward L. Hannan; Karl E. Hammermeister; Elizabeth R. DeLong; Gerald T. O'Connor; Russell V. Luepker; Victor Parsonnet; David B. Pryor

    1996-01-01

    Objectives. The purpose of this consensus effort was of define and prioritize the importance of a set of clinical variables useful for monitoring and improving the short-term mortality of patients undergoing coronary artery bypass graft surgery (CABG).Background. Despite widespread use of data bases to monitor the outcome of patients undergoing CABG, no consistent set of clinical variables has been defined

  13. 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.

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

    NASA Astrophysics Data System (ADS)

    Sankaran, Sethuraman; Marsden, Alison

    2010-11-01

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

  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. Coronary bypass grafting for patients dependent on dialysis: modified ultrafiltration for perioperative management.

    PubMed

    Otaki, Masaki; Enmoto, Takeshi; Oku, Hidetaka

    2003-01-01

    Coronary bypass grafting for patients on chronic dialysis has increased the risk of operative mortality, and long-term survival is considered poor. Thirty-three patients dependent on dialysis undergoing coronary bypass grafting were analyzed. The 33 patients were divided into two groups according to the strategy for renal support. In group A, 12 patients underwent continuous hemofiltration (CHF) during and after cardiopulmonary bypass and CHF in an intensive care unit (ICU) and then returned to regular dialysis. In group B, 21 patients underwent modified ultrafiltration (UF) immediately after cardiopulmonary bypass and continuous hemodialysis and filtration in an ICU with early reinstitution of regular dialysis. Two patients died in group A, and there were no operative deaths in group B (17% vs. 0%, p < 0.05). Three patients in group A and one patient in group B had bleeding complications requiring reoperation (25% vs. 5%, p < 0.05). Three patients in group A and one patient in group B needed intraaortic balloon pump (IABP) support postoperatively (25% vs. 5%, p < 0.05). Four patients in group A and one in group B required long-term ventilation of more than 3 days (33% vs. 5%, p < 0.05). There were five patients in group A and two patients in group B requiring long-term ICU stay of more than 4 days (41% vs. 10%, p < 0.05). Postoperative blood loss within 24 hours was 1310 ml in group A and 623 ml in group B (p < 0.05). Transfusion requirements were 9.3 units in group A and 3.0 units in group B (p < 0.05). During follow-up, the long-term survival, New York Heart Association (NYHA) functional class, and incidence of recurrent angina were considered favorable in both groups. Cardiac event-free rates after surgery at 1, 3, and 5 years were 88%, 73%, and 67%, respectively. The operative mortality, morbidity, and long-term survival for dialysis dependent patients were reasonably acceptable. As renal support, modified UF can play an important role in reducing bleeding complications, shortening the ICU stay, and decreasing blood loss and transfusion requirements. PMID:14655729

  17. Effect of preoperative obstructive sleep apnea on the frequency of atrial fibrillation after coronary artery bypass grafting.

    PubMed

    van Oosten, Erik M; Hamilton, Andrew; Petsikas, Dimitri; Payne, Darrin; Redfearn, Damian P; Zhang, Shetuan; Hopman, Wilma M; Baranchuk, Adrian

    2014-03-15

    Patients with obstructive sleep apnea (OSA) have intermittent hypoxia leading to atrial remodeling and this has been associated with the development of atrial fibrillation (AF). Postoperative AF is a common complication of coronary artery bypass grafting (CABG). The aim of this prospective study was to determine whether the presence of OSA predicts the occurrence of post-CABG AF (PCAF). This was a prospective single-center study. Patients undergoing elective CABG were evaluated and categorized as confirmed, high-risk, or low-risk OSA according to a modified Berlin questionnaire. PCAF was evaluated by 24-hour cardiac monitoring strip or 12-lead electrocardiography during the postoperative period, and validated by an electrophysiologist. We included 277 patients. OSA prevalence was 47.7%, with body mass index (31.0 vs 26.9 kg/m(2), p ?0.001), advanced age (63.7 vs 66.4 years, p = 0.031), hypertension (78.0% vs 64.8%, p = 0.015), and diabetes (45.5% vs 28.3%, p = 0.003) more prevalent in the OSA group. PCAF was found to occur in 37.2% of all patients and OSA was found to be a strong predictor of PCAF (45.5% vs 29.7%, p = 0.007). PCAF was also associated with continuous positive airway pressure use (12.6% vs 5.2%, p = 0.027). Increased length of stay was associated with PCAF (6.5 vs 5.3 days, p = 0.006), as was longer time from surgery to occurrence of PCAF (p = 0.001). In conclusion, OSA was found to be a strong predictor of PCAF, which in turn was found to be associated with increased length of stay. PMID:24462068

  18. Pseudo-Kaposi sarcoma worsening after leg vein harvest for coronary artery bypass grafting.

    PubMed

    Alshihry, Hind; Chisti, Muzamil Amin; Hamadah, Issam

    2014-01-01

    Acroangiodermatitis (AAD) (synonym, pseudo-Kaposi sarcoma) is a term that encompasses 2 different conditions: (1) AAD of Mali, which refers to skin lesions that mainly develop bilaterally on the lower extremities of patients with chronic venous insufficiency and is an extreme form of stasis dermatitis and (2) Stewart-Bluefarb syndrome, which consists of an arteriovenous malformation that mainly affects the limbs of young patients unilaterally. We present a case of a 68-year-old lady with progressive skin lesions on both lower limbs (right > left) as a result of chronic venous insufficiency that became worse after the leg-vein harvest for coronary artery bypass grafting was taken from the right leg. Up to our knowledge this is the first case of its kind to be reported. PMID:24894790

  19. Endoscopic Harvesting Device Type and Outcomes in Patients Undergoing Coronary Artery Bypass Surgery

    PubMed Central

    van Diepen, Sean; Brennan, J. Matthew; Hafley, Gail E.; Reyes, Eric M.; Allen, Keith B.; Ferguson, T. Bruce; Peterson, Eric D.; Williams, Judson B.; Gibson, C. Michael; Mack, Michael J.; Kouchoukos, Nicholas T.; Alexander, John H.; Lopes, Renato D.

    2015-01-01

    Objective To evaluate angiographic and clinical outcomes associated with open and closed tunnel dissection endoscopic vein harvesting (EVH) devices. Summary Background Data A previous PREVENT-IV analysis reported that EVH for coronary artery bypass graft (CABG) surgery was associated with worse outcomes compared with traditional vein harvesting; however, outcomes by EVH device type were not available. Methods Using data from the PREVENT-IV trial, we compared 1549 patients from 75 surgical sites who underwent EVH with open (n=390) or closed (n=1159) harvest tunnel devices. Outcomes included the incidence of vein graft failure at 12 to 18 months and a composite of death, myocardial infarction, or revascularization through 5 years. Results Among patients undergoing open and closed tunnel EVH, no difference in the per-patient incidence of vein graft failure (43.8% vs. 47.1%; adjusted odds ratio [OR], 0.91; 95% confidence interval [CI], 0.53 to 1.55; p=0.724) or per-graft incidence of vein graft failure (25.5% vs. 25.9%; adjusted OR, 0.96; 95% CI, 0.59 to 1.55; p=0.847) was observed. At 5 years, no difference was observed in the primary composite clinical outcome between open and closed system EVH patients (21.5% vs. 23.9%; adjusted hazard ratio, 0.85; 95% CI, 0.66 to 1.10; p=0.221). Conclusion No differences in angiographic or clinical outcomes were observed among patients who underwent open vs. closed tunnel endoscopic harvesting for coronary bypass surgery. These findings suggest that the risks associated with EVH that were reported in a previous PREVENT-IV analysis are not related to a specific EVH device. PMID:24368640

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

    PubMed Central

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

    2012-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was what the optimal intraoperative anticoagulation strategy should be in patients undergoing off-pump coronary artery bypass graft (CABG) surgery. A total of 157 papers were identified using the reported search, of which 8 were judged to represent the best evidence. The authors, journal, date, country of publication, study type, patient group studied, relevant outcomes and results were tabulated. The quality of clinical trials was assessed. Off-pump CABG is currently considered as a safe and effective alternative to CABG with the use of cardiopulmonary bypass, especially in the presence of off-pump expertise and certain pathologies. Although most technical steps in off-pump revascularization are standardized, it appears that there is inconsistency in intraoperative anticoagulation practice. Surveys conducted in the USA and Europe confirm the lack of uniform policy, with heparin dose ranging between 70 and 500 U/kg and from full-dose protamine to no reversal of anticoagulation. Although the quality of evidence is low, there is a trend for utilization of heparin at 150 U/kg, followed by half-dose protamine reversal, which appears to provide adequate anticoagulation for the safe conduct of anastomoses and thromboprophylaxis without significantly increasing the risk of postoperative bleeding. However, more research is necessary before firm recommendations can be made. PMID:22307394

  1. Cardiac CT Angiography After Coronary Bypass Surgery: Prevalence of Incidental Findings

    PubMed Central

    Mueller, Jeffrey; Jeudy, Jean; Poston, Robert

    2014-01-01

    OBJECTIVE Cardiac CT angiography (CTA) is commonly performed after coronary artery bypass grafting surgery (CABG) to assess graft patency, but the images also include parts of the lungs, abdomen, and mediastinum. The purpose of our study was to retrospectively assess the prevalence of unsuspected disease identified on cardiac CTA examinations after CABG and to determine their potential clinical significance. MATERIALS AND METHODS CTA was performed postoperatively in 259 patients (mean, 5.2 days), and 40 patients underwent a follow-up CT scan (mean, 12.7 months). Cardiac CTA was acquired using a 16-MDCT scanner with ECG-gating and bolus timing with a small field of view centered on the heart. Two thoracic radiologists assessed each examination in consensus. The prevalence of graft disease and incidental findings (cardiac and noncardiac) was established. The electronic medical record was reviewed. A finding was judged potentially significant if a therapeutic intervention or radiologic follow-up was deemed advisable on the basis of the cardiac CTA. Bypass graft occlusions were analyzed separately. RESULTS In the immediate postoperative period, 51 patients (19.7%) had at least one unsuspected, potentially significant finding. Twenty-four patients (9.3%) had a cardiac finding such as a ventricular pseudoaneurysm, ventricular perfusion deficit, or intracardiac thrombus, and 34 patients (13.1%) had a noncardiac finding including pulmonary embolism, lung cancer, or pneumonia. At least one bypass graft was occluded in 17 patients (6.6%) in the immediate postoperative period. In the later postoperative period, seven patients (17.5%) had a potentially significant unsuspected finding. Four patients (10.0%) had at least one graft occlusion. CONCLUSION Cardiac CTA after CABG revealed a high prevalence of unsuspected cardiac and noncardiac findings with potential clinical significance. Interpreters of these studies should be familiar with the spectrum of these abnormalities. PMID:17646469

  2. 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

  3. Changes in left ventricular performance related to perioperative myocardial infarction in coronary artery bypass graft surgery

    SciTech Connect

    Roberts, A.J.; Spies, S.M.; Lichtenthal, P.R.; Moran, J.M.; Sanders, J.H.; Michaelis, L.L.

    1983-05-01

    Strict electrocardiographic, enzymatic, scintigraphic, and hemodynamic criteria for perioperative myocardial infarction (MI) were defined and related to serial assessments of left ventricular performance during rest and exercise in patients seen early and late after coronary artery bypass graft operation. Global left ventricular performance was determined by radionuclide ventriculography from which changes in the pattern of serial postoperative ejection fractions (EF) were obtained. Patients were divided into two groups based on the presence or absence of perioperative MI, and were matched in pairs on the basis of preoperative EF and extent as well as location of coronary artery obstructions. The results indicate that neither short- nor long-term depression in resting EF occurred subsequent to perioperative MI. However, an exercise-related increase in EF eight months postoperatively was depressed in patients who had perioperative MI compared with those who did not. Patients with new Q waves and abnormal postoperative elevation in serum levels of the myocardial isoenzyme of creatine kinase (CK-MB) had a greater early decrease in EF compared with patients without evidence of perioperative MI. However, seven days after operation, the EF in both groups returned to preoperative levels. Patients with abnormal technetium 99m-pyrophosphate scintigrams had changes in perioperative EF similar to those in patients without MI. The presence of low cardiac output syndrome immediately after operation was associated with immediate and short-term decreases in EF, which were not seen in any of the other patient subgroups.

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

    SciTech Connect

    Tamaki, N.; Yonekura, Y.; Yamashita, K.; Saji, H.; Magata, Y.; Senda, M.; Konishi, Y.; Hirata, K.; Ban, T.; Konishi, J. (Kyoto Univ. Faculty of Medicine (Japan))

    1989-10-15

    To assess the clinical value of positron emission tomography (PET) in the evaluation of coronary artery bypass grafting (CABG), PET perfusion and metabolic imaging using nitrogen-13 ammonia and fluorine-18 deoxyglucose (FDG) was performed before and 5 to 7 weeks after CABG in 22 patients with coronary artery disease. Postoperative improvement in hypoperfusion was observed more often in the metabolically active segments (62%) than in the inactive segments (27%) on the preoperative PET study (p less than 0.05). Similarly, the postoperative lessening of wall motion abnormality was observed more often in the metabolically active segments (78%) than in the inactive segments (22%) (p less than 0.001). Of 19 asynergic segments showing increased FDG uptake before operation, the postoperative PET revealed a decrease in FDG uptake in 13 (68%) and persistent uptake in 6 (32%). The improvement in asynergy was observed in all the segments that showed a postoperative decrease in FDG uptake, but in only 50% of those with persistent uptake (p less than 0.01). On the other hand, 4 of 5 segments showing a new FDG uptake after operation revealed further wall motion abnormality. Furthermore, the segments metabolically active before operation were more likely to have patent grafts (95%) than the metabolically inactive segments (70%) (p less than 0.05). Thus, preoperative metabolic imaging using PET appears to be useful for predicting the response to CABG. Improvement in metabolic derangement was associated with improvement in regional function after CABG.

  5. CASE REPORT Sternal Chondrosarcoma After Sternotomy for Coronary Artery Bypass Grafting

    PubMed Central

    Singh, Vijay A.; Abreu, Juan; Bowman, Kimberly; Shariff, Masood A.; McGinn, Joseph T.

    2013-01-01

    Objective: Primary bony tumors of the chest wall are usually benign and most commonly located in the ribs or sternum. Chondrosarcoma is regarded as one of the most frequent primary malignancies of the chest wall and its incidence after a sternotomy for a cardiac procedure is extremely rare. We present a case of sternal chondrosarcoma. Methods: The patient presented with a sternal mass 4 years after undergoing coronary artery bypass grafting for ischemic coronary artery disease. The mass originally emanated from the upper portion of the patients’ sternum and then rapidly enlarged to include the anterior aspects of his neck. Radiologic imaging studies were undertaken: computed tomographic scan and magnetic resonance imaging, with surgical intervention for excision. Results: Computed tomographic scan and magnetic resonance imaging established an 8.4 × 6.2 × 8.6 cm3 complex solid tissue mass within the lower neck arising from the sternal manubrium, with extensive bone destruction. Computed tomography-guided biopsy showed cells of uncertain significance. Surgical excision was performed and the mass was diagnosed as a grade II chondrosarcoma. Discussion: Primary sarcomas of the sternum though uncommon are potentially curable with wide surgical excision. Success depends on tumor histologic type and grade, which dictate recurrence. PMID:23372861

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

    PubMed

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

    2013-12-01

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

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

    PubMed Central

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

    2011-01-01

    Background Redo coronary artery bypass grafting surgery (CABG) is associated with a higher risk of mortality than the first operation. However, the impact of percutaneous coronary intervention (PCI) on the outcome in such patients is currently unclear. We evaluated the in-hospital and six-month clinical outcomes of post-CABG patients who underwent PCI in our center. Methods Between April 2008 and July 2009, 71 post-CABG patients (16 women and 55 men) underwent 110 stent implantations (74% drug-eluting stents) for 89 lesions. Sixty percent of the PCI procedures were performed on the native coronary arteries, 32% on graft arteries, and 8% on both types of vessels. Major adverse cardiac events (MACE) were recorded in hospital and at six months’ follow-up. Results The procedural success rate was 93%, and the in-hospital MACE rate was 5.6 % (1 death, 3 myocardial infarctions). At 6 months, the incidence of MACE was 5.6% (no death or myocardial infarction, but 4 target lesion revascularizations) and 4 (5.6 %) in-stent restenoses. There was no statistically significant difference in the comparison of MACE between the patients treated in either native arteries or in the grafts (15% vs.12%, p value = 0.8). According to the univariate analysis, hypertension and the use of the bare metal stent vs. the drug-eluting stent were the significant predictors of MACE, whereas the multivariate analysis showed that only hypertension (OR = 3.7, 95% CI 3.4–4, p value < 0.048) was the independent predictor of MACE. The mean of the left ventricular ejection fraction had no effect on the incidence of MACE (p value = 0.9). The multivariate analysis showed hypertension (p value < 0.048) and the use of the bare metal stent (p value < 0.018) were the independent predictors of MACE. The chronic total occlusion (CTO) (p value < 0.01) was the independent predictor of the success rate. The prevalence of diabetes had no impact on the incidence of MACE according to the univariate analysis (p value = 0.9). Our multivariate analysis showed that hypertension and the use of the bare metal stent were the independent predictors of MACE and that chronic total occlusion was the independent predictor of the procedural failure rate. Conclusion PCI is preferable to redo CABG for post-CABG patients. The independent predictors of MACE were hypertension and bare metal stents. PMID:23074602

  8. Autonomic cardiovascular dysregulation as a potential mechanism underlying depression and coronary artery bypass grafting surgery outcomes

    PubMed Central

    2010-01-01

    Background Coronary artery bypass grafting (CABG) is often used to treat patients with significant coronary heart disease (CHD). To date, multiple longitudinal and cross-sectional studies have examined the association between depression and CABG outcomes. Although this relationship is well established, the mechanism underlying this relationship remains unclear. The purpose of this study was twofold. First, we compared three markers of autonomic nervous system (ANS) function in four groups of patients: 1) Patients with coronary heart disease and depression (CHD/Dep), 2) Patients without CHD but with depression (NonCHD/Dep), 3) Patients with CHD but without depression (CHD/NonDep), and 4) Patients without CHD and depression (NonCHD/NonDep). Second, we investigated the impact of depression and autonomic nervous system activity on CABG outcomes. Methods Patients were screened to determine whether they met some of the study's inclusion or exclusion criteria. ANS function (i.e., heart rate, heart rate variability, and plasma norepinephrine levels) were measured. Chi-square and one-way analysis of variance were performed to evaluate group differences across demographic, medical variables, and indicators of ANS function. Logistic regression and multiple regression analyses were used to assess impact of depression and autonomic nervous system activity on CABG outcomes. Results The results of the study provide some support to suggest that depressed patients with CHD have greater ANS dysregulation compared to those with only CHD or depression. Furthermore, independent predictors of in-hospital length of stay and non-routine discharge included having a diagnosis of depression and CHD, elevated heart rate, and low heart rate variability. Conclusions The current study presents evidence to support the hypothesis that ANS dysregulation might be one of the underlying mechanisms that links depression to cardiovascular CABG surgery outcomes. Thus, future studies should focus on developing and testing interventions that targets modifying ANS dysregulation, which may lead to improved patient outcomes. PMID:20465820

  9. Comparison of thermodilution bolus cardiac output and Doppler cardiac output in the early post-cardiopulmonary bypass period

    Microsoft Academic Search

    Xiaoqin Zhao; John S. Mashikian; Pete Panzica; Adam Lerner; Kyung W. Park; Mark E. Comunale

    2003-01-01

    Objective: To evaluate the accuracy of measuring cardiac output (CO) in the early post-cardiopulmonary bypass (CPB) period by comparing thermodilution with Doppler methods. Design: Prospective and blinded human trial. Setting: Academic medical center. Participants: Thirty adult patients undergoing elective coronary artery bypass graft surgery. Measurements and Main Results: Thermodilution CO (TCO) was obtained in triplicate. Doppler CO (DCO) in triplicate

  10. Role of coronary artery bypass grafting during the acute and subacute phase of ST-elevation myocardial infarction

    Microsoft Academic Search

    Y. L. Gu; I. C. C. van der Horst; Y. L. Douglas; T. Svilaas; M. A. Mariani; F. Zijlstra

    2010-01-01

    \\u000a Abstract  Background\\/Objectives. We aimed to investigate the incidence and clinical outcome of coronary artery bypass grafting (CABG) performed in contemporary\\u000a patients with ST-elevation myocardial infarction (STEMI) within 30 days after presentation.\\u000a \\u000a \\u000a Methods. All 1071 patients enrolled in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction\\u000a Study (TAPAS) were included in this analysis. CABG was indicated for both ischaemic

  11. A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery

    Microsoft Academic Search

    J. M. Murkin; J. S. Martzke; A. M. Buchan; C. Bentley; C. J. Wong

    1995-01-01

    The impact of perfusion technique and mode of pH management during cardiopulmonary bypass has not been well characterized with respect to postoperative cardiovascular outcome. Methods : This double-blind, randomized study comparing outcomes after alpha-stat or pH-stat management and pulsatile or nonpulsatile perfusion during moderate hypothermic cardiopulmonary bypass was undertaken in 316 patients undergoing coronary artery bypass operations. Results : Cardiovascular

  12. 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

  13. 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

  14. Prospective study of health related quality of life before and after coronary artery bypass grafting: outcome at five years

    Microsoft Academic Search

    N Caine; L D Sharples; J Wallwork

    1999-01-01

    OBJECTIVETo determine the long term health related quality of life of coronary artery bypass graft patients, to look at changes between one and five years after surgery, and to examine the ability of preoperative variables to predict longer term outcome.DESIGNNottingham health profile (NHP) was used to assess patients at five years compared to results obtained at one year.PATIENTS100 male patients

  15. Predictors of poor mid-term health related quality of life after primary isolated coronary artery bypass grafting surgery

    Microsoft Academic Search

    S Al-Ruzzeh; T Athanasiou; O Mangoush; J Wray; T Modine; S George; M Amrani

    2005-01-01

    Objective: To assess the determinants of poor mid-term health related quality of life (HRQoL) at one year after primary isolated coronary artery bypass grafting (CABG).Methods: 463 patients who underwent primary isolated CABG for multivessel disease and came for their annual follow up at the outpatient clinic during one year at Harefield Hospital, Middlesex, were approached to participate in the present

  16. New-Onset Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Graft Surgery and Long-Term Survival

    Microsoft Academic Search

    Giovanni Filardo; Cody Hamilton; Robert F. Hebeler; Baron Hamman; Paul Grayburn

    2010-01-01

    Background—The advancing age and generally increasing risk profile of patients receiving isolated coronary artery bypass graft (CABG) surgery is expected to raise incidence of new-onset postoperative atrial fibrillation (AFIB) resulting in potentially higher risk of adverse outcomes. In the early postoperative course, new-onset post-CABG AFIB is considered relatively easy to treat and is believed to have little impact on patients'

  17. 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

  18. Recalcitrant Chest Wall Aspergillus Fumigatus Osteomyelitis After Coronary Artery Bypass Grafting: Successful Radical Surgical and Medical Management

    Microsoft Academic Search

    Mohammed M. Elahi; Amit Mitra; Julia Spears; James B. McClurken

    2005-01-01

    This report describes a 62-year-old male diabetic patient with persistent chest wall osteomyelitis that developed after repeat coronary artery bypass grafting. The chronic infection was localized to the right anterior chest wall and refractory to medical and surgical treatment including long-term antiobiotics, five separate intraoperative debridements, and reconstruction with vascularized omentum over a two-year period at outside institutions. Aggressive surgical

  19. Relationship between postoperative clopidogrel use and subsequent angiographic and clinical outcomes following coronary artery bypass grafting

    PubMed Central

    Williams, Judson B.; Lopes, Renato D.; Hafley, Gail E.; Ferguson, T. Bruce; Mack, Michael J.; Gibson, C. Michael; Harrington, Robert A.; Peterson, Eric D.; Smith, Peter K.; Mehta, Rajendra H.

    2015-01-01

    Dual antiplatelet therapy with both aspirin and clopidogrel is increasingly used after coronary artery bypass grafting (CABG); however, little is known about the safety or efficacy. We sought to determine the relationship between postoperative clopidogrel and clinical and angiographic outcomes following CABG. We evaluated 3,014 patients from PREVENT IV who underwent CABG at 107 US sites. Postoperative antiplatelet therapy was left to physician discretion. Risk-adjusted angiographic and clinical outcomes were compared in patients taking and not taking clopidogrel 30 days post-CABG. At 30 days, 633 (21 %) patients were taking clopidogrel. Clopidogrel users were more likely to have peripheral vascular (15 vs. 11 %) and cerebrovascular disease (17 vs. 11 %), prior myocardial infarction (MI) (46 vs. 41 %), and off-pump surgery (33 vs. 18 %). Clopidogrel use was associated with statistically insignificant higher graft failure (adjusted odds ratio 1.3; 95 % confidence interval [CI] [1.0, 1.7]; P = 0.05). At 5-year follow-up, clopidogrel use was associated with similar composite rates of death, MI, or revascularization (27 vs. 24 %; adjusted hazard ratio 1.1; 95 % CI [0.9, 1.4]; P = 0.38) compared with those not using clopidogrel. There was an interaction between use of cardiopulmonary bypass and clopidogrel with a trend toward lower 5-year clinical events with clopidogrel in patients undergoing off-pump CABG. In this observational analysis, clopidogrel use was not associated with better 5-year outcomes following CABG. There may be better outcomes with clopidogrel among patients having off-pump surgery. Adequately powered randomized clinical trials are needed to determine the role of dual antiplatelet therapy after CABG. PMID:23543398

  20. Symptom profiles of coronary artery bypass surgery patients at risk for poor functioning outcomes.

    PubMed

    Zimmerman, Lani; Barnason, Susan; Young, Lufei; Tu, Chunhao; Schulz, Paula; Abbott, Amy A

    2010-01-01

    The purpose of this secondary analysis was to profile or cluster 226 patients, who had participated in a randomized controlled trial, on symptoms after coronary artery bypass surgery and to examine how these profiles could potentially be used by clinicians to identify groups at risk for impaired functioning during the first 6 months after surgery. Variables measured were symptom presence and burden and functioning. The model-based clustering method was used for cluster analysis of the symptom burden measure, and analyses of covariance were used to determine if there were differences on functioning (physical functioning and physical activity) by symptom burden group at 6 weeks and at 3 and 6 months after dismissal. The majority of the 226 subjects were married (86%), male (83%), and had a mean age of 71 (SD, 4.96) years. Eight symptoms were used in the model-based clustering method-shortness of breath, fatigue, depression, sleep disturbances, pain, swelling, anxiety, and appetite problems-and demonstrated that there were 3 patient clusters of symptom burden. Cluster 1 had low symptom burden on all 8 symptoms, cluster 3 had moderate symptom burden on all 8 symptoms, and cluster 2 had a combination of low (shortness of breath, fatigue, depression, pain, and anxiety) and moderate symptom burden (sleep problems, swelling, and appetite problems). Analyses of covariance revealed no significant cluster x time interactions for any of the variables. However, there were significant main effects (P < .01) for symptom burden groups for physical functioning (physical and vitality functioning) and physical activity (estimated energy expenditure and mean daily total activity counts). Significant main effects for time indicated physical functioning and physical activity measures, except bodily pain, improved over time (P < .05). Study results indicate that the use of profiling coronary artery bypass surgery patients on their symptoms prior to hospital discharge may assist health care providers to identify patients who could be at risk for having more difficulty with physical functioning and physical activity during the first 6 months after surgery. PMID:20498614

  1. The value of exercise radionuclide ventriculography in risk stratification after coronary arterial bypass grafting

    SciTech Connect

    Iskandrian, A.S.; Hakki, A.H.; Goel, I.P.; Mundth, E.D.; Kane, S.; Schenk, C.

    1985-05-01

    Cardiac events after coronary artery bypass surgery (CABG) may be related to left ventricular (LV) function, residual coronary artery diseases (CAD), graft occlusion, and progression of CAD. This study examined the value of rest and exercise (EX) radionuclide ventriculography (RNV) done 3-6 mos after CABG in risk stratification in 212 pts. There were 185 men and 27 women, aged 57 +- 8 years (mean +- SD). During a followup period of up to 4 years, (15 +- 10 months), there were 23 cardiac events; 13 pts died of cardiac causes and 20 had non-fatal acute myocardial infarctions. The pts with and without events did not differ in: clinical presentation after CABG (most were asymptomatic), medications and ECG findings at rest and EX. The pts with events had lower EX systolic blood pressure (p < 0.01); resting LV ejection fraction (EF) (p = 0.002), and EX EF (40 +- 18% vs 54 +- 16%, p = 0.002). The change in EF (rest to EX) was not significantly different (l.6 +- 8.2%, vs 2.1 +- 9.2%). Survival analysis (Cox model) identified the EX EF as the best predictor of death and total events (X/sup 2/ = 4.3 and 2.4, p = 0.04 and 0.07 respectively). Actuarial life table analysis showed that the risk increased as the EX EF decreased when pts were grouped into EX EF greater than or equal to 50, 30-49, and <30%, (p < 0.001, Mantel-Cox). Thus, EX RNA is useful in risk stratification after CABG. The EX LVEF is an important descriptor that categorizes pts into different risks groups. The pts at high risk probably require more aggressive followup and continued medical therapy.

  2. Correlation of functional recovery with myocardial blood flow, glucose uptake, and morphologic features in patients with chronic left ventricular ischemic dysfunction undergoing coronary artery bypass grafting

    Microsoft Academic Search

    Christophe Depré; Jean-Louis J. Vanoverschelde; Bernhard Gerber; Marcel Borgers; Jacques A. Melin; Robert Dion

    1997-01-01

    Objective: Our objective was to investigate the influence of preoperative myocardial ultrastructure and metabolism on recovery of contractile function after coronary artery bypass grafting in patients with coronary artery disease and left ventricular dysfunction. Methods: Dynamic positron emission tomography with 13N-ammonia and 18F-deoxyglucose was used to assess myocardial perfusion and glucose uptake in 53 patients scheduled for coronary revascularization because

  3. Late remote ischemic preconditioning provides benefit to patients undergoing elective percutaneous coronary intervention.

    PubMed

    Liu, Zhi; Wang, Yan-Ling; Hua, Qi; Chu, Yan-Yan; Ji, Xun-Ming

    2014-09-01

    To assess whether late remote ischemic preconditioning (L-RIPC) is effective in myocardial protection in patients with ischemic heart disease undergoing elective percutaneous coronary intervention (PCI). L-RIPC is exerted by newly synthesized cardioprotective proteins. The cardioprotective effects of L-RIPC are more durable. 200 consecutive patients undergoing elective PCI were randomized to receive L-RIPC (induced by three 5-minute inflations of a blood pressure cuff to 200 mmHg around the upper arm, followed by 5-min intervals of reperfusion) or control (an uninflated cuff around the arm) at 18 h before PCI. Creatine phosphokinase (CK), its cardiac isoenzyme (CK-MB), troponin I (TNI), and high-sensitivity C-reactive protein (hs-CRP) levels were measured at 24 h after PCI. Adverse events' rates at 6 months were assessed. Compared with the control group, patients in L-RIPC group were observed with significantly lower incidences in Chest pain score >1 and ECG ST deviation >1 mm (P < 0.05). The median TNI, CK, and CK-MB concentrations at 24 h were lower in the L-RIPC group (0.009 vs. 0.036 ng/mL, 123 vs. 186 IU/L, 15 vs. 27 IU/L; P < 0.05). There was no statistical difference in hs-CRP between two groups. At 6 months, the adverse events' rate was lower in the L-RIPC group (P = 0.036). L-RIPC is effective in myocardial protection in patients undergoing elective PCI and reduces adverse events' rate at 6 months. PMID:25015066

  4. 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.

  5. The Efficacy and Safety of a Pharmacologic Protocol for Maintaining Coronary Artery Bypass Patients at a Higher Mean Arterial Pressure during Cardiopulmonary Bypass

    PubMed Central

    Pirraglia, Paul A.; Peterson, Janey C.; Hartman, Gregg S.; Yao, Fun Sun F.; Thomas, Stephen J.; Charlson, Mary E.

    2015-01-01

    A recent randomized trial of higher versus lower mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) showed that higher MAP on CPB was associated with a lower incidence of overall cardiac and neurologic morbidity and mortality in coronary artery bypass graft surgery (CABG) patients. Cardiopulmonary bypass MAP was controlled pharmacologically while CPB flow was held constant for any given period. The objective of the present study was to assess the efficacy and safety of this pharmacologic protocol. Two hundred forty-eight patients participated in the study; the mean age was 65.8 ± 9.4 years, 20% were women, and the mean preoperative ejection fraction was 48%. The low-flow corrected CPB MAP attained for the low and high MAP groups was 56.7 ± 5.0 mmHg and 77.7 ± 7.1 mmHg, respectively (p = 0.0001). Major cardiac and neurologic outcomes, postoperative blood loss, renal dysfunction, intensive care unit (ICU) stay, and duration of intubation were not found to be significantly associated with any drug in the pharmacologic protocol. These findings support that the pharmacologic protocol used to maintain CABG patients at higher MAP on CPB is both efficacious and safe. PMID:24303604

  6. 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

  7. Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Cavalcante, Elder dos Santos; Magario, Rosmeiri; Conforti, César Augusto; Cipriano Júnior, Gerson; Arena, Ross; Carvalho, Antonio Carlos C.; Buffolo, Enio; Luna Filho, Bráulio

    2014-01-01

    Background Coronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) – 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) – 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ? 0.05 were considered significant. Results Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ? 0.01). Conclusion Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity. PMID:25352459

  8. Virtual coaching for the high-intensity training of a powerlifter following coronary artery bypass grafting

    PubMed Central

    Adams, Richard; Qin, Huanying; Bilbrey, Tim; Schussler, Jeffrey M.

    2015-01-01

    A 55-year-old powerlifter in Tennessee learned about the sport-specific, high-intensity cardiac rehabilitation training available in Dallas, Texas, and contacted the staff by phone. He was recovering from quadruple coronary artery bypass grafting (CABG) and had completed several weeks of traditional cardiac rehabilitation in his hometown, but the exercise program no longer met his needs. He wanted help in returning both to his normal training regimen and to powerlifting competition but was unable to attend the Dallas program in person. An exercise physiologist with the program devised a virtual coaching model in which the patient was sent a wrist blood pressure cuff for self-monitoring and was advised about exercises that would not harm his healing sternum, even as the weight loads were gradually increased. After 17 weeks of symptom-limited, high-intensity training that was complemented by phone and e-mail support, the patient was lifting heavier loads than he had before CABG. At a powerlifting competition 10 months after CABG, he placed first in his age group. This case report exemplifies the need for alternative approaches to the delivery of cardiac rehabilitation services. PMID:25552808

  9. The New Zealand priority criteria project. Part 2: Coronary artery bypass graft surgery.

    PubMed Central

    Hadorn, D. C.; Holmes, A. C.

    1997-01-01

    Priority criteria developed during a national project were used to conduct an audit of all 662 patients on waiting lists for coronary artery bypass surgery in New Zealand during spring 1996. Based on the observed distribution of priority scores, the cost of providing surgery to all patients down to various levels of priority was estimated. Descriptions incorporating life expectancy and quality of life implications of surgery were developed of the kinds of patients who would or would not receive surgery at each of several possible funding levels. Cardiologists and cardiac surgeons agreed that a threshold of 25 points was a reasonable clinical goal but to work with a threshold of 35, which can be sustained with current levels of funding. All agree that the gap between these clinically preferred and currently afforded thresholds is a subject for wider societal dialogue and decision. The ability to measure the size of the gap between clinical desirability and financial sustainability provides a new transparency to the problem of healthcare resource allocation. PMID:9006478

  10. Nafamostat Mesilate: Can It Be Used as a Conduit Preserving Agent in Coronary Artery Bypass Surgery?

    PubMed Central

    Yoon, Yoo Sang; Oh, Hyunkong; Kim, Yonghwan; Lim, Seung Pyung

    2013-01-01

    Background Graft vessel preservation solution in coronary artery bypass surgery is used to maintain the graft conduit in optimal condition during the perioperative period. Nafamostat mesilate (NM) has anticoagulation and anti-inflammatory properties. Therefore, we investigated NM as a conduit preservative agent and compared it to papaverine. Methods Sprague-Dawley (SD) rat thoracic aortas were examined for their contraction-relaxation ability using phenylephrine (PE) and acetylcholine (ACh) following preincubation with papaverine and NM in standard classical organ baths. Human umbilical vein endothelial cells (HUVECs) were cultured to check for the endothelial cell viability. Histopathological examination and terminal deoxynucleotidyl transferase dUTP nick end labeling assay were performed on the thoracic aortas of SD rats. Results The anti-contraction effects of papaverine were superior to those of NM at PE (p<0.05). The relaxation effect of NM on ACh-induced vasodilatation was not statistically different from that of papaverine. Viability assays using HUVECs showed endothelial cell survival rates of >90% in various concentrations of both NM and papaverine. A histopathological study showed a protective effect against necrosis and apoptosis (p<0.05) in the NM group. Conclusion NM exhibited good vascular relaxation and a reasonable anti-vasocontraction effect with a better cell protecting effect than papaverine; therefore, we concluded that NM is a good potential conduit preserving agent. PMID:24368967

  11. Clopidogrel improves aspirin response after off-pump coronary artery bypass surgery

    PubMed Central

    Wang, Xuezhong; Gong, Xiaoxuan; Zhu, Tiantian; Zhang, Qiu; Zhang, Yangyang; Wang, Xiaowei; Yang, Zhijian; Li, Chunjian

    2014-01-01

    Abstract We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass (OPCAB) surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group (30 patients) received mono-antiplatelet treatment (MAPT) with aspirin 100?mg daily and the other group received dual antiplatelet treatment (DAPT) with aspirin 100?mg daily plus clopidogrel 75?mg daily. Platelet aggregations in response to arachidonic acid (PLAA) and adenosine diphosphate (ADP) (PLADP) were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given (62.1% vs. 32.1%, 34.5% vs. 10.7%, respectively, both P < 0.05). There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance. PMID:24683408

  12. 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

  13. 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

  14. The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery

    Microsoft Academic Search

    Madhav Swaminathan; Barbara G Phillips-Bute; Peter J Conlon; Peter K Smith; Mark F Newman; Mark Stafford-Smith

    2003-01-01

    BackgroundAcute renal injury is a common serious complication of cardiac surgery. Moderate hemodilution is thought to reduce the risk of kidney injury but the current practice of extreme hemodilution (target hematocrit 22% to 24%) during cardiopulmonary bypass (CPB) has been linked to adverse outcomes after cardiac surgery. Therefore we tested the hypothesis that lowest hematocrit during CPB is independently associated

  15. The Association of Lowest Hematocrit During Cardiopulmonary Bypass With Acute Renal Injury After Coronary Artery Bypass Surgery

    Microsoft Academic Search

    Madhav Swaminathan; Barbara G. Phillips-Bute; Peter J. Conlon

    2010-01-01

    Background. Acute renal injury is a common serious complication of cardiac surgery. Moderate hemodilution is thought to reduce the risk of kidney injury but the current practice of extreme hemodilution (target hemat- ocrit 22% to 24%) during cardiopulmonary bypass (CPB) has been linked to adverse outcomes after cardiac sur- gery. Therefore we tested the hypothesis that lowest hematocrit during CPB

  16. Feasibility of Temporary Biventricular Pacing after Off-Pump Coronary Artery Bypass Grafting in Patients with Reduced Left Ventricular Function

    PubMed Central

    Wang, Daniel Y.; Kelly, Lauren A.; Richmond, Marc E.; Quinn, T. Alexander; Cheng, Bin; Spotnitz, Michelle D.; Cabreriza, Santos E.; Naka, Yoshifumi; Stewart, Allan S.; Smith, Craig R.; Spotnitz, Henry M.

    2013-01-01

    In selected patients undergoing cardiac surgery, our research group previously showed that optimized temporary biventricular pacing can increase cardiac output one hour after weaning from cardiopulmonary bypass. Whether pacing is effective after beating-heart surgery is unknown. Accordingly, in this study we examined the feasibility of temporary biventricular pacing after off-pump coronary artery bypass grafting. The effects of optimized pacing on cardiac output were measured with an electromagnetic aortic flow probe at the conclusion of surgery in 5 patients with a preoperative mean left ventricular ejection fraction of 0.26 (range, 0.15–0.35). Atrioventricular (7) and interventricular (9) delay settings were optimized in randomized order. Cardiac output with optimized biventricular pacing was 4.2 ± 0.7 L/min; in sinus rhythm, it was 3.8 ± 0.5 L/min. Atrial pacing at a matched heart rate resulted in cardiac output intermediate to that of sinus rhythm and biventricular pacing (4 ± 0.6 L/min). Optimization of atrioventricular and interventricular delay, in comparison with nominal settings, trended toward increased flow. This study shows that temporary biventricular pacing is feasible in patients with preoperative left ventricular dysfunction who are undergoing off-pump coronary artery bypass grafting. Further study of the possible clinical benefits of this intervention is warranted. PMID:24082369

  17. Improving outcomes following elective percutaneous coronary intervention: the key role of exercise and the advanced practice nurse.

    PubMed

    Throndson, Karen; Sawatzky, Jo-Ann V

    2009-01-01

    Percutaneous coronary intervention (PCI) is a safe, effective, non-surgical treatment for coronary artery disease (CAD). The demand for PCI has increased exponentially since the 1980s and it has become the treatment of choice for many individuals with CAD. Since PCI is not a cure, secondary prevention strategies are critical to prevent disease progression. Unfortunately, current strategies ignore the specific needs of the elective PCI population. In this article, the authors highlight the unique characteristics of these patients, which may contribute to their lack of engagement in healthy lifestyles. Elective PCI patients are vulnerable due to limited knowledge and follow-up, and lack of enrolment in secondary prevention programs. Exercise is a central component of any cardiac prevention strategy. Individualized exercise programs that incorporate physical activity and counselling can potentially improve the clinical outcomes of these patients. Advanced practice cardiovascular nurses play a key role in developing, implementing, and evaluating exercise programs in this population. PMID:19517901

  18. Pain Location and Intensity During the First Week Following Coronary Artery Bypass Graft Surgery

    PubMed Central

    Totonchi, Ziae; Seifi, Somayeh; Chitsazan, Mitra; Alizadeh Ghavidel, Alireza; Baazm, Farah; Faritus, Seyedeh Zahra

    2013-01-01

    Background Despite the advances in pain control following surgery, data on the location and distribution of pain following coronary artery bypass grafting (CABG) are lacking. Objectives This study was intended to investigate the location, distribution, and intensity of pain in patients undergoing CABG during their postoperative hospital stay from the operation to the end of the first postoperative week. Factors that could affect pain intensity and distribution were analyzed as well. Patients and Methods The present study was conducted on 138 patients who underwent CABG surgery at Rajaei cardiovascular, Medical and Research Center during May and July 2011. Location and intensity of pain were assessed using numeric rating scale (NRS) over time: every six hours after the operation on the first day (T1-T4, respectively), and on two (POD2), three (POD3), and seven days after the operation (POD7). Results Among 138 patients assessed in the study, the greatest severity of pain was reported on T2, with the mean severity of 3.4, followed by POD2 with the mean severity of 2.9 (P < 0.01). The location of the surgical incision had the most severity of pain in all patients (P < 0.01). On the site of surgical incision, a negative correlation was seen between the age and the severity of pain on T1 (P = 0.03, r = -0.180). Women experienced more severe pain compared to men at POD7. A significant correlation was seen between the severity of pain on POD7 and body mass index (BMI) (P < 0.01, r = 0.23). In patients who had the longer duration of cardiopulmonary bypass (CBD), the most pain intensity was reported on T1 (P < 0.01, r = 0.18). A significant correlation was seen on the pain intensity on T4 and chest tube drainage (P < 0.01, r = 0.24). The correlation between the pain severity pain and duration of admission in intensive care unit (ICU), was significant on T1 (P < 0.05, r = 0.18), T4 (P < 0.01, r = 0.29), POD2 (P < 0.01, r = 0.35) and POD7 (P < 0.05, r = 0.18). Conclusions Following CABG, the most severity of pain was reported at surgical incision on time T2. Pain began to decrease from the third day following the operation. Age, sex and BMI along with operation-related factors such as duration of CBP or chest tube drainage may affect the pain pattern following CABG surgery. PMID:24660142

  19. Intraoperative administration of clevidipine to prevent vasospasm after radial and internal mammary artery grafts during coronary artery bypass grafting.

    PubMed

    Patel, Mitesh; Meyer, Thomas; Tharakan, Ajit; Tobias, Joseph D

    2012-05-01

    During coronary artery bypass graft surgery, various arterial and venous conduits have been used to carry blood flow from the aorta to the coronary vasculature. Arterial conduits provide certain advantages over the saphenous vein, including superior long-term patency, relative resistance to the development of atherosclerosis, and greater endothelium-dependent relaxation. However, the perioperative release of catecholamines and thromboxane A, mechanical manipulation, and underlying endothelial cell dysfunction may result in vasoconstriction or vasospasm of the arterial conduit and a compromise of myocardial perfusion. Given these issues, pharmacologic therapy is frequently initiated intraoperatively to prevent vasospasm. Clevidipine is a rapidly acting calcium channel antagonist. Like nicardipine, it is a member of the dihydropyridine subgroup. Its rapid metabolism by tissue and plasma esterases results in an effective half-life of 1 to 3 minutes. We report, for the first time, the perioperative use of clevidipine to prevent vasospasm after coronary artery bypass graft surgery with the use of internal mammary artery and bilateral radial artery conduits. Its potential application in this scenario and advantages when compared with other commonly used agents is discussed. PMID:20634670

  20. Lipoprotein (a) and anticardiolipin antibodies are risk factors for clinically relevant restenosis after elective balloon percutaneous transluminal coronary angioplasty

    Microsoft Academic Search

    Ludia Chiarugi; Domenico Prisco; Emilia Antonucci; Monia Capanni; Sandra Fedi; Agatina Alessandrello Liotta; Massimo Margheri; Ignazio Simonetti; Gian Franco Gensini; Rosanna Abbate

    2001-01-01

    Recent reports have shown the importance of new risk factors for cardiovascular disease. We investigated the relationship between Lp(a), fibrinolytic parameters and anticardiolipin antibodies (aCL) and the occurrence of clinical recurrence owing to restenosis after elective balloon percutaneous transluminal coronary angioplasty (PTCA) without stenting. In 167 patients, undergoing PTCA, Lp(a) plasma levels, aCL, euglobulin lysis time (ELT), plasminogen activator inhibitor-1

  1. 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

  2. Restenosis after elective coronary balloon angioplasty in patients with end stage renal disease: a case-control study using quantitative coronary angiography

    PubMed Central

    Schoebel, F.; Gradaus, F.; Ivens, K.; Heering, P.; Jax, T. W.; Grabensee, B.; Strauer, B.; Leschke, M.

    1997-01-01

    Objective—To assess the rate of angiographic restenosis in patients with end stage renal disease after elective coronary angioplasty.?Design—A retrospective case-control study of 20 patients with end stage renal disease and 20 sex and age matched controls without renal disease, who had undergone primarily successful coronary angioplasty. Control coronary angiography was performed regardless of worsening or renewed incidence of anginal symptoms.?Main outcome measures—Group comparison of coronary morphology, as evaluated by quantitative coronary angiography, and of cardiovascular risk factors.?Results—The rate of angiographic restenosis was 60% in patients with renal disease and 35% in controls. In patients with end stage renal disease the following differences (mean (SD) were found versus controls: raised plasma fibrinogen (483 (101) v 326 (62) mg/dl, p < 0.001); raised plasma triglyceride (269 (163) v 207 (176) mg/dl, p < 0.01); smaller diameter of the coronary reference segment (2.59 (0.87) v 2.90 (0.55) mm, p < 0.10); smaller minimum luminal diameter of the dilated stenosis (0.77 (0.46) v 0.97 (0.27) mm, p < 0.05). Discriminant analysis showed that minimum luminal diameter before angioplasty (r = ?0.79) and fibrinogen (r = +0.34) had the highest statistical association with restenosis.?Conclusions—The high rate of angiographic restenosis in patients with end stage renal disease seems to be related to the size of the vessel dilated and to an increased prothrombotic risk, as indicated by higher fibrinogen concentrations.?? Keywords: renal disease;  coronary artery disease;  coronary angioplasty;  restenosis PMID:9404246

  3. Is single-unit blood transfusion bad post-coronary artery bypass surgery?†

    PubMed Central

    Warwick, Richard; Mediratta, Neeraj; Chalmers, John; Pullan, Mark; Shaw, Matthew; Mcshane, James; Poullis, Michael

    2013-01-01

    OBJECTIVES Publications in the surgical literature are very consistent in their conclusions that blood is dangerous with regard to in-hospital mortality, morbidity and long-term survival. Blood is frequently used as a volume expander while simultaneously increasing the haematocrit. We investigated the effects of a single-unit blood transfusion on long-term survival post-cardiac surgery in isolated coronary artery bypass grafting patients. METHODS A prospective single-institution cardiac surgery database was analysed involving 4615 patients. Univariate, multivariate stepwise Cox regression analysis and propensity matching were performed to identify whether a single-unit blood transfusion was detrimental to long-term survival. RESULTS Univariate analysis revealed that blood was significantly associated with a reduced long-term survival even with a single-unit transfused, P = 0.0001. Cox multivariate regression analysis identified age, ejection fraction, preoperative dialysis, logistic EuroSCORE, postoperative CKMB, blood transfusion, urgent operative status and atrial fibrillation as significant factors determining long-term survival. When the Cox regression was repeated with patients who received no blood or only one unit of blood, transfusion was not a risk factor for long-term survival. An interaction analysis revealed that blood transfusion was significantly interacting with preoperative haemoglobin levels, P = 0.02. Propensity analysis demonstrated that a single-unit transfusion is not associated with a detrimental long-term survival, P = 0.3. CONCLUSIONS Cox regression and propensity matching both indicate that a single-unit transfusion is not a significant cause of reduced long-term survival. Preoperative anaemia is a significant confounding factor. Despite demonstrating the negligible risks of a single-unit blood transfusion, we are not advocating liberal transfusion and would recommend changing from a double-unit to a single-unit transfusion policy. We speculate that blood is not bad, but that the underlying reason that it is given might be. PMID:23449665

  4. Use of blood products and risk of stroke after coronary artery bypass surgery

    PubMed Central

    Mikkola, Reija; Gunn, Jarmo; Heikkinen, Jouni; Wistbacka, Jan-Ola; Teittinen, Kari; Kuttila, Kari; Lahtinen, Jarmo; Juvonen, Tatu; Airaksinen, Juhani KE; Biancari, Fausto

    2012-01-01

    Background The impact of blood transfusion on the development of post-operative stroke after coronary artery bypass grafting (CABG) is not well established. We, therefore, investigated this issue. Materials and methods. Complete data on peri-operative blood transfusion were available for 2,226 patients who underwent CABG in three Finnish hospitals. Results Stroke occurred post-operatively in 53 patients (2.4%). Logistic regression showed that pre-operative creatinine (OR 1.003, 95% CI 1.000–1.006), extracardiac arteriopathy (OR 2.344, 95% CI 1.133–4.847), pre-operative atrial fibrillation (OR 2.409, 95% CI 1.149–5.052), and the number of packed red blood cell units transfused (OR 1.121, 95% CI 1.065–1.180) were significantly associated with post-operative stroke. When the various blood product transfusions instead of transfused units were included in the multivariable analysis, solvent/detergent treated plasma (Octaplas®) transfusion (OR 2.149, 95% CI 1.141–4.047), but not red blood cell transfusion, was significantly associated with postoperative stroke. Use of blood products ranging from no transfusion (stroke rate 1.6%) to combined transfusion of red blood cells, platelets and Octaplas® was associated with a significant increase in post-operative stroke incidence (6.6%, adjusted analysis: OR 1.727, 95% 1.350–2.209). Patients who received >2 units of red blood cells, >4 units of Octaplas® units and >8 units of platelets had the highest stroke rate of 21%. CART analysis showed that increasing amount of transfused Octaplas®, platelets and history of extracardiac arteriopathy were significantly associated with post-operative stroke. Conclusions Transfusion of blood products after CABG has a strong, dose-dependent association with the risk of stroke. The use of Octaplas® and platelet transfusions seem to have an even larger impact on the development of stroke than red blood cell transfusions. PMID:22395355

  5. Functional recovery of hibernating myocardium after coronary bypass surgery: Does it coincide with improvement in perfusion

    SciTech Connect

    Takeishi, Y.; Tono-oka, I.; Kubota, I.; Ikeda, K.; Masakane, I.; Chiba, J.; Abe, S.; Tsuiki, K.; Komatani, A.; Yamaguchi, I. (First Department of Internal Medicine, Yamagata University School of Medicine (Japan))

    1991-09-01

    To determine the relationship between functional recovery and improvement in perfusion after coronary artery bypass graft surgery (CABG), 49 patients were studied. Radionuclide angiography was performed before, 1 month after, and 6 to 12 months after CABG to evaluate regional wall motion. Exercise thallium-201 myocardial perfusion imaging was done before and 1 month after CABG to assess regional perfusion. Preoperative asynergy was observed in 108 segments, and 74 of them showed an improvement in wall motion 1 month after CABG (segment A). Sixty-six of these segments (89%) were associated with an improvement in perfusion. Eight segments that had not improved 1 month after CABG demonstrated a delayed recovery of wall motion 6 to 12 months after CABG (segment B). However, seven of eight segments (88%) already showed an improvement in perfusion 1 month after CABG. A total of 82 segments exhibited functional recovery after CABG and were considered hibernating segments. In the preoperative study segment B more frequently had areas of akinesis or dyskinesis than segment A (75% vs 34%, p less than 0.05). The mean percent thallium-201 uptake in segment B was lower than that in segment A (74% {plus minus} 9% vs 83% {plus minus} 8%, p less than 0.05). Functional recovery of hibernating myocardium usually coincided with an improvement in perfusion. However, delayed functional recovery after reperfusion was observed in some instances. Severe asynergy and severe thallium-201 defects were more frequently observed in these segments with delayed recovery. Hibernating myocardium might remain stunned during those recovery periods.

  6. 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

  7. Triclosan-coated sutures do not reduce leg wound infections after coronary artery bypass grafting

    PubMed Central

    Seim, Bjørn Edvard; Tønnessen, Theis; Woldbaek, Per Reidar

    2012-01-01

    OBJECTIVES Leg wound infection is a common complication after coronary artery bypass grafting (CABG). Suture contamination has been suggested as a mechanism of surgical site infections. Vicryl Plus® is a polyglacitin suture coated with the antiseptic chemical substance Triclosan, which has been shown to inhibit the growth of Staphylococcus aureus in vitro. The first aim of the present study was to compare Vicryl Plus with conventional Vicryl® sutures with regard to leg wound infections following CABG. The second aim was to examine patient- and operative characteristics, which are assumed to predict leg wound infections. METHODS After statistical calculations a priori, 328 CABG patients were prospectively randomized to leg wound closure with Vicryl Plus (164 patients) or conventional Vicryl sutures (164 patients). Incidences of leg wound infection and predictors of infection related to patient- and operative characteristics were examined. RESULTS The incidence of leg wound infections was 10.4% (17/163) in the Vicryl group, and 10.0% (16/160) in the Vicryl Plus group (P = 1.00). Patients with leg wound infections had increased body mass index and prolonged extracorporeal circulation and aortic clamping time compared with patients without infections. CONCLUSIONS In the present study, we report for the first time that Vicryl Plus did not reduce the incidence of leg wound infections in patients undergoing CABG. Obesity and prolonged time of extracorporeal circulation were both associated with the increased risk of infections. Currently, the clinical role and indication for the use of Vicryl Plus have yet to be defined. PMID:22691378

  8. Cytomegalovirus Infection and Atherosclerosis in Candidate of Coronary Artery Bypass Graft

    PubMed Central

    Heybar, Habib; Alavi, Seyed Mohammad; Farashahi Nejad, Mehdi; Latifi, Mahmood

    2015-01-01

    Background: Although there is enough evidence that infectious agents such as Chlamydia pneumonia and Helicobacter pylori may play a pathogenic role in atherosclerosis, this role for cytomegalovirus (CMV) is yet controversial. Objectives: The aim of the present study was to detect CMV-DNA in atherosclerotic plaques in patients who underwent coronary artery bypass graft (CABG). Patients and Methods: In this case-control study, candidates for CABG (cases) and patients with valvular or congenital malformation but without atherosclerotic plaques (controls) were studied from 2012 to 2013 at Golestan hospital, Ahvaz, IR Iran. Demographic and laboratory data were collected. Atherosclerotic and histological samples were obtained from visible plaques and from aorta by the surgeon. All the samples were examined for the presence of CMV-DNA by polymerase chain reaction (PCR) method using a commercial kit (SinaClon, Tehran, IR Iran). Results: The mean ages in case and control groups were 60.8 ± 6.8 and 57.5 ± 11.5 years, respectively, with no significant difference (P = 0.09). Thirty patients (54.5%) in case and 32 (58.2%) in control groups were male with no significant difference (P = 0.7). CMV-DNA was present in 8 (14.5%) of the cases and 2 (4%) of the controls. CMV-DNA was associated with higher risk of atherosclerosis (OR: 7.7, 95% CI = 1.1-51.4, P = 0.03). Of the total normal aortic samples (55 in cases and 55 in controls), there was no individual with simultaneous positive CMV-DNA among aortic atherosclerotic and normal tissue samples. Conclusions: The presence of CMV-DNA in aortic plaques is associated with increased risk of atherosclerosis. CMV infection may be considered as an independent risk factor for this event.

  9. Mid-Term Patency in Radial Artery and Saphenous Vein After Coronary Artery Bypass Grafting in Asymptomatic Patients Using 128-Slice CT Coronary Angiography

    PubMed Central

    Sadeghpour, Ali; Pouraliakbar, Hamidreza; Azarfarin, Rasoul; Alizadeh Ghavidel, Alireza; Zavareian, Somayeh; Amirahmadi, Ali

    2015-01-01

    Background: Patency of the revascularization conduit is an essential predictor of long-standing survival after coronary artery bypass grafting. Objectives: We have conducted this study to compare the mid-term patency rates of radial artery (RA), left internal thoracic artery (LITA) and also saphenous vein (SV) grafts in asymptomatic patients following coronary artery bypass graft surgery (CABG) undergoing total IV anesthesia. Patients and Methods: In this study, 30 three-vessel disease patients with 104 RA, LITA, and SV grafts used concomitantly for primary isolated non-emergent CABG surgery were assessed. The primary end point was CT angiographic graft patency rate. After 53.5 (24-97) months’ follow-up, graft patency was assessed using 128-slice CT coronary angiography. Logistic regression analysis was used to detect the independent predictors of graft failure. Results: A total of 104 grafts, including 30 LITA, 44 SV, and 30 RA grafts, were studied. Cumulative graft patency rates were 93.3% in LITA, 83.3% in RA, and 70.5% in SV grafts. Statistically significant difference was found between the LITA and the SV graft patency rates (P = 0.019), whereas the difference between the RA conduit patency and the LITA or SV graft patency rates did not have any statistical significance (P = 0.424 and P = 0.273, respectively). Independent predictors of RA grafts occlusion were native coronary stenosis < 70% and female gender. Conclusions: In our patients, the RA grafts had an acceptable patency rate in 2 to 5 years’ follow-up. Although the SV grafts had a relatively higher patency rate than RA grafts in our asymptomatic patients, the patency rates in RA and SV grafts were close to each other. The RA graft function was poor in the patients with a higher number of risk factors and in the females. PMID:25789243

  10. Alfentanil infusion as a component of intravenous anaesthesia for coronary artery bypass surgery with "fast-track" recovery.

    PubMed

    Blake, D W; Royse, C F; Royse, A G; Bjorksten, A R; Soeding, P F; Pang, J

    2003-04-01

    Alfentanil and propofol total intravenous anaesthesia was assessed in 25 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass (CPB). A manually controlled alfentanil infusion, calculated from estimated lean body mass and published pharmacokinetic data, was effective in achieving target plasma concentrations, while the "Diprifusor" system was used to vary propofol target concentrations according to changes in haemodynamics and anaesthetic requirement. The effects of CPB on alfentanil plasma concentrations were offset by changes in protein binding and free-fraction of the drug. With the use of only two target plasma concentrations for alfentanil (changed after CPB), a pre-determined infusion profile ensured effective plasma concentrations during surgery and concentrations unlikely to inhibit extubation within six hours of sternal closure. PMID:12712782

  11. Effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery: A meta-analysis

    PubMed Central

    FANG, YU; QIU, ZHANDONG; HU, WENTAO; YANG, JIA; YI, XIYAN; HUANG, LIANGJIANG; ZHANG, SUMING

    2014-01-01

    Cognitive impairments are observed in numerous patients following coronary bypass surgery, and piracetam are nootropic compounds that modulate cerebral functions by directly enhancing cognitive processes. The present meta-analysis was conducted to evaluate the protective effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery. The relevant studies were identified by searching Medline, EMBASE, PubMed and the Cochrane Library up to June 2013 and the pertinent bibliographies from the retrieved studies were reviewed. Data were selected from the studies according to predefined criteria. The meta-analysis included two randomized control trials involving 184 patients and including the Syndrom-Kurz test (SKT). Findings of the meta-analysis showed that following treatment the change from baseline observed in five SKT subtest scores, conducted with piracetam patients, indicated a significant advantage over those patients that were in the placebo group. The subtests included immediate pictured object recall, weighted mean difference (WMD)=0.91, 95% confidence interval (CI) 0.51–1.31, P<0.00001; delayed pictured object recall, WMD=0.74, 95% CI 0.19–1.28, P=0.008; delayed picture recognition, WMD=0.82, 95% CI 0.31–1.31, P=0.001; immediate word recall, WMD=0.87, 95% CI 0.47–1.28, P<0.0001; and letter interference, WMD=3.46, 95% CI ?5.69 to ?1.23, P=0.002. These results indicated that piracetam may have been effective in improving the short-term cognitive performance of patients undergoing coronary bypass surgery. High quality, well-controlled and longer randomized trials are required to corroborate this result. PMID:24396419

  12. 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

  13. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting.

    PubMed

    Gibson, Patrick H; Cuthbertson, Brian H; Croal, Bernard L; Rae, Daniela; El-Shafei, Hussein; Gibson, George; Jeffrey, Robert R; Buchan, Keith G; Hillis, Graham S

    2010-01-15

    The neutrophil/lymphocyte (N/L) ratio integrates information on the inflammatory milieu and physiologic stress. It is an emerging marker of prognosis in patients with cardiovascular disease. We investigated the relation between the N/L ratio and postoperative atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting. In a prospective cohort study, 275 patients undergoing nonemergency coronary artery bypass grafting were recruited. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. The N/L ratio was determined preoperatively and on postoperative day 2. The study end point was AF lasting >30 seconds. Patients who developed AF (n = 107, 39%) had had a greater preoperative N/L ratio (median 3.0 vs 2.4, p = 0.001), but no differences were found in the other white blood cell parameters or C-reactive protein. The postoperative N/L ratio was greater in patients with AF (day 2, median 9.2 vs 7.2, p <0.001), and in multivariate models, a greater postoperative N/L ratio was independently associated with a greater incidence of AF (odds ratio 1.10 per unit increase, p = 0.003: odds ratio for N/L ratio >10.14 [optimal postoperative cutoff in our cohort], 2.83 per unit, p <0.001). Elevated pre- and postoperative N/L ratios were associated with an increased occurrence of AF after coronary artery bypass grafting. In conclusion, these results support an inflammatory etiology in postoperative AF but suggest that other factors are also important. PMID:20102916

  14. Evaluation of the Society of Thoracic Surgeons score system for isolated coronary bypass graft surgery in a Brazilian population

    PubMed Central

    Ikeoka, Dimas Tadahiro; Fernandes, Viviane Aparecida; Gebara, Otavio; Garcia, Jose Carlos Teixeira; Silva, Pedro Gabriel Melo de Barros e; Rodrigues, Marcelo Jamus; Furlan, Valter; Baruzzi, Antonio Claudio do Amaral

    2014-01-01

    Objective Report the experience with the Society of Thoracic Surgeons scoring system in a Brazilian population submitted to isolated coronary artery bypass graft surgery. Methods Data were collected from January-2010 to December-2011, and analyzed to determine the performance of the Society of Thoracic Surgeons scoring system on the determination of postoperative mortality and morbidity, using the method of the receiver operating characteristic curve as well as the Hosmer-Lemeshow and the Chi-square goodness of fit tests. From the 1083 cardiac surgeries performed during the study period 659 represented coronary artery bypass graft procedures which are included in the present analysis. Mean age was 61.4 years and 77% were men. Results Goodness of fit tests have shown good calibration indexes both for mortality (X2=6.78, P=0.56) and general morbidity (X2=6.69, P=0.57). Analysis of area under the ROC-curve (AUC) demonstrated a good performance to detect the risk of death (AUC 0.76; P<0.001), renal failure (AUC 0.79; P<0.001), prolonged ventilation (AUC 0.80; P<0.001), reoperation (AUC 0.76; P<0.001) and major morbidity (AUC 0.75; P<0.001) which represents the combination of the assessed postoperative complications. STS scoring system did not present comparable results for short term hospital stay, prolonged length of hospital stay and could not be properly tested for stroke and wound infection. Conclusion Society of Thoracic Surgeons scoring system presented a good calibration and discrimination in our population to predict postoperative mortality and the majority of the harmful events following coronary artery bypass graft surgery. Analysis of larger samples might be needed to further validate the use of the score system in Brazilian populations. PMID:24896163

  15. Effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery: A meta-analysis.

    PubMed

    Fang, Yu; Qiu, Zhandong; Hu, Wentao; Yang, Jia; Yi, Xiyan; Huang, Liangjiang; Zhang, Suming

    2014-02-01

    Cognitive impairments are observed in numerous patients following coronary bypass surgery, and piracetam are nootropic compounds that modulate cerebral functions by directly enhancing cognitive processes. The present meta-analysis was conducted to evaluate the protective effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery. The relevant studies were identified by searching Medline, EMBASE, PubMed and the Cochrane Library up to June 2013 and the pertinent bibliographies from the retrieved studies were reviewed. Data were selected from the studies according to predefined criteria. The meta-analysis included two randomized control trials involving 184 patients and including the Syndrom-Kurz test (SKT). Findings of the meta-analysis showed that following treatment the change from baseline observed in five SKT subtest scores, conducted with piracetam patients, indicated a significant advantage over those patients that were in the placebo group. The subtests included immediate pictured object recall, weighted mean difference (WMD)=0.91, 95% confidence interval (CI) 0.51-1.31, P<0.00001; delayed pictured object recall, WMD=0.74, 95% CI 0.19-1.28, P=0.008; delayed picture recognition, WMD=0.82, 95% CI 0.31-1.31, P=0.001; immediate word recall, WMD=0.87, 95% CI 0.47-1.28, P<0.0001; and letter interference, WMD=3.46, 95% CI -5.69 to -1.23, P=0.002. These results indicated that piracetam may have been effective in improving the short-term cognitive performance of patients undergoing coronary bypass surgery. High quality, well-controlled and longer randomized trials are required to corroborate this result. PMID:24396419

  16. 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

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

    Microsoft Academic Search

    Henrik K. Kjaergard; Horace R. Trumbull

    1998-01-01

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

  18. A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery

    Microsoft Academic Search

    J. M. Murkin; J. S. Martzke; A. M. Buchan; C. Bentley; C. J. Wong

    1995-01-01

    This double-blind, randomized comparison of pulsatile or nonpulsatile perfusion and alpha-stat or pH-stat management during cardiopulmonary bypass was designed to assess postoperative central nervous system outcomes. Methods : Neurologic and cognitive testing was conducted before the operation and 7 days and 2 months after the operation in 316 patients having coronary artery bypass and in a reference cohort of 40

  19. Assessment of changes in general health status using the short-form 36 questionnaire 1 year following coronary artery bypass grafting

    Microsoft Academic Search

    Grace M Lindsay; Phillip Hanlon; Lorraine N Smith; David J Wheatley

    2000-01-01

    Objective: The problem addressed in the study was to gain a greater understanding of the health benefits of coronary artery bypass grafting (CABG). The purpose of the study was to assess general health status, using the short-form (SF)-36 questionnaire, approximately 12 months following CABG, and to document any associations between pre-operative health status, level of social support, coronary artery disease

  20. 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

  1. The impact of blood use on patients undergoing coronary artery bypass surgery: a prospective study

    PubMed Central

    LAKO, S.; BILALI, S.; MEMISHAJ, S.; DAKA, A.; DEDEJ, T.; NURKA, T.; BILALI, V.; GJYLAMETI, V.

    2014-01-01

    Summary Objectives This survey aimed at assessing the incidence of blood use and the impact of cardiopulmonary bypass (CBP), sex, age, number of grafts, combined cardiac interventions, and hematocrit level in patients who undergo coronary artery bypass graft (CABG) surgery. Patients and Methods A prospective study included patients in the department of cardiac surgery at the American Hospital, in Tirana, Albania. We studied 164 consecutive patients who underwent CABG surgery over a 2-year period (2011–2013). Results We analyzed 164 patients: 138 men and 26 women. The average age was 61.8 years (range, 34–82 years). Of these, 116 patients (101 men/15 women) and 48 patients (37 men/11 women) were operated on-pump and off-pump, respectively. Packed red blood cells (PRBC) were administered to 79.87% of patients (131/164). In total, 334 units were transfused. The average number of PRBC units per patient was 2.03 ± 1.5 (range, 0–8 units). Blood transfusion was administered to 87.06% and 62.5% of on-pump and off-pump patients, respectively. On-pump and off-pump patients received 2.4 and 1 unit of PRBC, respectively (p < 0.001). Female and male patients received 2.2 and 2 units, respectively (p = 0.1). Patients aged ? 62.5 years received 2.3 units on average versus the average of 1.7 units received by patients aged < 62.5 years (p < 0.001). Interventions with 4–6 grafts (79/164) received an average 2.5 units, while those with 1–3 grafts (85/164) received 1.5 units (p < 0.001). Patients requiring other cardiac surgical interventions (35/164) received an average of 2.6 units, while those without other cardiac surgical interventions (129/164) received an average of 1.8 units (p < 0.001). Patients with preoperative hematocrit < 35% received an average 1.2 units of PRBC intraoperatively, and 2.8 units throughout the hospital stay, while patients with preoperative hematocrit ? 35% received an average of 0.75 units intraoperatively (p < 0.001) and 1.9 units throughout the hospital stay (p < 0.001). Conclusion Blood transfusion was required for 79.87% of patients. Five variables were important factors in the use of blood in patients undergoing CABG: using CBP, a higher number of grafts, age ? 62.5 years, combined heart interventions and preoperative hematocrit < 35%. Female patients required more PRBC than male patients, although it was not statistically significant. Knowledge of these risk factors enables better prediction of the probability of patients who might require more blood, better distribution of blood in CABG procedures, use by the blood bank, and evaluation of cost-effectiveness in the use of blood products. PMID:24690337

  2. Monocyte Fc gamma receptor expression in patients undergoing coronary artery bypass grafting

    Microsoft Academic Search

    Demetrios C Stefanou; George Asimakopoulos; Darshna R Yagnik; Dorian O Haskard; Jon R Anderson; Pandelis Philippidis; R. Clive Landis; Kenneth M Taylor

    2004-01-01

    BackgroundCardiopulmonary bypass is associated with an inflammatory response with potential deleterious effects. The white cell subpopulation mostly investigated so far is the neutrophil. To date very little has been investigated regarding the role of the monocyte\\/macrophage. This study focuses on the expression of Fc gamma receptors I, II, and III by monocytes in patients undergoing cardiopulmonary bypass.

  3. Effect of coronary artery bypass grafting on left ventricular systolic function at rest: evidence for preoperative subclinical myocardial ischemia

    SciTech Connect

    Dilsizian, V.; Bonow, R.O.; Cannon, R.O. 3d.; Tracy, C.M.; Vitale, D.F.; McIntosh, C.L.; Clark, R.E.; Bacharach, S.L.; Green, M.V.

    1988-06-01

    Successful coronary artery bypass grafting (CABG) improves exercise-induced left ventricular (LV) dysfunction in patients with coronary artery disease (CAD), but its potential for improving resting LV function remains controversial. To assess the influence of CABG on LV function at rest, 31 CAD patients without previous myocardial infarction were studied before and 6 months after CABG by radionuclide angiography after all cardiac medicines were withdrawn. No patient had angina or ischemic electrocardiographic changes at rest. In 27 patients with patent bypass grafts, CABG significantly increased LV ejection fraction during exercise (47 +/- 11% before to 63 +/- 9% after operation, p less than 0.001), indicating reduction in exercise-induced LV ischemia. Moreover, LV ejection fraction at rest also increased (55 +/- 9 to 60 +/- 8%, p less than 0.001), with 20 of 27 patients manifesting an increase compared with preoperative values. Eleven of these 20 patients had apparently normal LV function at rest (ejection fraction and regional wall motion) before CABG. LV regional ejection fraction was computed by dividing the LV region of interest into 20 sectors. Regional analysis indicated that improved ejection fraction at rest after CABG occurred in regions developing ischemia during exercise before CABG. In 4 patients with occluded grafts, the ejection fraction at rest was unchanged by CABG globally (59 +/- 8 to 58 +/- 9%, difference not significant) and regionally. Thus, LV global and regional function at rest improved after successful CABG, even in patients with normal global LV ejection fraction and no visually detectable wall motion abnormality before surgery.

  4. Protocol for the PREHAB study—Pre-operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial

    PubMed Central

    Stammers, Andrew N; Kehler, D Scott; Afilalo, Jonathan; Avery, Lorraine J; Bagshaw, Sean M; Grocott, Hilary P; Légaré, Jean-Francois; Logsetty, Sarvesh; Metge, Colleen; Nguyen, Thang; Rockwood, Kenneth; Sareen, Jitender; Sawatzky, Jo-Ann; Tangri, Navdeep; Giacomantonio, Nicholas; Hassan, Ansar; Duhamel, Todd A; Arora, Rakesh C

    2015-01-01

    Introduction Frailty is a geriatric syndrome characterised by reductions in muscle mass, strength, endurance and activity level. The frailty syndrome, prevalent in 25–50% of patients undergoing cardiac surgery, is associated with increased rates of mortality and major morbidity as well as function decline postoperatively. This trial will compare a preoperative, interdisciplinary exercise and health promotion intervention to current standard of care (StanC) for elective coronary artery bypass and valvular surgery patients for the purpose of determining if the intervention improves 3-month and 12-month clinical outcomes among a population of frail patients waiting for elective cardiac surgery. Methods and analysis This is a multicentre, randomised, open end point, controlled trial using assessor blinding and intent-to-treat analysis. Two-hundred and forty-four elective cardiac surgical patients will be recruited and randomised to receive either StanC or StanC plus an 8-week exercise and education intervention at a certified medical fitness facility. Patients will attend two weekly sessions and aerobic exercise will be prescribed at 40–60% of heart rate reserve. Data collection will occur at baseline, 1–2?weeks preoperatively, and at 3 and 12?months postoperatively. The primary outcome of the trial will be the proportion of patients requiring a hospital length of stay greater than 7?days. Potential impact of study The healthcare team is faced with an increasingly complex older adult patient population. As such, this trial aims to provide novel evidence supporting a health intervention to ensure that frail, older adult patients thrive after undergoing cardiac surgery. Ethics and dissemination Trial results will be published in peer-reviewed journals, and presented at national and international scientific meetings. The University of Manitoba Health Research Ethics Board has approved the study protocol V.1.3, dated 11 August 2014 (H2014:208). Trial registration number The trial has been registered on ClinicalTrials.gov, a registry and results database of privately and publicly funded clinical studies (NCT02219815). PMID:25753362

  5. Does early coronary artery bypass surgery improve survival in non-ST acute myocardial infarction?

    PubMed Central

    Dayan, Victor; Soca, Gerardo; Parma, Gabriel; Mila, Rafael

    2013-01-01

    A best evidence topic was written according to a structured protocol. Lack of evidence exists regarding the optimal timing for coronary artery bypass graft (CABG) surgery after non-ST myocardial infarction (NSTEMI). While some authors address the importance of the timing of surgery alone, others take into account the extent of myocardial damage. The question addressed was whether early or late CABG surgery improves hospital mortality and cardiovascular events after NSTEMI in stable patients. Using a designated search strategy, 459 articles were found, of which seven represented the best available evidence. All of these studies were level 3 (retrospective cohort studies). Studies could be divided into those which assessed CABG outcome based on preoperative cardiac troponin I (cTnI) level as a measure of the extent of myocardial damage and those which considered only the timing after myocardial infarction. Outcome measures included short-term survival, hospital mortality, length of hospital stay and major adverse cardiovascular events (MACEs). The biggest retrospective study analysing postoperative outcomes based on the timing of surgery after NSTEMI concluded that operative mortality is higher when surgery is performed within 6 h of the event. After 6 h, mortality is similar at any timepoint after 6h of NSTEMI. While other smaller studies agree that there are fewer postoperative complications when surgery is performed after 48 h of the event, no consensus is found regarding mortality between early (less than 48 h) and late CABG surgery. Taking into account preoperative cTnI values, CABG has a higher incidence of MACEs and hospital mortality in patients with cTnI >0.15 ng/ml. When surgery is performed within 24 h of symptoms, preoperative cTnI >0.72 ng/ml is associated with worse outcomes. In view of the methodological limitations and level of evidence of the studies included, it appears that surgery may be safely performed in NSTEMI patients at any time after the first 6 h of the event in patients with cTnI <0.15 ng/ml, whereas in those patients with higher values of cTnI, waiting for cTnI to reduce before considering surgery seems to be a wise option in order to decrease the incidence of MACEs and hospital mortality. PMID:23575760

  6. Symptom burden clusters and their impact on psychosocial functioning following coronary artery bypass surgery.

    PubMed

    Abbott, Amy A; Barnason, Susan; Zimmerman, Lani

    2010-01-01

    Although there is extensive literature on symptoms experienced by patients after coronary artery bypass surgery (CABS), there is a paucity of data on symptom clusters and their impact on functional outcomes. The purpose of these descriptive, secondary analyses was to identify and describe cluster subgroups of 226 elderly CABS patients at discharge and to examine the cluster's impact on psychosocial functioning over time (baseline, 6 weeks, and 3 months) using the 36-item Medical Outcome Study Short Form subscales. Cluster analysis revealed a 3-cluster solution with low, low-moderate, and moderate symptom burden clusters. Significant differences were detected for Duke Activity Status Index (F(2,223) = 5.12, P = .007), Barnason Efficacy Expectation Scale (F(2,223) = 9.60, P < .0001), Hospital Anxiety and Depression Scale (F(2,219) = 15.14, P < .0001), and New York Heart Association classification (chi = 17.44, P = .008). Significant differences were noted on all variables between the low and moderate symptom burden clusters with differences between the low-moderate and moderate clusters for only the Barnason Efficacy Expectation Scale and the Hospital Anxiety and Depression Scale. Those in the moderate symptom burden cluster had more symptoms, anxiety, and depression along with lower self-efficacy and physiological functioning than those in the other 2 clusters. There was no interaction or simple main effects for the role-emotional or social subscales as measured by the 36-item Medical Outcome Study Short Form. There was no significant interaction for mental functioning by time and cluster (F(4,641) = .30, P = .88); however, there was a simple main effect for cluster (F(2,641) = 4.11, P = .02). Follow-up analysis indicated significant differences between the low and low-moderate clusters, indicating that those with low symptom burden had significantly better mental health functioning than those with moderate symptom burden. Findings provide a foundation of knowledge on symptom clusters in CABS populations and may be useful to clinicians to identify patients at risk for slowed or delayed recovery and for early intervention. PMID:20539164

  7. 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

  8. Predictors of low cardiac output syndrome after isolated coronary artery bypass grafting.

    PubMed

    Ding, WenJun; Ji, Qiang; Shi, YunQing; Ma, RunHua

    2015-03-20

    Low cardiac output syndrome (LCOS) is one of the most important complications following coronary artery bypass grafting (CABG) and results in higher morbidity and mortality. However, few reports have focused on the predictors of LCOS following CABG. This study aimed to evaluate the predictors of LCOS following isolated CABG through the review of 1524 consecutive well-documented patients in a single center, retrospective trial.The relevant preoperative and intraoperative data of patients with complete information from medical records undergoing isolated CABG from January 2010 to December 2013 in our center were investigated and retrospectively analyzed. LCOS was considered when the following criteria were met: signs of impairment of body perfusion and need for inotropic support with vasoactive drugs or mechanical circulatory support with an intra-aortic balloon pump to maintain systolic blood pressure greater than 90 mmHg.LCOS developed in 205 patients following CABG, accounting for 13.5% of the total population. The in-hospital mortality in the LCOS group was significantly higher than that in the non-LCOS group (25.4% versus 1.8%, P < 0.0001). In addition to the length of ICU stay and postoperative hospital stay, LCOS was correlated with negative cerebral, respiratory and renal outcomes. Through univariate analysis and then logistic regression analysis, the predictors of LCOS following CABG included older age (age > 65 years) (OR = 1.85, 95%CI 1.27-3.76), impaired left ventricular function (OR = 2.05, 95%CI 1.53-4.54), on-pump CABG (OR = 2.16, 95%CI 1.53-4.86), emergent CPB (OR = 9.15, 95%CI 3.84-16.49), and incomplete revascularization (OR = 2.62, 95%CI 1.79-5.15).LCOS following isolated CABG caused higher mortality, higher rates of morbidity, and longer ICU and postoperative hospital stays. Older age, impaired left ventricular function, on-pump CABG, emergent CPB, and incomplete revascularization were identified as 5 predictors of LCOS following isolated CABG surgery. PMID:25740396

  9. Different activation patterns in the plasma kallikrein-kinin and complement systems during coronary bypass surgery.

    PubMed

    Kongsgaard, U E; Smith-Erichsen, N; Geiran, O; Amundsen, E; Mollnes, T E; Garred, P

    1989-07-01

    Components of the plasma kallikrein-kinin and complement systems were determined in patients undergoing open heart surgery with cardiopulmonary bypass. Spontaneous kallikrein activity (KK), plasma prekallikrein (PKK), functional kallikrein inhibition capacity (KKI), C3 activation products (C3-act), and the terminal complement complex (TCC) were measured. A marked, transitory increase in KK and a decrease in PKK were found prior to cardiopulmonary bypass just after heparin injection. An additional decline in PKK and KKI during bypass with a return to near control levels in the postoperative period was observed. C3-act increased in all patients during bypass, reaching a peak value at wound closure. The TCC concentration also increased significantly during cardiopulmonary bypass, returned to control levels in the early postoperative period, and then increased again in the late postoperative period. It is concluded that activation of the kallikrein-kinin system started after injection of heparin, prior to cardiopulmonary bypass. Activation of both the initial and the terminal complement cascade, however, started only after onset of cardiopulmonary bypass. PMID:2800971

  10. 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

  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

    Microsoft Academic Search

    John M. Ruiz; Karen A. Matthews; Michael F. Scheier; Richard Schulz

    2006-01-01

    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

  12. Assessing equity in access to health care provision in the UK: does where you live affect your chances of getting a coronary artery bypass graft?

    Microsoft Academic Search

    Y Ben-Shlomo; N Chaturvedi

    1995-01-01

    STUDY OBJECTIVES--Equity should be monitored routinely for all health care services, but ideal studies for each service would be prohibitively expensive and time consuming. A simple, quick, and cheap method for the preliminary exploration of equity in health care provision using routine data was devised. This method was illustrated by examining whether coronary artery bypass graft (CABG) operations reflect socioeconomic

  13. 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.…

  14. Diabetes and outcomes of coronary artery bypass graft surgery in patients with severe left ventricular dysfunction: results from The CABG Patch Trial database

    Microsoft Academic Search

    William Whang; J. Thomas Bigger

    2000-01-01

    OBJECTIVESWe examined the relationship between diabetes mellitus and outcomes after coronary artery bypass graft (CABG) surgery in patients with severe left ventricular (LV) dysfunction.BACKGROUNDAlthough diabetes is associated with poor outcomes after CABG surgery among unselected patients, the relationship between diabetes and mortality after CABG surgery among patients with LV dysfunction is less certain.METHODSUsing data from The CABG Patch Trial, a

  15. Coronary artery bypass graft surgery: socioeconomic inequalities in access and in 30 day mortality. A population-based study in Rome, Italy

    Microsoft Academic Search

    Carla Ancona; Nera Agabiti; Francesco Forastiere; Massimo Arcà; Danilo Fusco; Salvatore Ferro; Carlo A Perucci

    2000-01-01

    OBJECTIVESTo evaluate whether coronary artery bypass graft (CABG) surgery is equally provided among different socioeconomic status (SES) groups in accordance with need. To estimate the association between SES and mortality occurring 30 days after CABG surgery.DESIGNIndividual socioeconomic index assigned with respect to the characteristics of the census tract of residence (level I = highest SES; level IV = lowest SES).

  16. Physician response to Medicare fee reductions: changes in the volume of coronary artery bypass graft (CABG) surgeries in the Medicare and private sectors

    Microsoft Academic Search

    Winnie C. Yip

    1998-01-01

    The demand inducement hypothesis predicts that physicians will respond to reductions in their income by increasing the volume of their services when the income effect is strong and negative. I test for such inducement in the market for coronary artery bypass grafting (CABG), using a longitudinal panel of physicians in New York and Washington states. The results show that physicians

  17. Mortality and need for reoperation in patients with mild-to-moderate asymptomatic aortic valve disease undergoing coronary artery bypass graft alone

    Microsoft Academic Search

    James Hochrein; John C. Lucke; J. Kevin Harrison; Thomas M. Bashore; Walter G. Wolfe; Robert H. Jones; James E. Lowe; William D. White; Donald D. Glower

    1999-01-01

    Background Patients presenting for coronary artery bypass graft (CABG) surgery may have concurrent asymptomatic aortic stenosis (AS) or aortic insufficiency (AI). This retrospective study was performed to evaluate outcomes in patients with aortic valve disease undergoing CABG with or without aortic valve replacement (AVR). Methods Study groups included 414 patients undergoing combined AVR and CABG (AVR-CABG group) and 62 patients

  18. 4G\\/5G PAI-1 Promoter Polymorphism and Acute-Phase Levels of PAI-1 Following Coronary Bypass Surgery: A Prospective Study

    Microsoft Academic Search

    Francesco Burzotta; Licia Iacoviello; Augusto Di Castelnuovo; Roberto Zamparelli; Andria D'Orazio; Concetta Amore; Rocco Schiavello; Maria Benedetta Donati; Attilio Maseri; GianFederico Possati; Felicita Andreotti

    2003-01-01

    Background and objective: The 4G\\/5G plasminogen activator inhibitor-1 (PAI-1) promoter polymorphism has been associated with basal PAI-1 levels, with ischemic heart disease, and with adverse prognosis in critically ill patients. We hypothesized it might also influence the acute-phase levels of PAI-1 following coronary bypass surgery.

  19. Detection of Postoperative Cognitive Decline After Coronary Artery Bypass Graft Surgery is Affected by the Number of Neuropsychological Tests in the Assessment Battery

    Microsoft Academic Search

    Matthew S. Lewis; Paul Maruff; Brendan S. Silbert; Lis A. Evered; David A. Scott

    2006-01-01

    Background. The assessment of postoperative cognitive dysfunction after coronary artery bypass graft surgery is made with the repeated administration of cognitive tests. This classification is vulnerable to error, and it has been suggested that increasing the number of tests in a battery while maintaining constant inclusion criteria for postop- erative cognitive dysfunction increases the rate of false positive classification of

  20. 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

  1. Comparative efficacies and durations of action of phenoxybenzamine, verapamil\\/nitroglycerin solution, and papaverine as topical antispasmodics for radial artery coronary bypass grafting

    Microsoft Academic Search

    Shafi Mussa; Tomasz J Guzik; Edward Black; Michelle A Dipp; Keith M Channon; David P Taggart

    2003-01-01

    ObjectiveRadial arteries are increasingly used as conduits for coronary artery bypass grafts, but perioperative graft vasospasm continues to be a concern. Phenoxybenzamine, verapamil\\/nitroglycerin solution, and papaverine have been advocated as topical antispasmodic agents. We compared the relative efficacies and durations of action of these agents.

  2. Blood levels of corticosteroid-binding globulin, total cortisol and unbound cortisol in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass.

    PubMed

    Roth-Isigkeit, A K; Dibbelt, L; Schmucker, P

    2000-09-01

    Previous studies have demonstrated a persistent rise in serum cortisol concentrations after cardiac surgery. To further investigate this finding and to evaluate the effect of hemodilution that occurs with the onset of cardiopulmonary bypass (CPB), concentrations of cortisol-binding globulin (CBG), total and unbound cortisol, and packed cell volume (PCV) were studied in 28 patients undergoing coronary artery bypass graft surgery. All patients received a standardized general anesthetic using a balanced technique with sufentanil, isoflurane, and midazolam. Blood was collected preoperatively, intraoperatively during CPB, and postoperatively in the evenings on the day of surgery and on the first and second postoperative day. Cortisol and CBG concentrations were measured by radioimmunoassay and were used to calculate the fraction of unbound cortisol. Serum CBG and cortisol concentrations corrected for hemodilution were significantly higher than non-corrected values. Perioperatively, CBG measurements were significantly intercorrelated. Intraoperatively, total and unbound cortisol concentrations were not significantly increased compared to preoperative values. Postoperatively up to the end of the study period serum concentrations of total and unbound cortisol were significantly increased compared to baseline values. Our results suggest that hemodilution occurs in all patients during cardiac surgery and continues up to the second postoperative day. This may lead to an underestimation of serum cortisol and CBG concentrations in patients undergoing heart surgery with CPB. Intraoperatively, concentrations of total and unbound cortisol were not significantly elevated. The postoperative rise in serum total cortisol concentration was accompanied by an increase in unbound cortisol concentration. The postoperative increase of unbound cortisol concentrations in patients undergoing cardiac surgery with CPB was largely due to an increase in cortisol secretion. PMID:10978730

  3. Growth Differentiation Factor-15 (GDF-15) Levels Are Associated with Cardiac and Renal Injury in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

    PubMed Central

    Kahli, Abdelkader; Guenancia, Charles; Zeller, Marianne; Grosjean, Sandrine; Stamboul, Karim; Rochette, Luc; Girard, Claude; Vergely, Catherine

    2014-01-01

    Objective Growth differentiation factor-15 (GDF-15) has been identified as a strong marker of cardiovascular disease; however, no data are available concerning the role of GDF-15 in the occurrence of organ dysfunction during coronary artery bypass grafting (CABG) associated with cardiopulmonary bypass (CPB). Methods Five arterial blood samples were taken sequentially in 34 patients from anesthesia induction (IND) until 24 h after arrival at the intensive care unit (ICU). Plasma levels of GDF-15, follistatin-like 1 (FLST1), myeloperoxidases (MPO), hydroperoxides and plasma antioxidant status (PAS) were measured at each time-point. Markers of cardiac (cardiac-troponin I, cTnI) and renal dysfunction (neutrophil gelatinase-associated lipocalin, NGAL) and other classical biological factors and clinical data were measured. Results Plasma GDF-15 levels increased gradually during and after surgery, reaching nearly three times the IND levels in the ICU (3,075±284 ng/L vs. 1,061±90 ng/L, p<0.001). Plasma MPO levels increased dramatically during surgery, attaining their highest level after unclamping (UNCLAMP) (49±11 ng/mL vs. 1,679±153 ng/mL, p<0.001) while PAS significantly decreased between IND and UNCLAMP (p<0.05), confirming the high oxidative status induced by this surgical procedure. ICU levels of GDF-15 correlated positively with cTnI and NGAL (p?=?0.006 and p?=?0.036, respectively), and also with hemoglobin and estimated glomerular filtration rate (eGFR). Among all the post-operative biomarkers available, only eGFR, NGAL and GDF-15 measured at ICU arrival were significantly associated with the onset of acute kidney injury (AKI). Patients with a EuroSCORE >3 were shown to have higher GDF-15 levels. Conclusions During cardiac surgery associated with CPB, GDF-15 levels increased substantially and were associated with markers of cardiac injury and renal dysfunction. PMID:25171167

  4. Intravenous Patient-Controlled Remifentanil Versus Paracetamol in Post-Operative Pain Management in Patients Undergoing Coronary Artery Bypass Graft Surgery

    PubMed Central

    Jahangiri Fard, Alireza; Babaee, Touraj; Alavi, Seyed Mostafa; Nasiri, Ali Akbar; Ghoreishi, Seyed Mohamad Mehran; Noori, Noor Mohammad; Mahjoubifard, Maziar

    2014-01-01

    Background: Pain management after cardiac surgery has been based on parenteral long-acting opioids such as morphine. The other alternatives are paracetamol and remifentanil. Objectives: In this prospective, double-blind, randomized study, we compared the efficacy of intravenous patient-controlled analgesia (IV-PCA) paracetamol and remifentanil for post cardiac surgery pain relief. Materials and Methods: One-hundred patients scheduled for elective coronary artery bypass grafting from May to October 2011, were randomized into two groups after the surgery. For the first group (group R, n = 50, with mean age of 58.16 ± 11.80), the IV-PCA protocol was remifentanil infusion 100 ?g/h; bolus of 25 ?g and lockout time of 15 minutes. In the second group (group P, n = 50, with mean age of 53.8 ± 15.08), patients received paracetamol 15 mg/kg as a bolus at the end of surgery and then IV-PCA protocol was 100 ?g/h, bolus of 25 ?g; and lockout time of 15 minutes. Pain was assessed with visual analog scale score (VAS) in the first 24 hours after surgery for seven times. Results: The trend of pain scores did not have any significantly difference between group R and group P except for hour 8 and hour 18 after surgery that VAS was significantly lower in group P than group R (P = 0.031, P = 0.023, respectively). Respiratory rate (RR) was also statistically lower in group R comparing to group P in all seven evaluating times. The groups were similar in terms of hemodynamic, ABG results (except for PaO2, which was significantly lower in group R than group P at 6 evaluating times), intubation time, renal function tests, and incidences of atelectasis, myocardial infarction or adverse effects. Conclusions: Both PCA techniques provided effective pain scores (< 3) after cardiac surgery; but generally, PCA-paracetamol infusion has a better analgesic effect. PMID:25729675

  5. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m2 for off pump coronary artery bypass surgery.

    PubMed

    Sharma, Munish; Mehta, Yatin; Sawhney, Ravinder; Vats, Mayank; Trehan, Naresh

    2010-01-01

    Perioperative Thoracic epidural analgesia (TEA) is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB). We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index >30 kg/m2 for elective OPCAB were randomized into two groups (n=30 each). Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO2/FiO2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB. PMID:20075532

  6. Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery.

    PubMed

    Cavalcante, Elder Dos Santos; Magario, Rosmeiri; Conforti, César Augusto; Cipriano Júnior, Gerson; Arena, Ross; Carvalho, Antonio Carlos C; Buffolo, Enio; Luna Filho, Bráulio

    2014-11-01

    Background: Coronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective: This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods: Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) - 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) - 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ? 0.05 were considered significant. Results: Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ? 0.01). Conclusion: Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.Fundamento: A cirurgia de revascularização miocárdica (CRM) é a opção cirúrgica padrão para pacientes com placas arteriais difusas e significativas. Tal procedimento, no entanto, não é desprovido de complicações pós-operatórias, especialmente distúrbios pulmonares e cognitivos. Objetivo: Comparar o impacto de duas abordagens fisioterapêuticas diferentes nas funções pulmonar e cognitiva de pacientes submetidos a CRM. Métodos: Testes de função pulmonar e neuropsicológicos foram aplicados, antes e após CRM, a 39 pacientes randomizados em dois grupos: Grupo 1 - 20 pacientes-controle submetidos a uma sessão de fisioterapia por dia; Grupo 2 - 19 pacientes submetidos a três sessões de fisioterapia por dia durante recuperação no hospital. Testes t de Student pareado e não pareado foram usados para comparar as variáveis contínuas. Variáveis sem distribuição normal foram comparadas entre os grupos usando-se o teste de Mann-Whitney, e, dentro do mesmo grupo em momentos diferentes, usando-se o teste de Wilcoxon. O teste do qui-quadrado avaliou diferenças das variáveis categóricas. Testes estatísticos com p valor ? 0,05 foram considerados significativos. Resultados: As alterações da função pulmonar não diferiram significativamente entre os grupos. Entretanto, o mesmo não ocorreu com a função neurocognitiva, que apresentou declínio no Grupo 1, mas não no Grupo 2 (p ? 0,01). Conclusão: Tais resultados reforçam a importância da fisioterapia após CRM e da realização de múltiplas sessões por dia, o que oferece aos pacientes melhores condições psicossociais e menos morbidade. PMID:25352459

  7. Pump blood processing, salvage and re-transfusion improves hemoglobin levels after coronary artery bypass grafting, but affects coagulative and fibrinolytic systems.

    PubMed

    Scrascia, G; Rotunno, C; Nanna, D; Rociola, R; Guida, P; Rubino, G; de Luca Tupputi Schinosa, L; Paparella, D

    2012-07-01

    Cell saving systems are commonly used during cardiac operations to improve hemoglobin levels and to reduce blood product requirements. We analyzed the effects of residual pump blood salvage through a cell saver on coagulation and fibrinolysis activation and on postoperative hemoglobin levels. Thirty-four elective coronary artery bypass graft (CABG) patients were randomized. In 17 patients, residual cardiopulmonary bypass (CPB) circuit blood was transfused after the cell saving procedure (cell salvage group). In the other 17 patients, residual CPB circuit blood was discarded (control group). Activation of the coagulative, fibrinolytic and inflammatory systems was evaluated pre-operatively (Pre), 2 hours after the termination of CPB (T0) and 24 hours postoperatively (T1), measuring prothrombin fragment 1.2 (PF 1.2), plasmin-anti-plasmin (PAP), plasminogen activator inhibitor-1 (PAI-1) and interleukin-6 (IL-6). The cell salvage group of patients had a significant improvement in hemoglobin levels after processed blood infusion (2.7 ± 1.7 g/dL vs 1.2 ± 1.1 g/dL; p=0.003). PF1.2 levels were significantly higher after infusion (T0: 1175 ± 770 pmol/L vs 730 ± 237 pmol/L; p=0.037; T1: 331 ± 235 pmol/L vs 174 ± 134 pmol/L; p=0.026). Also, PAP levels were higher in the cell salvage group, although not significantly (T0: 253 ± 251 ng/mL vs 168 ± 96 ng/mL; p: NS; T1: 95 ± 60 ng/mL vs 53 ± 32 ng/mL; p: NS). No differences were found for PAI-1, IL-6, heparin levels or for red blood cell (RBC) transfusions. The cell salvage group of patients had increased chest tube drainage (749 ± 320 vs 592 ± 264; p: NS) and fresh frozen plasma transfusion rate (5 (29%) pts vs 0 pts; p<0.04). Pump blood salvage with a cell saving system improved postoperative hemoglobin levels, but induced a strong thrombin generation, fibrinolysis activation and lower fibrinolysis inhibition. These conditions could generate a consumption coagulopathy. PMID:22440640

  8. XIENCE PRIME Everolimus Eluting Coronary Stent System (EECSS) China Single-Arm Study

    ClinicalTrials.gov

    2015-01-12

    Angioplasty; Cardiovascular Disease; Chronic Coronary Occlusion; Coronary Artery Bypass Graft (CABG); Coronary Artery Disease; Coronary Heart Disease; Coronary Restenosis; Myocardial Infarction; Myocardial Ischemia; Stent Thrombosis; Vascular Disease

  9. The severity of coronary atherosclerosis in diabetic and non-diabetic metabolic syndrome patients diagnosed according to different criteria and undergoing elective angiography

    Microsoft Academic Search

    S. Ertek; A. F. Cicero; M. Cesur; M. Akcil; T. Altuner Kayhan; U. Avcioglu; M. E. Korkmaz

    2011-01-01

    Our aim in this study was to evaluate the relationship between metabolic syndrome (MS) as defined by different criteria and\\u000a the severity of coronary lesions in a sample of diabetic and non-diabetic patients undergoing elective coronary angiography.\\u000a All patients had blood and urine tests, physical examinations were performed before angiography, and finally they were classified\\u000a based on three criteria (World

  10. Clinical consequences and cost of limiting use of vancomycin for perioperative prophylaxis: example of coronary artery bypass surgery.

    PubMed Central

    Zanetti, G.; Goldie, S. J.; Platt, R.

    2001-01-01

    Routine us 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 prophylaxis, cefazolin, and vancomycin, in coronary artery bypass graft surgery. In the base case, vancomycin resulted in 7% fewer surgical site infections and 1% lower all-cause mortality and saved $117 per procedure, compared with cefazolin. Cefazolin, in turn, resulted in substantially fewer infections and deaths and lower costs than no prophylaxis. We conclude that perioperative antibiotic prophylaxis with vancomycin is usually more effective and less expensive than cefazolin. Data on vancomycin's impact on resistance are needed to quantify the trade-off between individual patients' improved clinical outcomes and lower costs and the future long-term consequences to society. PMID:11747694

  11. 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?

  12. Quantitative Evaluation of Left Ventricular Wall Motion in Patient with Coronary Artery Bypass Grafting Using Magnetic Resonance Tagging Technique

    NASA Astrophysics Data System (ADS)

    Inaba, Tadashi; Nakano, Takahiro; Tsutsumi, Masakazu; Kawasaki, Shingo; Kinosada, Yasutomi; Tokuda, Masataka

    Left ventricular wall motions during systole were investigated from a mechanical perspective by using a magnetic resonance tagging technique. Subjects were 7 patients with coronary artery bypass grafting (CABG). First, by analyzing strain in the left ventricular wall, cardiac contractility was evaluated in the patients with CABG. Next, by calculating displacement in the myocardial wall, paradoxical movements following CABG were quantitatively evaluated. Strain analysis showed local decreases in circumferential strain in 4 of 7 subjects. The results of displacement analysis clarified that following CABG, the degree of radial displacement was small in the septal wall and large in the lateral wall, and circumferential displacement towards the septal wall occurred in the anterior and posterior walls. Since this behavior was seen in both reduced and normal cardiac contractility groups, paradoxical movements in the present patients were not caused by reduced cardiac contractility, but rather by rigid-body motion of the entire heart.

  13. Sympathetic ganglion transcutaneous electrical nerve stimulation after coronary artery bypass graft surgery improves femoral blood flow and exercise tolerance.

    PubMed

    Cipriano, Gerson; Neder, J Alberto; Umpierre, Daniel; Arena, Ross; Vieira, Paulo J C; Chiappa, Adriana M Güntzel; Ribeiro, Jorge P; Chiappa, Gaspar R

    2014-09-15

    We tested the hypothesis that transcutaneous electrical nerve stimulation (TENS) over the stellate ganglion region would reduce sympathetic overstimulation and improve femoral blood flow (FBF) after coronary artery bypass graft surgery. Thirty-eight patients (20 men, 24 New York Heart Association class III-IV) were randomized to 5-day postoperative TENS (n = 20; 4 times/day; 30 min/session) or sham TENS (n = 18) applied to the posterior cervical region (C7-T4). Sympathetic nervous system was stimulated by the cold pressor test, with FBF being measured by ultrasound Doppler. Femoral vascular conductance (FVC) was calculated as FBF/mean arterial pressure (MAP). Six-min walking distance established patients' functional capacity. Before and after the intervention periods, pain scores, opiate requirements, and circulating ?-endorphin levels were determined. As expected, preoperative MAP increased and FBF and FVC decreased during the cold pressor test. Sham TENS had no significant effect on these variables (P > 0.05). In contrast, MAP decreased in the TENS group (125 ± 12 vs. 112 ± 10 mmHg). This finding, in association with a consistent increase in FBF (95 ± 5 vs. 145 ± 14 ml/min), led to significant improvements in FVC (P < 0.01). Moreover, 6-min walking distance improved only with TENS (postsurgery-presurgery = 35 ± 12 vs. 6 ± 10 m; P < 0.01). TENS was associated with lesser postoperative pain and opiate requirements but greater circulating ?-endorphin levels (P < 0.05). In conclusion, stellate ganglion TENS after coronary artery bypass graft surgery positively impacted on limb blood flow during a sympathetic stimulation maneuver, a beneficial effect associated with improved clinical and functional outcomes. PMID:25103974

  14. Direct aortic interposition of anomalous left anterior descending coronary artery without cardiopulmonary bypass.

    PubMed

    Cebi, Niyazi; Frömke, Johannes; Walterbusch, Gerd

    2004-12-01

    An anomalous origin of the left anterior descending (LAD) coronary artery arising from the pulmonary artery is a congenital malformation rarely described in adults. We describe the case of a 42-year-old man with this malformation who underwent an interposition of the LAD coronary artery to the ascending aorta with an off-pump technique. The clinical presentation, angiographic findings, and surgical treatment are discussed. PMID:15561071

  15. Rationale, design and methodology for a Prospective Randomized Study of graft patency in Off-pump and On-pump MultI-Vessel coronary artery bypasS Surgery (PROMISS) using multidetector computed tomography

    PubMed Central

    Uva, Miguel Sousa; Matias, Fernando; Cavaco, Sara; Magalhães, Manuel Pedro

    2008-01-01

    Background Off-pump coronary artery bypass grafting has been accused of possibly compromising graft patency. Sixteen slice computed tomography has shown good diagnostic accuracy in the assessment of coronary bypass graft patency when compared with conventional coronary artery angiography and is less invasive. The study hypothesis is that coronary artery bypass grafting (CABG) performed without cardiopulmonary bypass (Off-Pump) has equivalent early graft patency as if performed with cardiopulmonary bypass (On-Pump) and may have reduced complication rate. Methods/Design The Prospective Randomized Comparison of Off-Pump and On-Pump MultI-vessel Coronary Artery BypasS Surgery (PROMISS) is a controlled, single blinded, single centre clinical trial, comparing early graft patency using 16-slice computed tomography in patients with multi-vessel coronary artery disease operated either without or with extracorporeal circulation. Inclusion criteria are multivessel disease with an indication for first time, isolated, non emergent coronary artery bypass grafting with a minimum of three distal anastomoses. Secondary end points are peri-operative mortality, combined morbidity, length of stay, neuro-cognitive testing at 6 weeks and adverse events, stress test and quality of life at 6 months and one year. The sample size of one hundred and fifty patients was calculated in order to enable the detection of a 5% difference in graft patency, with 80% power, considering a minimum of 3 distal anastomoses per patient. Enrolment started in April 2005 and ended July 2007 with study closure in July 2008. Conclusion The PROMISS trial aims to shed new light on the effect of Off-Pump as compared to On-Pump coronary artery bypass surgery on graft patency, assessed by multidetector computed tomography, in unselected patients with multivessel coronary artery disease. Trial Registration Current Controlled Trials ISRCTN58800729 PMID:18637191

  16. Predictors and outcomes of early coronary angiography in patients with prior coronary artery bypass surgery presenting with non-ST elevation myocardial infarction

    PubMed Central

    Asrar ul Haq, Muhammad; Rudd, Nima; Mian, Mueed; Castles, Anastasia; Mogilevski, Tamara; Mutha, Vivek; Van Gaal, William J

    2014-01-01

    Introduction The best strategy in patients with prior coronary artery bypass graft surgery (CABG) who present with non-ST elevation myocardial infarction (NSTEMI) remains less well defined. We compare the characteristics, therapeutic interventions and outcomes of patients with prior CABG presenting with NSTEMI. Methods All patients who presented to our hospital during 2007–2012 with available electronic records were analysed retrospectively. Outcomes were compared between patients who underwent coronary angiography or percutaneous coronary intervention (PCI) versus those who were treated medically. Results A total of 117 patients were analysed. Of that, 79 patients were managed medically while 38 underwent early angiography, of which only 11 (9.5%) received PCI. Patients treated medically (did not undergo angiography) were older (74±10 vs70±8; p=0.05). ECG changes were the only independent predictor for early angiography (OR 0.4, 95% CI 0.15 to 0.99; p=0.05) while recurrent chest pain (OR 0.2, 95% CI 0.05 to 0.97; p=0.05) predicted PCI on multivariate analysis. The PCI group had higher Global Registry of Acute Cardiac Events (GRACE) score (176±29 vs 150±31; p=0.01). No significant difference was found in readmission rates, morbidity (unstable angina pectoris, NSTEMI, ST elevation myocardial infarction (STEMI), or combination) or mortality at 12?months between the groups who underwent angiography, PCI, or treated medically on univariate and multivariate analysis. Conclusions The opportunity to intervene in prior CABG patients presenting with NSTEMI is often low. Initial medical management may be a reasonable option in carefully selected patients particularly in the absence of ongoing symptoms, ECG changes or very high GRACE scores. Further studies are required to evaluate the safety of non-invasive strategies in managing this population. PMID:25332800

  17. Influence of previous percutaneous coronary intervention on clinical outcome of coronary artery bypass grafting: a meta-analysis of comparative studies†.

    PubMed

    Ueki, Chikara; Sakaguchi, Genichi; Akimoto, Takehide; Shintani, Tsunehiro; Ohashi, Yuko; Sato, Hirofumi

    2015-04-01

    The prognostic significance of previous percutaneous coronary intervention (PCI) in patients undergoing coronary artery bypass grafting (CABG) is still unclear. Although many studies have reported adverse effects of previous PCI on postoperative mortality in CABG, as yet no meta-analysis has been carried out. We conducted this first meta-analysis to assess whether previous PCI increases postoperative mortality in CABG. MEDLINE and EMBASE were searched for relevant articles up to and including April 2014. Studies published in English satisfying the following criteria were included in the meta-analysis: (i) comparing CABG patients with previous PCI versus without previous PCI; and (ii) reporting hospital mortality. Our search identified 23 comparative studies, including 174 777 patients: 19 179 with previous PCI and 155 598 without previous PCI. Pooled analysis demonstrated that previous PCI had an adverse effect on hospital mortality: odds ratio (OR) 1.187, 95% confidence interval (CI) 1.075-1.312. Furthermore, subgroup analysis stratified by the proportion of multiple previous PCI (i.e. number of patients with multiple previous PCI/number of patients with single or multiple previous PCI) was performed. In the subgroup of studies with the proportion <40%, the adverse effect was not significant: OR 0.897 (95% CI 0.723-1.113); however, in the subgroup of studies with the proportion ?40%, the adverse effect of previous PCI was significant: OR 1.987 (95% CI 1.563-2.526). A meta-regression coefficient was significantly positive for the proportion of patients with a history of multiple PCI (coefficient 0.841; 95% CI 0.457-1.226; P < 0.001). This meta-analysis would argue that as the proportion of patients with multiple previous PCI in the CABG cohort increases, postoperative mortality also increases. This result re-emphasizes the importance of the heart team approach to coronary revascularization. PMID:25583647

  18. Stenting for Left Subclavian Artery Stenosis before and after Coronary Artery Bypass Grafting Using the Internal Mammary Artery

    PubMed Central

    Chokyu, I.; Terada, T.; Matsuda, Y.; Okumura, H.; Shintani, A.; Nakamura, Y.; Ohura, Y.; Tsumoto, T.; Masuo, O.; Matsumoto, H.; Itakura, T.

    2008-01-01

    Summary Stenosis of the subclavian artery proximal to the origin of the internal mammary artery (IMA) used for coronary artery bypass grafting may produce flow reversal (steal syndrome) and cause myocardial ischemia. We present three cases of subclavian artery stenosis proximal to the IMA before and after CABG. The first case developed symptomatic myocardial ischemia resulting from a variant of coronary-subclavian steal syndrome. The second case had asymptomatic subclavian artery stenosis proximal to the IMA used for CABG. In the third case we planned to perform CABG using the left IMA to treat cardiac ischemia. All of the patients were successfully treated by stent placement without the use of a protection device. In the first and second cases, cardiac ischemia did not appear during balloon inflation of the subclavian artery and no embolic complication occurred. In the third case, CABG was performed six months after stenting. Subclavian artery stenting is a valid alternative to surgical treatment to restore the flow to the IMA before or after CABG. PMID:20557764

  19. Rest and redistribution thallium-201 myocardial scintigraphy to predict improvement in left ventricular function after coronary arterial bypass grafting

    SciTech Connect

    Iskandrian, A.S.; Hakki, A.H.; Kane, S.A.; Goel, I.P.; Mundth, E.D.; Hakki, A.H.; Segal, B.L.

    1983-05-01

    To examine the value of rest and redistribution thallium-201 imaging in predicting improvement in left ventricular (LV) ejection fraction (EF) after coronary artery bypass grafting (CABG), 26 patients with coronary artery disease (CAD) and abnormal LV function were studied. Nineteen patients had pathologic Q waves preoperatively. Rest and redistribution thallium-201 images and radionuclide ventriculograms were obtained before and after CABG, and the thallium scintigrams were evaluated both quantitatively and qualitatively. The patients were divided according to the preoperative thallium scintigrams into 2 groups: Group I (16 patients) had either normal resting thallium-201 images or reversible resting perfusion defects, and Group II (10 patients) had fixed resting perfusion defects. The resting EF was less than 50% preoperatively in all patients. Fourteen patients (54%) showed improvement in EF postoperatively. Three patients (2 in Group I and 1 in Group II) showed new postoperative perfusion defects, and none of the 3 showed improvement in LV function. Of the remaining 14 patients in Group I, 12 (86%) showed improvement in LV function, compared with 2 of 9 patients in Group II (p less than 0.01). Improvement in LV function was observed in 8 of the 19 patients (42%) with abnormal Q waves. Nitroglycerin intervention radionuclide ventriculograms were obtained in 20 patients before CABG. Of the 6 patients who showed improvement in LV function with nitroglycerin, 4 also showed improvement postoperatively. Postoperative improvement in LV function was also observed in 6 of the 14 patients who did not improve with nitroglycerin.

  20. Myocardial perfusion and coronary flow reserve in mammary artery and saphenous vein by-pass grafts with maximal dipyridamole vasodilation

    SciTech Connect

    Lassar, T.; Hendrix, L.; Port, S.; Ray, G.; Kamath, M.L.; Schmidt, D.H.

    1985-05-01

    This study was done to assess the functional adequacy of regional myocardial perfusion in angiographically patent internal mammary artery (IMAG) and saphenous vein (SVG) bypass grafts under conditions of maximal vasodilation. Utilizing the xenon-133 washout technique, quantitative RMP in ml/100g/min was measured at rest (R RMP), and after 0.6mg/kg of intravenous dipyridamole (DP RMP) via selective injection into coronary arteries with >75% diameter stenosis (SCA), angiographically normal vessels (NLCA), and two weeks postoperatively after IMAG or SVG. RMP and coronary flow reserve (CFR=DP RMP / R RMP) were compared between groups selected for study and the results are presented. The authors discuss that compared to SCA, there is a trend towards improved RMP under conditions of maximal vasodilatory demand in both IMAG and SVG. In part because of elevated R RMP, the CFR ratio may not always reflect this improvement, and finally, the trend towards higher DP RMP in SVG suggest that they may supply more adequate nutrient flow than IMAG during situations of peak demand.

  1. The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery.

    PubMed

    Yuruk, Koray; Bezemer, Rick; Euser, Mariska; Milstein, Dan M J; de Geus, Hilde H R; Scholten, Evert W; de Mol, Bas A J M; Ince, Can

    2012-09-01

    OBJECTIVES To reduce the complications associated with cardiopulmonary bypass (CPB) during cardiac surgery, many modifications have been made to conventional extracorporeal circulation systems. This trend has led to the development of miniaturized extracorporeal circulation systems. Cardiac surgery using conventional extracorporeal circulation systems has been associated with significantly reduced microcirculatory perfusion, but it remains unknown whether this could be prevented by an mECC system. Here, we aimed to test the hypothesis that microcirculatory perfusion decreases with the use of a conventional extracorporeal circulation system and would be preserved with the use of an miniaturized extracorporeal circulation system. METHODS Microcirculatory density and perfusion were assessed using sublingual side stream dark-field imaging in patients undergoing on-pump coronary artery bypass graft (CABG) surgery before, during and after the use of either a conventional extracorporeal circulation system (n = 10) or a miniaturized extracorporeal circulation system (n = 10). In addition, plasma neutrophil gelatinase-associated lipocalin and creatinine levels and creatinine clearance were assessed up to 5 days post-surgery to monitor renal function. RESULTS At the end of the CPB, one patient in the miniaturized extracorporeal circulation-treated group and five patients in the conventional extracorporeal circulation-treated group received one bag of packed red blood cells (300 ml). During the CPB, the haematocrit and haemoglobin levels were slightly higher in the miniaturized extracorporeal circulation-treated patients compared with the conventional extracorporeal circulation-treated patients (27.7 ± 3.3 vs 24.7 ± 2.0%; P = 0.03; and 6.42 ± 0.75 vs 5.41 ± 0.64 mmol/l; P < 0.01). The density of perfused vessels with a diameter <25 µm (i.e. perfused vessel density) decreased slightly in the conventional extracorporeal circulation-treated group from 16.4 ± 3.8 to 12.8 ± 3.3 mm/mm(2) (P < 0.01) and remained stable in the miniaturized extracorporeal circulation-treated group (16.3 ± 2.7 and 15.2 ± 2.9 mm/mm(2) before and during the pump, respectively). Plasma neutrophil gelatinase-associated lipocalin levels were increased following the use of extracorporeal circulation in both groups, and no differences were observed between the groups. Plasma creatinine levels and creatinine clearance were not affected by CABG surgery or CPB. CONCLUSIONS The results from this relatively small study suggest that the use of the miniaturized extracorporeal circulation system is associated with a statistically significant (but clinically insignificant) reduction in haemodilution and microcirculatory hypoperfusion compared with the use of the conventional extracorporeal circulation system. PMID:22700685

  2. A combination of anatomical and functional evaluations improves the prediction of cardiac event in patients with coronary artery bypass

    PubMed Central

    Kawai, Hideki; Sarai, Masayoshi; Motoyama, Sadako; Ito, Hajime; Takada, Kayoko; Harigaya, Hiroto; Takahashi, Hiroshi; Hashimoto, Shuji; Takagi, Yasushi; Ando, Motomi; Anno, Hirofumi; Ishii, Junichi; Murohara, Toyoaki; Ozaki, Yukio

    2013-01-01

    Objective To study the usefulness of combined risk stratification of coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) in patients with previous coronary-artery-bypass grafting (CABG). Design A retrospective, observational, single centre study. Setting and patients 204 patients (84.3% men, mean age 68.7±7.6) undergoing CTA and MPI. Main outcome measures CTA defined unprotected coronary territories (UCT; 0, 1, 2 or 3) by evaluating the number of significant stenoses which were defined as the left main trunk ?50% diameter stenosis, other native vessel stenosis ?70% or graft stenosis ?70%. Using a cut-off value with receiver-operating characteristics analysis, all patients were divided into four groups: group A (UCT=0, summed stress score (SSS)<4), group B (UCT?1, SSS<4), group C (UCT=0, SSS?4) and group D (UCT?1, SSS?4). Results Cardiac events, as a composite end point including cardiac death, non-fatal myocardial infarction, unstable angina requiring revascularisation and heart-failure hospitalisation, were observed in 27 patients for a median follow-up of 27.5?months. The annual event rates were 1.1%, 2%, 5.7% and 12.9% of patients in groups A, B, C and D, respectively (log rank p value <0.0001). Adding UCT or SSS to a model with significant clinical factors including left ventricular ejection fraction, time since CABG and Euro SCORE II improved the prediction of events, while adding UCT and SSS to the model improved it greatly with increasing C-index, net reclassification improvement and integrated discrimination improvement. Conclusions The combination of anatomical and functional evaluations non-invasively enhances the predictive accuracy of cardiac events in patients with CABG. PMID:24220113

  3. Associations between disease severity, coping and dimensions of health-related quality of life in patients admitted for elective coronary angiography – a cross sectional study

    Microsoft Academic Search

    Bjørg Ulvik; Ottar Nygård; Berit R Hanestad; Tore Wentzel-Larsen; Astrid K Wahl

    2008-01-01

    BACKGROUND: In patients with suspected coronary artery disease (CAD), the overall aim was to analyse the relationships between disease severity and both mental and physical dimensions of health related quality of life (HRQOL) using a modified version of the Wilson and Cleary model. METHODS: Using a cross-sectional design, 753 patients (74% men), mean age 62 years, referred for elective cardiac

  4. 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.

  5. Comparison of medicine alone, coronary angioplasty, and left internal mammary artery–coronary artery bypass for one-vessel proximal left anterior descending coronary artery disease

    Microsoft Academic Search

    Adam B Greenbaum; Robert M Califf; Robert H Jones; Laura H Gardner; Harry R Phillips; Michael H Sketch; Richard S Stack; Joseph A Puma

    2000-01-01

    Despite the deleterious and sometimes catastrophic consequences of proximal left anterior descending (LAD) artery occlusion, there is a paucity of data to guide the treatment of patients with such disease. Our aim was to describe outcomes with medical therapy, angioplasty, or left internal mammary artery (LIMA) bypass grafting in patients with 1-vessel, proximal LAD disease. We retrospectively analyzed prospectively collected

  6. Meta-analysis of randomised trials comparing coronary angioplasty with bypass surgery

    Microsoft Academic Search

    S. J Pocock; R. A Henderson; A. F Rickards; J. R Hampton; S. B King; C. W Hamm; J Puel; W Hueb; J-J Goy; A Rodriguez

    1995-01-01

    A patient with severe angina will often be eligible for either angioplasty (PTCA) or bypass surgery (CABG). Results from eight published randomised trials have been combined in a collaborative meta-analysis of 3371 patients (1661 CABG, 1710 PTCA) with a mean follow-up of 2·7 years. The total deaths in the CABG and PTCA groups were 73 and 79, respectively, with a

  7. 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

  8. Prevalence and Genotypes of Hepatitis B Virus Infection in Patients Underwent Coronary Angiography and Coronary Artery Bypass Grafting in Mazandaran Heart Center, Sari, Iran

    PubMed Central

    Mousavi, Tahoora; Ziabakhsh-Tabary, Shervin; Ghaemiyan, Ali; Haghshenas, Mohammad Reza

    2014-01-01

    ABSTRACT Background: Hepatitis B virus (HBV) infection is a major global health problem in the worldwide that associated with significant morbidity and mortality in cardiac surgery. The available data on HBV distribution and genotyping of HBV are very heterogeneous. Therefore in this study, we tried to indicate the prevalence of HBV infections in cardiac catheterization patients referred to health centers in the north of Iran and identified the HBV genotypes using polymerase chain reaction (PCR). Methods: In this cross-sectional study, we studied 2650 patients who underwent selective coronary artery angiography and coronary artery bypass grafting in Mazandaran heart center, Sari, Iran from 2011 to 2013. All serum samples were examined to detect HBsAg by ELISA test. HBV-DNA was extracted from HBsAg positive samples using Mini Elute Kit from Qiagen and determined the genotypes of HBV by PCR using the Master Mix kit with Taq-DNA polymerase enzyme and with type of specific primers. All samples were examined in the virology laboratory of Sari Medical School. Results: The mean age of patients was 59.7±10.9 (range, 20 to 81) year that 1590 (60%) patients were male and 1060 (40%) were female. Seventeen cases (0.08 %) were found with hepatitis B virus infection, and the highest rates of infection were reported among those aged 40–60 years old in this study. We found genotype D the predominant type in this study. Conclusion: This study indicates that the prevalence of HBV endemicity in the north of Iran is low and genotype D is the only genotype in patients infected with HBV. PMID:25568563

  9. PPAR Gamma Expression Levels during Development of Heart Failure in Patients with Coronary Artery Disease after Coronary Artery Bypass-Grafting

    PubMed Central

    Wojtkowska, Izabela; Tysarowski, Andrzej; Seliga, Katarzyna; Siedlecki, Janusz A.; Juraszy?ski, Zbigniew; Marona, Milosz; Greszata, Lidia; Skrobisz, Anna; Kaminski, Karol; Sawicki, Robert; St?pi?ska, Janina

    2014-01-01

    Genetic research has elucidated molecular mechanisms of heart failure (HF). Peroxisome proliferator-activated receptors (PPARs) seem to be important in etiology of HF. The aim of study was to find the correlation between PPAR? expression during development of HF in patients and coronary artery disease (CAD) after coronary artery bypass-grafting (CABG). Methods and Results. We followed up 157 patients (mean age 63) with CAD without clinical, laboratory, or echo parameters of HF who underwent CABG. Clinical and laboratory status were assessed before CABG and at 1, 12, and 24 months. During CABG slices of aorta (Ao) and LV were collected for genetic research. HF was defined as LVEF <40% or NT-proBNP >400?pg/mL or 6MWT <400?m. Patients were divided into 2 groups: with and without HF. PPAR? expression in Ao and LV was not increased in both groups at 2-year follow-up. Sensitivity of PPAR? expression in Ao above 1.1075 in detection of HF was 20.5% (AUC 0.531, 95% CI 0.442–0.619). Positive predictive value (Ppv) was 85.7%. Sensitivity and specificity of PPAR? expression in the LV in detection of HF were 58% and 92.9%, respectively (AUC 0.540, 95% CI 0.452–0.626). Ppv was 73.2%. Conclusion. PPAR? expression in Ao and LV was comparable and should not be used as predictive factor for development of HF in patients with CAD after CABG. PMID:25371662

  10. Minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for single-vessel disease: a meta-analysis of 2885 patients†.

    PubMed

    Deppe, Antje-Christin; Liakopoulos, Oliver J; Kuhn, Elmar W; Slottosch, Ingo; Scherner, Maximilian; Choi, Yeong-Hoon; Rahmanian, Parwis B; Wahlers, Thorsten

    2015-03-01

    Percutaneous coronary intervention (PCI) and minimally invasive direct coronary artery bypass (MIDCAB) grafting are both established therapeutic options for single-vessel disease of the left anterior descending artery (LAD). The present systematic review with meta-analysis aims to determine the current strength of evidence for or against PCI and MIDCAB for revascularization of the LAD. Therefore, we performed a meta-analysis of randomized, controlled trials (RCTs) and observational trials (OTs) that reported clinical outcome after isolated LAD revascularization. Analysed postoperative outcomes included major adverse cardiac and cerebrovascular events (MACCEs), all-cause mortality, myocardial infarction and stroke. Pooled treatment effects [odds ratio (OR) or weighted mean difference (WMD), 95% confidence intervals (95% CI)] were assessed using a fixed- or random-effects model. A total of 2885 patients from 12 studies (6 RCTs, 6 OTs) were identified after a literature search of major databases using a predefined list of keywords. PCI of the LAD was performed in 60.7% (n = 1751) and MIDCAB in 39.3% of patients (n = 1126). Pooled-effect estimates revealed an increased incidence for MACCEs after PCI (OR 1.98; 95% CI 1.45-2.69; P < 0.0001) 6 months after the procedure. Especially, PCI was particularly associated with an increased odds for target vessel revascularization (OR 2.11; 95% CI 1.00-4.47; P = 0.0295). No differences with regard to stroke, myocardial infarction and all-cause mortality were observed between both revascularization strategies. Patients after PCI had a shorter length of hospital stay (WMD -3.37 days; 95% CI (-)4.92 to (-)1.81; P < 0.0001). In conclusion, the present systematic review underscores the superiority of MIDCAB over PCI for treatment of single-vessel disease of the LAD. PMID:25100715

  11. A study design to assess the safety and efficacy of on-pump versus off-pump coronary bypass grafting: the ROOBY trial

    Microsoft Academic Search

    Dimitri Novitzky; A Laurie Shroyer; Joseph F Collins; Gerald O McDonald; John Lucke; Brack Hattler; Elizabeth Kozora; Douglas D Bradham; Janet Baltz; Frederick L Grover

    2007-01-01

    Background Since the late 1960s, coronary artery bypass graft (CABG-only) procedures were traditionally performed using a heart-lung machine on an arrested heart (on-pump). Over the past decade, an increasing number CABG-only procedures were performed on a beating heart (off-pump). Advocates of the off-pump approach expect to reduce many of the adverse side effects related to using the heart-lung machine, while

  12. The effect of cardiac rehabilitation on recovery of heart rate over one minute after exercise in patients with coronary artery bypass graft surgery

    Microsoft Academic Search

    Sen-Wei Tsai; Yi-Wen Lin; Shyi-Kuen Wu

    2005-01-01

    Objective: To evaluate the effects of cardiac rehabilitation on the recovery of heart rate over 1 min after peak exercise of patients who received coronary artery bypass graft (CABG) surgery.Design: Thirty subjects who received CABG surgery were randomly assigned to enter or not enter a cardiac rehabilitation exercise programme (cardiac rehabilitation n=15; control group n=15).Setting: Outpatient cardiac rehabilitation centre in

  13. 57 The impact of preoperative renal dysfunction and therapy type in patients with type 2 diabetes undergoing coronary artery bypass surgery

    Microsoft Academic Search

    A Menon; J Hodson; D Pagano; J Mascaro; I C Wilson; S J Rooney; T R Graham; R S Bonser

    2011-01-01

    IntroductionThere is limited data addressing the impact of preoperative renal dysfunction in type 2 diabetics (T2DM) undergoing first-time coronary artery bypass surgery (CABG); specifically exploring the influence of diabetic management (oral hypoglycaemic (OH) and insulin therapy (IN)). We assessed the impact of preoperative renal status and diabetic management on the post operative renal status, morbidity, 30-day and long-term survival in

  14. Cardiac troponin I plasma levels for diagnosis and quantitation of perioperative myocardial damage in patients undergoing coronary artery bypass surgery1

    Microsoft Academic Search

    Volker Sadony; Michael Korber; Guido Albes; Volker Podtschaske; Thorleif Etgen; Thomas Trosken; Ursula Ravens; Max Ernst Scheulen

    Objective: The definition of a reliable and generally accepted diagnostic standard for perioperative myocardial damage is desirable. Cardiac troponin I (cTnI) is highly specific for myocardial tissue and can be measured rapidly. The aim of our study was to evaluate the diagnostic potential of cTnI for myocardial lesions in patients undergoing coronary artery bypass surgery (CABG). Methods: A total of

  15. A pilot study to assess the effects of a guided imagery audiotape intervention on psychological outcomes in patients undergoing coronary artery bypass graft surgery.

    PubMed

    Stein, Traci R; Olivo, Erin L; Grand, Sandy Hermele; Namerow, Pearila B; Costa, Joseph; Oz, Mehmet C

    2010-01-01

    Depression and anxiety are associated with increased risk of postoperative cardiac events and death in patients who have undergone coronary artery bypass graft surgery. These risks persist even several months after the procedure. Guided imagery has been used with cardiac surgery patients for some time and with numerous anecdotal reports of considerable benefit. In addition, this therapy is low-cost and easy to implement, and the literature holds ample evidence for its efficacy in symptom reduction in various patient populations. It was thus hypothesized that preoperative use of guided imagery would reduce postoperative distress in patients undergoing coronary artery bypass graft. Fifty-six patients scheduled to undergo coronary artery bypass graft at Columbia University Medical Center were randomized into 3 groups: guided imagery, music therapy, and standard care control. Patients in the imagery and music groups listened to audiotapes preoperatively and intraoperatively. All patients completed psychological, complementary medicine therapies use, and other assessments preoperatively and at 1 week and 6 months postoperatively. Only preoperative distress was predictive of postoperative distress at follow-up. Use of complementary medicine therapies was high in all groups and this fact, in addition to the small sample size, may have accounted for the lack of significant relationship between imagery and postoperative distress. Regardless, this complementary and alternative medicine therapy remains palatable to patients. Given its efficacy in other patient populations, it is worth exploring its potential utility for this population with a larger sample. PMID:20588130

  16. 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

  17. 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

  18. [Should we use clopidogrel instead of ticlopidine in elective coronary angioplasty?].

    PubMed

    Baralis, Giorgio; Steffenino, Giuseppe; Dellavalle, Antonio; La Scala, Eugenio; Uslenghi, Eugenio

    2003-09-01

    The use of ticlopidine in association with aspirin has reduced the incidence of subacute stent thrombosis to currently < 1% after coronary stent implantation. Clopidogrel, a more recently marketed thienopyridine derivative, has a lower incidence of side effects than ticlopidine. The use of clopidogrel in association with aspirin as compared to aspirin alone from the second through the sixth month after coronary angioplasty has been shown to reduce the 6-month incidence of major adverse cardiac events by 20-30%. Comparative studies about the use of ticlopidine and clopidogrel in patients undergoing stent implantation are scarce: these data are briefly reviewed. The conclusion is reached that, except for patients with non-ST-elevation acute coronary syndromes, there is at present no evidence that ticlopidine should be replaced with clopidogrel in all patients undergoing stent implantation; clopidogrel might be reserved for those patients who have shown side effects due to ticlopidine. PMID:14635395

  19. Digital dipyridamole stress echocardiography in silent ischemia after coronary artery bypass grafting and/or after healing of acute myocardial infarction.

    PubMed

    Bjoernstad, K; Aakhus, S; Lundbom, J; Bolz, K D; Rokseth, R; Skjaerpe, T; Hatle, L

    1993-09-15

    This study evaluates dipyridamole stress echocardiography in silent ischemia. Fourteen patients with previous coronary artery bypass grafting (group A) and 16 patients with healed myocardial infarction (group B) were studied. All had > or = 1 mm ST depression without chest pain during bicycle exercise testing. Left ventricular wall motion was analyzed using a computerized display of digital systolic cineloops with a high frame rate. Test results were compared with coronary angiography. Dipyridamole echocardiography accurately identified patients with significant coronary artery stenosis in both groups (3 of 4 in group A, 11 of 14 in group B). Retrograde flow to the occluded native artery was associated with positive results on dipyridamole testing in 6 of 7 patients in group A and all 3 in group B. Sensitivity, specificity and diagnostic accuracy for detecting significant coronary stenosis or occlusions with retrograde flow was 78, 100 and 83%, respectively. Patients with angiographic multivessel disease had a significantly larger increase in wall motion score index during dipyridamole stress than patients with 0- or 1-vessel disease, 0.18 +/- 0.11 versus 0.05 +/- 0.18 (p < 0.05). Two patients developed symptomatic bradycardia and hypotension during dipyridamole infusion. It is concluded that dipyridamole echocardiography accurately identifies myocardial regions with restricted coronary flow. Stress echocardiography is a valuable tool for assessing coronary flow in silent ischemia. PMID:8249837

  20. Cerebral Lesions in Patients Undergoing Coronary Artery Bypass Grafting in Relation to Asymptomatic Carotid and Vertebral Artery Stenosis

    PubMed Central

    Schoos, Mikkel; Sillesen, Henrik; Thomsen, Carsten; Hassager, Christian; Steinbrüchel, Daniel; Schroeder, Torben; Clemmensen, Peter; Kelbæk, Henning

    2015-01-01

    Objectives: Carotid artery stenosis (CAS) and vertebral artery stenosis (VAS) are associated with cerebral infarction after coronary artery bypass graft surgery (CABG). It remains unclear whether this association is causal. We investigated the associations between neurologically asymptomatic CAS and VAS and the occurrence of subclinical cerebral lesions after CABG verified by magnetic resonance imaging. Methods: CABG patients were included and CAS and VAS were identified by magnetic resonance angiography. Cerebral magnetic resonance imaging was performed to identify new post-operative subclinical cerebral lesions. The associations between CAS/VAS post-operative cerebral lesions were investigated. Results: Forty-six patients were included in the study. 13% had significant CAS and 11% had significant VAS. Thirty-five percent had new cerebral infarction postoperatively. We found a significant association between the presence of cerebral vessel stenosis and acute cerebral infarction (67% vs. 27%, p = 0.047). However none of the patients with stenosis had isolated cerebral lesions in the ipsilateral vascular territory. Conclusion: Asymptomatic CAS and VAS is common in CABG patients and is associated with an increased risk of postoperative cerebral infarction. Our study suggests that asymptomatic CAS and VAS primarily are risk markers rather than causal factors for cerebral infarction after CABG.

  1. 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

  2. Improving Public Reporting and Data Validation for Complex Surgical Site Infections After Coronary Artery Bypass Graft Surgery and Hip Arthroplasty

    PubMed Central

    Calderwood, Michael S.; Kleinman, Ken; Murphy, Michael V.; Platt, Richard; Huang, Susan S.

    2014-01-01

    Background ?Deep and organ/space surgical site infections (D/OS SSI) cause significant morbidity, mortality, and costs. Rates are publicly reported and increasingly used as quality metrics affecting hospital payment. Lack of standardized surveillance methods threaten the accuracy of reported data and decrease confidence in comparisons based upon these data. Methods ?We analyzed data from national validation studies that used Medicare claims to trigger chart review for SSI confirmation after coronary artery bypass graft surgery (CABG) and hip arthroplasty. We evaluated code performance (sensitivity and positive predictive value) to select diagnosis codes that best identified D/OS SSI. Codes were analyzed individually and in combination. Results ?Analysis included 143 patients with D/OS SSI after CABG and 175 patients with D/OS SSI after hip arthroplasty. For CABG, 9 International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes identified 92% of D/OS SSI, with 1 D/OS SSI identified for every 4 cases with a diagnosis code. For hip arthroplasty, 6 ICD-9 diagnosis codes identified 99% of D/OS SSI, with 1 D/OS SSI identified for every 2 cases with a diagnosis code. Conclusions ?This standardized and efficient approach for identifying D/OS SSI can be used by hospitals to improve case detection and public reporting. This method can also be used to identify potential D/OS SSI cases for review during hospital audits for data validation. PMID:25734174

  3. Use of genetic programming, logistic regression, and artificial neural nets to predict readmission after coronary artery bypass surgery.

    PubMed

    Engoren, Milo; Habib, Robert H; Dooner, John J; Schwann, Thomas A

    2013-08-01

    As many as 14 % of patients undergoing coronary artery bypass surgery are readmitted within 30 days. Readmission is usually the result of morbidity and may lead to death. The purpose of this study is to develop and compare statistical and genetic programming models to predict readmission. Patients were divided into separate Construction and Validation populations. Using 88 variables, logistic regression, genetic programs, and artificial neural nets were used to develop predictive models. Models were first constructed and tested on the Construction populations, then validated on the Validation population. Areas under the receiver operator characteristic curves (AU ROC) were used to compare the models. Two hundred and two patients (7.6 %) in the 2,644 patient Construction group and 216 (8.0 %) of the 2,711 patient Validation group were re-admitted within 30 days of CABG surgery. Logistic regression predicted readmission with AU ROC = .675 ± .021 in the Construction group. Genetic programs significantly improved the accuracy, AU ROC = .767 ± .001, p < .001). Artificial neural nets were less accurate with AU ROC = 0.597 ± .001 in the Construction group. Predictive accuracy of all three techniques fell in the Validation group. However, the accuracy of genetic programming (AU ROC = .654 ± .001) was still trivially but statistically non-significantly better than that of the logistic regression (AU ROC = .644 ± .020, p = .61). Genetic programming and logistic regression provide alternative methods to predict readmission that are similarly accurate. PMID:23504197

  4. Haemodynamic analysis of coronary artery bypass grafting in a non-linear deformable artery and Newtonian pulsatile blood flow.

    PubMed

    Kouhi, E; Morsi, Y S; Masood, S H

    2008-11-01

    A three-dimensional (3D) computational model of stenotic coronary artery bypass grafting (CABG) system with fluid-structure interaction (FSI) using realistic physiological conditions is introduced. Unsteady pulsatile blood flow is applied to the wall of non-linear deformable arteries over the systolic period. In the analysis, the arbitrarily Lagrangian-Eulerian (ALE) formulation is used to couple the fluid region and solid domain. The method couples the equations of the deformation of the artery wall and applies them as the fluid domain boundary condition. The flow distribution and haemodynamic forces are presented in terms of velocity profiles and temporal and spatial wall shear stresses (WSSs) at the distal area. Rapid changes in the flow fields are observed in the early stages of the cardiac cycle, which alters the location of the recirculation zone from the toe to the host bed and then to the heel. The migration of the recirculation zone, considering the effect of deformability of the artery wall, indicates the same trend as the rigid wall model according to the location of low and high WSSs. However, the WSSs in the critical areas such as toe, heel, and suture lines are found to have dramatic drops in magnitudes in comparison with those of the rigid wall model. This could initiate the promotion of intimal hyperplasia (IH) and may cause an early graft failure in CABG. PMID:19143420

  5. Mean Platelet Volume as a Predictor of One-Year Major Adverse Cardiac Events following Elective Percutaneous Coronary Interventions

    PubMed Central

    Nozari, Younes; Bahrehmand, Mostafa; Hosseini, Seyed Kianoosh; Mahmoodian, Mehran; Sharafi, Ahmad

    2014-01-01

    Abstract Background: Mean platelet volume (MPV) correlates with platelet activity. The relation between MPV and long-term outcome in patients undergoing percutaneous coronary intervention (PCI) has been investigated in several studies. The aim of the present study was to investigate the utility of MPV in prognosticating the long-term outcome after elective PCI. Methods: The study cohort included 2627 patients undergoing elective PCI between September 2008 and June 2010, whose baseline MPV measurements before PCI were available. The patients were divided into three groups of MPV < 9.1 fL, MPV = 9.1 to 10 fL, and MPV > 10 fL, and they were assessed for developing major adverse cardiac events (MACE), comprising death, myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR) over a one-year follow-up. Results: Of 2539 patients, major adverse cardiac events (MACE) at one year occurred in 77 (3.0%) patients, including mortality in 26 (1.0%). The patients in the highest tertile (MPV > 10 fL) had no increased frequency of MACE compared to those in the mid (9.1 to 10 fL) and lowest (< 9.1 fL) tertiles (3.3%, 2.2%, and 3.8%, respectively; p value = 0.14). No significant differences were found for each of the primary endpoints among the MPV tertiles. In multivariate logistic regression, we investigated the association between high MPV and total MACE (OR = 1.10, 95%CI: 0.69–1.77; p value = 0.68), death (OR = 1.14, 95%CI: 0.51–2.54; p value = 0.74), and non-fatal MI (OR = 1.85, 95%CI: 0.73–4.67; p value = 0.19) at one year's follow-up but MPV did not remain in the model in any of the cases. In the diabetic patients, the one-way analysis of variance demonstrated that mortality was 1.6% (4 patients) in the highest tertile, 0.8% (2 patients) in the mid tertile, and 0.5% (one patient) in the lowest tertile. Conclusion: There was no direct correlation between pre-procedural MPV and MACE in elective PCI. MPV can only be considered as an appropriate factor for predicting mortality in diabetic patients undergoing elective PCI.

  6. Extensive deendothelialization and thrombogenicity in routinely prepared vein grafts for coronary bypass operations: facts and remedy

    PubMed Central

    Weiss, Dominik R.; Juchem, Gerd; Kemkes, Bernhard M.; Gansera, Brigitte; Nees, Stephan

    2009-01-01

    The objective of this study was to gain deeper insight into the early reasons for saphenous vein graft disease and to find a practical approach to obviate it. Intraoperative storage of freshly explanted venous grafts (45 min, 20°C; n=25 in each case) in saline, saline + 5% albumin, or HTK-solution and also in heparinized autologous blood was poorly tolerated by the endothelium. Large endothelial areas (mostly >75% of total surface) were detached already during brief non-pulsatile flushing just before the transplantation. Contact of deendothelialized areas in graft remnants with defined mixtures of coagulation factors or blood (n=11-17) caused rapid coagulatory processes via expression of tissue factor and assembly of prothrombinase in the subendothelium. Attached platelets and leukocytes accelerated the procoagulatory processes further, and endothelium-dependent anticoagulatory activities were significantly abolished. During pulsatile arterial flow, the resulting blood clots exacerbated the damage of the intima markedly, because they were flushed away tearing off further endothelium. In contrast, storage of venous grafts in a plasma preparation freed from isoagglutinins and coagulation factors preserved the endothelium, which resisted arterial flow and revealed anticoagulatory activity in the presence of antithrombin III and/or protein C. We conclude that gentle preparation and preservation of the vascular endothelium with a suitable storage solution during bypass surgery is a decisive first step to obviate saphenous vein graft disease. PMID:19684884

  7. Aprotinin does not decrease early graft patency after coronary artery bypass grafting despite reducing postoperative bleeding and use of donated blood.

    PubMed

    Havel, M; Grabenwöger, F; Schneider, J; Laufer, G; Wollenek, G; Owen, A; Simon, P; Teufelsbauer, H; Wolner, E

    1994-03-01

    Forty-five male patients with planned coronary artery bypass operation were randomized in a double blind fashion to receive either 6 million kallikrein inactivator units of aprotinin (high-dose group), 2 million kallikrein inactivator units of aprotinin (low-dose group), or placebo (control group). Postoperative bleeding was significantly decreased in both aprotinin groups in comparison to that in the control group (590 ml [290 to 1800 ml] high-dose group and 650 ml [280 to 1900 ml] low-dose group versus 920 ml (350 to 2700 ml) control group, p < 0.001). There was no difference between the two aprotinin groups. The need for postoperative blood transfusion was significantly lower in the aprotinin groups (1.46 [0 to 4] blood units high-dose group and 1.65 [0 to 5] blood units low-dose group versus 2.43 [0 to 7] blood units control group, p < 0.05). All patients underwent coronary angiography between the seventh and twelfth postoperative day. No difference was found among the three groups in patency of vein grafts-93.8% in the high-dose group, 94.5% in the low-dose groups, and 93.3% in the control group. Therefore, aprotinin significantly reduced postoperative bleeding and transfusion requirement after coronary artery bypass grafting without influencing early graft patency. PMID:7510351

  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. 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

  10. The Relationships between Fatigue and Early Postoperative Recovery Outcomes Over Time in Elderly Coronary Artery Bypass Graft (CABG) Surgery Patients

    PubMed Central

    Barnason, Susan; Zimmerman, Lani; Nieveen, Janet; Schulz, Paula; Miller, Connie; Hertzog, Melody; Rasmussen, Doris

    2008-01-01

    BACKGROUND Despite successful coronary artery bypass graft (CABG) surgery, some patients continue to experience fatigue following their surgery. OBJECTIVE The purpose of this secondary analysis study was to examine the relationships of fatigue and early recovery outcomes (psychosocial and physiological functioning, and physical activity) over time (6-weeks and 3-months) among older adult subjects, age 65 years and older, following CABG surgery. Comparison groups were those subjects who had fatigue at 3-weeks after surgery and non-fatigued subjects. DESIGN A prospective, comparative design was used for this secondary analysis study. SAMPLE Subjects in this study were drawn from the control group of subjects enrolled in the larger, parent study. Subjects (N=119) were dichotomized into fatigue (n=66) and non-fatigued (n=53) groups based on their 3-week self-report of postoperative fatigue. RESULTS At 6-weeks after surgery, fatigued subjects had significantly (p<.05) more impaired psychosocial functioning, [role-emotional (t=1.9), social (t=2.6), and mental (t=1.9) functioning], based Medical Outcome Study short form-36 (MOS SF-36). They had significantly (p<.005) higher anxiety (t= ?3.6) and depression (t= ?2.9) mean Hospital Anxiety and Depression subscale (HADS) scores. Anxiety (t= ?2.3, p<.05) remained significantly (p<.05) impaired at 3-months. At 6-weeks, role physical functioning, measured by the MOS SF-36, was significantly impaired (t=2.4, p<.01). There were no significant differences in physical activity variables as measured by a RT3® accelerometer and self-report diary. CONCLUSIONS Persistent fatigue can hamper early recovery following CABG surgery. Tailored interventions are needed to address fatigue management and improve patient outcomes. PMID:18620100

  11. 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

  12. 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

  13. Release of soluble vascular endothelial growth factor receptor-1 (sFlt-1) during coronary artery bypass surgery

    PubMed Central

    Denizot, Yves; Leguyader, Alexandre; Cornu, Elisabeth; Laskar, Marc; Orsel, Isabelle; Vincent, Christelle; Nathan, Nathalie

    2007-01-01

    Background This study was conducted to follow plasma concentrations of sFlt-1 and sKDR, two soluble forms of the vascular endothelial growth factor (VEGF) receptor in patients undergoing coronary artery bypass graft (CABG) surgery with extracorporeal circulation (ECC). Methods Plasma samples were obtained before, during and after surgery in 15 patients scheduled to undergo CABG. Levels of sFlt-1 and KDR levels were investigated using specific ELISA. Results A 75-fold increase of sFlt-1 was found during cardiac surgery, sFlt-1 levels returning to pre-operative values at the 6th post-operative hour. In contrast sKDR levels did not change during surgery. The ECC-derived sFlt-1 was functional as judge by its inhibitory effect on the VEGF mitogenic response in human umbilical vein endothelial cells (HUVECs). Kinetic experiments revealed sFlt-1 release immediately after the beginning of ECC suggesting a proteolysis of its membrane form (mFlt-1) rather than an elevated transcription/translation process. Flow cytometry analysis highlighted no effect of ECC on the shedding of mFlt-1 on platelets and leukocytes suggesting vascular endothelial cell as a putative cell source for the ECC-derived sFlt-1. Conclusion sFlt-1 is released during CABG with ECC. It might be suggested that sFlt-1 production, by neutralizing VEGF and/or by inactivating membrane-bound Flt-1 and KDR receptors, might play a role in the occurrence of post-CABG complication. PMID:17888151

  14. Endotracheal tube cuff pressure assessment maneuver induces drop of expired tidal volume in the postoperative of coronary artery bypass grafting

    PubMed Central

    2012-01-01

    Background Previous investigations reported that the cuff pressure (CP) can decrease secondary to the CP evaluation itself. However is not established in literature if this loss of CP is able to generate alterations on expired tidal volume (ETV). Therefore, the aim of this study was to evaluate the potential consequences of the endotracheal CP assessment maneuver on CP levels and ETV in the early postoperative of coronary artery bypass grafting (CABG). Methods A total of 488 patients were analyzed. After the operation, the lungs were ventilated in pressure-assist-control mode and the same ventilatory settings were adjusted for all patients. After intensive care unit arrival, the cuff was fully deflated and then progressively inflated by air injection, to promote a minimal volume to occlude the trachea. To assist the cuff inflation and the air leakage identification, the graphical monitoring of the volume-time curve was adopted. After 20 minutes a first cuff pressure evaluation was performed (P1) and a second measurement (P2) was taken after 20 minutes with an analog manometer. ETV was obtained always pre and post P1 measurement. Results The CP assessment maneuver promoted a significant drop of P2 in relation to P1 when the manometer was attached to the pilot balloon (p?

  15. Remote ischemic preconditioning has a neutral effect on the incidence of kidney injury after coronary artery bypass graft surgery.

    PubMed

    Gallagher, Sean M; Jones, Dan A; Kapur, Akhil; Wragg, Andrew; Harwood, Steve M; Mathur, Rohini; Archbold, R Andrew; Uppal, Rakesh; Yaqoob, Muhammad M

    2015-02-01

    Acute kidney injury (AKI) is a frequent complication of cardiac surgery and usually occurs in patients with preexisting chronic kidney disease (CKD). Remote ischemic preconditioning (RIPC) may mitigate the renal ischemia-reperfusion injury associated with cardiac surgery and may be a preventive strategy for postsurgical AKI. We undertook a randomized controlled trial of RIPC to prevent AKI in 86 patients with CKD (estimated glomerular filtration rate under 60?ml/min per 1.73?m(2)) undergoing coronary artery bypass graft (CABG) surgery. Forty-three patients each were randomized to receive standard care with or without RIPC consisting of three 5-minute cycles of forearm ischemia followed by reperfusion. The primary end point was the development of AKI defined as an increase in serum creatinine concentration over 0.3?mg/dl within 48?h of surgery. Secondary end points included a comparison between the study and control groups of several serum biomarkers of renal injury including cystatin-C, neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 (IL-18), and urinary biomarkers including NGAL, IL-18, and kidney injury molecule-1 measured at 6, 12, and 24?h after CABG, and the 72-h serum troponin T concentration area under the curve as a marker of myocardial injury. Clinical and operative characteristics were similar between the preconditioned and control groups. AKI developed in 12 patients in both groups within 48?h of CABG. There were no significant differences between the two groups in the concentrations of any of the serum or urinary biomarkers of renal or cardiac injury after CABG. Thus, RIPC induced by forearm ischemia-reperfusion had no effect on the frequency of AKI after CABG in patients with CKD. PMID:25075773

  16. Value of thallium-201 reinjection after delayed SPECT imaging for predicting reversible ischemia after coronary artery bypass grafting

    SciTech Connect

    Ohtani, H.; Tamaki, N.; Yonekura, Y.; Mohiuddin, I.H.; Hirata, K.; Ban, T.; Konishi, J. (Kyoto Univ. Faculty of Medicine (Japan))

    1990-08-15

    The reinjection of a small dose (40 MBq) of thallium-201 after stress and delayed imaging often shows new redistribution in the regions with persistent defect. To assess whether these segments may represent reversible ischemia, reinjection thallium-201 single-photon emission computed tomography (SPECT) was performed after stress and 3-hour delayed imaging in 24 patients before coronary artery bypass grafting (CABG). The left ventricular myocardium was divided into 5 myocardial segments and regional wall motion was scored on a scale from 0 (normal) to 4 (dyskinesia). Thallium-201 findings were compared with improvement in regional perfusion and wall motion 1 to 2 months after CABG. The reinjection imaging identified new redistribution in 15 of 32 persistent defects (47%) on the 3-hour delayed images. In the study of stress and delayed SPECT imaging, the improvement in perfusion was observed in 34 of 43 segments (79%) exhibiting redistribution and 15 of 32 (47%) segments without redistribution (p less than 0.01). The reinjection SPECT identified new redistribution in 12 of the 15 improved segments that were not detected on the delayed images. Similarly, the improvement in wall motion was observed in 23 of 31 segments (74%) exhibiting redistribution and 14 of 30 segments (47%) without redistribution on the delayed images (p less than 0.05). The reinjection identified new redistribution in 10 of the 14 improved segments that were undetected on the delayed images. The predictive values for improvement in perfusion and wall motion by the reinjection imaging were significantly higher (92 and 89%) than those by the delayed imaging (69 and 62%, respectively, p less than 0.05 each).

  17. Establishment of a rabbit model of coronary artery bypass graft and endothelial nitric oxide synthase gene transfection.

    PubMed

    Zhu, Y; Wang, H-S; Li, X-M; Wang, Z-W

    2015-01-01

    This study established an animal model of coronary artery bypass graft (CABG) surgery. The human endothelial nitric oxide synthase (eNOS) gene was transfected into grafted arterial walls to verify transfection efficiency. Forty rabbits were randomized into the following 4 equal groups: 1) eNOS gene transfection group (eNOS group); 2) empty eNOS gene transfection group (empty gene group); 3) control group; 4) normal femoral artery group. Grafted arteries, and normal carotid and femoral artery specimens were obtained 3 weeks later. Immunohistochemistry and analyses of tissue nitric oxide (NO) levels, eNOS activity, and eNOS protein western blotting were performed. The effectiveness and efficiency of transfection were observed and confirmed. All rabbits survived. The grafted arteries retained patency. Varying degrees of adaptability changes were observed in grafted arteries in each group. The eNOS group exhibited vascular wall thickening and significantly increased eNOS protein expression. The control and empty gene groups exhibited vessel wall degeneration, and eNOS protein was weakly or not expressed (P < 0.05). The arterial wall NO concentration and total eNOS activity in the eNOS group were significantly higher than those in the other groups (P < 0.05). Western blotting demonstrated that the vascular wall eNOS protein concentration was significantly greater than that in the other groups (P < 0.05). Furthermore, the eNOS gene transfection can increase eNOS expression and activity in vessel walls, increasing local NO concentration and expression. PMID:25730087

  18. Histological evaluation of age-related variations in saphenous vein grafts used for coronary artery bypass grafting

    PubMed Central

    Mali?ska, Agnieszka; Nowicki, Micha?; Misterski, Marcin; Ostalska-Nowicka, Danuta; Jemielity, Marek

    2012-01-01

    Introduction Venous coronary artery bypass grafts (CABG) might undergo a process of arterialization resulting in neointimal formation and medial hypertrophy. It is often followed by critical occlusion of the graft lumen. The aim of the study was to assess histological representative features of saphenous vein reconstruction in aging as well as to establish optimal patients’ age limits applicable for optimal selection of grafts. Material and methods One hundred and ten patients undergoing venous CABG were divided into 4 age subgroups: (A) 50 years and less, (B) 51-60 years, (C) 61-70 years and (D) > 70 year-old subjects. Distal venous graft segments were saved for an adequate morphometric assay which was followed by suitable statistical analysis. Results The entire venous wall thickness as well as its tunica media were found to become significantly thinner between subgroups A and D. The number of smooth muscle cell (SMC) nuclei within the tunica media did not differ between study subgroups. The majority of these nuclei in subgroup D were found, however, to be more elongated than in subgroup A (SMC length/width index in subgroup D was found to be significantly higher than in subgroup A). Conclusions Progressive, age-related thinning of the venous wall and tunica media as well as SMC nucleus elongation might suggest impairment of SMCs’ migration and proliferation rate. Consequently, individuals aged 70 years and over may benefit clinically more from venous CABG than younger patients due to the lower risk of arterialization and occlusion of the graft lumen in the future. PMID:23319979

  19. Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Seabra, Victor F.; Alobaidi, Sami; Balk, Ethan M.; Poon, Alan H.

    2010-01-01

    Background and objectives: Off-pump coronary artery bypass grafting (CABG) has been advocated to cause less inflammation, morbidity, and mortality than the more traditional on-pump technique. This meta-analysis compares these two surgical techniques with respect to causing acute kidney injury (AKI). Design, setting, participants, & measurements: This study searched for randomized controlled trials in MEDLINE and abstracts from the proceedings of scientific meetings through February 2010. Included were trials comparing off-pump to on-pump CABG that reported the incidence of AKI, as defined by a mixture of criteria including biochemical parameter/urine output/dialysis requirement. Mortality was evaluated among the studies that reported kidney-related outcomes. For primary and subgroup analyses, fixed-effect meta-analyses of odds ratios (OR) were performed. Results: In 22 identified trials (4819 patients), the weighted incidence of AKI in the on-pump CABG group was 4.0% (95% confidence interval [CI] 1.8%, 8.5%), dialysis requirement 2.4% (95% CI 1.6%, 3.7%), and mortality 2.6% (95% CI 1.6%, 4.0%). By meta-analysis, off-pump CABG was associated with a 40% lower odds of postoperative AKI (OR 0.60; 95% CI 0.43, 0.84; P = 0.003) and a nonsignificant 33% lower odds for dialysis requirement (OR 0.67; 95% CI 0.40, 1.12; P = 0.12). Within the selected trials, off-pump CABG was not associated with a significant decrease in mortality. Conclusions: Off-pump CABG may be associated with a lower incidence of postoperative AKI but may not affect dialysis requirement, a serious complication of cardiac surgery. However, the different definitions of AKI used in individual trials and methodological concerns preclude definitive conclusions. PMID:20671222

  20. Application of Lidocaine Jelly on Chest Tubes to Reduce Pain Caused by Drainage Catheter after Coronary Artery Bypass Surgery

    PubMed Central

    Choe, Ju Won; Woo, Young Cheol; Kim, Sang Wook; Park, Soon J.

    2014-01-01

    The objective of this study was to assess the effect of lidocaine jelly application to chest tubes on the intensity and duration of overall pain, chest tube site pain and the required analgesics for postoperative pain relief in coronary artery bypass graft (CABG) patients. For patients in group L, we applied sterile 2% lidocaine jelly on the chest tubes just before insertion, and for patients in group C, we applied normal saline. Overall visual analogue scale (VAS), maximal pain area with their VAS were documented postoperatively, and the frequency that button of patient-controlled analgesia was pressed (FPB) and total fentanyl consumption were assessed. The number of patients who complained that tube site was the most painful site was significantly higher in group C than in group L (85% vs. 30% at extubation, P<0.001). The overall VAS score was significantly higher in group C than in group L (39.14±12.49 vs. 27.74±13.76 at extubation, P=0.006). After all of the tubes were removed, the VAS score decreased more in group C (5.74±4.77, P<0.001) than in group L (3.05±2.48, P<0.001). FPB and total fentanyl consumption were significantly higher in group C than in group L (73.00, 59.00-78.00 vs. 34.00, 31.00-39.25, P<0.001; 2,214.65±37.01 vs. 1,720.19±361.63, P<0.001, respectively). Lidocaine jelly application is a very simple way to reduce postoperative pain by reducing chest tube site pain after CABG. (Clinical Trials Registry No. ACTRN 12611001215910) PMID:25368494

  1. The effect of posterior pericardiotomy on pericardial effusion and atrial fibrillation after off-pump coronary artery bypass graft.

    PubMed

    Haddadzadeh, Mahdi; Motavaselian, Mahtab; Rahimianfar, Ali Akbar; Forouzannia, Seyed Khalil; Emami, Mahmood; Barzegar, Kazem

    2015-01-01

    The most common type of arrhythmia following coronary artery bypass graft (CABG) is atrial fibrillation (AF) with an incidence rate of 20-30%. Pericardial effusion is one of the etiologic factors of atrial fibrillation occurring after CABG. Posterior pericardiotomy (PP) causes the drainage of blood and fluids from the pericardial space into the pleural space leading to a decreased pericardial effusion. Most of the studies dealing with the occurrence of AF in the surgical operation of CABG have focused on patients undergoing on-pump CABG. The purpose of the present study was to determine the effect of posterior pericardiotomy on pericardial effusion and atrial fibrillation following the off-pump CABG. This study was a clinical trial conducted on 207 patients. The patients were randomly assigned to groups A, and B. Posterior pericardiotomy was performed on the patients in Group A. This was not done on patients in Group B. Following general anesthesia and median sternotomy, the left internal mammary artery (LIMA) and saphenous vein were harvested simultaneously. Following the injection of heparin, distal and proximal anastomosis was performed and at the end of surgery, a longitudinal incision with a length of 4 cm was performed parallel and posterior to the left phrenic nerve from the left vein to diaphragm for patients in the pericardiotomy group. 105 patients in the pericardiotomy group and 102 patients in the control group were examined regarding demographic variables, AF incidence, and pericardial effusion. There was no statistically significant correlation between two groups. There was no statistically significant difference between the two groups regarding the rate of AF incidence (P=0.719) and the rate of pericardial effusion (P=1). Posterior pericardiotomy has no effect on postoperative AF incidence and pericardial effusion in patients undergoing the off-pump CABG. PMID:25597607

  2. 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

  3. 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

  4. 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

  5. Coronary artery bypass on the beating heart with the Octopus: a North American experience 1 1 Doctor Spooner is a stockholder in Medtronic and is employed as a consultant for education and future development of the Octopus device. Ginny E. Dixon is employed as a consultant for education and future development of the device

    Microsoft Academic Search

    Ted H Spooner; Peter E Dyrud; Bjorn K Monson; Ginny E Dixon; Len D Robinson

    1998-01-01

    Background. The practice of minimally invasive coronary artery bypass grafting remains controversial. This study outlines the results of single and multiple vessel bypass performed using the Medtronic Octopus Tissue Stabilization System and beating heart techniques. Results are compared with those of a standard cardiopulmonary bypass group.Methods. The group included 89 patients having operations performed during a 10-month period with average

  6. 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

  7. Effect of remote ischemic preconditioning in the elderly patients with coronary artery disease with diabetes mellitus undergoing elective drug-eluting stent implantation.

    PubMed

    Xu, Xiaohan; Zhou, Yujie; Luo, Shengjie; Zhang, Weijun; Zhao, Yingxin; Yu, Miao; Ma, Qian; Gao, Fei; Shen, Hua; Zhang, Jianwei

    2014-09-01

    There is conflicting evidence regarding the effectiveness of remote ischemic preconditioning (RIPC) in patients undergoing elective percutaneous coronary intervention (PCI). Therefore, we prospectively enrolled elderly patients with coronary heart disease (CHD) with diabetes mellitus (DM) undergoing elective drug-eluting stent (DES) implantation. They were randomized to receive RIPC within 2 hours before PCI (n = 102) or not (controls, n = 98). Baseline clinical characteristics were similar between the 2 groups. Despite a trend toward decline, the median high-sensitivity cardiac troponin I (hscTnI) level (P = .256) and the incidence of myocardial infarction (MI) type 4a (P = .106) in the RIPC group 16 hours after PCI procedure was not significantly different from the control group. The RIPC could attenuate the release of a myocardial biomarker but failed to show a significant effect on hscTnI level or MI type 4a incidence after PCI procedure in elderly patients with CHD having DM undergoing elective DES implantation. PMID:24163121

  8. Does a minimally invasive approach result in better pulmonary function postoperatively when compared with median sternotomy for coronary artery bypass graft?

    PubMed

    Dooley, Andrew; Asimakopoulos, George

    2013-06-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does a minimally invasive approach result in better pulmonary function postoperatively when compared with median sternotomy for coronary artery bypass graft?'. Procedures such as limited sternotomy and minimally invasive direct coronary artery bypass (MIDCAB) though a minithoracotomy were regarded as minimally invasive. Overall, 681 papers were found, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, evidence level, relevant outcomes and results of these papers were tabulated. Three randomized, controlled trials (RCT) were included: One study suggested that ministernotomy dividing the corpus sterni (n = 50) offers no advantage over standard sternotomy (n = 50) during the first 10 postoperative days. Two further studies reported on minithoracotomy: one trial presented data suggesting that minithoracotomy (n = 21) is as safe as standard sternotomy with (n = 18) or without (n = 19) cardiopulmonary bypass, but without the benefit ascribed to the minimally invasive incision. A two-centre report investigated pulmonary function as a secondary outcome and claimed that minithoracotomy worsens FEV1 and FVC. The study was not powered to detect these differences as pulmonary function data were available only for one of the centres. Five non-randomized reports were also included in this analysis: These investigated outcomes after minithoracotomy or limited sternotomy compared with standard sternotomy. Patient groups were small, involving <20 subjects per group. Non-randomized studies suggested a benefit to postoperative lung function in using thoracotomy. One of these reports included only patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 <70% of predicted) and detected benefits in selected patients undergoing MIDCAB. A further study was in agreement with the above statement in patients without COPD. MIDCAB may be more painful initially, but results in quicker recovery of lung function. Demonstrating the benefits of ministernotomy compared with the standard sternal incision was less clear. One paper demonstrates better outcomes when compared with standard sternotomy, while another reports no difference. We conclude that non-randomized studies support the hypothesis that minimally invasive coronary artery bypass benefits postoperative lung function in patients with known respiratory problems. PMID:23442936

  9. Predicting target vessel location on robot-assisted coronary artery bypass graft using CT to ultrasound registration

    SciTech Connect

    Cho, Daniel S.; Linte, Cristian; Chen, Elvis C. S.; Bainbridge, Daniel; Wedlake, Chris; Moore, John; Barron, John; Patel, Rajni; Peters, Terry [Imaging Research Laboratories, Robarts Research Institute and Biomedical Engineering Graduate Program, University of Western Ontario, Ontario N6A 5K8 (Canada); Imaging Research Laboratories, Robarts Research Institute and Biomedical Imaging Resource, Mayo Clinic, Rochester, Minnesota 55905 (United States); Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, Ontario N6A 5K8 (Canada); Canadian Surgical Technologies and Advanced Robotics, London, Ontario N6A 5A5 (Canada); Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, Ontario N6A 5K8 (Canada); Department of Computer Science, University of Western Ontario, Ontario N6A 5B7 (Canada); Canadian Surgical Technologies and Advanced Robotics, London, Ontario N6A 5A5 (Canada); Imaging Research Laboratories, Robarts Research Institute, Biomedical Engineering Graduate Program, University of Western Ontario N6A 5K8 (Canada); and Canadian Surgical Technologies and Advanced Robotics, London, Ontario N6A 5A5 (Canada)

    2012-03-15

    Purpose: Although robot-assisted coronary artery bypass grafting (RA-CABG) has gained more acceptance worldwide, its success still depends on the surgeon's experience and expertise, and the conversion rate to full sternotomy is in the order of 15%-25%. One of the reasons for conversion is poor pre-operative planning, which is based solely on pre-operative computed tomography (CT) images. In this paper, the authors propose a technique to estimate the global peri-operative displacement of the heart and to predict the intra-operative target vessel location, validated via both an in vitro and a clinical study. Methods: As the peri-operative heart migration during RA-CABG has never been reported in the literatures, a simple in vitro validation study was conducted using a heart phantom. To mimic the clinical workflow, a pre-operative CT as well as peri-operative ultrasound images at three different stages in the procedure (Stage{sub 0}--following intubation; Stage{sub 1}--following lung deflation; and Stage{sub 2}--following thoracic insufflation) were acquired during the experiment. Following image acquisition, a rigid-body registration using iterative closest point algorithm with the robust estimator was employed to map the pre-operative stage to each of the peri-operative ones, to estimate the heart migration and predict the peri-operative target vessel location. Moreover, a clinical validation of this technique was conducted using offline patient data, where a Monte Carlo simulation was used to overcome the limitations arising due to the invisibility of the target vessel in the peri-operative ultrasound images. Results: For the in vitro study, the computed target registration error (TRE) at Stage{sub 0}, Stage{sub 1}, and Stage{sub 2} was 2.1, 3.3, and 2.6 mm, respectively. According to the offline clinical validation study, the maximum TRE at the left anterior descending (LAD) coronary artery was 4.1 mm at Stage{sub 0}, 5.1 mm at Stage{sub 1}, and 3.4 mm at Stage{sub 2}. Conclusions: The authors proposed a method to measure and validate peri-operative shifts of the heart during RA-CABG. In vitro and clinical validation studies were conducted and yielded a TRE in the order of 5 mm for all cases. As the desired clinical accuracy imposed by this procedure is on the order of one intercostal space (10-15 mm), our technique suits the clinical requirements. The authors therefore believe this technique has the potential to improve the pre-operative planning by updating peri-operative migration patterns of the heart and, consequently, will lead to reduced conversion to conventional open thoracic procedures.

  10. Pharmacology and Biological Efficacy of a Recombinant, Humanized, Single-Chain Antibody C5 Complement Inhibitor in Patients Undergoing Coronary Artery Bypass Graft Surgery With Cardiopulmonary Bypass

    Microsoft Academic Search

    Jane C. K. Fitch; Scott Rollins; Louis Matis; Bernadette Alford; Sary Aranki; Charles D. Collard; Michael Dewar; John Elefteriades; Roberta Hines; Gary Kopf; Philip Kraker; Lan Li; Ruth O'Hara; Christine Rinder; Henry Rinder; Richard Shaw; Brian Smith; Gregory Stahl; Stanton K. Shernan

    2010-01-01

    Background—Cardiopulmonary bypass (CPB) induces a systemic inflammatory response that causes substantial clinical morbidity. Activation of complement during CPB contributes significantly to this inflammatory process. We examined the capability of a novel therapeutic complement inhibitor to prevent pathological complement activation and tissue injury in patients undergoing CPB. Methods and Results—A humanized, recombinant, single-chain antibody specific for human C5, h5G1.1-scFv, was intravenously

  11. Should we consider beating-heart on-pump coronary artery bypass grafting over conventional cardioplegic arrest to improve postoperative outcomes in selected patients?

    PubMed

    Al Jaaly, Emad; Chaudhry, Umar A R; Harling, Leanne; Athanasiou, Thanos

    2015-04-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether beating-heart on-pump coronary artery bypass grafting (BH-ONCAB) offered superior mortality and morbidity outcomes when compared with conventional on-pump coronary artery bypass grafting (C-ONCAB). Morbidity outcomes consisted of renal failure, stroke (transient or permanent), myocardial infarction, angina, congestive cardiac failure, reintervention and arrhythmias. Best evidence papers investigating BH-ONCAB versus C-ONCAB were considered. Where data were duplicated, the more credible evidence-based and recently published study was included. Two hundred and thirty-one papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. Two were prospective randomized controlled trials and the remaining 10 observational studies, of which one was propensity-matched. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Five of these studies demonstrated significantly improved mortality following BH-ONCAB; however, one study exhibited better survival after C-ONCAB. Notably, this study incorporated BH-ONCAB patients with significantly more haemodynamic instability, thus possibly explaining the worse mortality outcomes. In terms of morbidity, a slightly more mixed picture is drawn. Five studies report morbidity in favour of BH-ONCAB, whereas three studies include individual outcomes favouring C-ONCAB. The remaining studies showed equivalent mortality and morbidity data. In summary, the results presented here suggest that BH-ONCAB may improve survival following coronary artery bypass surgery. A key observation is that the greatest benefits of BH-ONCAB appear to be in studies including patients with considerably higher risk characteristics at the time of surgery (haemodialysis, end-stage coronary artery disease, emergency surgery, low ejection fraction). There are limitations of the current evidence presented. Only two studies were randomized controlled trials. There was variability in sample size, selection criteria and preoperative risk profiles between the studies. The studies span many years, and the outcomes may have been affected by evolving technologies and differing patient profiles between these periods. PMID:25535178

  12. Activation of coagulation and fibrinolysis during coronary artery bypass grafting: a comparison between on-pump and off-pump techniques.

    PubMed

    Roy, Shreosee; Saha, Kaushik; Mukherjee, Krishnendu; Dutta, Santanu; Mukhopadhyay, Debasis; Das, Indranil; Raychaudhuri, Gargi

    2014-12-01

    Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) is associated with intense activation of hemostatic mechanisms. But the precise knowledge of the effects of eliminating CPB in patients undergoing off-pump coronary artery bypass grafting (CABG) are not well established. The present study was carried out to compare and document the changes in selected coagulation and fibrinolysis variables in patients undergoing on-pump and off-pump CABG (OPCAB). A total of 42 patients of on-pump and 31 patients of off-pump CABG were selected for the study. Platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), Fibrinogen and D-dimer levels were measured immediately, 24 h and 7 days after operation and compared with the baseline preoperative values. Statistical analysis was done by mixed ANOVA for repeated measures and Post-hoc tests using the Bonferroni correction, Chi square and unpaired t test. All the parameters were significantly changed (P < 0.05) with the time. Platelet counts, fibrinogen and D-dimer levels were significantly different between on-pump and off-pump CABG patients on immediate and 24 h postoperative period and attained almost same level after 7 days of operation. Fibrinogen level and platelet counts were increased after a sharp fall in the immediate post-operative period whereas D-dimer levels were persistently increased with a sharp peak of rise in the immediate post-operative period in on-pump group. On-pump surgery was associated with excessive fibrinolytic activity immediately after operation. The off-pump group demonstrated less activation of coagulation and fibrinolysis and delayed postoperative response that became almost equal to the on-pump group in the later postoperative period. PMID:25435738

  13. Development and validation of a clinical prediction rule for major adverse outcomes in coronary bypass grafting ? ? A list of the members of the Academic Medical Center Consortium Quality Measurement and Management Initiative Working Group appears in the Appendix

    Microsoft Academic Search

    Elizabeth B Fortescue; Katherine Kahn; David W Bates

    2001-01-01

    In this study, we develop and internally validate a clinical prediction rule for in-hospital major adverse outcomes, defined as death, renal failure, reinfarction, cardiac arrest, cerebrovascular accident, or coma, in patients who underwent coronary artery bypass grafting (CABG). All adult patients (n = 9,498) who underwent a CABG and no other concomitant surgery at 12 academic medical centers from August

  14. Coronary Artery Bypass

    MedlinePLUS

    ... some cases, on the morning of surgery. Small metal disks called electrodes will be attached to your ... throat, into your stomach. This tube will stop liquid and air from collecting in your stomach, so ...

  15. Coronary Artery Bypass Grafting

    MedlinePLUS

    ... are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. ... Media Availability: Mitral valve repair following heart attack may offer ...

  16. 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

  17. 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

  18. Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation

    Microsoft Academic Search

    Yukio Okazaki; Kyomi Takarabe; Jun-ichi Murayama; Etsuro Suenaga; Kojiro Furukawa; Kazuhisa Rikitake; Masafumi Natsuaki; Tsuyoshi Itoh

    2001-01-01

    Objective: Although off-pump coronary artery bypass grafting (CABG) has been recognized less invasive than conventional CABG on cardiopulmonary bypass, off-pump CABG may be partly invasive especially to the coronary endothelium. The present study was designed to evaluate the adverse effects of coronary snaring with looped sutures and gas insufflation on the coronary endothelium. The protective efficacies on the coronary endothelium

  19. Radionuclide angiographic assessment of global and segmental left ventricular function at rest and during exercise after coronary artery bypass graft surgery

    SciTech Connect

    Lim, Y.L.; Kalff, V.; Kelly, M.J.; Mason, P.J.; Currie, P.J.; Harper, R.W.; Anderson, S.T.; Federman, J.; Stirling, G.R.; Pitt, A.

    1982-11-01

    Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The right anterior oblique gated first-pass technique was used to assess LVEF response to maximal exercise (Wmax), while the left anterior oblique equilibrium-gated technique was used to assess LVEF and relative LV volume changes during graded submaximal execise. The five subjects in whom LVEF decreased significantly during exercise postoperatively all had one or more blocked or stenosed grafts. This study documents, by two independent radionuclide techniques, an improved LVEF during exercise at an increased maximal work capacity and rate-pressure product 3 months after successful CABG. (JMT)

  20. Translation of appropriateness criteria into practice guidelines: application of decision table techniques to the RAND criteria for coronary artery bypass graft.

    PubMed

    Shiffman, R N; Leape, L L; Greenes, R A

    1993-01-01

    The process of creating clinical practice guidelines from collected evidence has not been well defined. We have developed a technique for translation of a comprehensive set of appropriateness criteria into a usable set of practice guidelines. The criteria are derived from a formal consensus process conducted by RAND and relate to indications for coronary artery bypass graft in acute myocardial infarction. The clinical indications defined by the expert panel are entered as conditions in a decision table. For each combination of relevant clinical findings, the recommended action is defined from the median ranking of the Rand panel. The fully constructed table is next compacted by conventional decision table techniques and sorted to facilitate parsing the knowledge. Ultimately, 8 narrative statements are derived from 51 rules. Augmented decision tables permit display of detailed data in the summary table and its access on an as-needed basis. PMID:8130471

  1. Technical considerations in deploying the sheathed Palmaz-Schatz stent in distal coronary artery and bypass graft lesions.

    PubMed

    Agarwal, R; Kaul, U; Jain, P

    1996-01-01

    The deliverable catheter length of the Palmaz-Schatz stent delivery system is significantly limited by the protective sheath and clamshell device. This limitation must be considered when planning distal stent placement, especially in bypass graft lesions. A technique for shortening the guide catheter without losing guidewire position is described. PMID:8770485

  2. Subclinical Cerebral Complications After Coronary Artery Bypass Grafting: Prospective Analysis With Magnetic Resonance Imaging, Quantitative Electroencephalography, and Neuropsychological Assessment

    Microsoft Academic Search

    Ritva Vanninen; Marja Aikia; Mervi Kononen; Kaarina Partanen; Harri Tulla; Paivi Hartikainen; Juhani Partanen; Hannu Manninen; Pentti Enberg; Mikko Hippelainen

    1998-01-01

    Objective: To analyze the frequency and severity of sub- clinical cerebral complications associated with coro- nary artery bypass grafting (CABG). Design: A prospective controlled study using preopera- tive and postoperative magnetic resonance imaging (MRI) of the brain, quantitative electroencephalography (QEEG), and detailed neuropsychological and neurologic exami- nations as potentially sensitive indicators of subclinical cerebral injury associated with CABG.

  3. Endovascular Stenting under Cardiac and Cerebral Protection for Subclavian Steal after Coronary Artery Bypass Grafting Due to Right Subclavian Artery Origin Stenosis

    PubMed Central

    Kiura, Yoshihiro; Okazaki, Takahito; Ichinose, Nobuhiko; Kurisu, Kaoru

    2015-01-01

    Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications. PMID:25874182

  4. Comparison of peak filling rate of left ventricle pre and post coronary bypass graft in patients with and without myocardial infarction

    SciTech Connect

    Hourani, M.; Gentili, A.; Bolooki, H.; Clarke, L.; Ashkar, F.; Sfakianakis, G.; Serafini, A.

    1984-01-01

    The study was undertaken to evaluate improvement in diastolic function by measuring peak filling rate (PFR) of left ventricle in 57 patients (pts) undergoing coronary artery bypass graft (CABG). Twenty seven patients had coronary artery disease (CAD) but no history of myocardial infarction (MI) (Group 1). Twenty three patients had documented (MI) but no aneurysms (Group 2). Group 3 had 7 patients with CAD and aneurysms. The pre and post operative ejection fraction (EF) and PFR were calculated from the time activity curve of resting gated cardiac studies performed so that the time per frame was 0.03 sec. The authors conclude that PFR is a more sensitive index than EF in evaluating the post-operative improvement in ventricular function in patients undergoing CABG especially in patients with normal wall motion and normal ejection fraction and will be a useful index to use for the follow-up of these patients. Improvement in PFR correlated well with the post-operative course of the patients. All patients who decreased thin PFR had a complicated post-op-course.

  5. Heart bypass surgery - minimally invasive

    MedlinePLUS

    ... MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery ... To perform this surgery: The heart surgeon will make a 3- to 5-inch-long surgical cut in the left part of your chest between your ribs ...

  6. Comparing On-pump and Off-pump Coronary Artery Bypass Grafting. Numerous Studies but Few Conclusions. A Scientific Statement From the American Heart Association Council on Cardiovascular Surgery and Anesthesia in Collaboration With the Interdisciplinary Working Group on Quality of Care and Outcomes Research

    Microsoft Academic Search

    Frank W. Sellke; J. Michael DiMaio; Louis R. Caplan

    2005-01-01

    One of the most hotly debated and polarizing issues in cardiac surgery has been whether coronary artery bypass grafting (CABG) without the use of cardiopulmonary bypass or cardioplegia (off-pump CABG, or OPCAB) is superior to that performed with the heart-lung machine and the heart's being chemically arrested (standard CABG). Various clinical trials are reviewed comparing the 2 surgical strategies, including

  7. Coronary Revascularization in Diabetic Patients A Comparison of the Randomized and Observational Components of the Bypass Angioplasty Revascularization Investigation (BARI)

    Microsoft Academic Search

    Katherine M. Detre; Ping Guo; Richard Holubkov; Robert M. Califf; George Sopko; Richard Bach; Maria Mori Brooks; Martial G. Bourassa; Richard J. Shemin; Allan D. Rosen; Ronald J. Krone; Robert L. Frye; Frederick Feit

    Background—Patients with treated diabetes in the randomized-trial segment of the Bypass Angioplasty Revascularization Investigation (BARI) who were randomized to initial revascularization with PTCA had significantly worse 5-year survival than patients assigned to CABG. This treatment difference was not seen among diabetic patients eligible for BARI who opted to select their mode of revascularization. We hypothesized that differences in patient characteristics,

  8. A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery

    Microsoft Academic Search

    Bob Kiaii; Byung C. Moon; David Massel; Yves Langlois; Thomas W. Austin; Andrea Willoughby; C. Guiraudon; Craig R. Howard; L. Ray Guo

    2002-01-01

    Objectives: Our objectives were (1) to determine whether minimally invasive endoscopic harvesting of the saphenous vein reduces morbidity due to postoperative wound infection and pain with improved cosmetic results and mobilization as compared with the conventional technique and (2) to compare the histologic properties of the saphenous veins harvested conventionally and endoscopically. Methods: One hundred forty-four patients undergoing coronary artery

  9. Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age

    Microsoft Academic Search

    Jens-Holger A Krannich; Peter Weyers; Stefan Lueger; Michael Herzog; Thomas Bohrer; Olaf Elert

    2007-01-01

    BACKGROUND: Scientific literature on depression and anxiety in patients with coronary heart disease (CHD) consistently reports data of elevated anxiety and depression scores indicating clinically relevant quantities of these psychopathological conditions. Depression is considered to be a risk factor for the development of CHD and deteriorates the outcome after cardiac rehabilitation efforts. The aim of our study was to evaluate

  10. Influence of diabetes mellitus on long-term outcomes of patients with unprotected left main coronary artery disease treated with either drug-eluting stents or coronary artery bypass grafting.

    PubMed

    Yu, Xianpeng; He, Jiqiang; Luo, Yawei; Yuan, Fei; Song, Xiantao; Gao, Yuechun; Li, Quan; Huang, Fangjiong; Gu, Chengxiong; Lv, Shuzheng; Chen, Fang

    2015-01-21

    Whether the effect of diabetes on patients with unprotected left main coronary artery (ULMCA) disease differs according to different strategies of revascularization was unknown. This study was conducted to evaluate the impact of diabetes on patients with ULMCA disease treated with either percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG).A total of 922 patients with ULMCA disease who received drug-eluting stent (DES) (n = 465) implantation or underwent CABG (n = 457) were retrospectively analyzed. We compared the effects of these 2 treatments on clinical outcomes (death, myocardial infarction, stroke, repeat revascularization, and the composite of death, myocardial infarction, or stroke), according to diabetic status.During the median follow-up of 7.1 years (interquartile range, 5.3 to 8.2 years), no difference was found between PCI and CABG in the adjusted occurrence of death (P = 0.112) and the composite endpoints of death, myocardial infarction, and stroke (P = 0.235). Significantly higher incidence of repeat revascularization (P < 0.001) was observed in the DES group, whereas the CABG group had a significantly higher rate of stroke (P = 0.001). These trends were consistent in both diabetic and nondiabetic patients. We did not observe significant interactions between treatment outcomes and the presence or absence of diabetes after adjustment for covariates (Pinteraction = 0.580 for the composite of death, MI and stroke, Pinteraction = 0.685 for death, Pinteraction = 0.416 for MI, Pinteraction = 0.470 for stroke, and Pinteraction = 0.502 for repeat revascularization).Presence of diabetes was not important for decision-making between CABG and PCI in patients with ULMCA disease. PMID:25742942

  11. Mechanisms of Death in the CABG Patch Trial A Randomized Trial of Implantable Cardiac Defibrillator Prophylaxis in Patients at High Risk of Death After Coronary Artery Bypass Graft Surgery

    Microsoft Academic Search

    J. Thomas Bigger; William Whang; Jeffrey N. Rottman; Robert E. Kleiger; Charles D. Gottlieb; Pearila B. Namerow; Richard C. Steinman; N. A. Mark; Estes III

    Background—The CABG Patch trial compared prophylactic implantable cardiac-defibrillator (ICD) implantation with no antiarrhythmic therapy in coronary bypass surgery patients who had a left ventricular ejection fraction ,0.36 and an abnormal signal-averaged ECG. There were 102 deaths among the 446 ICD group patients and 96 deaths among the 454 control group patients, a hazard ratio of 1.07 (P50.63). The mechanisms of

  12. Remote Ischemic Preconditioning Reduces Perioperative Cardiac and Renal Events in Patients Undergoing Elective Coronary Intervention: A Meta-Analysis of 11 Randomized Trials

    PubMed Central

    Pei, Hanjun; Wu, Yongjian; Wei, Yingjie; Yang, Yuejin; Teng, Siyong; Zhang, Haitao

    2014-01-01

    Background Results from randomized controlled trials (RCT) concerning cardiac and renal effect of remote ischemic preconditioning(RIPC) in patients with stable coronary artery disease(CAD) are inconsistent. The aim of this study was to explore whether RIPC reduce cardiac and renal events after elective percutaneous coronary intervention (PCI). Methods and Results RCTs with data on cardiac or renal effect of RIPC in PCI were searched from Pubmed, EMBase, and Cochrane library (up to July 2014). Meta-regression and subgroup analysis were performed to identify the potential sources of significant heterogeneity(I2?40%). Eleven RCTs enrolling a total of 1713 study subjects with stable CAD were selected. Compared with controls, RIPC significantly reduced perioperative incidence of myocardial infarction (MI) [odds ratio(OR) ?=?0.68; 95% CI, 0.51 to 0.91; P?=?0.01; I2?=?41.0%] and contrast-induced acute kidney injury(AKI) (OR?=?0.61; 95% CI, 0.38 to 0.98; P?=?0.04; I2?=?39.0%). Meta-regression and subgroup analyses confirmed that the major source of heterogeneity for the incidence of MI was male proportion (coefficient ?=??0.049; P?=?0.047; adjusted R2?=?0.988; P?=?0.02 for subgroup difference). Conclusions The present meta-analysis of RCTs suggests that RIPC may offer cardiorenal protection by reducing the incidence of MI and AKI in patients undergoing elective PCI. Moreover, this effect on MI is more pronounced in male subjects. Future high-quality, large-scale clinical trials should focus on the long-term clinical effect of RIPC. PMID:25551671

  13. Serum Lactate Is not Correlated with Mixed or Central Venous Oxygen Saturation for Detecting Tissue Hypo Perfusion During Coronary Artery Bypass Graft Surgery: A Prospective Observational Study

    PubMed Central

    Shahbazi, Shahrbano; Khademi, Saeed; Shafa, Masih; Joybar, Reza; Hadibarhaghtalab, Maryam; Sahmeddini, Mohammad Ali

    2013-01-01

    Objectives: Effective assessment of tissue perfusion is highly important during Coronary Artery Bypass Graft (CABG). Mixed venous O2 saturation (Svo2) is one of the best and routinely used markers of tissue perfusion. However, this method is costly and leads to considerable complications. Thus, the present study aimed to determine whether the Svo2 can be substituted with central venous saturation (Scvo2) and if there is any correlation between lactate level and Svo2. Methods: This prospective observational study was conducted on 62 patients scheduled for CABG. After induction and maintenance of anesthesia, blood samples drawn from central venous, pulmonary artery, and radial artery were used to measure Scvo2, Svo2 and serum lactate level respectively before and after Cardio Pulmonary Bypass (CPB). Pearson’s correlation test was used to determine the correlation between Svo2 and Scvo2 as well as between Svo2 and serum lactate level. Besides, P < 0.05 was considered as statistically significant. Results: Overall, 62 Patients, 33 males (53.2%) and 29 females (46.8%) were enrolled into the present study. The most common coexisting illness was hypertension detected in 33 patients (53.2%) followed by hypercholesterolemia in 28 ones (44.4%). In this study, Svo2 was positively correlated with Scvo2 (r = 0.63, P < 0.001). However, no correlation was found between Svo2 and lactate (r = 0.124, P = 0.348). Conclusions: In summary, Scvo2 is considered as the best substitute of Svo2 for detecting tissue hypo perfusion during CPB. Although the lactate level had been considered as an appropriate marker of tissue perfusion and ischemia, it was not correlated to Svo2 during CABG. PMID:24757637

  14. Monitoring changes in heart tissue temperature and evaluation of graft function after coronary artery bypass grafting surgery.

    PubMed

    Lekas, Raimundas; Jakuska, Povilas; Krisciukaitis, Algimantas; Veikutis, Vincentas; Dzemyda, Gintautas; Mickevicius, Tomas; Mork?naite, Kristina; Vilke, Alina; Treigys, Povilas; Civinskiene, Genuvaite; Andriuskevicius, Jonas; Vanagas, Tomas; Skauminas, Kestutis; Bernatoniene, Jurga

    2009-01-01

    Thermography is a relatively new contact-free method used in experimental and clinical studies and in cardiovascular surgery to investigate the myocardium and coronary artery function. Objects of complex study included mongrel dogs and patients with coronary artery disease who underwent cardiac surgery. For active dynamic thermography, we used a thermovision camera "A20V" (FLIR Systems, USA). Our data indicate that both experimental and clinical study performed on beating hearts could be an important approach to interoperation inspection of autovenous graft function. An infrared camera also can be successfully used to determine the extent of ischemic damage to the myocardium, heart, and blood vessels during surgery as a significant prognostic tool for evaluating outcome after cardiac operation. PMID:19357452

  15. Off-pump versus on-pump coronary artery bypass surgery in patients aged 80 years and older: institutional results and meta-analysis.

    PubMed

    Vasques, Francesco; Rainio, Antti; Heikkinen, Jouni; Mikkola, Reija; Lahtinen, Jarmo; Kettunen, Ulla; Juvonen, Tatu; Biancari, Fausto

    2013-01-01

    Patients aged ?80 years are at high risk of adverse events after coronary artery bypass grafting. This study was performed to evaluate whether off-pump coronary artery bypass surgery (OPCAB) is superior to conventional surgery (CCAB) in these high-risk patients. The outcome of 185 patients aged ?80 years who underwent OPCAB or CCAB at our institution was reviewed and a meta-analysis on this issue was performed. Similar immediate postoperative results were observed after OPCAB and CCAB at our institution, despite significantly different operative risk (mean logistic EuroSCORE, OPCAB 20.3% vs CCAB 13.4%, P = 0.003). Among 56 propensity score matched pairs a trend toward lower postoperative stroke (0%, 95% CI 0-0 vs 3.6%, 95% CI 0-10.0, P = 0.50) was observed after OPCAB. No significant differences were observed in the other outcome end points. Five-year survival was 81.0% after OPCAB and 78.1% after CCAB (P = 0.239). Pooled analysis of eight studies including 3416 patients showed a significantly higher risk of postoperative stroke after CCAB (pooled rates: 4.2%, 95% confidence interval (95% CI) 2.4-7.1 vs 1.5%, 95% CI 0.9-2.5, risk ratio (RR) 2.15, 95% CI 1.17-3.96, P = 0.01). A trend toward higher immediate postoperative mortality was observed after CCAB (15 studies including 4409 patients, pooled rates: 6.5%, 95% CI 5.2-8.0 vs 5.6%, 95% CI 4.2-7.4, RR 1.29, 95% CI 0.86-1.93, P = 0.21). Generic inverse variance analysis showed similar intermediate survival after CCAB and OPCAB (RR 1.31, 95% CI 0.85-2.01, P = 0.22). At 2 years, survival was 82.8% (95% CI 76.4-89.2) after CCAB and 88.3% (95% CI 82.9-93.7) after OPCAB. Current results indicate that OPCAB compared with CCAB in patients aged ?80 years is associated with significantly lower postoperative stroke and with a trend toward better early survival. However, suboptimal quality of the available studies, particularly the lack of comparability of the study groups, prevents conclusive results on this controversial issue. PMID:22068607

  16. Preventive Use of Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Coronary Artery Bypass Grafting: A Retrospective Study

    PubMed Central

    Zhang, Jingchao; Lang, Yan; Guo, Longhui; Song, Xiaodong; Shu, Liliang; Su, Gang; Liu, Hai; Xu, Jing

    2015-01-01

    Background Coronary artery bypass grafting (CABG) is an important therapeutic measure for CHD patients. The patients who score more than 12 EuroSCORE points cannot achieve good results because of their low cardiac output and delicate left ventricular function. Therefore, use of an intra-aortic balloon pump (IABP) is essential for coronary surgical patients in the peri-operative period. At present, there is no unified standard about when to insert an IABP. This study aimed to compare the short-term clinical outcomes of the IABP inserted in the preoperative condition with its use in the emergency condition for extremely high-risk patients. Material/Methods IABP support time, respirator support time, and ICU stay time were significantly shorter (all p<0.05) in the preoperative IABP group compared to the emergency IABP group, and the rates of low cardiac output syndrome (LCOS), acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower in the preoperative IABP group (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between two groups. Results Compared to the emergency IABP group, the IABP support time, respirator support time and ICU stay time were significantly lower in the preoperative IABP group (all p<0.05), and the rates of LCOS, acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between the 2 groups. Conclusions For high-risk patients with CABG, preoperative IABP insertion is a safe and effective measure. PMID:25797193

  17. Preventive use of intra-aortic balloon pump in patients undergoing high-risk coronary artery bypass grafting: a retrospective study.

    PubMed

    Zhang, Jingchao; Lang, Yan; Guo, Longhui; Song, Xiaodong; Shu, Liliang; Su, Gang; Liu, Hai; Xu, Jing

    2015-01-01

    Background Coronary artery bypass grafting (CABG) is an important therapeutic measure for CHD patients. The patients who score more than 12 EuroSCORE points cannot achieve good results because of their low cardiac output and delicate left ventricular function. Therefore, use of an intra-aortic balloon pump (IABP) is essential for coronary surgical patients in the peri-operative period. At present, there is no unified standard about when to insert an IABP. This study aimed to compare the short-term clinical outcomes of the IABP inserted in the preoperative condition with its use in the emergency condition for extremely high-risk patients. Material and Methods IABP support time, respirator support time, and ICU stay time were significantly shorter (all p<0.05) in the preoperative IABP group compared to the emergency IABP group, and the rates of low cardiac output syndrome (LCOS), acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower in the preoperative IABP group (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between two groups. Results Compared to the emergency IABP group, the IABP support time, respirator support time and ICU stay time were significantly lower in the preoperative IABP group (all p<0.05), and the rates of LCOS, acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between the 2 groups. Conclusions For high-risk patients with CABG, preoperative IABP insertion is a safe and effective measure. PMID:25797193

  18. Predicting prolonged intensive care unit length of stay in patients undergoing coronary artery bypass surgery--development of an entirely preoperative scorecard.

    PubMed

    Herman, Christine; Karolak, Wojtek; Yip, Alexandra M; Buth, Karen J; Hassan, Ansar; Légaré, Jean-Francois

    2009-10-01

    We sought to develop a predictive model based exclusively on preoperative factors to identify patients at risk for PrlICULOS following coronary artery bypass grafting (CABG). Retrospective analysis was performed on patients undergoing isolated CABG at a single center between June 1998 and December 2002. PrlICULOS was defined as initial admission to ICU exceeding 72 h. A parsimonious risk-predictive model was constructed on the basis of preoperative factors, with subsequent internal validation. Of 3483 patients undergoing isolated CABG between June 1998 and December 2002, 411 (11.8%) experienced PrlICULOS. Overall in-hospital mortality was higher among these patients (14.4% vs. 1.2%, P

  19. Comparison of the Length of Hospital Stay between the Patients with Atrial Fibrillation Treated with Amiodarone and Patients with Normal Sinus Rhythm after Coronary Artery Bypass Graft

    PubMed Central

    Shams Vahdati, Samad; Samadikhah, Jahanbakhsh; Hakim, Seied Hadi; Azarfarin, Rasoul; Ansarin, Mahsa

    2012-01-01

    Introduction Postoperative atrial fibrillation occurs in 20 % to 40 % of patients undergoing coronary artery bypass grafting ( CABG ) and contributes to increasing length of stay and hospital cost . The purpose of our study was to compare the length of hospital stay between patients of postoperative atrial fibrillation treated with amiodarone (experimental) and those with normal sinus rhythm ( NSR ) (Control ) after CABG. Methods From October of 2008 to October 2010, our experimental group including 26 patients was treated with amiodarone in Tabriz Madani Heart Center. The background variables, length of atrial fibrillation, and length of hospital stay were recorded. The experimental group was compared with a control group of 50 patients. The two groups were the same in terms of age, gender, ejection fraction, vascular diseases and risk factors. Results The hospital stay duration was 8.0 ±1.6 and 7.4 ±1.4 days (p = 0.08) for experimental, and control groups respectively. Atrial fibrillation occurred mainly (60%) on the second postoperative day. Conclusion 25 patients out of 26 patients (96 %) returned to NSR after starting the amiodarone protocol and the length of hospital stay in the experimental group was not significantly different from that of the control group. Thus, treating with Amiodarone in postoperative atrial fibrillation can reduce hospital stay duration compared to that of normal sinus patients. PMID:24250975

  20. Alterations in plasma soluble vascular endothelial growth factor receptor-1 (sFlt-1) concentrations during coronary artery bypass graft surgery: relationships with post-operative complications

    PubMed Central

    Denizot, Yves; Leguyader, Alexandre; Cornu, Elisabeth; Laskar, Marc; Orsel, Isabelle; Vincent, Christelle; Nathan, Nathalie

    2008-01-01

    Background Plasma concentrations of sFlt-1, the soluble form of the vascular endothelial growth factor receptor (VEGF), markedly increase during coronary artery bypass graft (CABG) surgery with extracorporeal circulation (ECC). We investigated if plasma sFlt-1 values might be related to the occurrence of surgical complications after CABG. Methods Plasma samples were collected from the radial artery catheter before vascular cannulation and after opening the chest, at the end of ECC just before clamp release, after cross release, after weaning from ECC, at the 6th and 24th post-operative hour. Thirty one patients were investigated. The presence of cardiovascular, haematological and respiratory dysfunctions was prospectively assessed. Plasma sFlt-1 levels were measured with commercially ELISA kits. Results Among the 31 investigated patients, 15 had uneventful surgery. Patients with and without complications had similar pre-operative plasma sFlt-1 levels. Lowered plasma sFlt-1 levels were observed at the end of ECC in patients with haematological (p = 0.001, ANOVA) or cardiovascular (p = 0.006) impairments, but not with respiratory ones (p = 0.053), as compared to patients with uneventful surgery. Conclusion These results identify an association between specific post-CABG complication and the lower release of sFlt-1 during ECC. sFlt-1-induced VEGF neutralisation might, thus, be beneficial to reduce the development of post-operative adverse effects after CABG. PMID:18423019

  1. Doppler derived quantitative flow estimate in coronary artery bypass graft: a computational multiscale model for the evaluation of the current clinical procedure.

    PubMed

    Ponzini, Raffaele; Lemma, Massimo; Morbiducci, Umberto; Montevecchi, Franco M; Redaelli, Alberto

    2008-09-01

    In order to investigate the reliability of the so called mean velocity/vessel area formula adopted in clinical practice for the estimation of the flow rate using an intravascular Doppler guide wire instrumentation, a multiscale computational model was used to give detailed predictions on flow profiles within Y-shaped coronary artery bypass graft (CABG) models. At this purpose three CABG models were built from clinical patient's data and used to evaluate and compare, in each model, the computed flow rate and the flow rate estimated according to the assumption of parabolic velocity profile. A consistent difference between the exact and the estimated value of the flow rate was found in every branch of all the graft models. In this study we showed that this discrepancy in the flow rate estimation is coherent to the theory of Womersley regarding spatial velocity profiles in unsteady flow conditions. In particular this work put in evidence that the error in flow rate estimation can be reduced by using the estimation formula recently proposed by Ponzini et al. [Ponzini R, Vergara C, Redaelli A, Veneziani A. Reliable CFD-based estimation of flow rate in haemodynamics measures. Ultrasound Med Biol 2006;32(10):1545-55], accounting for the unsteady nature of blood, applicable in the clinical practice without resorting to further measurements. PMID:17980641

  2. Investigating the effect of family-focused nursing intervention on caregiver burden of the family members of the patients undergoing coronary bypass surgery in Isfahan Shahid Chamran Hospital during 2012

    PubMed Central

    Moieni, Mahin; Poorpooneh, Zahra; Pahlavanzadeh, Saeed

    2014-01-01

    Background: Family burden is defined as the problems, concerns, and unpleasant events affecting the patients undergoing coronary arteries’ surgery, and is associated with these patients physical and psychological improvement. Nurses are in a good position to provide appropriate intervention. This study aimed to investigate the effect of family-focused nursing interventions on the burden of the family members of the patients undergoing coronary bypass surgery. Materials and Methods: This is a clinical trial conducted on 50 family members of the patients undergoing coronary bypass surgery in Isfahan Shahid Chamran hospital. Caregivers were selected by convenient sampling and were randomly assigned to two groups of study and control. Caregivers in the study group attended a three-interventional session program during their hospitalization time, while the subjects in control group did not. Data collection tool was Novak and Guest caring burden inventory (CBI). Data were analyzed by SPSS. Results: Means and SDs of caring burden before and after the intervention were 30.08 (14.03) and 19.2 (10) in the study group, respectively, and 30.16 (12.62) and 35.44 (10.42) in the control group, respectively. Changes of total scores of caring burden showed a significant difference after the intervention in the study and control groups (P < 0.001). Score changes of subscales of time dependence (P < 0.001), developmental (P < 0.001), physical (P < 0.001), and emotional caring burden (P = 0.007) were also significant. Conclusions: Results showed that family-focused nursing interventions were effective in reducing the family burden of the patients undergoing coronary bypass surgery. Nurses can administrate family-focused nursing interventions to reduce the caregiver burden. PMID:24834089

  3. Implantable cardioverter-defibrillators improve survival after coronary artery bypass grafting in patients with severely impaired left ventricular function

    PubMed Central

    Al-Dadah, Ashraf S; Voeller, Rochus K; Rahgozar, Paymon; Lawton, Jennifer S; Moon, Marc R; Pasque, Michael K; Damiano, Ralph J; Moazami, Nader

    2007-01-01

    Objective Patients with severe left ventricular (LV) dysfunction have a poor long term survival despite complete surgical revascularization. Recent data suggests that the use of Implantable Cardioverter-Defibrillator (ICD) improves survival in patients with severe LV dysfunction. We compared the survival impact of ICD implantation in patients with severe LV dysfunction who underwent CABG. Methods Between January 1996 and August 2004, 305 patients with LV ejection fraction (EF) ?25% had CABG surgery at our institution. Demographics of patients who had received an ICD (ICD+) in the post -operative period was compared to those without ICD (ICD-). Survival was evaluated by the Kaplan-Meier method. Results Of the entire group, 35 (11.5%) patients received an ICD with a median of 2 (+/-2) years after CABG. Indication for ICD implantation was clinical evidence of non sustained ventricular tachycardia (NSVT). There were no differences between the 2 groups with respect to age, gender, NYHA classification, number of bypasses, or other co-morbidities. Survival at 1, 3 and 5 years was 88%, 79%, and 67% for the ICD- group compared to 94%, 89% and 83% for the ICD+ group, respectively (figure, p < 0.05). Conclusion Implantation of ICD after CABG confers improved short and long term survival benefit to patients with severe LV dysfunction. Prophylactic ICD implantation in the setting of severe LV dysfunction and CABG surgery should be considered. PMID:17222353

  4. Coronary Artery Stenting

    Microsoft Academic Search

    Eric A. Heller; George D. Dangas

    \\u000a When Andreas Gruentzig performed the first percutaneous coronary angioplasty on an awake patient in 1977 (Zurich, Switzerland),\\u000a he created the nascent field of interventional cardiology and ushered in a new era of coronary revascularization. Percutaneous\\u000a coronary transluminal angioplasty (PTCA) was positioned to serve as an alternative and complement to coronary artery bypass\\u000a grafting (CABG) and optimal medical therapy. As in

  5. Emotional Processes in Patients Undergoing Coronary Artery Bypass Graft Surgeries with Extracorporeal Circulation in View of Selected Indicators of the Inflammatory Condition

    PubMed Central

    P?otek, W?odzimierz; Pielok, Joanna; Cybulski, Marcin; Samborska, Regina

    2015-01-01

    Background The aim of this study was to describe positive and negative emotions in patients undergoing coronary artery bypass graft (CABG) surgeries with extracorporeal circulation and the correlations between emotions and basic indicators of the inflammatory condition: C-reactive protein (CRP) concentration, body temperature, and leukocyte count. Material/Methods Standardized tools were used to select 52 patients (aged 47–63 years, 6 women – 11.5% and 46 men – 88.5%) without dementia or depression. The Positive and Negative Affect Schedule (PANAS) was used to examine positive affect (PA) and negative affect (NA) and the State-Trait Anxiety Inventory (STAI X1 and X2) was used to examine the anxiety level. The patients underwent CABG surgery according to a common anesthesia protocol and for 5 consecutive days they were observed in the ward, where selected indicators of the inflammatory condition were monitored. Results A detailed description of the results of examinations of emotions was presented. The patients with low PA-trait level, high NA-trait level, and high anxiety-trait level (STAI X2) exhibited statistically significantly higher body temperatures than the other patients in the postoperative period. The patients with high NA-trait and anxiety-state levels (STAI X1) had statistically significantly lower CRP levels in the postoperative period than the patients with low NA-trait and anxiety-state levels (STAI X1). Conclusions Patients undergoing CABG operations express both positive and negative affects. The changes in the inflammatory markers are expressed mostly by CRP concentration. There exist relationships between the result of tests assessing emotions and the markers of the inflammatory condition. PMID:25573296

  6. Effects of Metabolic Syndrome with or without Obesity on Outcomes after Coronary Artery Bypass Graft. A Cohort and 5-Year Study

    PubMed Central

    Ao, Hushan; Xu, Fei; Wang, Xianqiang; Tang, Xinran; Zheng, Zhe; Hu, Shengshou

    2015-01-01

    Background Metabolic syndrome (MetS) and obesity are risk factors for cardiovascular disease, however, it remains unclear about effects of MetS with or without obesity on perioperative and long-term morbidity and mortality after coronary artery bypass graft (CABG). Methods An observational cohort study was performed on 4,916 consecutive patients receiving isolated primary CABG in Fuwai hospital. Of all patients, 1238 patients met the inclusion criteria and were divided into three groups: control, MetS with obesity and MetS without obesity (n = 868, 76 and 294 respectively). The patient’s 5-year survival and major adverse cerebral and cardiovascular events (MACCE) were studied. Results Among all three groups, there were no significant differences in in-hospital postoperative complications, epinephrine use, stroke, ICU stay, ventilation time, atrial fibrillation, renal failure, coma, myocardial infarction, repeated revascularization, and long-term stroke. The patients in MetS without obesity group were not associated with increased perioperative or long-term morbidities and mortality. In contrast, the patients in MetS with obesity group were associated with significant increased perioperative complications including MACCE (30.26% vs. 20.75%, 16.7%, p = 0.0074) and mortality (11.84% vs. 3.74%, 3.11%, p = 0.0007) respectively. Patients in MetS with obesity group was associated with significantly increased long-term of MACCE (adjusted OR:2.040; 95%CI:1.196–3.481; P?0.05) and 5-years of mortality (adjusted HR:4.659; 95%CI:1.966–11.042; P?0.05). Conclusions Patients with metabolic syndrome and obesity are associated with significant increased perioperative and long-term complications and mortality, while metabolic syndrome without obesity do not worsen outcomes after CABG. PMID:25679397

  7. Investigating the relationship between intra-operative electrolyte abnormalities (sodium and potassium) with post-operative complications of coronary artery bypass surgery

    PubMed Central

    Bagheri, Kaivan; Safavi, Mohammadreza; Honarmand, Azim; Kashefi, Parviz; Ghasemi, Marziye; Mohammadinia, Leila

    2013-01-01

    Background: Generally, the electrolyte abnormalities are seen in many hospitalized patients, and this problem increases in ones with heart diseases. The purpose of this study is determination of the prevalence of electrolyte abnormalities during the coronary artery bypass surgery (CABG) and detecting the relationship between these abnormalities with the complications after the surgeries. Materials and Methods: This is a cross-sectional study, which is done in Chamran hospital, the medical and educational center of Isfahan, Iran, in 2011. The target population included the patients who have undergone CABG in this hospital. In this study, 100 patients who had been candidates for CABG were selected, and we extracted their recorded intra-operative electrolyte information. The collected data was entered into the computer and analyzed by SPSS software. The Chi-square and t student tests were used for data analysis. Results: The mean ± SD of sodium during CABG was 137.95 ± 4.6 (range 127-152) mg\\dl. Also, the mean ± SD of potassium was 4.65 ± 0.9 (range: 2.9-7.4). According to these results, 48 patients (48% of all) had electrolyte imbalance and 52 patients (52% of all) were normal. Sodium level in 71% of patients was normal, and in 29% of them was abnormal. Potassium level in 73% of individuals was normal, and in 27% of them was abnormal. Conclusion: Giving an attention to electrolyte abnormalities in patients who have undergone CABG surgery is a considerable necessity for them, and sufficient arrangements are needed to prevent such abnormalities. PMID:24520549

  8. Impact of aspirin resistance on outcomes among patients following coronary artery bypass grafting: exploratory analysis from randomized controlled trial (NCT01159639).

    PubMed

    Petricevic, Mate; Kopjar, Tomislav; Gasparovic, Hrvoje; Milicic, Davor; Svetina, Lucija; Zdilar, Boris; Boban, Marko; Mihaljevic, Martina Zrno; Biocina, Bojan

    2015-05-01

    Individual variability in the response to aspirin, has been established by various platelet function assays, however, the clinical relevance of aspirin resistance (AR) in patients undergoing coronary artery bypass grafting (CABG) has to be evaluated. Our working group conducted a randomized controlled trial (NCT01159639) with the aim to assess impact of dual antiplatelet therapy (APT) on outcomes among patients with AR following CABG. Patients that were aspirin resistant on fourth postoperative day (POD 4) were randomly assigned to receive either dual APT with clopidogrel (75 mg) plus aspirin (300 mg)-intervention arm or monotherapy with aspirin (300 mg)-control arm. This exploratory analysis compares clinical outcomes between aspirin resistant patients allocated to control arm and patients that have had adequate platelet inhibitory response to aspirin at POD 4. Both groups were treated with 300 mg of aspirin per day following surgery. We sought to evaluate the impact of early postoperative AR on outcomes among patients following CABG. Exploratory analysis included a total number of 325 patients. Of those, 215 patients with adequate response to aspirin and 110 patients with AR allocated to aspirin monotherapy following randomization protocol. The primary efficacy end point (MACCEs-major adverse cardiac and cardiovascular events) occurred in 10 and 6 % of patients with AR and with adequate aspirin response, respectively (p = 0.27). Non-significant differences were observed in bleeding events occurrence. Subgroup analysis of the primary end point revealed that aspirin resistant patients with BMI > 30 kg/m(2) tend to have a higher occurrence of MACCEs 18 versus 5 % (relative risk 0.44 [95 % CI 0.16-1.16]; p = 0.05). This exploratory analysis did not reveal significant impact of aspirin resistance on outcomes among patients undergoing CABG. Further, sufficiently powered studies are needed in order to evaluate clinical relevance of AR in patients undergoing CABG. PMID:25095738

  9. Comparison of the Effectiveness of Continuous versus Intermittent Cefazolin for the Prevention of Infection after Off-Pump Coronary Artery Bypass Graft

    PubMed Central

    Forouzannia, Seyed Khalil; Karimi-Bondarabadi, Ali Akbar; Bagherinasab, Mostafa; Sarebanhassanabadi, Mohammadtaghi

    2014-01-01

    Abstract Background: Surgical site infection is known as a common complication after cardiac surgery, and Cefazolin is the best prophylactic antibiotic to prevent this complication. The goal of this study was to evaluate the effect of continuous and intermittent Cefazolin for the prevention of superficial surgical site infection following off-pump coronary artery bypass (OPCAB). Methods: This prospective randomized clinical trial study was conducted on 141 patients candidated for OPCAB and divided into two groups. This study was performed between February 2011 and February 2012 in the Iranian city of Yazd. Patients in both groups received 2 g of Cefazolin as a starting dose and at 30 minutes before incision. Definition of surgical site infections was according to the Centers for Disease Control and Prevention Criteria (CDC-criteria). In the continuous infusion group (n = 74), 3 g of Cefazolin was infused over a 24-hour period after surgery. In the intermittent group (n = 67), 1 g of Cefazolin was administered at 3, 11, and 19 hours after the starting dose. Hyperlipidemia, diabetes, hypertension, smoking, history of heart disease, and incidences of superficial infection were compared between the two groups. Duration of follow- up was 4 weeks. Results: The mean age of the patients was 60.49 ± 10.63 years. The patients were 30.5% female and 69.5% male. There were no significant differences in age, body surface area, duration of operation, number of distal grafts, number of proximal grafts, and duration of hospital stay before heart surgery between two groups. The incidence of infection in intermittent group was (7.5%) and in continuous groups was (2.7%). There was no significant difference in the incidence of infection between the two groups (p value = 0.26). Conclusion: Our findings in this study showed no significant differences between continuous and intermittent Cefazolin for the prevention of superficial surgical site infections after OPCAB.

  10. Adventitial vessel growth and progenitor cells activation in an ex vivo culture system mimicking human saphenous vein wall strain after coronary artery bypass grafting.

    PubMed

    Prandi, Francesca; Piola, Marco; Soncini, Monica; Colussi, Claudia; D'Alessandra, Yuri; Penza, Eleonora; Agrifoglio, Marco; Vinci, Maria Cristina; Polvani, Gianluca; Gaetano, Carlo; Fiore, Gianfranco Beniamino; Pesce, Maurizio

    2015-01-01

    Saphenous vein graft disease is a timely problem in coronary artery bypass grafting. Indeed, after exposure of the vein to arterial blood flow, a progressive modification in the wall begins, due to proliferation of smooth muscle cells in the intima. As a consequence, the graft progressively occludes and this leads to recurrent ischemia. In the present study we employed a novel ex vivo culture system to assess the biological effects of arterial-like pressure on the human saphenous vein structure and physiology, and to compare the results to those achieved in the presence of a constant low pressure and flow mimicking the physiologic vein perfusion. While under both conditions we found an activation of Matrix Metallo-Proteases 2/9 and of microRNAs-21/146a/221, a specific effect of the arterial-like pressure was observed. This consisted in a marked geometrical remodeling, in the suppression of Tissue Inhibitor of Metallo-Protease-1, in the enhanced expression of TGF-?1 and BMP-2 mRNAs and, finally, in the upregulation of microRNAs-138/200b/200c. In addition, the veins exposed to arterial-like pressure showed an increase in the density of the adventitial vasa vasorum and of cells co-expressing NG2, CD44 and SM22? markers in the adventitia. Cells with nuclear expression of Sox-10, a transcription factor characterizing multipotent vascular stem cells, were finally found in adventitial vessels. Our findings suggest, for the first time, a role of arterial-like wall strain in the activation of pro-pathologic pathways resulting in adventitial vessels growth, activation of vasa vasorum cells, and upregulation of specific gene products associated to vascular remodeling and inflammation. PMID:25689822

  11. Predictors of packed red cell transfusion after isolated primary coronary artery bypass grafting – The experience of a single cardiac center: A prospective observational study

    PubMed Central

    Elmistekawy, Elsayed M; Errett, Lee; Fawzy, Hosam F

    2009-01-01

    Background Preoperative patients' characteristics can predict the need for perioperative blood component transfusion in cardiac surgical operations. The aim of this prospective observational study is to identify perioperative patient characteristics predicting the need for allogeneic packed red blood cell (PRBC) transfusion in isolated primary coronary artery bypass grafting (CABG) operations. Patients and Methods 105 patients undergoing isolated, first-time CABG were reviewed for their preoperative variables and followed for intraoperative and postoperative data. Patients were 97 males and 8 females, with mean age 58.28 ± 10.97 years. Regression logistic analysis was used for identifying the strongest perioperative predictors of PRBC transfusion. Results PRBC transfusion was used in 71 patients (67.6%); 35 patients (33.3%) needed > 2 units and 14 (13.3%) of these needed > 4 units. Univariate analysis identified female gender, age > 65 years, body weight ? 70 Kg, BSA ? 1.75 m2, BMI ? 25, preoperative hemoglobin ? 13 gm/dL, preoperative hematocrit ? 40%, serum creatinine > 100 ?mol/L, Euro SCORE (standard/logistic) > 2, use of CPB, radial artery use, higher number of distal anastomoses, and postoperative chest tube drainage > 1000 mL as significant predictors. The strongest predictors using multivariate analysis were CPB use, hematocrit, body weight, and serum creatinine. Conclusion The predictors of PRBC transfusion after primary isolated CABG are use of CPB, hematocrit ? 40%, weight ? 70 Kg, and serum creatinine > 100 ?mol/L. This leads to better utilization of blood bank resources and cost-efficient targeted use of expensive blood conservation modalities. PMID:19422707

  12. Modifiable risk factors control and its relationship with 1 year outcomes after coronary artery bypass surgery: insights from the REACH registry

    PubMed Central

    Mehta, Rajendra H.; Bhatt, Deepak L.; Steg, Ph. Gabriel; Goto, Shinya; Hirsch, Alan T.; Liau, Chiau-Suong; Röther, Joachim; Wilson, Peter W.F.; Richard, Alain-Jean; Eagle, Kim A.; Ohman, E. Magnus

    2008-01-01

    Aims To evaluate the influence of achieving secondary prevention target treatment goals for cardiovascular (CV) risk factors on clinical outcomes in patients with prior coronary artery bypass surgery (CABG). Methods and results Accordingly, we analysed treatment to target goals in patients with prior CABG and atherothrombotic disease or known risk factors (diabetes, hypertension, hypercholesterolaemia, smoking, obesity) enrolled in the global REduction in Atherothrombosis for Continued Health (REACH) Registry, and their association with 1 year outcomes. A total of 13 907 of 68 236 patients (20.4%) in REACH had a history of prior CABG, and 1 year outcomes data were available for 13 207 of these. At baseline <25, 25–<50, 50–<75, and ?75% risk factors were at goal in 3.7, 12.9, 31.7, and 51.7% of patients, respectively. One-year composite rates of CV death, non-fatal MI, non-fatal stroke were inversely related to the proportion of risk factors at goal at baseline (age, gender, and region adjusted rates 6.1, 5.6, 5.2, and 4.3% of patients with <25, 25–<50, 50–<75, and >75% risk factors at goal, respectively; P for trend 0.059). Conclusion Risk-factor control varied greatly in CABG patients. Although CABG patients are frequently treated with appropriate therapies, these treatments fail to achieve an adequate level of prevention in many. This failure was associated with a trend for worse age-, gender-, and region-adjusted clinical outcomes. Thus, perhaps secondary prevention after CABG needs to focus on more comprehensive modification of risk factors to target goals in the hope of preventing subsequent CV events, and represents an opportunity to improve CV health. PMID:18996953

  13. Adventitial Vessel Growth and Progenitor Cells Activation in an Ex Vivo Culture System Mimicking Human Saphenous Vein Wall Strain after Coronary Artery Bypass Grafting

    PubMed Central

    Prandi, Francesca; Piola, Marco; Soncini, Monica; Colussi, Claudia; D’Alessandra, Yuri; Penza, Eleonora; Agrifoglio, Marco; Vinci, Maria Cristina; Polvani, Gianluca; Gaetano, Carlo; Fiore, Gianfranco Beniamino; Pesce, Maurizio

    2015-01-01

    Saphenous vein graft disease is a timely problem in coronary artery bypass grafting. Indeed, after exposure of the vein to arterial blood flow, a progressive modification in the wall begins, due to proliferation of smooth muscle cells in the intima. As a consequence, the graft progressively occludes and this leads to recurrent ischemia. In the present study we employed a novel ex vivo culture system to assess the biological effects of arterial-like pressure on the human saphenous vein structure and physiology, and to compare the results to those achieved in the presence of a constant low pressure and flow mimicking the physiologic vein perfusion. While under both conditions we found an activation of Matrix Metallo-Proteases 2/9 and of microRNAs-21/146a/221, a specific effect of the arterial-like pressure was observed. This consisted in a marked geometrical remodeling, in the suppression of Tissue Inhibitor of Metallo-Protease-1, in the enhanced expression of TGF-?1 and BMP-2 mRNAs and, finally, in the upregulation of microRNAs-138/200b/200c. In addition, the veins exposed to arterial-like pressure showed an increase in the density of the adventitial vasa vasorum and of cells co-expressing NG2, CD44 and SM22? markers in the adventitia. Cells with nuclear expression of Sox-10, a transcription factor characterizing multipotent vascular stem cells, were finally found in adventitial vessels. Our findings suggest, for the first time, a role of arterial-like wall strain in the activation of pro-pathologic pathways resulting in adventitial vessels growth, activation of vasa vasorum cells, and upregulation of specific gene products associated to vascular remodeling and inflammation. PMID:25689822

  14. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial†

    PubMed Central

    Thimour-Bergström, Linda; Roman-Emanuel, Christine; Scherstén, Henrik; Friberg, Örjan; Gudbjartsson, Tomas; Jeppsson, Anders

    2013-01-01

    OBJECTIVES The incidence of surgical site infection (SSI) after open vein harvesting in coronary artery bypass grafting (CABG) patients ranges in different studies between 2 and 20%. Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis. We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting. METHODS An investigator-initiated prospective randomized double-blind single-centre study was performed with 374 patients, randomized to subcutaneous and intracutaneous leg-wound closure with either triclosan-coated sutures (Vicryl Plus® and Monocryl Plus®, Ethicon, Somerville, NJ, USA) (n = 184) or identical sutures without triclosan (n = 190) from the same manufacturer. All patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). Primary endpoint was SSI within 60 days after surgery according to the definition of Center for Disease Control. Predefined secondary endpoints included culture-proven and antibiotic-treated SSI. RESULTS The primary endpoint occurred in 23 patients (12.5%) with triclosan-coated sutures and in 38 patients (20.0%) in the group without triclosan (P = 0.0497, risk ratio 0.63, (95% confidence interval 0.39–1.00). Corresponding figures for culture-proven infections were 7.6 vs 12.1%, (P = 0.15), and for antibiotic-treated infections, 10.9 vs 18.4%, (P = 0.039). Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens in both groups. Insulin-treated diabetes and vein-harvesting time were associated with SSI after vein harvesting. CONCLUSIONS Leg-wound closure with triclosan-coated sutures in CABG patients reduces SSIs after open vein harvesting. (ClinicalTrials.gov number NCT01212315). PMID:23435526

  15. Hospital-Acquired Pneumonia in Patients Undergoing Coronary Artery Bypass Graft; Comparison of the Center for Disease Control Clinical Criteria With Physicians’ Judgment

    PubMed Central

    Baghban, Mahboubeh; Paknejad, Omalbanin; Yousefshahi, Fardin; Gohari Moghadam, Keivan; Bina, Payvand; Samimi Sadeh, Saghar

    2014-01-01

    Background: Following coronary artery bypass graft (CABG), patients are at high risk (3.2%-8.3%) for developing hospital-acquired pneumonia (HAP) with mortality rate of 24% to 50%. Some of routine features in patients undergoing CABG are similar to clinical criteria of Center of Disease Control (CDC) for diagnosis of pneumonia. This may lead to over-diagnosis of pneumonia in these patients. Objectives: This study aimed to assess the frequency of CDC criteria for diagnosis of pneumonia in patients undergoing CABG. Patients and Methods: This study was performed on CABG candidates admitted to post cardiac surgery Intensive Care Unit (ICU) in a six-month period. Patient’s records, Chest-X-Ray, and Laboratory tests were assessed for PNU1-CDC criteria for HAP diagnosis. At the same time, a physician who was unaware of the study protocol assessed the clinical diagnosis. Then the results were compared with CDC criteria-based diagnosis. Results: Of total 300 patients, 9 (3%) met CDC criteria for diagnosis of pneumonia while none of the cases were diagnosed as HAP according to the physicians’ clinical diagnosis. All nine patients were discharged with proper general condition and no need of antibiotic therapy. This study showed that loss of consciousness, tachypnea, dyspnea, PaO2 < 60 mm Hg, PaO2/FiO2 < 240, and local infiltration in 24 hours of operation were misleading features of CDC criteria, which were not considered in physicians’ clinical judgment to establish the diagnosis. Conclusions: Our findings suggest that in Post-CABG patients, physicians could judge the occurrence of HAP more accurately in comparison to making the diagnosis based on CDC criteria alone. Expert physician may intentionally do not take some of these criteria into account according the patients’ course of disease. Therefore, it is suggested that the value of these criteria in special group of patients like those undergoing CABG should be re-evaluated. PMID:25289379

  16. Temporal Trends in the Incidence of Surgical Site Infections in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Population-Based Cohort Study, 1993 to 2008

    PubMed Central

    Alasmari, Faisal A.; Tleyjeh, Imad M.; Riaz, Muhammad; Greason, Kevin L.; Berbari, Elie F.; Virk, Abinash; Baddour, Larry M.

    2012-01-01

    Objective To determine the incidence of and temporal trends in surgical site infections (SSIs) in patients underoing coronary artery bypass graft (CABG) surgery. Methods A population-based cohort study was conducted to describe the epidemiologic features of SSI in Olmsted County, Minnesota, between January 1, 1993, and December 31, 2008, using the Rochester Epidemiology Project. Period-specific incidence rates (in-hospital or within 30 days outside the hospital) were calculated. Logistic regression analysis was used to adjust for potential confounders that could affect temporal trends in SSI incidence rates. Results During the 16-year study, of 1424 residents of Olmsted County who underwent CABG surgery, 1189 (83%) had isolated CABG and 235 (17%) had combined CABG and valve surgery. The overall SSI incidence rate was 7.0% (95% confidence interval [CI], 5.7%-8.4%). The incidence rate of superficial sternal SSI was 2.0% (95% CI, 1.2%-2.7%) and of deep sternal SSI was 1.5% (95% CI, 0.9%-2.2%). The leg harvest site infection rate was 3.6% (95% CI, 2.6 %-4.5%). The incidence rate decreased over time with a statistically significant linear trend. The adjusted odds ratio (95% CI) of SSI showed a decreasing linear trend: 0.39 (0.19-0.81) vs 0.50 (0.27-0.93) vs 0.83 (0.48-1.42) vs reference for 2005-2008 vs 2001-2004 vs 1997-2000 vs 1993-1996. Conclusion In this population-based surveillance study of patients undergoing CABG surgery, the incidence of SSI decreased markedly between 1993 and 2008 in patients in Olmsted County. The factors responsible for this decrease are the focus of ongoing investigations. PMID:23127732

  17. The Angio-Seal arterial closure device for early ambulation after elective percutaneous coronary intervention in patients receiving low-dose enoxaparin.

    PubMed

    Lai, Y-C; Kao, H-L; Lin, Y-H; Lin, M-S; Ho, Y-L; Chao, C-L

    2008-01-01

    This study evaluated the efficacy and safety of use of the Angio-Seal vascular closure device deployment for early ambulation (2 h) after elective percutaneous coronary intervention in 143 consecutive patients receiving either intravenous low-dose enoxaparin (0.5 mg/kg) or unfractionated heparin (UFH). The initial success rate of Angio-Seal(trade mark) deployment was 98.6%, with no significant difference between the UFH group (98.9%) and the enoxaparin group (98.0%). In-hospital and clinic outcomes were evaluated in the 141 patients with successful Angio-Seal deployment. During hospitalization, there were no deaths, myocardial infarction, urgent target vessel revascularization or bleeding events in either group; three patients in the UFH group and none in the enoxaparin group had minor vascular complications (differences not significant). In clinic follow-up, two patients in the UFH group and none in the enoxaparin group had major vascular complications (differences not significant). Routine use of the Angio-Seal(trade mark) for early ambulation in patients receiving intravenous low-dose enoxaparin compared with UFH provides promising efficacy and safety for daily practice. PMID:18831904

  18. 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

  19. Perioperative prostate specific antigen levels among coronary artery bypass grafting patients: Does extracorporeal circulation and body temperature induce prostate specific antigen levels alterations?

    PubMed Central

    Patris, Emmanuel; Giakoumidakis, Konstantinos; Patris, Vasileios; Kuduvalli, Manoj; Argiriou, Mihalis; Charitos, Christos; Kalaitzis, Christos; Touloupidis, Stavros

    2015-01-01

    Purpose: The purpose of this study is to compare the perioperative total prostate specific antigen (tPSA) levels among coronary artery bypass grafting (CABG) patients with and without extracorporeal circulation (ECC), to investigate the changes overtime of tPSA in each group separately and to determine the effect of body core temperature on tPSA levels. Materials and Methods: A prospective study was conducted. Our sample was allocated to: (a) Seven patients who underwent off pump CABG (Group I) and (b) 16 CABG patients with ECC (Group II). The levels of tPSA were measured preoperatively (baseline), intra-operatively and at the 4th postoperative day. We compared the two groups on their tPSA levels and we investigated the changes of tPSA overtime in each group separately. Results: Intra-operative serum samples were obtained in significantly lower body temperature in patients of Group II than in those of Group I (31°C vs. 36.9°C, P < 0.001). In each group separately, postoperative tPSA levels were increased significantly compared to the baseline values (2.55 ng/ml vs. 0.39 ng/ml for Group I, P = 0.005 and 4.36 ng/ml vs. 0.77 for Group II, P < 0.001). CABG patients with ECC had significantly lower intra-operative tPSA levels than the baseline values (0.67 ng/ml vs. 0.77 ng/ml, P = 0.008). We did not observe significant differences of tPSA levels between the two groups. Conclusions: CABG surgery affects similarly the perioperative tPSA independently the involvement of ECC. Although all patients had significantly higher early postoperative tPSA levels, only those who underwent CABG with ECC had exceeded normal values and significantly decreased intra-operative tPSA. Hypothermia seems to be the causal factor of tPSA reduction. PMID:25657546

  20. The Effect of Reciting the Word “Allah” on Pain Severity After Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial Study in Iran

    PubMed Central

    Nasiri, Morteza; Fayazi, Sadigheh; Ghaderi, Musab; Naseri, Marjan; Adarvishi, Sara

    2014-01-01

    Background: One of the most expressed complains following coronary artery bypass graft (CABG) surgery is chest wall pain. Due to side effects of opioids used commonly for pain relief after heart surgeries, it is important to use low-cost and non-pharmacological methods independently or combined with palliatives to alleviate pain and consequently prevent undesirable drug adverse e?ects. Objectives: This study aimed to investigate the effect of Hazrate Zahra’s praises, which is one of the most known praises among Muslims in which the word “Allah” is repeated 100 times, on pain severity after CABG surgery. Patients and Methods: This randomized clinical trial study was performed on 80 patients in Busheher Bentolhoda Hospital, Iran, in 2013. Data was collected by a researcher-made questionnaire and Visual Analogue Scale (VAS). Patients were randomly assigned into intervention (n = 40) and control (n = 40) groups. In intervention group, we asked patients to recite Hazrate Zahra’s praises (AS) as one of the most known praises among Muslims in which the word “Allah” is repeated 100 times. In the control group, patients received routine procedures of hospital. Pain was assessed before and immediately after the intervention in three days after the operation in the both groups. Data was analyzed by SPSS 19 software using descriptive and analytic (Chi-square and independent and paired sample t test) statistical methods. Results: There was a significant difference regarding pain severity after the intervention between the two groups during three days after the operation (respectively P ? 0.001, P ? 0.001 and P ? 0.003), but no significant difference was found between the two studied groups before the intervention. Moreover, a significant difference was seen before and after recitation in the intervention group during three days after the operation (for three days P ? 0.001), while in control group no significant difference was revealed before and after the intervention (respectively P = 0.493, P = 0.541 and P = 0.119). Conclusions: Reciting the word “Allah” as a non-pharmacological, low-cost and non-invasive method with no side effects can be effective on pain relief after CABG surgery. PMID:25729678

  1. 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

  2. Radionuclide angiographic assessment of global and segmental left ventricular function at rest and during exercise after coronary artery bypass graft surgery

    SciTech Connect

    Lim, Y.L.; Kalff, V.; Kelly, M.J.; Mason, P.J.; Currie, P.J.; Harper, R.W.; Anderson, S.T.; Federman, J.; Stirling, G.R.; Pitt, A.

    1982-11-01

    Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The right anterior oblique gated first-pass technique was used to assess LVEF response to maximal exercise (Wmax), while the left anterior oblique equilibrium-gated technique was used to assess LVEF and relative LV volume changes during graded submaximal exercise. Mean LVEF was unchanged at rest after CABG by both the first-pass (60 +/- 12% vs 60 +/- 12%) and equilibrium-gated (61 +/- 13% vs 62 +/- 13%) measurements. At Wmax, mean first-pass LVEF was significantly higher postoperatively than preoperatively (63 +/- 17% vs 53 +/- 17%; p less than 0.01) with a higher Wmax (750 +/- 182 vs 590 +/- 202 kpm/min; p less than 0.001) and higher rate-pressure product (302 +/- 59 vs 222 +/- 57 units; p less than 0.001). Similarly, equilibrium-gated LVEF levels during graded exercise, using stepwise regression analysis, were significantly higher postoperatively than preoperatively (p less than 0.001); at the highest graded work load, they averaged 63 +/- 19% postoperatively and 53 +/- 17% preoperatively, with higher work loads (500 +/- 190 vs 417 +/- 155; p less than 0.05) and higher rate-pressure products (271 +/- 55 vs 207 +/- 53; p less than 0.001). The increase in exercise LVEF after surgery was due to a marked decrease in the ratio, relative to resting values, of counts-based end-systolic volumes during submaximal exercise (preoperatively 1.91 +/- 1.04; postoperatively 1.14 +/- 0.46; p less than 0.01). The five subjects in whom LVEF decreased significantly during exercise postoperatively all had one or more blocked or stenosed grafts. This study documents, by two independent radionuclide techniques, an improved LVEF during exercise at an increased maximal work capacity and rate-pressure product 3 months after successful CABG.

  3. Short and Long Term Mortality after Coronary Artery Bypass Grafting (CABG) Is Influenced by Socioeconomic Position but Not by Migration Status in Sweden, 1995–2007

    PubMed Central

    Dzayee, Dashti Ali M.; Ivert, Torbjörn; Beiki, Omid; Alfredsson, Lars; Ljung, Rickard; Moradi, Tahereh

    2013-01-01

    Background There are no nationwide studies on mortality after coronary artery bypass grafting (CABG) among foreign-born populations that include detailed information about country of birth and information about socioeconomic position. The objective was to investigate the risk of mortality after CABG considering socioeconomic position, sex and country of birth. Material and Methods We included all 72 333 patients undergoing a first isolated CABG in Sweden, during 1995 - 2007 of whom 12.7% were foreign-born. The patients were classified according to educational level, sex, and country of birth and were followed up to December 2007. We estimated the risk of short and long term mortality after CABG in a multivariable model adjusted for age, calendar year of surgery, diabetes, educational level, and waiting time for surgery. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated based on the Cox proportional hazard model. Findings There were 15,284 deaths during the follow-up, 10.4% of whom were foreign-born. The foreign-born patients were 3 to 4 years younger than Sweden-born patients at the time of CABG surgery. There were no significant differences in overall early or late mortality between foreign-born and Sweden-born men and women after CABG. All-cause mortality differed in between regions and was highest in foreign-born men from Eastern Africa (HR 3.80, 95% CI 1.58–9.17), China (HR 3.61, 95% CI 1.50–8.69), and in Chile (HR 2.12, 95% CI 1.01–4.47). Patients with low level of education had worse survival compared to those with longer than 12 years of education irrespective of sex and country of birth. This difference was more pronounced among foreign-born women (HR 1.50, 95% CI 1.00–2.33). Conclusion This national study showed higher CABG mortality in patients from lower socioeconomic position. Early and late mortality did not differ after isolated CABG in foreign-born and Sweden-born patients. PMID:23717501

  4. Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury

    Microsoft Academic Search

    Song Wan; Mohammad Bashar Izzat; Tak Wai Lee; Innes Y. P Wan; Nelson L. S Tang; Anthony P. C Yim

    1999-01-01

    Background. Proinflammatory cytokines play a key role in the inflammatory cascade after cardiopulmonary bypass and may induce cardiac dysfunction. We compared the production of cytokines and the degree of postoperative myocardial injury in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting through median sternotomy with or without cardiopulmonary bypass.Methods. Forty-four consecutive patients were studied. Patients were selected

  5. 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

  6. Morphometric analysis of particulate debris extracted by four different embolic protection devices from coronary arteries, aortocoronary saphenous vein conduits, and carotid arteries.

    PubMed

    Quan, Vu-Hung; Huynh, Rany; Seifert, Philip A; Kuchela, Arun; Chen, Wai-Hong; Sütsch, Gabor; Eisenhauer, Andrew C; Rogers, Campbell

    2005-06-15

    Different embolic protection devices have been introduced for endovascular interventions: filters or balloon occlusion and aspiration systems. Despite widening use in a variety of vascular beds and clinical syndromes, little is known about the particulate burden liberated from different vascular beds and caught by different protection devices. We performed histologic and morphometric analyses of particulate debris captured during stenting of degenerated saphenous vein bypass grafts and native coronary arteries during acute myocardial infarction or during elective intervention and carotid arteries to assess the relative performance of different protection devices. We analyzed 232 interventions (90 saphenous vein bypass grafts, 77 native coronary arteries, and 65 carotid arteries) with 4 different devices (65 FilterWires, 99 Interceptors, 41 GuardWires, and 27 Proxis catheters) using the RapidVue particle analyzer. No difference in embolic volume retrieved was demonstrated between devices in saphenous vein bypass grafts and carotid interventions. A smaller volume of particulate debris was retrieved by the GuardWire compared with the FilterWire and the Proxis catheter in native coronary artery interventions. The Interceptor and the GuardWire captured more smaller particles than did the FilterWire or Proxis catheter. During saphenous vein bypass graft or carotid intervention, different embolic protection strategies were performed similarly. In native coronary artery stenting, however, proximal embolic protection retrieved larger amounts of debris than did distal filters or occlusion devices. These data may allow greater tailoring of embolic protection device development and application in specific anatomic locales. PMID:15950562

  7. The no-touch vein graft for coronary artery bypass surgery preserves the left ventricular ejection fraction at 16?years postoperatively: long-term data from a longitudinal randomised trial

    PubMed Central

    Johansson, Benny; Samano, Ninos; Souza, Domingos; Bodin, Lennart; Filbey, Derek; Mannion, John D; Bojö, Leif

    2015-01-01

    Objectives To assess the left ventricular heart function and the clinical outcome 16?years after coronary artery bypass surgery. Design In a randomised trial, the no-touch (NT) vein graft in coronary artery bypass surgery has shown a superior patency rate, a slower progression of atherosclerosis and better clinical outcome compared to the conventional (C) vein graft at 8.5?years. All patients at mean time 16?years were offered an echocardiographic and clinical examination. Results In the NT-group 34 patients and in the C-group 31 patients underwent an echocardiography examination. A significantly better left ventricle ejection fraction was seen in the NT-group compared to the C-group (57.9% vs 49.4%; p=0.011). The size of the left atrium in NT was 21.7?cm2 compared to 23.9?cm2 in C; p=0.034. No patient in NT had atrial fibrillation compared to five patients in C (p=0.021). Patients with a brain natriuretic peptide value (BNP) ?150 was 30% in NT compared to 38% in C. Total mortality was 25% in NT vs 27% in C. Cardiac-related deaths were 8% and 12% in NT and C respectively. Conclusions The NT vein graft preserves the left ventricular ejection fraction after 16?years. A smaller left atrium, a lower BNP and no atrial fibrillation indicates an improved diastolic left ventricular function in the NT-group. Trial registration The study is registered with clinicaltrials.gov (NCT01686100) and The Research and Development registry in Sweden (no. 102841). PMID:25852948

  8. 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

  9. 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...

  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, 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...

  12. 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...

  13. Fisioterapia convencional versus terapia EPAP no pós-operatório de cirurgia de revascularização do miocárdio Conventional physical therapy versus EPAP therapy in postoperative coronary artery bypass grafting

    Microsoft Academic Search

    Daniela Bertol

    Introduction: Pulmonary complications in the immediate postoperative period of co- ronary artery bypass grafting (CABG) increase the morbidity and mortality risk. Respira- tory physical therapy with its techniques and resources, such as application of positive pressure, have been tested with the aim of diminishing the complications. Objective: To compare the effects of conventional chest physical therapy (PT) with the EPAP+PT

  14. Registration of a 4D Cardiac Motion Model to Endoscopic Video for Augmented Reality Image Guidance of Robotic Coronary Artery Bypass

    Microsoft Academic Search

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

    The aim of the work described in this paper is registration of a 4D preoperative motion model of the heart to the video view of the patient through the intraoperative endoscope, in order to overlay the real video sequence with it. As the heart motion is cyclical it can be modelled using multiple reconstructions of cardiac gated coronary CT. We

  15. Spontaneous coronary artery dissection of all major coronary arteries

    PubMed Central

    Harikrishnan, S; Ajithkumar, VK; Tharakan, JM

    2007-01-01

    Spontaneous coronary artery dissection is a rare cause of myocardial infarction and sudden cardiac death. A 32-year-old man presented with effort angina. He had a positive treadmill exercise electrocardiogram test, and coronary angiography showed that he had dissection of all major coronary vessels. The left anterior descending coronary artery was completely blocked, probably secondary to dissection and subsequent occlusion. He was advised to undergo coronary artery bypass surgery, to which he did not agree; instead, he was treated by medication and followed up. PMID:17380226

  16. Cardiac troponin I plasma levels for diagnosis and quantitation of perioperative myocardial damage in patients undergoing coronary artery bypass surgery 1 Presented in part at the 26th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, Dresden, Germany, 5–8 February, 1997. 1

    Microsoft Academic Search

    Volker Sadony; Michael Körber; Guido Albes; Volker Podtschaske; Thorleif Etgen; Thomas Trösken; Ursula Ravens; Max Ernst Scheulen

    1998-01-01

    Objective: The definition of a reliable and generally accepted diagnostic standard for perioperative myocardial damage is desirable. Cardiac troponin I (cTnI) is highly specific for myocardial tissue and can be measured rapidly. The aim of our study was to evaluate the diagnostic potential of cTnI for myocardial lesions in patients undergoing coronary artery bypass surgery (CABG). Methods: A total of

  17. 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

  18. Spontaneous coronary artery dissection and pseudoaneurysm: a case report.

    PubMed

    Nie, Jun-Gang; Dong, Jian-Zeng

    2014-02-01

    Spontaneous coronary artery dissection (SCAD) is a very rare but potentially fatal condition, which often causes acute myocardial infarction and sudden cardiac death. Spontaneous coronary artery dissection associated with pseudoaneurysm has been rarely reported mostly managed with coronary artery bypass grafting. We report a female patient with SCAD and pseudoaneurysm who was treated by successful percutaneous coronary intervention. PMID:24176591

  19. Doppler findings in a rare Coronary Artery Fistula

    Microsoft Academic Search

    Christian Jung; Carl Jorns; James Huhta

    2007-01-01

    One of the primary forms of congenital anomalies of the coronary arteries is coronary artery fistula (CAF). It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. We present a newborn baby with a large coronary artery fistula connecting the left anterior descending (LAD) artery

  20. Polymorphous ventricular tachycardia following cardiopulmonary bypass.

    PubMed Central

    Thompson, L. D.; Cohen, A. J.; Bellasis, R. M.

    1996-01-01

    A 62-year-old African-American man who underwent coronary artery bypass surgery was found to have repetitive ventricular tachycardia of the "Torsade des pointes" type. The arrhythmia was resistant to bretylium, lidocaine, and pacing, but was controlled by intravenous magnesium sulfate. The recurrent attacks were abolished by a bolus of 1 g magnesium sulfate and controlled using a 1 mg/minute drip for 12 hours. This case shows the effectiveness of intravenous magnesium in controlling Torsade des pointes in postoperative coronary bypass patients. PMID:8583493

  1. High-Dose Statin Pretreatment Decreases Periprocedural Myocardial Infarction and Cardiovascular Events in Patients Undergoing Elective Percutaneous Coronary Intervention: A Meta-Analysis of Twenty-Four Randomized Controlled Trials

    PubMed Central

    Wang, Le; Peng, Pingan; Zhang, Ou; Xu, Xiaohan; Yang, Shiwei; Zhao, Yingxin; Zhou, Yujie

    2014-01-01

    Background Evidence suggests that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE) for certain patients; however, previous analyses have not considered patients with a history of statin maintenance treatment. In this meta-analysis of randomized controlled trials (RCTs), we reevaluated the efficacy of short-term high-dose statin pretreatment to prevent PMI and MACE in an expanded set of patients undergoing elective percutaneous coronary intervention. Methods We searched the PubMed/Medline database for RCTs that compared high-dose statin pretreatment with no statin or low-dose statin pretreatment as a prevention of PMI and MACE. We evaluated the incidence of PMI and MACE, including death, spontaneous myocardial infarction, and target vessel revascularization at the longest follow-up for each study for subgroups stratified by disease classification and prior low-dose statin treatment. Results Twenty-four RCTs with a total of 5,526 patients were identified. High-dose statin pretreatment was associated with 59% relative reduction in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34–0.49; P<0.00001) and 39% relative reduction in MACE (OR: 0.61; 95% CI: 0.45–0.83; P?=?0.002). The benefit of high-dose statin pretreatment on MACE was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50–0.95; P?=?0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI: 0.12–0.65; P?=?0.003); and for patients with acute coronary syndrome (OR: 0.52; 95% CI: 0.34–0.79; P?=?0.003), but not for patients with stable angina (OR: 0.71; 95% CI 0.45–1.10; P?=?0.12). Long-term effects on survival were less obvious. Conclusions High-dose statin pretreatment can result in a significant reduction in PMI and MACE for patients undergoing elective PCI. The positive effect of high-dose statin pretreatment on PMI and MACE is significant for statin-naïve patients and patients with prior treatment. The positive effect of high-dose statin pretreatment on MACE is significant for patients with acute coronary syndrome. PMID:25473831

  2. 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

  3. Excimer laser coronary angioplasty: the New Approaches to Coronary Intervention (NACI) experience.

    PubMed

    Holmes, D R; Mehta, S; George, C J; Margolis, J R; Leon, M B; Isner, J M; Bittl, J A; King, S B; Siegel, R M; Sketch, M H; Cowley, M J; Roubin, G S; Brinker, J A; Overlie, P A; Tcheng, J; Sanborn, T A; Litvack, F

    1997-11-20

    In the New Approaches to Coronary Intervention (NACI) registry, 887 patients were electively treated with excimer laser coronary angioplasty (ELCA) for coronary artery disease. The Advanced Interventional System (AIS) system was used in 487 cases; the Spectranetics system, in 400. The mean age was 63.4 years. Most patients had unstable angina (60.3%); 43.7% had a prior myocardial infarction; and 18.6% were high risk or inoperable patients. Mean ejection fraction was 55.4%. A total of 1,000 lesions were treated in the 887 patients. Of the 1,000 lesions treated with ELCA in the 887 patients, 36% were in the right coronary artery; 33%, left anterior descending; 13%, circumflex; 3%, left main; and 16.6%, vein graft. By angiographic core laboratory analysis available for 752 (85%) patients with 839 lesions, lesions were 12.76 mm long. The minimum lumen diameter increased to 1.29 mm after the laser and finally to 1.95 mm after adjunctive percutaneous transluminal coronary angioplasty (PTCA) (which was performed in 93% of all lesions), with a final residual stenosis of 32.1% and Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in 95%. Dissections of grades B, C, or D were seen after 22.0% of initial laser attempts, and postlaser perforations were noted in 2.6%. Additional such dissections accumulated after adjunctive PTCA but the perforation rate remained low. Procedural success was achieved in 84% of patients, but 1.2% died, 0.7% experienced Q-wave myocardial infarction (MI), and 2.7% required emergency bypass surgery. Multiple logistic regression analysis could not identify any independent predictors of these in-hospital complications. One-year mortality was 5.7% and the cumulative incidence of Q-wave MI was 1.5%. Coronary artery bypass graft (CABG) surgery was performed in 15.0% of patients whereas 25.5% required repeat percutaneous intervention with a target lesion revascularization rate of 31%. Independent predictors of death, Q-wave MI, or target lesion revascularization (which, combined, occurred in 35.6% of patients) were the absence of prior MI, ELCA in the circumflex, perforation after the procedure, and small (<2 mm) final minimal lumen diameter. Considering the large number of patients with high-risk lesions, laser angioplasty was performed with excellent procedural success rates and a reasonable incidence of major complications. PMID:9409697

  4. 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

  5. Outcomes of patients with acute coronary syndromes and prior coronary artery bypass grafting: results from the platelet glycoprotein IIb\\/IIIa in unstable angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial

    Microsoft Academic Search

    Marino Labinaz; Rakhi Kilaru; Karen Pieper

    2002-01-01

    Background—Patients with prior CABG with a subsequent non-ST-segment elevation acute coronary syndrome (ACS) pose an increasingly important clinical problem. Although GP IIb\\/IIIa inhibitors have improved the outcome of patients with ACS, their efficacy in patients with prior CABG has not been previously evaluated. Methods and Results—We analyzed the 30- and 180-day outcomes of patients with prior CABG enrolled in the

  6. Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system

    Microsoft Academic Search

    Jens Wippermann; Johannes M. Albes; Martin Hartrumpf; Mirko Kaluza; Rüdiger Vollandt; Raimund Bruhin; Thorsten Wahlers

    2005-01-01

    Objective: Closed circuit extracorporeal circulation (CCECC) has been developed to reduce deleterious effects of standard cardiopulmonary bypass (CPB). This study compares the effects of CCECC (CORx system), CPB, and off-pump coronary artery bypass grafting (OPCAB) on red blood cell damage, coagulation activation, fibrinolysis and cytokine expression. Methods: Thirty patients underwent coronary artery bypass grafting (CABG). Twenty of them were randomized

  7. Management of a subclavian artery thrombosis causing acute anterior wall infarction and concurrent left arm ischemia in a patient with prior coronary bypass.

    PubMed

    Akgüllü, Ça?da?; Ery?lmaz, Ufuk; Zencir, Cemil; Güngör, Hasan

    2014-12-01

    We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report. PMID:25620337

  8. Heparin resistance and increased platelet activation in coronary surgery patients treated with enoxaparin preoperatively

    Microsoft Academic Search

    Hilde Pleym; Vibeke Videm; Alexander Wahba; Arne Åsberg; Tore Amundsen; Lise Bjella; Ola Dale; Roar Stenseth

    2006-01-01

    Objective: Patients with unstable coronary disease have changes in the hemostatic system. These patients are often treated with low molecular weight heparin. In patients who are accepted for coronary artery bypass grafting, treatment with low molecular weight heparin is frequently continued until surgery. We hypothesized that in coronary artery bypass grafting, the hypercoagulable state seen in unstable patients persists into

  9. Blood Levels of S-100 Calcium-Binding Protein B, High-Sensitivity C-Reactive Protein, and Interleukin-6 for Changes in Depressive Symptom Severity after Coronary Artery Bypass Grafting: Prospective Cohort Nested within a Randomized, Controlled Trial

    PubMed Central

    Pearlman, Daniel M.; Brown, Jeremiah R.; MacKenzie, Todd A.; Hernandez, Felix; Najjar, Souhel

    2014-01-01

    Background Cross-sectional and retrospective studies have associated major depressive disorder with glial activation and injury as well as blood–brain barrier disruption, but these associations have not been assessed prospectively. Here, we aimed to determine the relationship between changes in depressive symptom severity and in blood levels of S-100 calcium-binding protein B (S-100B), high-sensitivity C-reactive protein, and interleukin-6 following an inflammatory challenge. Methods Fifty unselected participants were recruited from a randomized, controlled trial comparing coronary artery bypass grafting procedures performed with versus without cardiopulmonary bypass for the risk of neurocognitive decline. Depressive symptom severity was measured at baseline, discharge, and six-month follow-up using the Beck Depression Inventory II (BDI-II). The primary outcome of the present biomarker study was acute change in depressive symptom severity, defined as the intra-subject difference between baseline and discharge BDI-II scores. Blood biomarker levels were determined at baseline and 2 days postoperative. Results Changes in S-100B levels correlated positively with acute changes in depressive symptom severity (Spearman ?, 0.62; P?=?0.0004) and accounted for about one-fourth of their observed variance (R2, 0.23; P?=?0.0105). This association remained statistically significant after adjusting for baseline S-100B levels, age, weight, body-mass index, or ?-blocker use, but not baseline BDI-II scores (P?=?0.064). There was no statistically significant association between the primary outcome and baseline S-100B levels, baseline high-sensitivity C-reactive protein or interleukin-6 levels, or changes in high-sensitivity C-reactive protein or interleukin-6 levels. Among most participants, levels of all three biomarkers were normal at baseline and markedly elevated at 2 days postoperative. Conclusions Acute changes in depressive symptom severity were specifically associated with incremental changes in S-100B blood levels, largely independent of covariates associated with either. These findings support the hypothesis that glial activation and injury and blood–brain barrier disruption can be mechanistically linked to acute exacerbation of depressive symptoms in some individuals. PMID:25329583

  10. 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 ...

  11. 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

  12. Multiobjective Patient-Specific Estimation of a Coronary Circulation Model for Triple Vessel Disease

    E-print Network

    Paris-Sud XI, Université de

    of the coronary circulation is critical for the patient outcome. Although some patients may develop an alternative angioplasty or coronary artery bypass graft (CABG) surgery. Since these procedures are delicate and complex

  13. Minimal Invasive Coronary Artery Fistula Ligation

    PubMed Central

    Mitropoulos, Fotios A.; Kanakis, Meletios A.; Chatzis, Andrew; Contrafouris, Constantinos; Sofianidou, Ioanna A.; Lioulias, Achilleas G.

    2014-01-01

    A coronary artery fistula was surgically ligated in a 38-year-old woman via a left anterior mini-thoracotomy without the use of cardiopulmonary bypass. In selected cases, this surgical approach can provide an excellent surgical exposure for coronary artery fistula ligation. It also offers an excellent cosmetic result and shorter hospital stay. PMID:25551078

  14. Coronary artery balloon angioplasty - series (image)

    MedlinePLUS

    ... flow through the coronary arteries and to the heart tissue in about 90% of patients and may eliminate the need for coronary artery bypass surgery. The outcome is relief from chest pain symptoms and an improved exercise capacity. In 2 out of 3 cases, the ...

  15. Relationship of High?Density Lipoprotein Cholesterol With Periprocedural Myocardial Injury Following Elective Percutaneous Coronary Intervention in Patients With Low?Density Lipoprotein Cholesterol Below 70 mg/dL

    PubMed Central

    Li, Xiao?Lin; Guo, Yuan?Lin; Zhu, Cheng?Gang; Xu, Rui?Xia; Qing, Ping; Wu, Na?Qiong; Jiang, Li?Xin; Xu, Bo; Gao, Run?Lin; Li, Jian?Jun

    2015-01-01

    Background Recent data showed inconsistent association of high?density lipoprotein cholesterol (HDL?C) with cardiovascular risk in patients with different levels of low?density lipoprotein cholesterol (LDL?C) or intensive statin therapy. This study sought to determine the relationship of HDL?C with periprocedural myocardial injury following elective percutaneous coronary intervention (PCI) across a range of LDL?C levels, especially in patients with LDL?C <70 mg/dL. Methods and Results We enrolled 2529 consecutive patients with normal preprocedural cardiac troponin I (cTnI) who underwent elective PCI. The association between preprocedural HDL?C and periprocedural myocardial injury was evaluated across LDL?C levels, especially in patients with LDL?C <70 mg/dL. The HDL?C level was not predictive of periprocedural myocardial injury across the entire study cohort. However, among patients with LDL?C <70 mg/dL, a 1 mg/dL increase in HDL?C was associated with a 3% reduced risk for postprocedural cTnI above 1×upper limit of normal (ULN) (odds ratio: 0.97; 95% CI: 0.95 to 0.99; P=0.004), a 3% reduced risk for postprocedural cTnI above 3×ULN odds ratio: 0.97; 95% CI: 0.95 to 0.99; P=0.022), and a 3% reduced risk for postprocedural cTnI above 5×ULN (odds ratio: 0.97; 95% CI: 0.95 to 0.99; P=0.017). The relation between plasma HDL?C level and risk of postprocedural cTnI elevation above 1×ULN, 3×ULN, and 5×ULN was modified by LDL?C level (all P for interaction <0.05). Conclusions Higher HDL?C levels were associated with reduced risk of periprocedural myocardial injury only in patients with LDL?C <70 mg/dL. PMID:25572484

  16. Positron emission tomography with oxygen-15 of stunned myocardium caused by coronary artery vasospasm after recovery

    Microsoft Academic Search

    D. Agostini; H. Iida; A. Takahashi

    1995-01-01

    Stunned myocardium is often observed after unstable angina, myocardial infarction, thrombolysis, angioplasty, and bypass surgery but rarely after coronary vasospasm. A case of stunned myocardium caused by diffuse coronary artery vasospasm and mimicking myocardial infarction is reported. The patient had an emergency coronary angiography, which showed no pathological coronary disease, but the left ventricular ejection fraction showed severe left ventricular

  17. Election '08

    ERIC Educational Resources Information Center

    Kennedy, Mike

    2008-01-01

    Every four years, the presidential election campaign unfolds, and the position of the candidates on education is predictable: They are in favor of it. Something else is easy to predict: In every presidential campaign, hot-button issues--some important and some infuriatingly not--suck up most of the oxygen, and the hoped-for focus on education…

  18. Election Fever

    ERIC Educational Resources Information Center

    Strom, Erich

    2012-01-01

    Kids learn by doing, which, experts agree, is the only real way to teach citizenship. This article presents election-year activities that stress action. These activities will show students what it means to be a good citizen. (Contains 6 online resources.)

  19. Physiologic assessment of coronary artery fistula

    SciTech Connect

    Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  20. [Cardiac tamponade due to ruptured coronary artery aneurysm associated with coronary-pulmonary artery fistula; report of a case].

    PubMed

    Tauchi, Yuuya; Shibukawa, Takanori; Satoh, Hisashi; Matsuda, Hikaru

    2014-12-01

    We report a successful operative treatment of ruptured coronary artery aneurysm associated with coronary-pulmonary artery fistula. A 67-year-old woman was diagnosed with coronary artery fistula previously but observed without any treatment. She had medical examination at a previous hospital because of sudden onset of dyspnea, and transported to our institution with a diagnosis of cardiac tamponade. Multi-detector computed tomography (MDCT) showed massive pericardial effusion, coronary-pulmonary artery fistula and giant coronary artery aneurysm. We performed emergency operation. Under cardiopulmonary bypass, coronary artery fistula and aneurysm was resected. Postoperative MDCT showed almost complete exclusion of coronary artery fistula. Postoperative course was uneventful. PMID:25434543

  1. Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2?×?2 factorial designed randomised NEO trial

    PubMed Central

    2014-01-01

    Background Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique. Methods/Design The NEO Trial is a randomised clinical trial with a 2?×?2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group. The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively. We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the radial artery. The trial also aims to show if there is any patency difference between mammario-radial compared to aorto-radial revascularisation techniques but this objective is exploratory. Trial registration ClinicalTrials.gov identifier: NCT01848886. Danish Ethics committee number: H-3-2012-116. Danish Data Protection Agency: 2007-58-0015/jr.n:30–0838. PMID:24754891

  2. Effect of Preoperatively Continued Aspirin Use on Early and Mid-Term Outcomes in Off-Pump Coronary Bypass Surgery: A Propensity Score-Matched Study of 1418 Patients

    PubMed Central

    Xiao, Fucheng; Wu, Hengchao; Sun, Hansong; Pan, Shiwei; Xu, Jianping; Song, Yunhu

    2015-01-01

    Background To date, effect of preoperatively continued aspirin administration in off-pump coronary artery bypass grafting (CABG) is less known. We aimed to assess the effect of preoperatively continued aspirin use on early and mid-term outcomes in patients receiving off-pump CABG. Methods From October 2009 to September 2013 at the Fuwai Hospital, 709 preoperative aspirin users were matched with unique 709 nonaspirin users using propensity score matching to obtain risk-adjusted outcome comparisons between the two groups. Early outcomes were in-hospital death, stroke, intra- and post-operative blood loss, reoperation for bleeding and blood product transfusion. Major adverse cardiac events (death, myocardial infarction or repeat revascularization), angina recurrence and cardiogenic readmission were considered as mid-term endpoints. Results There were no significant differences among the groups in baseline characteristics after propensity score matching. The median intraoperative blood loss (600 ml versus 450 ml, P = 0.56), median postoperative blood loss (800 ml versus 790 ml, P = 0.60), blood transfusion requirements (25.1% versus 24.4%, P = 0.76) and composite outcome of in-hospital death, stroke and reoperation for bleeding (2.8% versus 1.6%, P = 0.10) were similar in aspirin and nonaspirin use group. At about 4 years follow-up, no significant difference was observed among the aspirin and nonaspirin use group in major adverse cardiac events free survival estimates (95.7% versus 91.5%, P = 0.23) and freedom from cardiogenic readmission (88.5% versus 85.3%, P = 0.77) whereas the angina recurrence free survival rates was 83.7% and 73.9% in the aspirin and nonaspirin use group respectively (P = 0.02), with odd ratio for preoperative aspirin estimated at 0.71 (95% confidence interval, 0.49-1.04, P = 0.08). Conclusions Preoperatively continued aspirin use was not associated with increased risk of intra- and post-operative blood loss, blood transfusion requirements and composite outcome of in-hospital death, stroke and reoperation for bleeding in off-pump CABG. Preoperative aspirin use tended to decrease the hazard of mid-term angina recurrence. PMID:25706957

  3. Election Notes: Daily International News of Elections, Elections Calendar, Election Returns, Election Results, Election Administration, Campaign Finance, and Electoral Politics

    NSDL National Science Digital Library

    A fast, economical way to keep up with worldwide election news is Election Notes, a daily web service provided by Klipsan Press. The site provides concise summaries of election news by country, with hypertext connections to the news sources when available. Election returns (with sources) are provided when available.

  4. Popliteal-to-Distal Bypass for Limb Salvage

    Microsoft Academic Search

    Franco Grego; Michele Antonello; Rudi Stramana’; Giovanni P. Deriu; Sandro Lepidi

    2004-01-01

    A retrospective study was carried out to examine the patency and limb salvage rates of popliteal-to-distal bypass and compare the results of diabetic to those of nondiabetic patients and elective versus emergency procedures. From January 1990 to December 2001, 71 popliteal-to-distal bypasses were performed. Indications for surgery were rest pain, tissue loss, and acute ischemia, including extensive post-traumatic tibial lesions.

  5. Coronary Pressure Measurement Based Decision Making for Percutaneous Coronary Intervention

    PubMed Central

    Iwasaki, Kohichiro; Kusachi, Shozo

    2009-01-01

    The fractional flow reserve (FFR) is a simple, reliable, and reproducible physiologic index of lesion severity. In patients with intermediate stenosis, FFR?0.75 can be used to safely defer percutaneous coronary intervention (PCI), and patients with FFR?0.75 have a very low cardiac event rate. Coronary pressure measurement can determine which lesion should be treated with PCI in patients with tandem lesions, and PCI on the basis of FFR has been demonstrated to result in an acceptably low repeat PCI rate. FFR can identify patients with equivocal left main coronary artery disease who benefit from coronary bypass surgery. Coronary pressure measurement distinguishes patients with an abrupt pressure drop pattern from those with a gradual pressure drop pattern, and the former group of patients benefit from PCI. Coronary pressure measurement is clinically useful in evaluating sufficient recruitable coronary collateral blood flow for prevention of ischemia, which affects future cardiac events. FFR is useful for the prediction of restenosis after PCI. As an end-point of PCI, FFR ?0.95 and ?0.90 would be appropriate for coronary stenting and coronary angioplasty, respectively. In summary, if you encounter a coronary stenosis in doubt you should measure pressure rather than dilate it. PMID:21037849

  6. Coronary Arteries

    MedlinePLUS

    ... and animations for grades K-6. The Coronary Arteries | Share Coronary Circulation The heart muscle, like every ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...

  7. Elections 2004

    NSDL National Science Digital Library

    Every presidential election in the United States gives rise to greater legions of so-called "spin doctors," and a number of pundits offering their opinions on the chances of each candidate who has thrown their hat in the ring. Fortunately, the University of Michigan Documents Center has developed this helpful and informative website that culls together hundreds of useful websites about the upcoming presidential election of 2004. From the homepage visitors can look through a number of helpful sections devoted to listing sites dedicated to such topics as Policy Issues, Candidates, and Campaign. Within each of these broad thematic areas are contained more specific areas dedicated to links on important subtopics such as campaign finances, media coverage, terrorism, economics, and many others. Scholars will want to take a look at the Academic Research section, which contains links to online periodical databases and some links to sites with recent working papers on the subject.

  8. Election Project

    NSDL National Science Digital Library

    Michael Phillips

    In late September (of an election year), one class session is devoted to developing a list of issues key to the class and likely to be discussed by the candidates. The list is converted into 3-5 questions all students will research and answer. Each student is assigned a candidate (President, Governor, congress, state legislature). An effort is made to assign each student a candidate who will appear on his/her ballot and to assign third party candidates. Student research candidates' positions using web resources, news papers, and campaign materials. Students are strongly encouraged to contact the campaign directly and question the candidate, if possible. Students report back to the class with a 3-5 minute presentation and a poster that may be displayed in a college commons area. Reports are presented a week prior to the election.

  9. Quality of Life After Bypass Surgery in Patients with Chest Pain and Heart Failure

    MedlinePLUS

    ... Bypass Surgery in Patients With Chest Pain and Heart Failure The full report is titled “Quality-of-Life ... in patients who have coronary artery disease plus heart failure, which can cause additional symptoms, such as shortness ...

  10. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to cannulate the vessels, perfuse the coronary arteries, and to interconnect the catheters and cannulas with an oxygenator. The device includes accessory bypass equipment....

  11. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to cannulate the vessels, perfuse the coronary arteries, and to interconnect the catheters and cannulas with an oxygenator. The device includes accessory bypass equipment....

  12. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to cannulate the vessels, perfuse the coronary arteries, and to interconnect the catheters and cannulas with an oxygenator. The device includes accessory bypass equipment....

  13. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to cannulate the vessels, perfuse the coronary arteries, and to interconnect the catheters and cannulas with an oxygenator. The device includes accessory bypass equipment....

  14. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to cannulate the vessels, perfuse the coronary arteries, and to interconnect the catheters and cannulas with an oxygenator. The device includes accessory bypass equipment....

  15. The impact of uncertainty on shape optimization of idealized bypass graft models in unsteady flow

    E-print Network

    Marsden, Alison L.

    . The operative mortality rate for coronary artery bypass graft CABG surgery is around 3%, and clinical outcomes The influence of geometry on hemodynamics has been quantitatively studied for CABG.4 In general, the angle

  16. Conf Proc IEEE Eng Med Biol Soc . Author manuscript Multiobjective patient-specific estimation of a coronary circulation model

    E-print Network

    Boyer, Edmond

    is critical for the patient outcome. Although some patients may develop an alternative source of blood supply therapeutic action in the case of complete stenosis is based on coronary angioplasty or coronary artery bypass

  17. [Coronary angioplasty in diabetic patients].

    PubMed

    Steffenino, Giuseppe; La Scala, Eugenio; Riva, Lucilla; Menardi, Endrj

    2002-01-01

    Increased thrombogenicity, endothelial dysfunction, proliferation of both the cells and the matrix in the vessel walls, dislipidemia and insulin-resistance are the main metabolic alterations in the diabetic scenario, with possible implications in terms of vessel restenosis after coronary angioplasty. The outcome of balloon coronary angioplasty in diabetics is poor. This is due to both increased restenosis and a high incidence of medium/long-term cardiac events; the use of stents in these patients has substantially improved the results, but the recurrence rate has not been abated to the level observed in the general population. Abciximab may be a helpful adjunct to coronary angioplasty in these patients, while coronary artery bypass grafting may still be preferable--as at present--in case of multivessel coronary artery disease. This viewpoint is likely to be substantially modified in the near future, if the promise of "zero restenosis" devices is kept. PMID:11899579

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

    MedlinePLUS

    ... with arteries with the aim of reducing the patient's risk of needing another operation. Another technique aimed at ... keep in mind that estimates of a particular patient's risk of any of these complications can only be ...

  19. Who Needs Coronary Artery Bypass Grafting?

    MedlinePLUS

    ... are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. ... Media Availability: Mitral valve repair following heart attack may offer ...

  20. Does off-pump coronary surgery reduce morbidity and mortality?

    Microsoft Academic Search

    Joseph F. Sabik; A. Marc Gillinov; Eugene H. Blackstone; Catherine Vacha; Penny L. Houghtaling; Jose Navia; Nicholas G. Smedira; Patrick M. McCarthy; Delos M. Cosgrove; Bruce W. Lytle

    2002-01-01

    Objective: To compare hospital outcomes of on-pump and off-pump coronary artery bypass surgery. Methods: From 1997 to 2000, primary coronary artery bypass grafting was performed in 481 patients off pump and in 3231 patients on pump. Hospital outcomes were compared between propensity-matched pairs of 406 on-pump and 406 off-pump patients. The 2 groups were similar in age (P = .9),

  1. Minnesota Bypass Experiences

    E-print Network

    Minnesota, University of

    #12;#12;#12;#12;#12;More Recent Works · Effects of Highway Bypasses on Rural Communities and Small;(continued) · Highway Bypasses on Small Communities (Weisbrod 2001) The Economic Impact of Rural Bypasses variables: retail sales, gasoline sales, bank debits ­ Several used follow-up interviews with merchants

  2. Pre-Approved1 Bioengineering Electives for Biological Engineering (NOTE: Technical Electives Engineering Electives Bioengineering Electives)2

    E-print Network

    Dyer, Bill

    Pre-Approved1 Bioengineering Electives for Biological Engineering (NOTE: Technical Electives Engineering Electives Bioengineering Electives)2 Updated: November 2014 Course # Title Offered Credits may be allowed for bioengineering elective credit, but you should get any course you are considering

  3. Coronary calcium in patients with and without diabetes: first manifestation of acute or chronic coronary events is characterized by different calcification patterns

    PubMed Central

    2013-01-01

    Background Coronary artery calcification (CAC) is closely related to coronary atherosclerosis. However, less is known about the clinical significance of extensive CAC (ECAC) in regard to types of first coronary events (acute vs. chronic). Diabetes mellitus (DM) represents a strong risk factor for CAD although its association with CAC is controversial. Aiming to elucidate these controversies we investigated the long-term outcome of coronary artery disease (CAD) in relation to degree of CAC in patients with and without DM from our annual cheek-up outpatient clinic. Methods Coronary artery computed tomography (CT) was performed in 667 patients who were yearly evaluated during a mean follow-up period of 6.3 ±3.4 year. The following 4 CAC categories were established: calcium absence; total calcium score (TCS): 1–100 AU; TCS: 101–600 AU and ECAC: TCS above 600 AU. Acute event was defined as first acute myocardial infarction (MI) or a new unstable angina. First chronic event was defined as a positive stress test with a consequent elective percutaneous coronary intervention or coronary artery bypass grafting. Results 628 subjects (94%) were free from any cardiac events, 39 (6%) experienced first cardiac event: 18 of them suffered acute and 21 chronic events. There were 67 patients with and 600 patients without DM: 78% of patients with DM presented CAC vs. 50% of patients without DM (p?coronary events but presented a high level of chronic CAD-related events during the 6.3 ±3.4 year follow-up. In contrast, first acute CAD-related events occurred mostly in subjects with mild and moderate CAC score. PMID:24188692

  4. Iatrogenic Left Main Coronary Artery Stenosis Following Aortic and Mitral Valve Replacement

    PubMed Central

    Alsaddah, Jadan; Alkandari, Saad; Younan, Hany

    2015-01-01

    Iatrogenic coronary artery disease following prosthetic valve implantation is a rare complication. This may result from mechanical injury in the intraoperative period. The use of balloon tip perfusion catheter presumably provides the initial insult with local vessel wall hypoxia. Once the diagnosis of coronary ostial stenosis is established, the procedure of choice is coronary artery bypass surgery. We report a case of a young lady who underwent aortic and mitral valves replacement for infective endocarditis. She was then diagnosed with ostial left main stem coronary stenosis after presenting with atypical symptoms. The patient eventually underwent coronary artery bypass surgery.

  5. Composite Arterial Y Graft Has Less Coronary Flow Reserve Than Independent Grafts

    Microsoft Academic Search

    Genichi Sakaguchi; Eiji Tadamura; Motoaki Ohnaka; Keiichi Tambara; Kazunobu Nishimura; Masashi Komeda

    2010-01-01

    Background. It is not known whether a composite Y graft of the left internal thoracic artery can provide sufficient blood flow to the whole left coronary system. The aim of this study was to compare regional myocar- dial blood flow (MBF) and coronary flow reserve after coronary artery bypass grafting using arterial composite Y graft or independent arterial grafts. Methods.

  6. Composite arterial Y graft has less coronary flow reserve than independent grafts

    Microsoft Academic Search

    Genichi Sakaguchi; Eiji Tadamura; Motoaki Ohnaka; Keiichi Tambara; Kazunobu Nishimura; Masashi Komeda

    2002-01-01

    Background. It is not known whether a composite Y graft of the left internal thoracic artery can provide sufficient blood flow to the whole left coronary system. The aim of this study was to compare regional myocardial blood flow (MBF) and coronary flow reserve after coronary artery bypass grafting using arterial composite Y graft or independent arterial grafts.Methods. Positron emission

  7. Incidence, predictors, in-hospital, and late outcomes of coronary artery perforations

    Microsoft Academic Search

    Goran Stankovic; Dejan Orlic; Nicola Corvaja; Flavio Airoldi; Alaide Chieffo; Vassilis Spanos; Matteo Montorfano; Mauro Carlino; Leo Finci; Giuseppe Sangiorgi; Antonio Colombo

    2004-01-01

    We sought to determine the incidence of coronary perforations, predisposing factors, and in-hospital and late outcome of patients with coronary perforations. Perforations occurred in 0.84% of treated lesions and more frequently in patients with complex lesions after atheroablative procedures and who underwent intravascular ultrasound guided lumen optimization. The incidence of adverse events, emergency coronary artery bypass grafting and death significantly

  8. Minimally invasive coronary artery revascularization on the beating heart

    Microsoft Academic Search

    Jochen T Cremer; Thorsten Wittwer; Andreas Böning; Marcel B Anssar; Theo Kofidis; Andreas Mügge; Axel Haverich

    2000-01-01

    Background. The quality of surgical beating heart revascularization is frequently questioned, especially when the surgical access is limited. Nevertheless, the number of off-pump coronary procedures is expanding worldwide.Methods. Since getting started with minimally invasive direct coronary artery bypass to anterior myocardial vessels in June 1996, 306 patients received left internal mammary artery grafting through an anterior minithoracotomy. Risk increasing comorbidities

  9. Contemporary management of concomitant carotid and coronary artery disease

    Microsoft Academic Search

    Sridhar Venkatachalam; Bruce H Gray; Debabrata Mukherjee; Mehdi H Shishehbor

    2010-01-01

    The best approach to the management of concomitant severe carotid and coronary artery disease remains unanswered. The American College of Cardiology\\/American Heart Association (ACC\\/AHA) guidelines recommend carotid endarterectomy (CEA) in asymptomatic carotid stenosis of ?80% either prior to or combined with coronary artery bypass surgery (CABG). Currently, there is no consensus as to which surgical approach is superior. More recently,

  10. Surgical management of concomitant carotid and coronary artery occlusive disease

    Microsoft Academic Search

    Sibu P. Saha; Anthony G. Rogers; Gary F. Earle; Craig A. Nachbauer; Bassam A. Khalil; Robert O. Mitchell; Robert Mentzer; Mary L. Baker

    2000-01-01

    The management of concomitant coronary and carotid disease is controversial. We report our experience of simultaneous coronary artery bypass surgery and carotid artery endarterectomy on 70 consecutive patients (34 males and 36 females) with a mean age of 68 years. The oldest patient was 91 years old. The average percent of carotid artery stenosis was 86% (range 60%–99%). The average

  11. Spontaneous coronary artery dissection by intravascular ultrasound in a patient with myocardial infarction

    PubMed Central

    Jang, Ji Hun; Kim, Dae Hyeok; Yang, Dong Hyuk; Woo, Seong Il; Kwan, Jun; Park, Keum Soo

    2014-01-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and sudden cardiac death. The incidence, causes, pathogenesis, and treatment have not been defined clearly, but spontaneous coronary artery dissection should be considered in young patients without major cardiovascular risk factors or in patients in the peripartum period who present with acute coronary syndrome. The treatment is often challenging. Medical treatment is usually considered, and percutaneous coronary intervention or coronary artery bypass surgery may be possible in some patients. We herein report two cases of middle-aged males with myocardial infarction who were treated with percutaneous coronary angioplasty. PMID:24574840

  12. Clogging the enrichment bypass

    SciTech Connect

    NONE

    1995-05-01

    The issue that has come to be known as the bypass is the latest dispute in the continuing saga of uranium trade between the United States and the Commonwealth of Indepenent States. Bypass deals now being conducted by US utilities have drawn heavy criticism from the US Department of Commerce but are perfectly legal under the terms of the Suspension Agreements. Urged on by the United States Enrichment Corporation, the US DOC intends to stop, or at least severely restrict, bypass deals. Using a recent agreement with Kazakhstan as a case study, this article reviews the implications of such bypass deals.

  13. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft.

    PubMed

    Lansky, Alexandra J; Yang, Yi-ming; Khan, Yosef; Costa, Ricardo A; Pietras, Cody; Tsuchiya, Yoshihiro; Cristea, Ecaterina; Collins, Michael; Mehran, Roxana; Dangas, George D; Moses, Jeffrey W; Leon, Martin B; Stone, Gregg W

    2006-08-01

    Coronary artery perforation is a rare, but dreaded, complication of percutaneous coronary intervention. Conventional treatment, including reversal of anticoagulation and prolonged balloon inflation, is associated with a high incidence of death, Q-wave myocardial infarction, and emergency coronary bypass surgery. Although a number of case reports have demonstrated the feasibility of sealing coronary perforations with synthetic material-covered stent grafts, the efficacy of this treatment has not been reported in a large, multicenter series. We used a retrospective international registry to examine the outcomes of the polytetrafluoroethylene-coated JOSTENT coronary stent graft (CSG) in 41 cases of coronary perforations. Perforations were relatively severe: 16.7% Ellis grade 1, 54.2% grade 2, and 29.1% grade 3. Of the 41 patients, > 1/3 (n = 14) experienced life-threatening complications before stent graft implantation, including pericardial tamponade (12.2%), cardiogenic shock (9.8%), and cardiac arrest (2.4%). A total of 52 CSGs were used to treat the 41 perforations (mean 1.3 per lesion). All CSGs were placed successfully, with 92.9% of the perforations sealed completely and 7.1% partially. One patient developed abrupt vessel closure after CSG deployment, resulting in an overall procedure success rate of 96.4%. No in-hospital Q-wave myocardial infarctions, emergency coronary bypass surgeries, or deaths resulted. The CSG may be a reliable and highly effective treatment option for sealing coronary perforations complicating percutaneous coronary interventions. PMID:16860026

  14. Coronary artery surgery: cardiotomy suction or cell salvage?

    PubMed Central

    Lau, Kelvin; Shah, Hetul; Kelleher, Andrea; Moat, Neil

    2007-01-01

    Coronary artery bypass grafting (CABG) today results in what may be regarded as acceptable levels of blood loss with many institutions avoiding allogeneic red cell transfusion in over 60% of their patients. The majority of cardiac surgeons employ cardiotomy suction to preserve autologous blood during on-pump coronary artery bypass surgery; however the use of cardiotomy suction is associated with a more pronounced systemic inflammatory response and a resulting coagulopathy as well as exacerbating the microembolic load. This leads to a tendency to increased blood loss, transfusion requirement and organ dysfunction. Conversely, the avoidance of cardiotomy suction in coronary artery bypass surgery is not associated with an increased transfusion requirement. There is therefore no indication for the routine use of cardiotomy suction in on-pump coronary artery surgery. PMID:17961227

  15. Effect of Anticoagulation Protocol on Outcome in Patients Undergoing CABG With Heparin-Bonded Cardiopulmonary Bypass Circuits

    Microsoft Academic Search

    Gabriel S Aldea; Paul O’Gara; Oz M Shapira; Patrick Treanor; Ashraf Osman; Eva Patalis; Charles Arkin; Rhea Diamond; Viken Babikian; Harold L Lazar; Richard J Shemin

    1998-01-01

    Background. We have demonstrated that the use of heparin-bonded cardiopulmonary bypass circuits (HBCs) combined with a lower anticoagulation protocol as an adjunct to an integrated blood conservation strategy decreases the incidence and magnitude of homologous transfusion and improves clinical outcome in patients undergoing primary coronary artery bypass grafting. It is not known whether it is the lower anticoagulation protocol that

  16. The clinical significance and management of patients with incomplete coronary angiography and the value of additional computed tomography coronary angiography.

    PubMed

    Pregowski, Jerzy; Kepka, Cezary; Kruk, Mariusz; Mintz, Gary S; Kalinczuk, Lukasz; Ciszewski, Michal; Kochanowski, Lukasz; Wolny, Rafal; Chmielak, Zbigniew; Jastrz?bski, Jan; Klopotowski, Mariusz; Zalewska, Joanna; Demkow, Marcin; Karcz, Maciej; Witkowski, Adam

    2014-04-01

    To assess the anatomical background and significance of incomplete invasive coronary angiography (ICA) and to evaluate the value of coronary computed tomography angiography (CTA) in this scenario. The current study is an analysis of high volume center experience with prospective registry of coronary CTA and ICA. The target population was identified through a review of the electronic database. We included consecutive patients referred for coronary CTA after ICA, which did not visualize at least one native coronary artery or by-pass graft. Between January 2009 and April 2013, 13,603 diagnostic ICA were performed. There were 45 (0.3 %) patients referred for coronary CTA after incomplete ICA. Patients were divided into 3 groups: angina symptoms without previous coronary artery by-pass grafting (CABG) (n = 11,212), angina symptoms with previous CABG (n = 986), and patients prior to valvular surgery (n = 925). ICA did not identify by-pass grafts in 21 (2.2 %) patients and in 24 (0.2 %) cases of native arteries. The explanations for an incomplete ICA included: 11 ostium anomalies, 2 left main spasms, 5 access site problems, 5 ascending aorta aneurysms, and 2 tortuous take-off of a subclavian artery. However, in 20 (44 %) patients no specific reason for the incomplete ICA was identified. After coronary CTA revascularization was performed in 11 (24 %) patients: 6 successful repeat ICA and percutaneous intervention and 5 CABG. Incomplete ICA constitutes rare, but a significant clinical problem. Coronary CTA provides adequate clinical information in these patients. PMID:24623270

  17. Heart bypass surgery

    MedlinePLUS Videos and Cool Tools

    Heart bypass surgery begins with an incision made in the chest, with the breastbone cut exposing the heart. Next, a portion of the saphenous vein is ... used to bypass the blocked arteries in the heart. The venous graft is sewn to the aorta ...

  18. Improved red blood cell survival after cardiac operations with administration of urea during cardiopulmonary bypass

    SciTech Connect

    Roberts, D.; Bake, B.; William-Olsson, G.

    1985-01-01

    The plasma hemoglobin and red blood cell survival (half-life of /sup 51/Cr) was studied in 48 patients undergoing single valve replacement or coronary artery bypass graft. Urea or placebo was administered during cardiopulmonary bypass in a prospective, randomized, double-blind manner to test the potential effect on mechanical hemolysis. The mean plasma hemoglobin level at the end of extracorporeal circulation was significantly lower in the urea-treated groups (coronary artery bypass 342 mg/L; valve replacement 364 mg/L) than in the control groups (coronary artery bypass 635 mg/L, valve replacement 518 mg/L. The half-life of /sup 51/Cr was significantly longer in the urea-treated patients (coronary artery bypass 18 days; valve replacement 16 days) than in the control groups (coronary artery bypass 12.4 days; valve replacement 12.7 days) but still below the normal reference value (29 +/- 4 days). The plasma hemoglobin returned to near normal values (50 mg/L) the day after operation (day 1) and remained low with no differences between control and urea-treated groups. The total blood hemoglobin was followed for 2 weeks after operation and showed significantly less anemia in the urea-treated group. The lowest mean blood hemoglobin level was noted between days 5 and 9-114 (coronary artery bypass) and 107 (valve replacement) gm/L in the urea-treated patients compared to 92.3 gm/L in the control subjects. The reduction in the severity of the anemia led to less transfusion in the urea-treated patients (approximately 0.5 unit/patient) than in the control subjects (approximately 1 unit/patient) between days 3 and 14.

  19. Elected Super Girl

    E-print Network

    Hacker, Randi; Tsutsui, William; Willis, Sheree

    2005-12-28

    commented, "... people might say, 'Hey! Why not elect a mayor the way we elected Supergirl?" Pop stars and TV series might just be the unlikely building blocks of democracy in contemporary China. #ceas #china #tsutsui #willis...

  20. Auditing the Election Ecosystem

    E-print Network

    Alvarez, R. Michael

    2009-08-10

    Election administration is a highly complex process that involves multiple actors all working to achieve the goal of running an effective election. One critical technique for gathering the performance data needed to improve ...

  1. Stenting in small coronary arteries (SISCA) trial

    Microsoft Academic Search

    Rasmus Moer; Yngvar Myreng; Per Mølstad; Per Albertsson; Pål Gunnes; Bo Lindvall; Rune Wiseth; Kjetil Ytre-Arne; John Kjekshus; Svein Golf

    2001-01-01

    OBJECTIVESThe purpose of this study was to assess the clinical and angiographic benefits of elective stenting in coronary arteries with a reference diameter of 2.1 to 3.0 mm, as compared with traditional percutaneous transluminal coronary angioplasty (PTCA).BACKGROUNDThe problems related to small-vessel stenting might be overcome using modern stents designed for small vessels, combined with effective antiplatelet therapy.METHODSIn five centers, 145

  2. USCM Mayoral Elections Database

    NSDL National Science Digital Library

    The US Conference of Mayors (USCM) (see the January 1, 1999 Scout Report) provides the Mayoral Elections Database. The database allows citizens from all 50 states and the District of Columbia to locate information on mayoral elections held in 1999. Users may search the database by city, state, political party, or name of candidate. Searches yield city name, state, party and name of election winner, percentage of votes earned by winner, and month of election. [AO

  3. Excellence in Election Administration

    E-print Network

    Levinson, David M.

    serves township, city, county, and state-level election staff, elected officials, county attorneys Ritchie, Minnesota Secretary of State Tom Wilkey, Executive Director, United States Elections Assistance for its role in shaping policy at the local, state, national, and international level. The Hubert H

  4. Fluid distribution kinetics during cardiopulmonary bypass

    PubMed Central

    Törnudd, Mattias; Hahn, Robert G.; Zdolsek, Joachim H.

    2014-01-01

    OBJECTIVE: The purpose of this study was to examine the isovolumetric distribution kinetics of crystalloid fluid during cardiopulmonary bypass. METHODS: Ten patients undergoing coronary artery bypass grafting participated in this prospective observational study. The blood hemoglobin and the serum albumin and sodium concentrations were measured repeatedly during the distribution of priming solution (Ringer's acetate 1470 ml and mannitol 15% 200 ml) and initial cardioplegia. The rate of crystalloid fluid distribution was calculated based on 3-min Hb changes. The preoperative blood volume was extrapolated from the marked hemodilution occurring during the onset of cardiopulmonary bypass. Clinicaltrials.gov: NCT01115166. RESULTS: The distribution half-time of Ringer's acetate averaged 8 minutes, corresponding to a transcapillary escape rate of 0.38 ml/kg/min. The intravascular albumin mass increased by 5.4% according to mass balance calculations. The preoperative blood volume, as extrapolated from the drop in hemoglobin concentration by 32% (mean) at the beginning of cardiopulmonary bypass, was 0.6-1.2 L less than that estimated by anthropometric methods (p<0.02). The mass balance of sodium indicated a translocation from the intracellular to the extracellular fluid space in 8 of the 10 patients, with a median volume of 236 ml. CONCLUSIONS: The distribution half-time of Ringer's solution during isovolumetric cardiopulmonary bypass was 8 minutes, which is the same as for crystalloid fluid infusions in healthy subjects. The intravascular albumin mass increased. Most patients were hypovolemic prior to the start of anesthesia. Intracellular edema did not occur. PMID:25141112

  5. Hybrid coronary revascularization: promising, but yet to take off.

    PubMed

    Panoulas, Vasileios F; Colombo, Antonio; Margonato, Alberto; Maisano, Francesco

    2015-01-01

    Hybrid coronary revascularization (HCR) combines arterial coronary artery bypass surgery (most commonly minimally invasive) and percutaneous coronary intervention in the treatment of a particular subset of multivessel coronary artery disease. It was first introduced in the mid-1990s, and aspired to bring together the "best of both worlds": the excellent patency rates and survival benefits associated with the durable left internal mammary artery graft to the left anterior descending artery alongside the good patency rates of drug-eluting stents, which outlive saphenous vein grafts to non-left anterior descending vessels. Although in theory this is a very attractive revascularization strategy, several years later, only one small randomized controlled trial comparing HCR with coronary artery bypass grafting has recently emerged in the medical literature, raising concerns regarding HCR's role and generalizability. In the current review, we discuss HCR's rationale, the current evidence behind it, its limitations and procedural challenges. PMID:25572514

  6. Qualitative evaluation of coronary flow during anesthetic induction using thallium-201 perfusion scans

    SciTech Connect

    Kleinman, B.; Henkin, R.E.; Glisson, S.N.; el-Etr, A.A.; Bakhos, M.; Sullivan, H.J.; Montoya, A.; Pifarre, R.

    1986-02-01

    Qualitative distribution of coronary flow using thallium-201 perfusion scans immediately postintubation was studied in 22 patients scheduled for elective coronary artery bypass surgery. Ten patients received a thiopental (4 mg/kg) and halothane induction. Twelve patients received a fentanyl (100 micrograms/kg) induction. Baseline thallium-201 perfusion scans were performed 24 h prior to surgery. These scans were compared with the scans performed postintubation. A thallium-positive scan was accepted as evidence of relative hypoperfusion. Baseline hemodynamic and ECG data were obtained prior to induction of anesthesia. These data were compared with the data obtained postintubation. Ten patients developed postintubation thallium-perfusion scan defects (thallium-positive scan), even though there was no statistical difference between their baseline hemodynamics and hemodynamics at the time of intubation. There was no difference in the incidence of thallium-positive scans between those patients anesthetized by fentanyl and those patients anesthetized with thiopental-halothane. The authors conclude that relative hypoperfusion, and possibly ischemia, occurred in 45% of patients studied, despite stable hemodynamics, and that the incidence of these events was the same with two different anesthetic techniques.

  7. Cardiac CT: atherosclerosis to acute coronary syndrome

    PubMed Central

    Munnur, Ravi Kiran; Cameron, James D.; Ko, Brian S.; Meredith, Ian T.

    2014-01-01

    Coronary computed tomographic angiography (CCTA) is a robust non-invasive method to assess coronary artery disease (CAD). Qualitative and quantitative assessment of atherosclerotic coronary stenosis with CCTA has been favourably compared with invasive coronary angiography (ICA) and intravascular ultrasound (IVUS). Importantly, it allows the study of preclinical stages of atherosclerotic disease, may help improve risk stratification and monitor the progressive course of the disease. The diagnostic accuracy of CCTA in the assessment of coronary artery bypass grafts (CABG) is excellent and the constantly improving technology is making the evaluation of stents feasible. Novel techniques are being developed to assess the functional significance of coronary stenosis. The excellent negative predictive value of CCTA in ruling out disease enables early and safe discharge of patients with suspected acute coronary syndromes (ACS) in the Emergency Department (ED). In addition, CCTA is useful in predicting clinical outcomes based on the extent of coronary atherosclerosis and also based on individual plaque characteristics such as low attenuation plaque (LAP), positive remodelling and spotty calcification. In this article, we review the role of CCTA in the detection of coronary atherosclerosis in native vessels, stented vessels, calcified arteries and grafts; the assessment of plaque progression, evaluation of chest pain in the ED, assessment of functional significance of stenosis and the prognostic significance of CCTA. PMID:25610801

  8. Coronary steal or large collateral? Three cases of graft failure in sequential and composite grafts.

    PubMed

    Morakhia, Jwalit; Ramachandran, Padmakumar; Sanjeeva, Naveen Chandra Ganiga; Thakkar, Ashok

    2014-01-01

    Coronary bypass grafting using conduits with multiple distal anastomoses continues to demand scrutiny. While on one hand these techniques allow the surgeon to avoid or minimise aortic manipulation, the unique flow and pressure characteristics lead to complex forms of graft failure if the anatomy of the target vascular bed is not carefully taken into consideration. We report three cases of graft failure in patients with coronary bypass grafting performed using multiple distal anastomoses, and percutaneous revascularisation in one patient. PMID:25395430

  9. On-pump versus off-pump coronary revascularization: evaluation of renal function

    Microsoft Academic Search

    Raimondo Ascione; Clinton T Lloyd; Malcom J Underwood; Walter J Gomes; Gianni D Angelini

    1999-01-01

    Background. Coronary revascularization with cardiopulmonary bypass has the potential risk of renal dysfunction related to the nonphysiologic nature of cardiopulmonary bypass. Recently, there has been a revival of interest in performing myocardial revascularization on the beating heart and we investigated whether this prevents renal compromise.Methods. A prospective, randomized, controlled trial was performed in 50 patients (45 males, mean age 61

  10. Cognition After Coronary Artery Surgery Is Not Related to Postoperative Jugular Bulb Oxyhemoglobin Desaturation

    Microsoft Academic Search

    KENNETH J. TUMAN

    During the early postoperative period after coronary artery bypass grafting (CABG) surgery, many patients experience jugular bulb oxyhemoglobin desaturation (Sjo2 , 50%). We sought to determine whether Sjo2 dur- ing cardiopulmonary bypass and the early postopera- tive period influenced long-term cognitive perfor- mance after CABG surgery. One hundred two patients completed a battery of cognitive tests the day before and

  11. Russian Duma Elections 1999

    NSDL National Science Digital Library

    A project of the Carnegie Endowment for International Peace (CEIP) and the Carnegie Moscow Center, this modest site offers several helpful resources for following and understanding the December 19 Russian Duma Elections. Among these are pre-election bulletins, an election calendar, issue briefs, op-ed pieces, links to political parties/ blocs contesting the 1999 Duma Elections, and a number of related English- and Russian-language links. Additional content includes links to polling data and a listing of books recently published by the Carnegie Endowment Project on Russian domestic politics.

  12. Pre-Approved1 Bioengineering Electives for Biological Engineering (NOTE: Technical Electives Engineering Electives Bioengineering Electives)2

    E-print Network

    Lawrence, Rick L.

    Pre-Approved1 Bioengineering Electives for Biological Engineering (NOTE: Technical Electives Engineering Electives Bioengineering Electives)2 Updated: March 2014 Course # Title Offered Credits Prereqs may be allowed for bioengineering elective credit, but you should get any course you are considering

  13. Pre-Approved1 Bioengineering Electives for Biological Engineering (NOTE: Technical Electives Engineering Electives Bioengineering Electives)2

    E-print Network

    Lawrence, Rick L.

    Pre-Approved1 Bioengineering Electives for Biological Engineering (NOTE: Technical Electives Engineering Electives Bioengineering Electives)2 Updated: April 2013 Course # Title Offered Credits Prereqs 380, BIOM 360, or consent Note 1: Other courses may be allowed for bioengineering elective credit

  14. Barometer elections in comparative perspective

    Microsoft Academic Search

    Daniel S Ward

    1996-01-01

    This paper develops a conceptual framework for studying the performance of the government in what we term ‘barometer elections’. Barometer elections are defined as elections that reflect changes in citizens' attitudes toward the government in response to changing political and economic conditions, absent the opportunity to install a new executive. We classify British by-elections and German Land elections as barometer

  15. Cistatina C e taxa de filtração glomerular em cirurgia cardíaca com circulação extracorpórea Cystatin C and glomerular filtration rate in the cardiac surgery with cardiopulmonary bypass

    Microsoft Academic Search

    Marcello Laneza FELICIO; Rubens Ramos de ANDRADE; Yara Marcondes; Machado CASTIGLIA

    Objective: The aim of this study was to compare cystatin C versus creatinine as a marker for acute kidney injury in patients submitted to cardiac surgery with cardiopulmonary bypass. Methods: Fifty consecutive patients submitted to coronary artery bypass grafting were studied. Renal function was evaluated by serum cystatin C and creatinine. Blood samples were obtained from each patient at three

  16. Bail-out coronary stenting in an extremely tortuous right coronary artery with the Palmaz-Schatz stent and Teleguide sheath.

    PubMed

    Foran, J P; Nordrehaug, J E; Xynopoulos, G; Wainwright, R J

    1993-09-01

    Significant vessel tortuosity is a relative contraindication to the use of the Palmaz-Schatz coronary stent for fear of stent displacement during delivery. We describe a patient with unstable angina in whom conventional coronary angioplasty in an extremely tortuous right coronary artery resulted in an occlusive dissection. Emergency bypass surgery was avoided by the successful placement of a protected Palmaz-Schatz stent using a 5F Teleguide sheath. PMID:8402861

  17. Heart bypass surgery

    MedlinePLUS

    ... Philadelphia, PA: Saunders Elsevier; 2012:chap 60. Morrow DA, Boden WE. Stable ischemic heart disease. In: Bonow ... pub2. Moller CH, Penninga L, Wettersley J, Steinbruchel DA, Gluud C. Off-pump versus on-pump coronary ...

  18. The effect of high-frequency ventilation of the lungs on postbypass oxygenation: A comparison with other ventilation methods applied during cardiopulmonary bypass

    Microsoft Academic Search

    Deeb Zabeeda; Revaz Gefen; Beniamin Medalion; Vadim Khazin; Arie Shachner; Tiberiu Ezri

    2003-01-01

    Objective: To compare the effect of high-frequency ventilation versus other ventilation methods applied during cardiopulmonary bypass on postbypass oxygenation. Design: Prospective, randomized study. Setting: University hospital. Participants: Seventy-five patients undergoing coronary artery bypass graft surgery. Interventions: Patients were allocated to 5 equal groups of different ventilation methods during bypass. Groups 1 and 2 received high-frequency, low-volume ventilation with 100% and

  19. Pre-Approved1 Chemical Engineering Technical Electives (NOTE: Technical Electives Engineering Electives Bioengineering Electives)2

    E-print Network

    Lawrence, Rick L.

    Electives Bioengineering Electives)2 Updated: November 2012 Course # Title Offered Credits BCH 441 Instrumental Analysis Lab [F] 2 EBIO 216 Elem Princ of Bioengineering [S] 3 EBIO 324 Bioengineering Transport [F] 3 EBIO 439 Downstream Processing [S] 3 EBIO 443 Bioengineering Lab II [S] 2 EBIO 490

  20. Pre-Approved1 Chemical Engineering Technical Electives (NOTE: Technical Electives Engineering Electives Bioengineering Electives)2

    E-print Network

    Dyer, Bill

    Electives Bioengineering Electives)2 Updated: March 2014 Course # Title Offered Credits BCH 441 of Bioengineering [S] 3 EBIO 324 Bioengineering Transport [F] 3 EBIO 439 Downstream Processing [S] 3 EBIO 443 Bioengineering Lab II [S] 2 EBIO 490 Undergraduate Research [F,S,Su] 1 to 3 EBIO 491 Intro Biomedical Engineering