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1

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

PubMed Central

Objective To evaluate the outcome of off-pump coronary artery bypass grafting (OPCABG) using a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. Methods From October 2002 to December 2008, 208 patients (196 males and 12 females) underwent OPCABG using a BIMA Y configuration graft. The average age of the patients was 56.5 ± 11.3 years, with an age range of 33–78 years. A total of 167 (80.2%) cases had triple-vessel disease. Left main stem disease was found in 33 (15.9%) cases, and double-vessel disease was found in 8 (3.9%) cases. The semi-skeletonization technique was used to harvest the two internal mammary arteries (IMAs), and then the free right internal mammary artery was connected end-to-side to the left internal mammary artery (LIMA) in situ to complete the Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery in all patients. Graft patency was assessed intra-operatively with the HT311 transit time flowmeter. Results A total of 728 distal anastomoses were performed in 208 patients, with the average being 3.5 ± 1.3 per person. No one died or experienced recurrent angina within 30 days after the operation. Conclusions OPCABG using the BIMA Y graft was safe and effective to achieve total arterial revascularization. This method avoids surgical operation on the ascending aorta and other incisions.

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

2012-01-01

2

Full myocardial revascularization with bilateral internal mammary artery Y grafts  

PubMed Central

Background Bilateral internal mammary artery (BIMA) grafting in coronary artery surgery provides better long term outcomes than single internal mammary artery and saphenous vein grafting but the optimum configuration of BIMAs has not been established. This study analyzed perioperative and late outcomes of patients who underwent BIMA grafting with a composite Y configuration. Methods Patients (n=922) who underwent BIMA Y grafting were identified from a cardiac surgical database and then cross matched against hospital and cardiology databases and the state death register to identify episodes of repeat coronary angiography, cardiac surgical re-intervention and death. Analysis of repeat angiography was performed after retrieval of the angiogram reports. Results In 95% of patients, full myocardial revascularization was achieved with BIMAs alone, using a composite Y configuration with an average of 4.1 IMA to coronary artery anastomoses per patient. The perioperative mortality was 1.5% and the 5-, 10- and 15-year survival estimates were 95%, 87% and 77% respectively. Analysis of 166 symptom-driven post-discharge coronary angiograms showed grafts to the left anterior descending artery and increasing severity of coronary artery stenosis at preoperative angiography as predictors of anastomotic patency. Conclusions Full myocardial revascularization can be achieved with reasonable safety in most patients with triple vessel disease and good left ventricular function, and provides good late survival.

Naidoo, Rishendran; Byth, Karen; Chen, Cheng; Denniss, A. Robert

2013-01-01

3

Internal mammary artery versus saphenous vein graft. Comparative performance in patients with combined revascularisation.  

PubMed Central

Thirty three patients with coronary artery disease undergoing combined myocardial revascularisation with internal mammary artery and saphenous vein grafts underwent angiographic studies up to 10 years after operation. Each patient had one internal mammary artery graft and one or more saphenous vein grafts. Eleven symptom-free patients, studies one month to five years (mean 1.9 years) after operation, had intact internal mammary artery and saphenous vein grafts in a good state of preservation. Of the six patients developing symptoms within the first year after surgery, three had evidence of poor flow in the internal mammary artery graft because of large side branches and the other three had stenosis or occlusion of the saphenous vein grafts. Sixteen patients developed symptoms after several years free of symptoms and were studied three to 10 years (mean six years) after operation. Of the 23 saphenous vein grafts in this group, 17 (74%) were either occluded or severely stenosed and six (26%) were in good condition. One internal mammary artery graft was occluded and the remaining 15 were in good condition. Saphenous vein graft failure was the predominant cause of late development of symptoms in patients with combined revascularisation. Long term performance of the internal mammary artery grafts is far superior to the saphenous vein grafts. Images

Singh, R N; Sosa, J A; Green, G E

1983-01-01

4

Sustained Supraventricular Tachyarrhythmias Following Coronary Artery Bypass Surgery Comparing Mammary Versus Saphenous vein Grafts  

Microsoft Academic Search

This retrospective study was designed to determine the incidence of sus tained supraventricular tachyarrhythmias (SVTs) in patients undergoing coro nary artery bypass grafting (CABG) with internal mammary artery (IMA) grafts, Group A, compared with those with saphenous vein grafts (SVG), Group B.Among 569 consecutive patients who underwent CABG surgery in the same institution, a total of 80 cases from Group

Bakr I. Salem; Abdul Chaudhry; Maged Haikal; Siddhesh Gowda; Amy Campbell; Cordie Coordes; Ronad Leidenfrost

1991-01-01

5

Left internal mammary artery graft dysfunction diagnosed by transthoracic Doppler echocardiography. A report of two cases.  

PubMed

Transthoracic Doppler echocardiography (TDE) is a non-invasive and easy reproducible method to assess the left internal mammary artery (LIMA) graft patency after coronary artery bypass graft surgery (CABG). LIMA graft dysfunction is rare, its rate being 10% at 10 to 15 years after revascularization. The most common cause of graft dysfunction is the competitive flow with the native coronary artery, when the stenosis of the bypassed vessels is not severe. We present two cases of LIMA graft dysfunction diagnosed by TDE and confirmed by angiography, with two particular pulsed-wave color Doppler flow signals. PMID:23243649

Parv, Annamaria; Anchidin, Ovidiu; Ober, Camelia; Bindea, Dan; Radulescu, Dan; Duncea, Caius; Capalneanu, Radu

2012-12-01

6

Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur  

Microsoft Academic Search

A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. Cardiac catheterization then performed and revealed patent

Umit Guray; Yesim Guray; Cemal Ozbakir; M. Birhan Yilmaz; Hatice Sasmaz; Sule Korkmaz

2004-01-01

7

Total Arterial Off-pump Coronary Revascularization with a Bilateral Internal Mammary Artery Y Graft (208 cases)  

PubMed Central

Objective: The aim was to evaluate the early outcome of off-pump coronary artery bypass grafting (OPCABG) with a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. Materials and Methods: From October 2002 to December 2008, 208 patients (196 male and 12 female patients) underwent OPCABG by only using a BIMA Y configuration graft. The average age of the patients was 56.5±11.3 years, with the age range being 33–78 years. A total of 167 (80.2%) cases had triple-vessel disease. Left main stem disease was found in 33 (15.9%) cases, and double-vessel disease was found in 8 (3.9%) cases. The semiskeletonization skill was used to harvest the two IMAs, and then the free right internal mammary artery was anastomosed end-to-side to the in situ left internal mammary artery to composite a Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery for the patients. Graft patency was assessed by using the HT311 transit time flowmeter (USA Transonic Systems Inc.), intraoperatively. Results: We performed distal anastomoses of the grafts in 728 patients, the average being 3.5±1.3 per person. No one died and got recurrent angina within 30 days after operation. Conclusion: OPCABG by using the BIMA Y graft was safe and effective to achieve total arterial revascularization, and avoid surgical operation on the ascending aorta, and other incisions.

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

2012-01-01

8

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

PubMed

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

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

2012-05-01

9

Initial and subsequent angiographic outcome of percutaneous transluminal angioplasty performed on internal mammary artery grafts.  

PubMed Central

OBJECTIVE--To estimate the initial outcome and incidence of restenosis of angioplasty of internal mammary artery grafts in a retrospective study. METHODS--The study population consisted of 46 patients (48 lesions) who underwent first balloon angioplasty within the internal mammary artery graft. Most (37/48) were at the distal anastomosis. A few (8/48) were in the graft body. Six patients with the evidence of angiographic restenosis underwent a second angioplasty. RESULTS--The success rate and the restenosis rate of the first angioplasty was 73% and 30% respectively. Of the 34 patients (35 lesions) with a successful first angioplasty, 30 underwent follow up angiography with a restenosis rate of 30% (9/30). A second angioplasty was performed on six of the nine restenotic lesions, with a success rate of 83% and no restenoses. The percent diameter stenosis of the recipient native coronary artery was significantly greater in the restenosis group, at 75 (SD 27)% v 89 (17)%, p < 0.05. CONCLUSIONS--First angioplasty of 46 patients (48 lesions) within an internal mammary artery graft was performed with a success rate of 73% and a restenosis rate of 30% (follow up rate of 88%). The extent of the stenosis of the recipient native coronary artery may affect the restenosis rate.

Ishizaka, N.; Ishizaka, Y.; Ikari, Y.; Isshiki, T.; Tamura, T.; Suma, H.; Yamaguchi, T.

1995-01-01

10

Single Versus Bilateral Internal Mammary Artery Grafts: 10Year Outcome Analysis  

Microsoft Academic Search

Background. The superior long-term patency of the internal mammary artery (IMA) confers important short-term and late survival advantages when grafted to the left anterior descending coronary artery. However, it remains uncertain whether patients derive additional survival benefit when both IMAs are used in coronary revascularization.Methods. Between June 1983 and May 1986, 160 patients (mean age 60 years) received bilateral IMA

Adrian W Pick; Thomas A Orszulak; Betty J Anderson; Hartzell V Schaff

1997-01-01

11

A comparison of early mortality and morbidity after single and bilateral internal mammary artery grafting with the free right internal mammary artery.  

PubMed Central

OBJECTIVE--To compare differences in early mortality and morbidity in patients receiving a single internal mammary artery graft (SIMA) with those receiving bilateral internal mammary artery grafts (BIMA) with a free right internal mammary artery (RIMA). DESIGN--Retrospective analysis of 150 patients undergoing BIMA grafting between 1989-1992 who were carefully matched with 150 patients undergoing SIMA grafting between 1987-1992 for known cardiovascular risk factors, extent of coronary disease, left ventricular function, and number of coronary grafts. Operative variables noted included aortic cross clamp time and bypass time. Postoperative cardiac, respiratory, and wound complications were also noted. RESULTS--Operative mortality was 2% in the SIMA group and 1.3% in the BIMA group (NS). Other than the prevalence of ventricular arrhythmias (P = 0.025), which were more common in the BIMA group, there were no significant differences between the two groups in terms of postoperative morbidity. At median (interquartile range) follow up of 27.94(0.86) and 23.94(0.74) months for the SIMA and BIMA groups respectively there were no deaths. 87% of the SIMA group and 91% of the BIMA group were free of symptoms at follow up. CONCLUSIONS--The earlier fears regarding increased early mortality and morbidity after BIMA surgery were not confirmed by this study. All patients receiving both mammary arteries had a free rather than pedicle right internal mammary graft. The early mortality and morbidity reported here compares favourably with previous reports on the use of a pedicle graft.

Ashraf, S S; Shaukat, N; Akhtar, K; Love, H; Shaw, J; Rowlands, D J; Keenan, D

1994-01-01

12

Postoperative Changes in Duplex Ultrasound Velocity Characteristics in the Nonmobilized Right Internal Mammary Artery in Patients with Left Internal Mammary Artery Bypass Grafting  

Microsoft Academic Search

The internal mammary artery (IMA) is the conduit of choice in coronary revascularization because of its long-term patency. We analyzed the effect of left internal mammary artery (LIMA) harvesting on sternal perfusion. Diameters and velocity parameters of the nonmobilized right internal mammary artery (RIMA) were noninvasively analyzed with duplex ultrasound in 41 patients with LIMA myocardial revascularization pre- (2.6 ±

J. M. Hartman; J. C. Kelder; R. G. A. Ackerstaff; H. A. van Swieten; F. E. E. Vermeulen; A. J. J. C. Bogers

2004-01-01

13

Assessment of internal mammary artery and saphenous vein graft patency and flow reserve using transthoracic Doppler echocardiography  

NASA Technical Reports Server (NTRS)

OBJECTIVE: To investigate transthoracic Doppler echocardiography in the identification of coronary artery bypass graft (CABG) flow for assessing graft patency. DESIGN: The initial study group comprised 45 consecutive patients with previous CABG undergoing elective cardiac catheterisation for recurrent ischaemia. The Doppler variables best correlated with angiographic graft patency were then tested prospectively in a further 84 patients (test group). SETTING: Three tertiary referral centres. INTERVENTIONS: Flow velocities in grafts were recorded at rest and during hyperaemia induced by dipyridamole (0.56 mg/kg/4 min), under the guidance of transthoracic colour Doppler flow mapping. Findings on transthoracic Doppler were compared with angiography. MAIN OUTCOME MEASURES: Feasibility of identifying open grafts by Doppler and diagnostic accuracy for Doppler detection of significant (>/= 70%) graft stenosis. RESULTS: In the test group the identification rate for mammary artery grafts was 100%, for saphenous vein grafts to left anterior descending coronary artery 91%, for vein grafts to right coronary artery 96%, and for vein grafts to circumflex artery 90%. Coronary flow reserve (the ratio between peak diastolic velocity under hyperaemia and at baseline) of < 1.9 (95% confidence interval 1.83 to 2.08) had 100% sensitivity, 98% specificity, 87.5% positive predictive value, and 100% negative predictive value for mammary artery graft stenosis. Coronary flow reserve of < 1.6 (95% CI 1.51 to 1.73) had 91% sensitivity, 87% specificity, 85.4% positive predictive value, and 92.3% negative predictive value for significant vein graft stenosis. CONCLUSIONS: Transthoracic Doppler can provide non-invasive assessment of CABG patency.

Chirillo, F.; Bruni, A.; Balestra, G.; Cavallini, C.; Olivari, Z.; Thomas, J. D.; Stritoni, P.

2001-01-01

14

Radial artery for coronary artery bypass grafting: does proximal anastomosis to the aorta or left internal mammary artery achieve better patency?  

PubMed

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in coronary artery bypass grafting using radial artery grafts, does proximal anastomosis to the aorta or left internal mammary artery achieve better patency'. Altogether >183 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Radial artery grafts typically have a narrower lumen than vein grafts, and as such there is some concern that anastomosing them directly to the aorta during coronary artery bypass grafting (CABG) may impair graft patency. As such, some surgeons prefer to anastomose radial artery grafts to a second-order vessel such as the left internal mammary artery (LIMA). We sought to assess the evidence for this. A handful of papers directly addressing the issue of the effect of the site of proximal anastomosis on graft patency were found, with three showing no significant difference. One such study reported an insignificant difference in angiographic patency at 32 months postoperatively, with 94.1% of off-aorta grafts remaining patent vs 87.2% of off-LIMA grafts (p = 0.123). However, a large-scale well-designed study was able to demonstrate a statistically significant difference at five years postoperatively, with 74.3% of off-aorta grafts patent, compared with 65.2% of off-LIMA (p = 0.004). Nonetheless, a number of papers that report patency for either off-aorta or off-LIMA grafts give comparable figures for each technique. Additionally, different centres and investigators report very different patency results for grafts that have the same site of proximal anastomosis. One centre was able to achieve patency rates for off-LIMA grafts of 88% up to a mean of 7.7 years postoperatively while another centre reported a patency rate of only 78.6% at three years. Given this, and the plethora of other factors influencing graft patency, we conclude that the best evidence suggests that the site of proximal anastomosis has little or no effect on radial artery graft patency following CABG. PMID:23975715

Watson, Robert A; Hamza, Mustafa; Tsakok, Teresa M; Tsakok, Maria T

2013-12-01

15

Should dialysis-dependent patients with upper limb arterio-venous fistulae undergoing coronary artery bypass grafting avoid having ipsilateral in situ mammary artery grafts?  

PubMed

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether dialysis-dependent patients with upper limb arterio-venous fistulae (AVFs) undergoing coronary artery bypass grafting should avoid having ipsilateral in situ internal mammary artery (IMA) grafts. A literature search performed yielded 28 peer reviewed articles, of which 21 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The papers identified included 478 patients, of whom 219 had in situ IMA grafts with ipsilateral upper limb arterio-venous fistulae. There was a substantial variation between the papers, from single case reports to small retrospective cohort studies, but no randomized, controlled trials. The largest retrospective study included 155 patients and followed up for up to 5 years. Methods used to determine coronary steal included clinical assessment, electrocardiogram or echocardiographic changes, Doppler ultrasound of mammary arteries and angiography. The aggregate evidence suggested that 61 of the 219 patients with ipsilateral IMA grafts developed some clinical or physiological evidence of malperfusion during the use of the AVFs for dialysis. Comparisons with the contralateral IMA suggested that 27 of the 61 patients suffered similar problems when dialysis was applied. A number of studies used controls, including in situ right internal mammary artery (RIMA) flow and patients not on dialysis. In total, 32 patients had their in situ RIMA flow measurements studied, of which none showed any statistically significant flow alteration. While further strong evidence to demonstrate long-term outcomes is required, we recommend the avoidance, where possible, of ipsilateral in situ IMA grafts in patients with an upper limb AVF. There is sufficient experimental and anecdotal evidence to suggest that steal occurs and that in some patients, this has clinical implications on both morbidity and mortality. In this scenario, the use of the contralateral mammary is strongly advocated to maximize the patency of grafts in an already high-risk population. PMID:24497603

Cuthbert, Gary A; Kirmani, Bilal H; Muir, Andrew D

2014-05-01

16

Sustained supraventricular tachyarrhythmias following coronary artery bypass surgery comparing mammary versus saphenous vein grafts.  

PubMed

This retrospective study was designed to determine the incidence of sustained supraventricular tachyarrhythmias (SVTs) in patients undergoing coronary artery bypass grafting (CABG) with internal mammary artery (IMA) grafts, Group A, compared with those with saphenous vein grafts (SVG), Group B. Among 569 consecutive patients who underwent CABG surgery in the same institution, a total of 80 cases from Group A and 80 cases from Group B were selected for this study after application of exclusion criteria. Excluded from this study were the following: patients with preexisting or prior history of SVTs, significant left ventricular dysfunction (ejection fraction less than 40%), postoperative myocardial infarction, drug toxicity or electrolyte imbalance, and advanced chronic obstructive lung disease. Group A consisted of 63 men and 17 women and Group B consisted of 52 men and 28 women. All patients were monitored either in ICU or by telemetry for a period of three to six days after surgery and all had a predischarge 12-lead electrocardiogram. Both groups were fairly comparable in most of their clinical profile and number of grafts. The incidence of SVTs in Group A was 31% (25 of 80 patients) and in Group B was 24% (19 of 80 patients). Furthermore, the incidence of postoperative pericarditis was noted in 35% (28 of 80 patients) of Group A and in 19% (15 of 80 patients) in Group B. The authors conclude that male tobacco smokers of Group A tended to have a significantly higher incidence of postoperative pericarditis with a higher trend for postoperative SVTs than patients from Group B. PMID:2042791

Salem, B I; Chaudhry, A; Haikal, M; Gowda, S; Campbell, A; Coordes, C; Leidenfrost, R

1991-06-01

17

Current status of arterial grafts for coronary artery bypass grafting  

PubMed Central

For over a decade there has been accumulating evidence that the use of more than a single arterial graft during coronary artery bypass grafting can improve clinical outcomes. However the vast majority of patients in most developed countries still only receive a single arterial conduit even in the presence of multivessel coronary artery disease. This review summarizes the current evidence for the use of a second internal mammary artery and/or radial artery graft. While in comparison to vein grafts the superior patency of internal mammary artery grafts is well established, there now exists strong and consistent evidence of the superior patency of radial arteries over the longer term. Likewise, there is a rapidly growing body of evidence that the superior patency of both these arteries in comparison to vein grafts translates into improved clinical outcomes.

2013-01-01

18

Current status of arterial grafts for coronary artery bypass grafting.  

PubMed

For over a decade there has been accumulating evidence that the use of more than a single arterial graft during coronary artery bypass grafting can improve clinical outcomes. However the vast majority of patients in most developed countries still only receive a single arterial conduit even in the presence of multivessel coronary artery disease. This review summarizes the current evidence for the use of a second internal mammary artery and/or radial artery graft. While in comparison to vein grafts the superior patency of internal mammary artery grafts is well established, there now exists strong and consistent evidence of the superior patency of radial arteries over the longer term. Likewise, there is a rapidly growing body of evidence that the superior patency of both these arteries in comparison to vein grafts translates into improved clinical outcomes. PMID:23977618

Taggart, David P

2013-07-01

19

The midterm outcome and MACE of robotically enhanced grafting of left anterior descending artery with left internal mammary artery  

PubMed Central

Background We assessed the midterm outcome and the incidence of major adverse cardiovascular events in UK’s largest Da Vinci assisted robotic coronary revascularisation cohort. This study was set up at the Imperial College NHS Trust, St. Mary’s Hospital, London, United Kingdom. Method Benchmarking approach through retrospective audit of the regional outcomes against standards in the published literature. Data was collected from the patient’s records, communication with the primary care physicians and the national strategic tracing service. The results were compared with the published literature. Patients who underwent robotic assisted coronary revascularisation were included. Other robotic procedures or minimally invasive revascularisation without the use of the Da Vinci robot were excluded. The main outcome measure was the midterm survival up to five years and the incidence of major adverse cardiovascular events (MACE) up to three years. Results Since April 2002, one hundred consecutive patients underwent either off pump robotic assisted single vessel small thoracotomy (SVST, n?=?88), or off pump total endoscopic coronary artery bypass grafting (TCAB, n?=?12). All patients were operated on by the same primary surgeon but different assisting surgeons. All patients received a left internal mammary arterial (LIMA) graft as planned. The primary outcome of total one month and three years MACE and up to five year survival was 0, 9 and 96% respectively. Conclusions The procedural success rates in terms of morbidity and mortality up to five years are compatible to the outcomes observed outside the United Kingdom. These results are not inferior to that of conventional off pump single vessel coronary surgery or percutaneous coronary intervention to the LAD.

2014-01-01

20

Contrast-enhanced magnetic resonance angiography of mammary artery grafts after minimally invasive coronary bypass surgery  

Microsoft Academic Search

Background. The aim of the study was to investigate the application of the contrast-enhanced magnetic resonance angiography (CE-MRA) for the visualization of left internal mammary artery (LIMA) bypass.Methods. A total of 30 patients with LIMA bypass (22 men, 8 women, 35 to 77 years) received a CE-MRA 4 to 20 days after surgery. The non–ECG-triggered CE-MRA was performed during expiration

Herbert O Vetter; Rudolf Driever; Heinrich Mertens; Udo Kempkes; Bernhard M Cramer

2001-01-01

21

Anterograde flow compromise of a patent left internal mammary artery graft from a proximal subclavian artery stenosis. Myocardial ischemia not driven by the coronary-subclavian steal syndrome mechanism.  

PubMed

A 54-year male with previous triple vessel coronary artery and aorto-bi-femoral bypass graft surgeries complained of crescent angina. Stress induced myocardial ischemia on echocardiography was demonstrated. We performed direct stenting of a saphenous vein graft to the right coronary artery, via right radial approach. Subsequently stenting of a severe left subclavian artery proximal stenosis was performed via right brachial approach in order to relieve an overt myocardial ischemia in the territory supplied by a patent left internal mammary artery graft originated distally to the left subclavian stenosis. The finding of a total left axillary artery occlusion complement the pathogenesis of myocardial ischemia produced by limited anterograde flow and not driven by the common flow reversal mechanism of a typical coronary-subclavian steal syndrome. PMID:22735654

Alcocer, Alejandro; Castillo, Genaro; Rivera-Capello, Juan M; González, Vidal; Meaney, Eduardo

2012-01-01

22

Atherosclerosis and the internal mammary arteries  

SciTech Connect

One hundred and fifty patients with coronary artery disease (CAD), 14 (9.3%) of whom had coexisting peripheral vascular disease, underwent bilateral internal mammary arteriography to study the incidence and extent of atherosclerosis in these vessels. Significant atherosclerosis of the internal mammary arteries (IMAs) was present in three patients (2%), of whom one had coexisting peripheral vascular disease. Lesions in the IMAs were found either proximally, close to the origin or distally, around the terminal bifurcation. Six of the 14 patients with peripheral vascular disease (4% of total subjects) had significant atherosclerosis of the brachiocephalic arteries. Atherosclerotic involvement of the IMA is very unusual and rarely interferes with the use of these vessels for coronary bypass. More common, however, is atherosclerosis of the subclavian arteries, a contraindication for IMA grafting if the lesion is proximal to the IMA origin.

Singh, R.N.

1983-06-01

23

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

PubMed Central

Coronary artery bypass grafting (CABG) was first used in the late 1960s. This revolutionary procedure created hope among ischemic heart disease patients. Multiple conduits are used and the golden standard is the left internal mammary artery to the left anterior descending artery. Although all approaches were advocated by doctors, the use of saphenous vein grafts became the leading approach used by the majority of cardiac surgeons in the 1970s. The radial artery graft was introduced at the same time but was not as prevalent due to complications. It was reintroduced into clinical practice in 1989. The procedure was not well received initially but it has since shown superiority in patency as well as long-term survival after CABG. This review provides a summary of characteristics, technical features and patency rates of the radial artery graft in comparison with venous conduits. Current studies and research into radial artery grafts and saphenous vein grafts for CABG are explored. However, more studies are required to verify the various findings of the positive effects of coronary artery bypass grafting with the help of radial arteries on mortality and long-lasting patency.

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

2013-01-01

24

Endoscopic harvesting of the left internal mammary artery  

PubMed Central

Minimally invasive coronary artery bypass grafting via left anterior small thoracotomy is routinely performed on patients with single coronary artery disease, but recently has been expanded to a larger population as a part of a hybrid treatment in multivessel coronary artery disease. While the methods of internal mammary artery harvesting used in these operations can be different, the endoscopic method is more advantageous than operations performed by direct vision, and thus should be used as a technique of choice. In this article, we present detailed description of endoscopic mammary artery harvesting focusing on anatomical and technical aspects.

Bisleri, Gianluigi

2013-01-01

25

Arterial grafts: clinical classification and pharmacological management.  

PubMed

In comparison with standard saphenous vein grafts, use of the internal mammary artery (IMA) as a coronary artery bypass graft has achieved superior long-term results. This is related to the differences in the biological characteristics between the venous and arterial grafts. However, even arterial grafts are not uniform in their biological characteristics. The variation in the perioperative behavior of the grafts and in their long-term patency may be related to different characteristics. These factors should be taken into account in the use of arterial grafts, some of which are subjected to more active pharmacological intervention during and after the operation to obtain satisfactory results. To better understand the biological behavior of the grafts, their common features and their differences, a clinical classification may be useful for a practicing surgeon. Based on experimental studies of their vasoreactivity combined with anatomical, physiological and embryological considerations, we have proposed a functional classification for arterial grafts that may be useful clinically. Our classification suggests that there are three types of arterial grafts: Type I-somatic arteries; Type II-splanchnic arteries; and Type III-limb arteries. Type I arteries have enhanced endothelial function and release more nitric oxide and other relaxing factors. Type II arteries, such as the gastro-epiploic artery, and Type III arteries, such as the radial artery (RA), have higher pharmacological reactivity to vasoconstrictors. This classification explains why the IMA has the best long-term patency. Because Type II and III arteries are prone to spasms due to higher contractility, they require more active pharmacological interventions. Furthermore, the harvesting technique of the conduits, including the saphenous vein and IMA, are described and discussed in this article. Prevention of spasms using two cocktails of medications (verapamil + nitroglycerin and nicardipine + nitroglycerin) during harvesting of the conduits is described. These solutions have been demonstrated to be clinically effective. PMID:23977630

He, Guo-Wei

2013-07-01

26

Antithrombotic therapy in patients with saphenous vein and internal mammary artery bypass grafts: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.  

PubMed

This chapter about prevention of coronary artery bypass occlusion is part of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this chapter are the following: For patients undergoing coronary artery bypass grafting (CABG), we recommend aspirin, 75 to 162 mg/d, starting 6 h after operation over preoperative aspirin (Grade 1A). In patients in whom postoperative bleeding prevents the administration of aspirin at 6 h after CABG, we recommend starting aspirin as soon as possible thereafter (Grade 1C). For patients undergoing CABG, we recommend against addition of dipyridamole to aspirin therapy (Grade 1A). For patients with coronary artery disease undergoing CABG who are allergic to aspirin, we recommend clopidogrel, 300 mg, as a loading dose 6 h after operation followed by 75 mg/d p.o. (Grade 1C+). In patients who undergo CABG for non-ST-segment elevation acute coronary syndrome (ACS), we recommend clopidogrel, 75 mg/d for 9 to 12 months following the procedure in addition to treatment with aspirin (Grade 1A). For patients who have received clopidogrel for ACS and are scheduled for CABG, we recommend discontinuing clopidogrel for 5 days prior to the scheduled surgery (Grade 2A). For patients undergoing CABG who have no other indication for vitamin K antagonists (VKAs), we suggest clinicians to not administer VKAs (Grade 2B). For patients undergoing CABG in whom oral anticoagulants are indicated, such as those with heart valve replacement, we suggest clinicians administer VKA in addition to aspirin (Grade 2C). For all patients with coronary artery disease who undergo internal mammary artery (IMA) bypass grafting, we recommend aspirin, 75 to 162 mg/d, indefinitely (Grade 1A). For all patients undergoing IMA bypass grafting without other indication for VKA, we suggest clinicians not use VKA (Grade 2C). PMID:15383486

Stein, Paul D; Schünemann, Holger J; Dalen, James E; Gutterman, David

2004-09-01

27

Dilation of the internal mammary artery by external and intraluminal papaverine application  

Microsoft Academic Search

Three methods for prevention of perioperative spasm of the internal mammary artery were compared in 78 patients undergoing coronary artery bypass grafting. In group 1, internal mammary artery pedicles were divided distally, clamped, and placed under the upper sternum submerged in papaverine solution (1.5 mg\\/ml). In group 2, as in group 1 but before clamping, 2 ml of heparinized blood

E. Dregelid; K. Heldal; F. Resch; L. Stangeland; K. Breivik; E. Svendsen

1995-01-01

28

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

Microsoft Academic Search

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

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

2005-01-01

29

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

PubMed

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

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

2012-05-01

30

Short-term results of bovine internal mammary artery use in cardiovascular surgery.  

PubMed Central

Over a 14-month period, 28 bovine internal mammary arteries (Bioflow, Bio-Vascular, Inc.; St. Paul, Minnesota, USA) were implanted in 20 patients at our institutions. In 8 patients, the bovine internal mammary artery was used to bypass coronary vessels: in 4 of these patients, coronary artery bypass grafting was performed because of coronary disease (1 type-I aortic dissection); in the other 4 (all with aortic dissection), the modified Bentall technique was used for coronary artery reimplantation. In the remaining 12 patients, the bovine artery was used in vascular surgery: as a graft for lower-extremity occlusive disease (4 patients), arteriovenous fistula (2 patients), and aorticorenal bypass (1 patient); and as a patch to the carotid bifurcation or the common femoral artery in association with endarterectomy (5 patients). The 21 bovine grafts were all 5 mm in diameter; the 7 bovine patches were 4 mm. Of the 8 coronary bypass patients, 2 who underwent coronary artery bypass grafting had acute postoperative myocardial infarctions, and 2 who underwent the modified Bentall technique died in surgery. Follow-up angiography showed complete bovine internal mammary artery graft occlusion in 2 patients; 2 symptom-free patients refused examination. Of the vascular surgery patients, 1 with mild left leg claudication had graft occlusion, shown by angiography, 4 months after surgery. Renal scintigraphy performed in the patient with aorticorenal bypass 4 months after operation showed no blood flow to the kidney. Two patients died for reasons unrelated to bovine mammary artery grafting. The remaining patients are well and free of complications. In view of the high incidence of early occlusion, we do not recommend use of the bovine internal mammary artery graft in coronary surgery. In vascular surgery, the results are more encouraging; however, studies comprising a larger number of patients and longer follow-up are needed to determine whether the use of the bovine internal mammary artery graft can be recommended.

Esposito, F; Vitale, N; Crescenzi, B; Scardone, M; de Luca, L; Cotrufo, M

1994-01-01

31

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

PubMed Central

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

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

2013-01-01

32

The internal mammary artery bypass - the principles of preoperative and postoperative diagnosis using colour-duplex ultrasound  

Microsoft Academic Search

Background: The aim of the study was the assessment of functional characteristics of the left internal mammary artery (LIMA) bypass in patients after coronary artery bypass grafting (CABG) in compari- son with the native LIMA using colour-duplex ultrasound as the non-invasive diagnostic method. Methods: We examined 303 patients after myocardial revascularization with the internal mammary artery bypass using the Hewllett

Madaric J; Mistrik A; Pacak J

2001-01-01

33

Treatment of a Left Internal Mammary Artery to Pulmonary Artery Fistula with Polytetrafluoroethylene Covered Stents: A Case Report and Review of the Literature  

SciTech Connect

Internal mammary artery (IMA) to pulmonary artery (PA) fistula is a rare complication of coronary artery bypass grafting (CABG) that may present as myocardial ischemia. We describe a case of left IMA-to-PA fistula treated with balloon expandable coronary polytetrafluoroethylene (PTFE) graft stents and review previously reported cases of this entity.

Abbott, J. Dawn; Brennan, Joseph J.; Remetz, Michael S. [Yale University School of Medicine, Section of Cardiovascular Medicine New Haven, CT, Department of Internal Medicine (United States)

2004-01-15

34

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

PubMed

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

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

2014-07-01

35

Blood Flow in Composite Arterial Grafts and Effect of Native Coronary Flow  

Microsoft Academic Search

Background. Total arterial coronary revascularization can be achieved by joining arteries together as a compos- ite graft with the proximal left internal mammary artery as the only source of blood inflow. Proof of the capacity of this composite conduit to provide adequate blood flow to the coronary circulation is required. Methods. The radial artery was anastomosed to the left internal

Alistair G. Royse; Colin F. Royse; Karen L. Groves; Gang Yu; M App Sc

2010-01-01

36

[In coronary surgery can both internal mammary arteries be used systematically? Apropos of 560 patients].  

PubMed

The grafts commonly used in coronary bypass surgery are the left internal mammary artery and the saphenous veins of the legs: the use of both internal mammary arteries, with potential long-term benefits, is only justified if the operative risk is not increased. Since 1987, the authors use both internal mammary arteries systematically in patients under 70 years of age and in good general condition. The retrospective analysis of 560 patients having undergone this surgery from 1987 to 1994 was undertaken to determine if this surgical option is justified without increased operative risk. The dissection of the mammary arteries is performed in a special manner by skeletonization technique. The total hospital complication rate was 12% with 9 deaths in the first 30 postoperative days (1.6%). Mediastinitis was observed in 6 patients (1.1%) Early angiographic controls showed a patent mammary graft rate of 98%. The use of both internal mammary arteries does not therefore increase postoperative morbidity or mortality. It may be proposed systematically in patients in good general condition and may provide long-term benefits in graft patency rates. PMID:9181033

Braunberger, E; Fischer, M; Robinault, J; Foiret, J C; Rolland, J M; Fromes, Y; Py, A; Maribas, P; Bouharaoua, T; Souffrant, G; Bical, O

1997-02-01

37

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

Microsoft Academic Search

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

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

2002-01-01

38

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

SciTech Connect

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

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

2006-04-15

39

Right Internal Mammary Artery Implantation into Right Ventricular Myocardium for Revascularization of the Entire Heart  

PubMed Central

The left internal mammary artery implant combined with epicardiectomy and free omental graft provides three extra-coronary sources of blood. This operation tested in dogs with 92% main-stem occlusion of three coronary arteries protected 75% of the animals. Applied clinically in over 100 patients, the operation resulted in 90% improvement. To obtain complete myocardial revascularization, the right internal mammary artery has been used as a fourth source of extra-coronary blood. In 57 animals, the right internal mammary arteries were implanted into the anterior walls of the right ventricle; in 80% this vessel formed anastomoses with the right coronary tree, and in 65% with the right and left coronary arteriolar systems. Six patients are described who underwent right internal mammary artery implantation; five of these in addition had the combined operation of left internal mammary artery implant, epicardiectomy and free omental graft. All patients had completely blocked right coronary arteries; in addition, five had advanced disease of the left coronary arterial tree. ImagesFig. 1aFig. 1b

Vineberg, Arthur M.; Zamora, Benjamin O.

1966-01-01

40

Gastroepiploic artery graft in coronary artery bypass grafting  

PubMed Central

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

2013-01-01

41

Coronary Artery Bypass Grafting  

MedlinePLUS

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

42

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

PubMed

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

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

2014-07-01

43

Types of Coronary Artery Bypass Grafting  

MedlinePLUS

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

44

Dilation of the internal mammary artery by external and intraluminal papaverine application.  

PubMed

Three methods for prevention of perioperative spasm of the internal mammary artery were compared in 78 patients undergoing coronary artery bypass grafting. In group 1, internal mammary artery pedicles were divided distally, clamped, and placed under the upper sternum submerged in papaverine solution (1.5 mg/ml). In group 2, as in group 1 but before clamping, 2 ml of heparinized blood with 1.5 mg/ml papaverine added was injected into the vessel lumen. In group 3 treatment was as in group 2, but heparinized blood with papaverine was injected a second time just before extracorporeal bypass was begun. In a univariate analysis free flow from dilated internal mammary arteries was not significantly different among the groups (group 1, 58 ml/min; group 2, 82 ml/min; group 3, 68 ml/min; p < 0.1). When free flow from dilated internal mammary arteries was the dependent variable in a regression analysis, the use of intraluminal papaverine, high blood pressure during flow measurement, and high initial blood flow were predictors of high flow (all p < 0.01). Morphometric measurements on the resected distal portion of the dilated internal mammary arteries disclosed less folding of the internal elastic lamina and a larger luminal area in groups 2 and 3 compared with respective findings in group 1 (1.21 mm2 and 1.42 mm2 versus 0.77 mm2; p < 0.02). Mechanical vessel wall injury occurred in 8 of 52 internal mammary arteries treated with intraluminal papaverine. Intraluminal papaverine solution injected once or twice in addition to external papaverine exposure therefore provides a better blood flow rate and distal dilation than mere submersion in papaverine solution, but at a considerable risk of mechanical wall injury. PMID:7564436

Dregelid, E; Heldal, K; Resch, F; Stangeland, L; Breivik, K; Svendsen, E

1995-09-01

45

Coronary artery bypass graft degenerative disease  

Microsoft Academic Search

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

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

2001-01-01

46

Endothelial function of internal mammary artery in patients with coronary artery disease and in cardiac transplant recipients.  

PubMed

The objective of this study was to examine the endothelial function of internal mammary artery in patients with coronary artery disease and in heart transplant recipients. Therefore the response of this artery to increasing concentrations of acetylcholine (1, 10, 20 microg/min for 2.5 minutes each) was assessed in 6 patients in a control group, 16 patients with coronary artery disease (CAD group) matched for risk factors with 16 heart graft recipients (who underwent transplantation for nonischemic heart failure), and 12 patients with coronary artery disease and peripheral vascular disease (PVD group). Diameters of proximal and middle segments of internal mammary artery were measured by quantitative angiography. The responses to the first concentration of acetylcholine were attenuated in these three groups compared with the control group. At the highest concentration of acetylcholine the diameter increase was similar in the control and CAD groups, whereas the responses remained significantly impaired in the transplant and PVD groups. However, after selective infusion of L-arginine (30 mg/min for 11 minutes), the precursor of endothelium-derived nitric oxide, was performed, the responses to acetylcholine were restored in these two latter groups. Endothelin plasma levels were significantly enhanced in the PVD group, which exhibited the most severe impairment in acetylcholine-induced vasodilation. Thus some patients with CAD, mainly those with advanced atherosclerosis, and cardiac transplant recipients exhibit internal mammary artery endothelial dysfunction, and this abnormality seems reversible. PMID:9506335

Berkenboom, G; Crasset, V; Giot, C; Unger, P; Vachiery, J L; LeClerc, J L

1998-03-01

47

Reversal of flow in the mammary artery to treat subclavian steal syndrome in conjunction with coronary bypass surgery.  

PubMed

Occasionally patients with multi-vessel disease present with coronary stenoses and subclavian steal syndrome. A novel surgical approach for the treatment of these vascular problems is described. The in situ left internal mammary artery was used to create an aortosubclavian shunt, thus restoring antegrade vertebral flow and vein grafts were used for coronary revascularization. PMID:21172534

John, Alexander; Hofmann, Steffen; Ostowar, Abazar; Ferdosi, Abbas; Warnecke, Henning

2011-01-01

48

Angiography of the internal mammary artery via the contralateral brachial artery.  

PubMed

A new technique for angiography of the contralateral internal mammary artery via the brachial artery approach is described. A Simmons (sidewinder) catheter is maneuvered into the ascending aorta and is rotated as to assume its performed shape. The catheter is advanced into the contralateral subclavian artery beyond the internal mammary artery. With the aid of an exchange wire, the Simmons catheter is replaced with a preformed internal mammary angiographic catheter. The internal mammary artery is cannulated, and angiography is performed. Fifty patients were successfully studied by means of this technique without incident. In 20 cases, the ipsilateral internal mammary artery was subsequently visualized. Brachial angiographers may prefer to add this technique to their repertoire. PMID:3581167

Dorros, G; Lewin, R F

1987-01-01

49

Mechanical Properties of Coronary Arteries and Internal Mammary Arteries Beyond Physiological Deformations.  

National Technical Information Service (NTIS)

Passive circumferential and axial mechanical properties of porcine coronary arteries and internal mammary arteries (IMA) were measured and compared. The cylindrical specimens were subjected to axial stretch and internal pressures up to 300 mmHg. Stress-st...

C. J. Van Andel P. V. Pistecky C. Borst

2001-01-01

50

Radiopharmaceutical uptake as a marker of sternal blood supply following internal mammary artery harvesting.  

PubMed

To evaluate the impact of internal mammary artery harvesting on sternal blood supply after open heart surgery, a conventional bone scan was performed 7 days after operation in 30 patients. After administration of 370 MBq of technetium 99 m-medronic acid complex, imaging was carried out at the level of the sternum and including the humerus as a reference. A quantitative analysis of uptake (sternum/humerus uptake index) was performed and compared in three different groups of patients: group A, ten patients who had only vein grafts or valve surgery; group B, ten patients with single internal mammary artery harvesting; and group C, ten patients with bilateral internal mammary artery harvesting. These results were compared with 24 non-surgical subjects as a control (group D). Although intervention had a significant influence in raising the uptake index of the surgical groups (A = 3.34; B = 3.09 and C = 3.48) when compared with normal subjects (D = 2.45) (P < 0.01), there was not a statistically significant difference among the three surgical groups (P > 0.05). It was concluded that the vascular supply of the sternum is not entirely dependent upon the internal mammary arteries and that mobilization of both vessels does not cause per se additional serious impact to the bone vascularization after midline sternotomy, at least beyond day 7 after operation. PMID:7914146

Rivas, L F; Hawkins, T; Morritt, G N; Behl, R P; Griffin, S C; Brown, A H

1994-04-01

51

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

PubMed

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

Mills, N L; Everson, C T

1991-02-01

52

Should Coronary Artery Bypass Grafting Be Regionalized?  

Microsoft Academic Search

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

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

2010-01-01

53

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

PubMed

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

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

1994-02-01

54

Endoscopic radial artery harvesting procedure for coronary artery bypass grafting  

PubMed Central

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

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

2013-01-01

55

Comparative genome-wide transcriptional analysis of human left and right internal mammary arteries.  

PubMed

In coronary artery bypass grafting (CABG), the combined use of left and right internal mammary arteries (LIMA and RIMA) - collectively known as bilateral IMAs (BIMAs) provides a survival advantage over the use of LIMA alone. However, gene expression in RIMA has never been compared to that in LIMA. Here we report a genome-wide transcriptional analysis of BIMA to investigate the expression profiles of these conduits in patients undergoing CABG. As expected, in comparing the BIMAs to the aorta, we found differences in pathways and processes associated with atherosclerosis, inflammation, and cell signaling - pathways which provide biological support for the observation that BIMA grafts deliver long-term benefits to the patients and protect against continued atherosclerosis. These data support the widespread use of BIMAs as the preferred conduits in CABG. PMID:24858532

Ferrari, Giovanni; Quackenbush, John; Strobeck, John; Hu, Lan; Johnson, Christopher K; Mak, Andrew; Shaw, Richard E; Sayles, Kathleen; Brizzio, Mariano E; Zapolanski, Alex; Grau, Juan B

2014-07-01

56

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

MedlinePLUS

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

57

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

PubMed

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

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

2014-04-01

58

Economics of coronary artery bypass grafting  

Microsoft Academic Search

To decide whether the number of operations for coronary artery bypass grafting should be increased, maintained at the present levels, or decreased we need to know how cost effective they are relative to other claimants on the resources of the National Health Service. For this purpose effectiveness is taken to be the effect on life expectancy adjusted for the quality

Alan Williams

1985-01-01

59

Total arterial revascularization with an internal thoracic artery and radial artery T graft  

Microsoft Academic Search

Background. Proximal anastomosis of the radial artery to the side of the internal thoracic artery (ITA) permits complete arterial revascularization in most patients, with the aim of improving long-term results of coronary artery bypass through greater long-term graft patency. The short-term results, however, have yet to be defined. We therefore reviewed our early experience with this grafting strategy.Methods. Between October

Thoralf M Sundt; Hendrick B Barner; Cynthia J Camillo; William A Gay

1999-01-01

60

Total Arterial Revascularization With an Internal Thoracic Artery and Radial Artery T Graft  

Microsoft Academic Search

Background. Proximal anastomosis of the radial artery to the side of the internal thoracic artery (ITA) permits complete arterial revascularization in most patients, with the aim of improving long-term results of coronary artery bypass through greater long-term graft patency. The short-term results, however, have yet to be defined. We therefore reviewed our early experience with this graft- ing strategy. Methods.

Thoralf M. Sundt III; Hendrick B. Barner; Cynthia J. Camillo; William A. Gay

61

Fifteen-year follow-up for double internal thoracic artery grafts  

Microsoft Academic Search

The internal mammary artery (IMA) is the conduit of choice for myocardial revascularization. From 1972 to 1989,586 patients received bilateral IMA and supplemental vein grafts. There were 506 men (86%) and 79 women (14%) with a mean age of 55.5 years (range 32-77 years). Unstable angina was present in 138 patients (24%), insulin-requiring diabetes mellitus in 83 (14%) and previous

A. C. Fiore; K. S. Naunheim; L. R. McBride; P. S. Peigh; D. G. Pennington; G. C. Kaiser; V WILLMAN; H BARNER

1991-01-01

62

The Short Saphenous Vein: A Viable Alternative Conduit for Coronary Artery Bypass Grafts Harvested Using a Novel Technical Approach  

PubMed Central

A multitude of vascular conduits are available to the Cardiac Surgeon performing Coronary Artery Bypass Graft operations. The Internal Mammary Artery, Radial Artery (RA), and the Long Saphenous Vein (LSV) have proven to be excellent conduits, especially in the current era of statin usage. However, previous stripping or varicosities of the LSV and calcification of the RA, coupled with the need for multiple vessel grafting, requires an alternative candidate. We describe a novel harvesting technique for bilateral simultaneous Short Saphenous Vein harvest and propose this, often forgotten vein, as a viable alternative conduit.

Sarwar, Umran; Chetty, Govind; Sarkar, Pradip

2012-01-01

63

Silent Aspiration After Coronary Artery Bypass Grafting  

Microsoft Academic Search

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

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

1998-01-01

64

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

PubMed Central

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

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

2014-01-01

65

The Vineberg legacy: internal mammary artery implantation from inception to obsolescence.  

PubMed Central

At a time when cardiac surgery was still approached with hesitation, Arthur M. Vineberg developed the procedure of direct implantation of the internal mammary artery into the left ventricle for the relief of myocardial ischemia. The Vineberg operation, as it became known, had merit but never received broad endorsement from the medical and surgical communities. Its physiologic benefits were inconsistent and for years were documented by little more than anecdotal evidence, until coronary angiography (newly developed by Mason Sones) was able to demonstrate that the procedure did in fact increase perfusion in the diseased heart. This supporting evidence came rather late, for within the next decade direct aortocoronary artery bypass grafting overtook the Vineberg operation as a more efficient means of revascularizing the myocardium. Thousands of patients, however, had benefited from internal mammary artery implantation at a time when options were few; and the procedure was an aggressive move towards current (and similarly aggressive) treatments for myocardial ischemia. Moreover, the characteristics of the myocardium that Vineberg sought to exploit may form the basis for future therapy. A reappraisal of the implant is warranted, as today's physicians and surgeons inherit the last remaining recipients of Vineberg implants. Images

Thomas, J L

1999-01-01

66

Treatment of an Iatrogenic Left Internal Mammary Artery to Pulmonary Artery Fistula with a Bovine Pericardium Covered Stent  

SciTech Connect

We report a case with an acquired fistula between the left internal mammary artery and the pulmonary artery following coronary bypass surgery treated with a bovine pericardium covered stent. We also reviewed similar cases reported previously.

Heper, Gulumser [SSK Ihtisas Hospital, Department of Cardiology (Turkey)], E-mail: heperg@hotmail.com; Barcin, Cem; Iyisoy, Atila; Tore, Hasan F. [Gulhane Military Medical Academy, Department of Cardiology (Turkey)

2006-10-15

67

Radial artery jump graft from anterior to posterior descending coronary artery.  

PubMed

A novel technique to achieve total arterial grafting, using a radial artery jump graft from the anterior descending coronary artery to the posterior descending artery, was employed in a preliminary series of 10 patients. All radial artery grafts were patent. This was confirmed using the SPY intraoperative fluorescence imaging system. There were no postoperative complications in any patient, and all were discharged uneventfully. PMID:19592543

Taggart, David P; Balacumaraswami, Lognathen; Venkatapathy, Ajit

2009-04-01

68

Myocardial revascularization with multiple arterial grafts: comparison between the radial artery and the right internal thoracic artery  

Microsoft Academic Search

Background. Bilateral internal thoracic artery (ITA) harvesting is significantly underused, whereas the radial artery is being used with increasing frequency. We have retrospectively analyzed perioperative and short-term outcomes of patients receiving a radial artery versus those receiving a right ITA as a second arterial graft.Methods. Between February 1999 and May 2000, 250 patients underwent coronary artery bypass grafting using the

Massimo Lemma; Guido Gelpi; Andrea Mangini; Paolo Vanelli; Cristina Carro; Annamaria Condemi; Carlo Antona

2001-01-01

69

Endothelial function of internal mammary artery in patients with coronary artery disease and in cardiac transplant recipients  

Microsoft Academic Search

The objective of this study was to examine the endothelial function of internal mammary artery in patients with coronary artery disease and in heart transplant recipients. Therefore the response of this artery to increasing concentrations of acetylcholine (1, 10, 20 ?g\\/min for 2.5 minutes each) was assessed in 6 patients in a control group, 16 patients with coronary artery disease

Guy Berkenboom; Vincent Crasset; Christophe Giot; Philippe Unger; Jean-Luc Vachiery; Jean-Louis LeClerc

1998-01-01

70

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

PubMed

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

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

2012-11-01

71

Criteria for Internal Mammary Artery Implantation Based on Cine Coronary Arteriography  

PubMed Central

Preoperative coronary arteriograms were correlated, in a group of 50 patients, with left internal mammary angiograms obtained from 11 to 32 months, with a mean of 17 months, after mammary artery implantation. In all patients in whom the internal mammary artery was patent and considered functional with good angiographic opacification of the anterior descending coronary artery, the preoperative coronary angiogram showed total or subtotal obstruction of the latter vessel, with indirect evidence of decreased flow and pressure distal to the obstruction. This evidence was provided by the presence of a collateral circulation or, in a few cases of subtotal obstruction, delayed opacification of the vessel distal to the obstruction. In patients in whom the internal mammary artery was patent but showed no anastomotic connection with the anterior descending coronary artery or only opacification of small coronary branches, the degree of coronary obstruction was, in most cases, less than 90% of the lumen of the coronary artery in the absence of any collateral circulation or delayed opacification of the vessel distal to the obstruction. Occlusion of the internal mammary artery was seen as often in the presence of total or subtotal obstructions as with lesser degrees of anterior descending coronary artery obstruction, and is believed unrelated to the degree of pre-existing coronary artery disease. Successful internal mammary artery implantation can be related to specific coronary angiographic patterns recognizable before operation; these may serve as reliable criteria for the selection of patients.

Bourassa, M. G.; Lesperance, J.; Castonguay, Y.; Campeau, L.; Saltiel, J.

1970-01-01

72

Outcomes of coronary artery bypass graft surgery  

PubMed Central

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

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

2006-01-01

73

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

PubMed Central

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

Wilson, J M; Ferguson, J J

1995-01-01

74

Internal mammary artery atherosclerosis: an ultrastructural study of two cases.  

PubMed

Atherosclerosis of the internal mammary artery (IMA) is generally regarded as a rare (but existent) pathological entity with only a few cases reported in the most recent literature. The only study which to our knowledge has investigated the ultrastructural features of IMA atherosclerosis, demonstrate the presence of endothelial cells loss, defects of internal elastic lamina with no evidence of lipid accumulation. In the present study, we describe two cases of IMA atherosclerosis in which ultrastructural analysis revealed the presence of a typical atherosclerotic plaque morphology with infiltration of inflammatory cells, formation of intraplaque lipid pools, and accumulation of lipid-laden foam cells throughout the thickened intima, never described in this rare lesion before. Microscopically, the lesions were also characterized by intimal thickening, invagination of endothelial cells, migration of smooth muscle cells with splitting, fenestration and/or fragmentation of the elastic sheets. Our observations add new data to the scarce and contradictory literature and to this largely understudied vascular disorder. PMID:24467374

Perrotta, Ida; Sciangula, Alfonso; Concistrè, Giovanni; Mazzulla, Sergio; Aquila, Saveria; Agnino, Alfonso

2014-05-01

75

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

PubMed Central

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

2013-01-01

76

Arteriovenous fistula of the internal mammary artery (combat injury): transcatheter intravascular coil occlusion.  

PubMed

A case of arteriovenous fistula of the left internal mammary artery occluded by Gianturco coil is reported. A 26-year-old male suffered multiple explosive injuries. Right heart failure developed postoperatively. Digital subtraction angiography demonstrated arteriovenous fistulas between the left internal mammary artery and left subclavian and innominate veins. Considering previous multiple surgical interventions and severe general condition of the patient, both arteriovenous fistulas were successfully occluded by transcatheter placement of a Gianturco coil. PMID:8797987

Radanovi?, B; Simuni?, S; Oberman, B B; Jernej, B; Tonkovi?, I; Kruzi?, Z

1996-01-01

77

Endovascular Stent-Grafting for Infected Iliac Artery Pseudoaneurysms  

Microsoft Academic Search

We report two cases of acutely infected pseudoaneurysms of the iliac arteries, successfully treated with endovascular stent-grafting. Two patients underwent stent-graft treatment for erosive rupture of the iliac artery caused by surrounding infection. The first case is that of a 61-year-old man who had undergone Miles’ operation for an advanced rectal cancer. Postoperatively, he developed intrapelvic abscess formation, from which

Junichiro Sanada; Osamu Matsui; Fumitaka Arakawa; Mari Tawara; Tamao Endo; Hiroshi Ito; Satoshi Ushijima; Masamitsu Endo; Masahiro Ikeda; Katsuyuki Miyazu

2005-01-01

78

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

PubMed Central

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

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

1997-01-01

79

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 ...

80

Transit-time flow predicts outcomes in coronary artery bypass graft patients: a series of 1000 consecutive arterial grafts  

Microsoft Academic Search

Objective: This study was undertaken to evaluate transit-time flow (TTF) as a tool to detect technical errors in arterial bypass grafts intra-operatively and predict outcomes. Methods: TTF's three parameters, pulsatility index (PI, index of resistance), flow (ccmin?1) and diastolic filling (DF, proportion of diastole with coronary flow), were measured in 990\\/1000 (99%) of arterial grafts in 336 consecutive patients, prospectively

Teresa Mary Kieser; Sarah Rose; Ryszard Kowalewski; Israel Belenkie

2010-01-01

81

Effect of antegrade graft cardioplegia combined with passive graft perfusion in on-pump coronary artery bypass grafting.  

PubMed

Patients undergoing on-pump coronary artery bypass graft (CABG) with proximal graft anastomosis were randomly divided into groups that received antegrade cardioplegic infusion only via the aortic root (group A) or antegrade cardioplegic infusion via the aortic root and additional cardioplegia via vein or free arterial grafts after completion of each distal anastomosis (group B). The group B patients also received bypass graft perfusion with warm arterial blood just after removal of the cross-clamp until the proximal graft anastomosis was completed. The need for defibrillation and inotropic support during separation from cardiopulmonary bypass (CPB), and total CPB time were significantly lower in group B than in group A. Group B also had significantly lower peak cardiac troponin I levels 12 h after operation compared with group A and this was more pronounced in subgroups with severe right coronary artery stenosis and poor left ventricular ejection fraction than in the whole population. It is concluded that antegrade graft cardioplegia and graft perfusion with warm blood during proximal graft anastomosis may improve myocardial protection. PMID:20926006

Goncu, M T; Sezen, M; Toktas, F; Ari, H; Gunes, M; Tiryakioglu, O; Yavuz, S

2010-01-01

82

[The St. Jude biopolymeric graft in reconstruction of peripheral arteries].  

PubMed

The authors present their preliminary results of St. Jude Bio Polymeric graft application in the periphery arteries reconstruction. This biograft like all the previous ones (Soleo, CB.S., human umbilical veins) was introduced with the aim of creating a better substitute for autovenous Graft, which has been irreplacible ever before, especially in cases of crural reconstruction. The operated patients were classified into the II stadium of occlusive disease (claudication) and indications for surgery have been based on Doppler sonography and arteriography. In three cases crural femoro-popliteal reconstruction was carried out, because of an occlusion of the superficial femoral artery, in one case a femoro-femoro cross over bypass due to an occlusion of the iliac artery. Postoperative follow-up ranged from 6 to 12 months and the control of the graft passage by. Doppler sonography and arteriography confirmed patency of all grafts. I.e. the preliminary results are excellent. PMID:8701683

Lotina, S; Davidovi?, L; Cinara, I

1990-01-01

83

[Redo Off-pump Coronary Artery Grafting through Left Thoracotomy].  

PubMed

An 80-year-old man successfully underwent reoperative coronary artery bypass grafting( CABG) via left thoracotomy without cardiopulmonary bypass. The proximal end of the saphenous vein graft( SVG)was connected to the thoracic aorta using an automated proximal anastomosis system. Then the SVG routed beneath the pulmonary hilum was anastomosed to the high lateral branch and the anterior descending artery in a sequential mode. He recovered uneventfully and is free of chest pain after redo CABG. In selected patients, redo CABG for the left coronary artery can be safely performed through left thoracotomy. PMID:24917403

Oguma, Fumiaki; Sugawara, Masaaki; Hirahara, Hiroyuki

2014-06-01

84

Metabolic Profiles Predict Adverse Events Following Coronary Artery Bypass Grafting  

PubMed Central

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

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

2012-01-01

85

Two Cases of Percutaneous Intervention for Coronary Artery Bypass Graft Anastomoses With Paclitaxel-Eluting Balloon Catheters  

PubMed Central

Coronary artery bypass graft (CABG) intervention, particularly anastomosis site intervention, is challenging for interventional cardiologists. A paclitaxel-eluting balloon catheter (SeQuent Please) is a recently-introduced device capable of delivering paclitaxel homogeneously into the targeted vessel wall. We herein report our experience with two cases. In the first case, coronary angiography showed significant stenosis at the site of anastomosis between the saphenous vein graft and the left anterior descending artery (LAD). In the second case, coronary angiography showed significant stenosis at the site of anastomosis between the left internal mammary artery and the LAD. We performed percutaneous intervention of these CABG anastomoses using paclitaxel-eluting balloon catheters, and obtained favorable angiographic and clinical outcomes.

Uhm, Jae-Sun; Lee, Seok Jong; Shin, Ah Young; Jung, Soo-Yeon; Kim, Chan-Joon; Seo, Suk-Min; Park, Hun-Jun; Kim, Pum-Joon; Chang, Kiyuk; Seung, Ki-Bae

2011-01-01

86

99mTc-MDP bone SPECT for the evaluation of sternal ischaemia following internal mammary artery dissection.  

PubMed

Coronary artery bypass grafting (CABG) is one of the most frequently performed operations in the United States. The use of internal mammary artery (IMA) grafting has been identified as increasing the risk of sternal wound infections and mediastinitis. The purpose of our study was to prospectively evaluate the effect of different techniques of left internal mammary artery (LIMA) harvesting on sternal vascularity. Thirty-three patients undergoing primary coronary artery bypass grafting were studied. The patients were divided into groups that received a skeletonized IMA (group I, n=11), a pedicled IMA (group II, n=12), or a semiskeletonized IMA (group III, n=10) graft. Each patient underwent a preoperative 99mTc-methylene diphosphonate bone scan using single photon emission computed tomography (SPECT). The ratio of the mean counts/pixel for each side of the sternum was obtained. Post-operatively, all patients had a repeat bone SPECT. Ratios of unilateral sternal uptakes were compared to the preoperative study. A univariable analysis of post-operative to pre-operative ratios revealed statistically significant reduction in vascularity to the left side of the sternum post-operatively in group II compared with groups I and III (0.68 0.12 vs 0.99 0.24 and 0.93 0.09; P<0.01). There was no difference between groups I and III (P=1). Multivariable analysis revealed only the type of harvesting to be associated with post-operative reduction in left to right sternal activity ratio (P<0.02). Pairwise comparisons revealed that differences are due to pedicled type of harvesting (group II vs group I, P=0.03; II vs III, P=0.001; and I vs III, P=0.115). A pedicled IMA graft causes acute post-operative sternal ischaemia. This does not occur when the IMA is skeletonized or semiskeletonized. Hence, it may be prudent to minimize dissection during mobilization of the IMA to decrease the likelihood of post-operative sternal complications. PMID:11748437

Lorberboym, M; Medalion, B; Bder, O; Lockman, J; Cohen, N; Schachner, A; Cohen, A J

2002-01-01

87

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

PubMed

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

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

2007-06-01

88

Vein graft adaptation and fistula maturation in the arterial environment.  

PubMed

Veins are exposed to the arterial environment during two common surgical procedures, creation of vein grafts and arteriovenous fistulae (AVF). In both cases, veins adapt to the arterial environment that is characterized by different hemodynamic conditions and increased oxygen tension compared with the venous environment. Successful venous adaptation to the arterial environment is critical for long-term success of the vein graft or AVF and, in both cases, is generally characterized by venous dilation and wall thickening. However, AVF are exposed to a high flow, high shear stress, low-pressure arterial environment and adapt mainly via outward dilation with less intimal thickening. Vein grafts are exposed to a moderate flow, moderate shear stress, high-pressure arterial environment and adapt mainly via increased wall thickening with less outward dilation. We review the data that describe these differences, as well as the underlying molecular mechanisms that mediate these processes. Despite extensive research, there are few differences in the molecular pathways that regulate cell proliferation and migration or matrix synthesis, secretion, or degradation currently identified between vein graft adaptation and AVF maturation that account for the different types of venous adaptation to arterial environments. PMID:24582063

Lu, Daniel Y; Chen, Elizabeth Y; Wong, Daniel J; Yamamoto, Kota; Protack, Clinton D; Williams, Willis T; Assi, Roland; Hall, Michael R; Sadaghianloo, Nirvana; Dardik, Alan

2014-05-01

89

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

PubMed

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

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

2010-01-01

90

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

Microsoft Academic Search

Off-pump coronary artery bypass grafting (CABG) has been rapidly increased, because of its less invasiveness with low complications. However, graft patency rate highly depends on the operators' capability due to technical difficulties. The SPY™ system, based on the fluorescence of indocyanine green, is an innovative device that permits validation of graft patency intra-operatively. Real time images of grafts are obtained

Masao Takahashi; Toshihiro Ishikawa; Koichi Higashidani; Hiroki Katoh

2004-01-01

91

Stent graft placement for a tracheoinnominate artery fistula.  

PubMed

A 68-year-old woman with ventilator-dependent respiratory failure and multiple comorbidities developed acute massive hemoptysis. Computed tomographic angiogram revealed a 3.9-cm pseudoaneurysm arising from the innominate artery abutting the trachea. The patient was successfully treated with stent graft insertion via the right common carotid artery, with exclusion of the aneurysm from the proximal innominate to the right common carotid artery, with ligation of the proximal right subclavian artery and right common carotid to subclavian artery bypass. The patient remained medically stable for 3 months after the procedure with no evidence of endoleak or infection. She then developed recurrent hemoptysis with fatal cardiac arrest. Open surgical repair has been the treatment of choice for tracheoinnominate artery fistula. However, direct repair confers a high mortality risk. Endovascular exclusion offers a less invasive treatment option for tracheoinnominate artery fistula and can serve as a bridge for patients with potential for becoming better surgical candidates. PMID:24333524

Troutman, Douglas A; Dougherty, Matthew J; Spivack, Adam I; Calligaro, Keith D

2014-05-01

92

Differential Pharmacologic Sensitivities of Phosphodiesterase3 Inhibitors Among Human Isolated Gastroepiploic, Internal Mammary, and Radial Arteries  

Microsoft Academic Search

Systematic investigations of the actions of phosphodi- esterase(PDE)-3inhibitorsondifferenthumanvascular tissues have not been performed. We investigated the effects of specific PDE-3 inhibitors (olprinone, milri- none, and amrinone) on contracted human gastroepip- loic arteries (n 70), internal mammary arteries (n 72),andradialarteries(n70)harvestedfromatotalof 134 patients, all of whom were undergoing coronary artery bypass surgery. Each of these PDE-3 inhibitors

Masanori Onomoto; Isao Tsuneyoshi; Arata Yonetani; Shoich Suehiro; Kazuhisa Matsumoto; Ryuzo Sakata; Yuichi Kanmura

2005-01-01

93

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

PubMed

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

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

2005-01-01

94

Coronary artery bypass grafting to a calcified right coronary artery  

Microsoft Academic Search

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

Masaru Yoshikai; Keiji Kamohara; Junji Yunoki

2002-01-01

95

Endovascular coiling of an internal mammary artery pseudoaneurysm following placement of an internal jugular central venous catheter.  

PubMed

We discuss an interesting case of a right internal mammary artery pseudoaneurysm discovered after an attempted right internal jugular venous catheter placement. Such injury to the internal mammary artery is a rare complication of traumatic injuries to the chest, sternotomies, and central venous catheter placements. It has been reported after subclavian line placements, but not after an internal jugular catheterization. PMID:20731269

Kindelan, Joshua; Crandall, Benjamin; Whittaker, David

2010-08-01

96

Awake coronary artery bypass grafting: utopia or reality?  

Microsoft Academic Search

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

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

2003-01-01

97

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

Microsoft Academic Search

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

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

2000-01-01

98

Laser assisted internal mammary artery-coronary artery anastomosis - an experimental study  

NASA Astrophysics Data System (ADS)

Objective: To observe the time required for anastomosis and the reliability for pressure tolerance after internal mammay artery (IMA) -coronary artery anastomosis. Method: Eight sheep underwent thoracotomy and left IMA harvest. In group I (T) the IMA were anastomosed to left anterior descending artery (LAD) with 7-0 prolene suture (n=4) and in group II (LA) IMA were anastomosed to LAD with laser. Result: The time required for laser technique was shorter than that required in suturing technique [117.5+/-39.48min (total) and 38.25+/-6.23 min vs 62.5+/-37.83 min (total) and 20+/-6.53 min respectively ] (p<0.01). Prior to closing thoracotomy both two groups endured the impact of pharmacologic vasopressor. No leakage at the anastomosed site was observed in both groups. After the closure of thoracotomy, well tolerance for both adrenalin and thoracic negative pressure was observed in the two groups. The peak systolic pressure induced by pharmacologic agent was similar in both groups. Neither stenosis nor thrombus or embolism was observed and immediate patency rate in both groups was 100%. Conclusion: Laser assisted technique seems to be favorable for patency rate and could lead to better result after coronary artery bypass grafting?CABG?.

Zhu, Hong-Sheng; Zhang, Liang-ping; Feng, Lian

2005-07-01

99

Circumferential choledochoplasties with autologous venous and arterial grafts.  

PubMed

Circumferential choledochoplasties with vascular grafts have rarely been attempted either experimentally or in clinical practice. In this study, choledochoplasties using autologous venous and arterial grafts were performed in rats. Sixty-four rats were randomly selected into five treatment groups: A) venous interpositional graft replacement of a choledochus gap without a stent; B) venous graft with prolene stent; C) venous graft with polyethylene stent; D) arterial graft; E) a control group with simple resection between ligatures in the choledochus. The operative mortality in treatment groups B, C, D, and E, was 0, and 13% in group A. At 12 weeks follow-up, all the rats in group E had died, whereas, 52.2% (P < .05) of the rats in group A, 30% of the rats in group B, 57% of the rats in group C, and 92.8% of the rats in group D survived treatment. Surviving animals were sacrificed at 3 months for further examination. The morphology and caliber of the common bile duct of these rats were normal in 25% of the rats in group A, 33% of the rats in group B, 25% of the rats in group C, and 84.6% of the rats in group D. Proximal dilations were found in the rats presenting with abnormal morphology. The dilations were less marked in the group treated by arterial choledochoplasties. Laboratory and clinical cholestatic parameters were within normal ranges in the presence of common bile duct dilations less than four times the normal duct caliber.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8289650

Flati, G; Flati, D; Porowska, B; Rossi, G; Francavilla, S; Santoro, E; Carboni, M

1993-01-01

100

Coronary Artery Bypass Grafting Nine Months after Pneumonectomy  

PubMed Central

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

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

2001-01-01

101

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

PubMed Central

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

Lin, John; Cheng, Wen; Czer, Lawrence S.; De Robertis, Michele A.; Mirocha, James; Ruzza, Andrea; Kass, Robert M.; Khoynezhad, Ali; Ramzy, Danny; Esmailian, Fardad; Trento, Alfredo

2013-01-01

102

Splenic Artery Transposition Graft Usage for the Supply of the Right Hepatic Artery: A Case Report  

PubMed Central

Hepatic artery aneurysms are responsible for 12% to 20% of all visceral arterial aneurysms. Because most patients are asymptomatic, this disease is generally diagnosed incidentally during radiologic examination. Aneurysm rupture develops in 14% to 80% of cases, depending on the aneurysmatic segment's diameter and location, as well as other etiologic factors. Mortality rates associated with rupture range between 20% and 70%. Thus, early diagnosis and timely initiation of medical interventions are critical to improve survival rates. Here, we present a male patient, age 69 years, with a hepatic artery aneurysm that was detected incidentally. The 3-cm aneurysm was detected on contrast-enhanced computed tomography and extended from the common hepatic artery to the hepatic trifurcation. A laparotomy was performed using a right subcostal incision. After dissection of the hepatoduodenal ligament, the common, right, and left hepatic arteries, as well as the gastroduodenal artery, were suspended separately. Then, the aneurysmatic hepatic artery segment was resected, and the gastroduodenal artery stump was ligated. An end-to-end anastomosis was formed between the left and common hepatic arteries, followed by an end-to-end anastomosis formed between the right hepatic artery and splenic artery using a splenic artery transposition graft. Postoperative follow-up examinations showed that both hepatic arterial circulations were good, and no splenic infraction had developed.

Odabasi, Mehmet; Eris, Cengiz; Yildiz, Mehmet Kamil; Abuoglu, Hasan; Akbulut, Sami; Saglam, Abdullah

2013-01-01

103

Scintigraphic documentation of hemorrhage from coronary artery bypass graft  

SciTech Connect

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

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

1986-11-01

104

Off-pump coronary artery bypass grafting in India  

PubMed Central

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

Saha, Kamales Kumar

2014-01-01

105

Racial Disparities in Outcomes Following Coronary Artery Bypass Grafting  

PubMed Central

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

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

2013-01-01

106

Save or sacrifice the internal mammary pedicle during anterior mediastinotomy?  

PubMed Central

Ligation and dissection of internal mammary vessels is the most under-estimated complication of anterior mediastinotomy. However, patients requiring anterior mediastinotomy may experience long survival that makes the development of ischemic heart disease throughout their life possible. Therefore, the un-judicial sacrifice of the internal mammary pedicle may deprive them from the benefit to have their internal mammary artery used as a graft in order to successfully bypass severe left anterior descending artery stenoses. We recommend the preservation of the internal mammary pedicle during anterior mediastinotomy, which should be a common message among our colleagues from the beginning of their training.

Apostolakis, Efstratios; Papakonstantinou, Nikolaos A.; Chlapoutakis, Serafeim; Prokakis, Christos

2014-01-01

107

Effect of target stenosis and location on radial artery graft patency  

Microsoft Academic Search

Objective: The purpose of this study was to evaluate the effect of target vessel characteristics on radial artery patency when used as a composite T graft. Methods: Between October 1993 and March 2001, 1022 patients underwent coronary bypass with the internal thoracic artery–radial artery composite T graft. Of these, angiography has been performed on 109 patients at a mean 27.1

Hersh S Maniar; Thoralf M Sundt; Hendrick B Barner; Sunil M Prasad; Linda Peterson; Tarek Absi; Pavlos Moustakidis

2002-01-01

108

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

Microsoft Academic Search

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

Martin Kostolny; Heinz Präuer; Norbert Augustin; Rüdiger Lange

2001-01-01

109

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

Microsoft Academic Search

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

Martin Kostolny Jr; Heinz Prauer; Norbert Augustin

110

Adolescent External Iliac Artery Trauma: Recurrent Aneurysmal Dilatation of an Iliofemoral Saphenous Vein Graft Treated by Stent-Grafting  

SciTech Connect

An adolescent male sustained a severe penetrating injury to the external iliac artery. Emergency surgical revascularization was with a reversed long saphenous vein interposition graft. The primary graft and the subsequent revision graft both became aneurysmal. The second graft aneurysm was successfully excluded by endovascular stent-grafts with medium-term primary patency. A venous graft was used initially rather than a synthetic graft to reduce the risk of infection and the potential problems from future growth. Aneurysmal dilatation of venous grafts in children and adolescents is a rare but recognized complication. To the best of our knowledge, exclusion of these aneurysms with stent-grafts has not been previously reported in the adolescent population.

Lenton, James, E-mail: jlenton@doctors.org.u [Leeds General Infirmary, Department of Vascular Radiology (United Kingdom); Davies, John; Homer-Vanniasinkam, S. [Leeds General Infirmary, Leeds Vascular Institute (United Kingdom); McPherson, Simon, E-mail: Simon.Mcpherson@leedsth.nhs.u [Leeds General Infirmary, Department of Vascular Radiology (United Kingdom)

2008-09-15

111

Options for left internal mammary harvest in minimal access coronary surgery  

PubMed Central

The left internal mammary artery (LIMA) to the left anterior descending artery bypass remains the gold standard for coronary artery bypass grafting. This review focuses on the three major options for LIMA takedown when using minimal access options to achieve this bypass, namely standard minimally invasive direct coronary artery bypass (MIDCAB), thoracoscopic MIDCAB, and robotically assisted MIDCAB.

Itagaki, Shinobu

2013-01-01

112

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

Microsoft Academic Search

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

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

113

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

PubMed

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

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

2014-07-15

114

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

PubMed

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

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

2005-01-01

115

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

National Technical Information Service (NTIS)

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

M. J. DeJong

1996-01-01

116

Off-pump coronary artery bypass grafting in India.  

PubMed

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

Saha, Kamales Kumar

2014-01-01

117

Glycemic Control during Coronary Artery Bypass Graft Surgery  

PubMed Central

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

Lazar, Harold L.

2012-01-01

118

Coronary artery bypass grafting in female patients on Thyroxine replacement  

Microsoft Academic Search

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

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

2005-01-01

119

A meta-analysis of randomized controlled trials on mid-term angiographic outcomes for radial artery versus saphenous vein in coronary artery bypass graft surgery  

PubMed Central

Background Currently, saphenous vein (SV) and radial artery (RA) are the most commonly used conduits in combination with the left internal mammary artery for conventional coronary artery bypass graft surgery (CABG). The present meta-analysis aimed to assess the existing evidence from randomized controlled trials (RCTs) to compare the angiographic outcomes of these two conduits at mid-term follow-up. Methods Four relevant and updated RCTs with follow-up beyond 3 years were identified using five electronic databases. Angiographic endpoints included complete occlusion, ‘string sign’, graft failure and complete patency. Results The incidence of complete occlusion was significantly lower after using RA compared to SV [6.7% vs. 17.2%; odd ratio (OR), 0.36; 95% confidence interval (CI), 0.23-0.58; P<0.0001]. The angiographic ‘string sign’ was significantly more likely to be identified after using RA compared to SV (3.1% vs. 0%; OR, 5.65; 95% CI, 1.21-26.39; P=0.03). Graft failure was significantly lower after RA compared to SV (9.6% vs. 18.8%; OR, 0.47; 95% CI, 0.30-0.72; P=0.0005). Complete graft patency was found to be significantly higher after RA compared to SV (88.6% vs. 75.8%; OR, 3.19; 95% CI, 1.42-7.16; P=0.005). Conclusions Results of the present meta-analysis suggest that selected patients with severe, proximal stenosis may have superior angiographic outcomes at mid-term follow-up after using RA compared to SV for CABG. However, RA is associated with a significantly higher incidence of the ‘string sign’. Future studies should aim to collect additional data on symptomatic outcomes.

Ang, Su C.; Wolak, Kevin; Peeceeyen, Sheen; Bannon, Paul; Yan, Tristan D.

2013-01-01

120

Association of pelvic arterial calcification with arteriovenous thigh graft failure in haemodialysis patients  

Microsoft Academic Search

Background. Arterial calcification is a common prob- lem in patients with chronic kidney disease, and has been associated with adverse clinical outcomes. The goal of the present study was to evaluate whether pelvic artery calcifications are associated with technical failure of arteriovenous thigh grafts in haemodialysis patients. Methods. From 1 January 1999 to 30 June 2002, thigh grafts were placed

Mark E. Lockhart; Michelle L. Robbin; Michelle M. McNamara; Michael Allon

121

Dialysis grafts arterial plug: Retrieval using the tulip sheath device in vitro  

Microsoft Academic Search

The 'arterial plug' is a resistant thrombus that frequently persists at the arterial anastomosis of clotted hemodialysis grafts following thrombolytic therapy. We studied the physical and morphological characteristics of the plug and determined the feasibility of transcatheter removal in vitro using the tulip compression thrombectomy system. Sixteen thrombus plugs were recovered during surgical thrombectomy of clotted human dialysis grafts. The

Melhem J. Sharafuddin; Jack L. Titus; Gu Xiaoping; David W. Hunter; Kurt Amplatz

1997-01-01

122

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

Microsoft Academic Search

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

M H Gottesman; Ibrahim Saraya; Franesco Tenti

1992-01-01

123

Quality of Life Improvement after Robotically Assisted Coronary Artery Bypass Grafting  

Microsoft Academic Search

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

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

2009-01-01

124

Treatment of a Hepatic Artery Aneurysm by Endovascular Stent-Grafting  

SciTech Connect

Aneurysms of the visceral arteries are rare. Traditional treatment has been surgical or endovascular with coil embolization. Recently, however, reports on endovascular therapy with stent-grafts have been published. We report the case of a 61-year-old man who was successfully treated with a stent-graft for a symptomatic combined celiac/hepatic artery aneurysm.

Jenssen, Guttorm L., E-mail: guje@haukeland.no; Wirsching, Jan [Haukeland University Hospital, Department of Radiology (Norway); Pedersen, Gustav; Amundsen, Svein Roar; Aune, Steinar; Dregelid, Einar; Jonung, Torbjorn; Daryapeyma, Alireza; Laxdal, Elin [Haukeland University Hospital, Department of Vascular Surgery (Norway)

2007-06-15

125

Novel technique for reimplantation of intercostal arteries using tailored patch graft  

Microsoft Academic Search

We developed a simple and secure technique for reimplantation of the intercostal arteries (ICAs) using a patch graft during thoracoabdominal aneurysm repair. With our procedure, a sidearm branch with its base is tailored from a 24 mm one-branch Dacron graft, and then sutured as a patch graft to the trimmed wall of the descending aorta to cover the ICA orifices

Koichi Toda; Kazuhiro Taniguchi; Satoshi Kainuma; Takenori Yokota

126

Novel technique for reimplantation of intercostal arteries using tailored patch graft  

Microsoft Academic Search

We developed a simple and secure technique for reimplantation of the intercostal arteries (ICAs) using a patch graft during thoracoabdominal aneurysm repair. With our procedure, a sidearm branch with its base is tailored from a 24mm one-branch Dacron graft, and then sutured as a patch graft to the trimmed wall of the descending aorta to cover the ICA orifices between

Koichi Toda; Kazuhiro Taniguchi; Satoshi Kainuma; Takenori Yokota

2008-01-01

127

Pancreatitis-Associated Splenic Artery Pseudoaneurysm: Endovascular Treatment with Self-Expandable Stent-Grafts  

SciTech Connect

We present a patient with a splenic arterypseudoaneurysm (SAPA) treated with placement of self-expandable stent-grafts. The procedure was complicated by stent-graft migration,but successful management resulted in lasting exclusion of the SAPA,while the patency of the splenic artery was preserved. This is the first report of self-expandable stent-graft treatment of SAPA.

Brountzos, Elias N. [Second Department of Radiology, Medical School, Athens University, Eugenidion Hospital, 20Papadiamantopoulou Street, Athens 11528 (Greece); Vagenas, Kostantinos [Department of Surgery, Medical School, Patras University, Patras University Hospital, Rion, Patras (Greece); Apostolopoulou, Sotiria C.; Panagiotou, Irene [Second Department of Radiology, Medical School, Athens University, Eugenidion Hospital, 20 Papadiamantopoulou Street, Athens 11528 (Greece); Lymberopoulou, Dimitra [Department of Surgery, Medical School, Patras University, Patras University Hospital, Rion, Patras (Greece); Kelekis, Dimitrios A. [Second Department of Radiology, Medical School, Athens University, Eugenidion Hospital, 20 Papadiamantopoulou Street, Athens 11528 (Greece)

2003-02-15

128

Hemodynamic Conditions in a Failing Peripheral Artery Bypass Graft  

PubMed Central

Objective The mechanisms of restenosis in autogenous vein bypass grafts placed for peripheral artery disease are not completely understood. We seek to investigate the role of hemodynamic stress in a case study of a revised bypass graft that failed due to restenosis. Methods The morphology of the lumen is reconstructed from a custom 3D ultrasound system. Scans were taken at one, six, and sixteen months after a patch angioplasty procedure. Computational hemodynamic simulations of the patient-specific model provide the blood flow features and the hemodynamic stresses on the vessel wall at the three time points studied. Results The vessel was initially free of any detectable lesions, but a 60% diameter reducing stenosis developed over the 16 month interval of study. As determined from the simulations, chaotic and recirculating flow occurred downstream of the stenosis due to the sudden widening of the lumen at the patch location. Curvature and a sudden increase in the lumen cross-sectional area induce these flow features that are hypothesized to be conducive to intimal hyperplasia. Favorable agreement was found between simulation results and in vivo Doppler ultrasound velocity measurements. Conclusions Transitional and chaotic flow occurs at the site of the revision, inducing a complex pattern of wall shear are computed with the hemodynamic simulations. This supports the hypothesis that the hemodynamic stresses in the revised segment, produced by the coupling of vessel geometry and chaotic flow, led to the intimal hyperplasia and restenosis of the graft.

McGah, Patrick M.; Leotta, Daniel F.; Beach, Kirk W.; Zierler, R. Eugene; Riley, James J.; Aliseda, Alberto

2012-01-01

129

Left anterior descending artery percutaneous coronary intervention via the left internal mammary artery in a 54-year-old type 1 diabetic woman: a case report  

PubMed Central

Data on the treatment of left anterior descending artery (LAD) stenosis involving or localized distally to left internal mammary artery anastomosis are scarce and not homogeneous. Both surgery (CABG) and percutaneous interventions (PCI) have been attempted, but the most effective treatment has not yet been established. We report a case of a 54-year-old woman suffering from chronic, stable angina and diabetes type 1 successfully treated with percutaneous angioplasty of LAD via the left internal mammary artery with drug-eluting stent implantation with excellent short-term results.

Kasprzak, Jaroslaw

2013-01-01

130

Evaluation of arterialized vein graft permeability with Evans blue dye and iodine 125-labeled albumin  

SciTech Connect

This study measured endothelial permeability, quantitatively (with iodine 125-labeled albumin) and qualitatively (with Evans blue dye) in arterialized vein grafts in 9 adult dogs. In each dog, the right common carotid artery was ligated and arterial flow was reconstituted with a 5-cm bypass graft of right external jugular vein. Twenty-four hours before the dogs were killed, each dog received both {sup 125}I-labeled albumin (8 microCi/kg) and Evans blue dye (15 mg/kg) intravenously. After the dogs' death, each arterialized vein graft and each left external jugular vein (as control) was harvested and studied. Arterialized vein graft permeability was significantly increased over control at 1, 3, and 6 months (3 dogs at each interval). Scanning electron microscopy revealed confluent endothelium in all specimens. This increased permeability may play a role in vein graft atherosclerosis.

Finck, S.J.; Mashburn, J.P.; Kottke, B.A.; Orszulak, T.A. (Mayo Clinic Jacksonville, FL (USA))

1989-11-01

131

Anastomosis of the Superficial Temporal Artery to the Middle Cerebral Artery with the Interposed Occipital Artery Graft in Moyamoya Disease: Case Report  

Microsoft Academic Search

BackgroundAlthough there have been various interposed bypass grafts used for cerebral revascularization, the occipital artery has never been used as a graft. Interposed occipital artery bypass graft in an adult case with moyamoya disease after failed indirect revascularization is presented.Case DescriptionThis 34-year-old woman with moyamoya disease, who had suffered from cerebral ischemic symptoms since the age of 6 years, was

Shigekazu Takeuchi; Tetsuo Koike; Ryuichi Tanaka

1997-01-01

132

Thinking inside the graft: applications of optical coherence tomography in coronary artery bypass grafting.  

PubMed

Recent advances in catheter-based optical coherence tomography (OCT) have provided the necessary resolution and acquisition speed for high-quality intravascular imaging. Complications associated with clearing blood from the vessel of a living patient have prevented its wider acceptance. We identify a surgical application that takes advantage of the vascular imaging powers of OCT but that circumvents the difficulties. Coronary artery bypass grafting (CABG) is the most commonly performed major surgery in America. A critical determinant of its outcome has been postulated to be injury to the conduit vessel incurred during the harvesting procedure or pathology preexistent in the harvested vessel. As a test of feasibility, intravascular OCT imaging is obtained from the radial arteries (RAs) and/or saphenous veins (SVs) of 35 patients scheduled for CABG. Pathologies detected by OCT are compared to registered histological sections obtained from discarded segments of each graft. OCT reliably detects atherosclerotic lesions in the RAs and discerns plaque morphology as fibrous, fibrocalcific, or fibroatheromatous. OCT is also used to assess intimal trauma and residual thrombi related to endoscopic harvest and the quality of the distal anastomosis. We demonstrate the feasibility of OCT imaging as an intraoperative tool to select conduit vessels for CABG. PMID:17994877

Brown, Emile N; Burris, Nicholas S; Gu, Junyan; Kon, Zachary N; Laird, Patrick; Kallam, Seeta; Tang, Cha-Min; Schmitt, Joseph M; Poston, Robert S

2007-01-01

133

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

Microsoft Academic Search

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

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

2010-01-01

134

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

PubMed

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

Lammy, Simon; Pessotto, Renzo

2014-02-01

135

[Immunocytochemical and ultrastructural study of saphenous vein, internal thoracic artery, and right gastroepiploic artery in coronary artery bypass grafting].  

PubMed

The arterial conduits such as internal thoracic artery (ITA) and right gastroepiploic artery (GEA) are widely used in coronary artery bypass surgery because of their resistance to atherosclerosis. In this study, immunophenotypes of smooth muscle cells (SMCs) in intima and media of ITA, GEA and saphenous vein (SV) were studied using monoclonal antibodies specific to cytoskeletal proteins; actin (A), vimentin (V) and desmin (V). In addition, the ultrastructures of endothelium of these vessels were examined. The most SMCs in intima and media of ITA and GEA were found positive for (A) and (V) but negative for (D). In contrast, the majority of SMCs both in intima and media of SV were found positive for (A), (V) and (D). The ultrastructure of endothelium of ITA and GEA showed the deeper penetration of cytoplasmic process than SV, which might anchor the endothelium. We suggest the morphological difference of endothelium and phenotypic diversity of SMCs between arterial and venous grafts may account for the different susceptibility to atherosclerotic changes in coronary bypass grafting. PMID:8376887

Sasaguri, S; Hosoda, Y; Tahara, M; Watanabe, T; Kazui, M; Kikuchi, N; Goto, M; Yamamuro, M; Yamamoto, S; Nukariya, M

1993-07-01

136

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

SciTech Connect

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

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

1987-02-01

137

Does Bilateral Internal Thoracic Artery Grafting Increase Surgical Risk in Diabetic Patients?  

Microsoft Academic Search

Background. The purpose of this study was to deter- mine whether, with appropriate techniques, diabetic patients could benefit from the advantages of double internal thoracic artery (ITA) coronary bypass without an increased hospital risk. Methods. Between January 1990 and December 1996, 207 consecutive diabetic patients underwent coronary artery bypass graft operations. In 74 patients both arteries (bilateral ITA group) were

Miguel Sousa Uva; Eric Braunberger; Marc Fisher; Yves Fromes; Phillipe H. Deleuze; Jean A. Celestin; Olivier M. Bical

2010-01-01

138

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

Microsoft Academic Search

Background. Beating heart coronary artery bypass graft surgery of the left anterior descending, diagonal, and right coronary artery can be performed safely with the Octopus Stabilization System. However, tilting of the heart, which is necessary to reach the obtuse marginal and distal right coronary arteries, causes hemodynamic instability. This study was performed to investigate the possible role of the Enabler

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

1999-01-01

139

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

Microsoft Academic Search

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

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

2006-01-01

140

Surgical Approach to Aortic Valve Replacement after Previous Bilateral Internal Thoracic Artery Grafting  

PubMed Central

The authors present a manubrium-sparing sternotomy technique for aortic valve replacement in patients who have undergone previous myocardial revascularization with both internal thoracic arteries. They have found that preoperative 64-multislice computed tomographic imaging facilitates surgical planning by delineating the course of patent grafts and, in particular, the relationship between the sternum and the right internal thoracic artery graft. A manubrium-sparing sternotomy can in such instances avoid injury to the right internal thoracic artery graft during both resternotomy and adhesion dissection, thus reducing surgical risk and operative time.

Zeitani, Jacob; Pugliese, Marta; Mvondo, Charles Mve; Chiariello, Giovanni; Bellos, Kiriakos; Simonetti, Giovanni; Chiariello, Luigi

2013-01-01

141

Screening of Carotid Artery Stenosis in Coronary Artery Bypass Grafting Patients  

PubMed Central

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

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

2010-01-01

142

Use of the inferior epigastric artery as a free graft for myocardial revascularization.  

PubMed

From March 1990 through January 1991, 47 patients undergoing myocardial revascularization had one (37) or both (10) inferior epigastric arteries (IEA) used as a conduit for bypass with 62 distal anastomoses. The internal thoracic artery (ITA) was used bilaterally in 41 patients and unilaterally in 6 with 100 distal anastomoses. Five patients had a single saphenous vein graft. In total, 167 anastomoses (3.55 per patient) were performed. Single IEA grafts were harvested through a paramedian incision and bilateral grafts, a midline incision. Harvest time was 36.5 minutes for IEA grafts and 29.6 minutes for ITA grafts (p less than 0.0001). Graft length was 11.9 cm for IEA grafts and 16.5 cm for ITA grafts (p less than 0.0001). Distal graft diameter was 2.0 mm for IEA grafts and 2.1 mm for ITA grafts (p less than 0.01). Graft flow was 49.7 mL/min for IEA grafts and 48.7 mL/min for ITA grafts. Microscopic assessment of segments of both the IEA and ITA from 14 patients revealed similar internal elastic laminae and an equal number of fenestrations. Combined intimal and medial thickness was comparable in both conduits. Medial elastic tissue was more prominent in ITA grafts and lacking in eight of the 14 IEA grafts. Gross plaque formation was noted in the proximal 1 to 3 cm of 50% of IEA grafts, but the lumen was not compromised and microscopic thickening was minimal. An unexpected finding was medial calcifications (Mönckeberg's disease) in two of the 14 IEAs without associated atherosclerosis. There was one hospital death, one abdominal wound infection, and one instance of fat necrosis superficial to the sternum.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1832849

Barner, H B; Naunheim, K S; Fiore, A C; Fischer, V W; Harris, H H

1991-09-01

143

Angiographic Evaluation of Carotid Artery Grafting with Prefabricated Small-Diameter, Small-Intestinal Submucosa Grafts in Sheep  

SciTech Connect

The purpose of this study was to report the longitudinal angiographic evaluation of prefabricated lyophilized small-intestinal submucosa (SIS) grafts placed in ovine carotid arteries and to demonstrate a variety of complications that developed. A total of 24 grafts, 10 cm long and 6 mm in diameter, were placed surgically as interposition grafts. Graft patency at 1 week was evaluated by Doppler ultrasound, and angiography was used for follow-up at 1 month and at 3 to 4 months. A 90% patency rate was found at 1 week, 65% at 1 month, and 30% at 3 to 4 months. On the patent grafts, angiography demonstrated a variety of changes, such as anastomotic stenoses, graft diffuse dilations and dissections, and aneurysm formation. These findings have not been previously demonstrated angiographically by other investigators reporting results with small-diameter vessel grafts made from fresh small-intestinal submucosa (SIS). The complications found were partially related to the graft construction from four SIS layers. Detailed longitudinal angiographic study should become an essential part of any future evaluation of small-vessel SIS grafting.

Pavcnik, Dusan, E-mail: pavcnikd@ohsu.ed [Oregon Health Sciences University, L342, Dotter Interventional Institute (United States); Obermiller, Josef [Cook Biotech (United States); Uchida, Barry T. [Oregon Health Sciences University, L342, Dotter Interventional Institute (United States); Van Alstine, William [Purdue University, Animal Disease Diagnostic Laboratory (United States); Edwards, James M. [Oregon Health and Science University, Division of Vascular Surgery, Department of Surgery (United States); Landry, Gregory J.; Kaufman, John A.; Keller, Frederick S.; Roesch, Josef [Oregon Health Sciences University, L342, Dotter Interventional Institute (United States)

2009-01-15

144

Stent-Graft Treatment of Late Stenosis of the Left Common Carotid Artery Following Thoracic Graft Placement  

SciTech Connect

We report the case of a patient with subtotal occlusion of the origin of the left common carotid artery (CCA) following thoracic graft placement. Retrograde endovascular placement of a stent-graft by minimal cervical access was undertaken to repair the occlusive lesion of the left CCA and prevent future complications of endoluminal thoracic reconstruction. The retrograde endovascular repair of CCA lesions, as other authors have already suggested, may be the treatment of choice in 'high-surgical-risk' patients. In these cases where the ostium of supra-aortic trunks is compromised following thoracic aorta stent-graft migration, endoluminal placement of a stent-graft in the CCA can guarantee both maintenance of carotid flow and thoracic stent-graft fixation.

Medda, Massimo; Lioupis, Christos, E-mail: lioupisC@vodafone.net.gr; Mollichelli, Nadia; Fantoni, Cecilia; Inglese, Luigi [Policlinico San Donato, Department of Cardiovascular Radiology (Italy)

2008-03-15

145

Effects of Skeletonized versus Pedicled Radial Artery on Postoperative Graft Patency and Flow  

PubMed Central

Background Radial artery (RA) was the second arterial graft introduced in clinical practice for myocardial revascularization. The skeletonization technique of the left internal thoracic artery (LITA) may actually change the graft's flow capacity with potential advantages. This leads to the assumption that the behavior of the RA, as a coronary graft, is similar to that of the LITA, when skeletonized. Objective This study evaluated 'free' aortic-coronary radial artery (RA) grafts, whether skeletonized or with adjacent tissues. Methods A prospective randomized study comparing 40 patients distributed into two groups was conducted. In group I, we used skeletonized radial arteries (20 patients), and in group II, we used radial arteries with adjacent tissues (20 patients). After the surgical procedure, patients underwent flow velocity measurements. Results The main surgical variables were: RA internal diameter, RA length, and free blood flow in the radial artery. The mean RA graft diameters as calculated using quantitative angiography in the immediate postoperative period were similar, as well as the flow velocity measurement variables. On the other hand, coronary cineangiography showed the presence of occlusion in one RA graft and stenosis in five RA grafts in GII, while GI presented stenosis in only one RA graft (p = 0.045). Conclusion These results show that the morphological and pathological features, as well as the hemodynamic performance of the free radial artery grafts, whether prepared in a skeletonized manner or with adjacent tissues, are similar. However, a larger number of non-obstructive lesions may be observed when RA is prepared with adjacent tissues.

Bonini, Romulo C. Arnal; Staico, Rodolfo; Issa, Mario; Arnoni, Antoninho Sanfins; Chaccur, Paulo; Abdulmassih, Camilo; Dinkhuysen, Jarbas Jackson; Paulista, Paulo Paredes; de Souza, Luiz Carlos Bento; Moreira, Luiz Felipe P.

2014-01-01

146

The geometry of unstented and stented pig common carotid artery bypass grafts.  

PubMed

The long-term success of arterial bypass grafting with autologous saphenous veins is limited by neointimal hyperplasia (NIH), which seemingly develops preferentially at sites where hydrodynamic wall shear is low. Placement of a loose-fitting, porous stent around end-to-end, or end-to-side, autologous saphenous vein grafts on the porcine common carotid artery has been found significantly to reduce NIH, but the mechanism is unclear. In a preliminary study, we implanted autologous saphenous vein grafts bilaterally on the common carotid arteries of pigs, placing a stent around one graft and leaving the contralateral graft unstented. At sacrifice 1 month post implantation, the grafts were pressure fixed in situ and resin casts were made. Unstented graft geometry was highly irregular, with non-uniform dilatation, substantial axial lengthening, curvature, kinking, and possible long-pitch helical distortion. In contrast, stented grafts showed no major dilatation, lengthening or curvature, but there was commonly fine corrugation, occasional slight kinking or narrowing of segments, and possible long-pitch helical distortion. Axial growth of grafts against effectively tethered anastomoses could account for these changes. CFD studies are planned, using 3D MR reconstructions, on the effects of graft geometry on the flow. Abnormality of the flow could favour the development of vascular pathology, including NIH. PMID:12122273

Caro, Colin; Jeremy, Jamie; Watkins, Nick; Bulbulia, Richard; Angelini, Gianni; Smith, Frank; Wan, Song; Yim, Anthony; Sherwin, Spencer; Peiró, Joaquim; Papaharilaou, Yannis; Falzon, Brian; Giordana, Sergio; Griffiths, Clydd

2002-01-01

147

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

PubMed Central

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

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

2008-01-01

148

Pseudoaneurysm of the Common Hepatic Artery: Treatment with a Stent-Graft  

SciTech Connect

We report a case of a pseudoaneurysm of the common hepatic artery treated with a stent-graft in a 67-year-old man. The patient presented with severe catheter bleeding through a drain following surgical and interventional procedures performed for therapeutic management of a choledochal cholangiocarcinoma. Selective hepatic arteriography showed a pseudoaneurysm close to the origin of the gastroduodenal artery. After a preliminary attempt at arterial embolization, it was decided to use a stent-graft to bridge the false aneurysm. Complete pseudoaneurysm exclusion was seen after the procedure with preservation of hepatic arterial flow.

Paci, Enrico; Antico, Ettore; Candelari, Roberto; Alborino, Salvatore [Interventional Radiology, Department of Radiology, Regional Hospital Umberto Io-Torrette, I-60020 Torrette, Ancona (Italy); Marmorale, Cristina; Landi, Eduardo [Clinical Surgery Department, University of Ancona, Regional Hospital Umberto Io-Torrette, I-60020 Torrette, Ancona (Italy)

2000-11-15

149

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

National Technical Information Service (NTIS)

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

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

1988-01-01

150

Stent grafting of acute hepatic artery bleeding following pancreatic head resection.  

PubMed

The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemorrhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump. PMID:16932877

Stoupis, Christoforos; Ludwig, Karin; Inderbitzin, Daniel; Do, Dai-Do; Triller, Juergen

2007-02-01

151

Decellularized ovine arteries as small-diameter vascular grafts.  

PubMed

Atherosclerosis and its complications still represent the leading cause of death in the developed countries. While autologous blood vessels may be regarded as the best solution for peripheral and coronary bypass, they are unavailable in most patients. Even though tissue engineering techniques are often applied to the development of small-diameter vascular grafts, limiting factors of this approach are represented by the lack of essential extracellular matrix proteins and/or poor biomechanical properties of the scaffolds used. Along these lines, the aim of this study was to develop a decellularization protocol for ovine carotids to be used as suitable small-diameter vascular grafts. Samples were treated either with sodium dodecyl sulphate (SDS) or with Trypsin and Triton X-100; a final nuclease digestion was performed for both protocols. Morphological analyses demonstrate complete removal of nuclei and cellular components in treated vessels, also confirmed by significant reduction in wall thickness and DNA content. Essential extracellular matrix proteins such as collagen, elastin, and fibronectin are well preserved after decellularization. From a mechanical point of view, Trypsin and Triton X-100 treated arteries show elastic modules and compliance comparable to native carotids, whereas the use of SDS makes samples stiffer, with a significant decrease in the compliance mean value and an increase in longitudinal and circumferential Young's modules. It is demonstrated that the treatment where Trypsin and Triton X-100 are combined guarantees complete decellularization of carotids, with no significant alteration of biomechanical and structural properties, thus preserving a suitable environment for adhesion, proliferation, and migration of cells. PMID:25050540

Mancuso, L; Gualerzi, A; Boschetti, F; Loy, F; Cao, G

2014-08-01

152

Impact of cervical internal carotid clamping and radial artery graft bypass on cortical arterial perfusion pressure during craniotomy.  

PubMed

Strategic cervical internal carotid occlusion is employed either temporarily or permanently in various neurosurgical procedures. The aim of the present study was to assess changes in cortical arterial pressure during cervical internal carotid cross-clamping before and after the placement of radial artery (RA) graft bypass in the treatment of complex carotid artery aneurysms. Perfusion pressure of the middle cerebral artery (MCA) was assessed in 22 patients with complex carotid aneurysm treated with RA graft bypass. Regional cerebral blood flow was assessed postoperatively using single-photon computed tomography. Mean cortical blood pressure (mcBP) was found to be 48.2?±?24.2 and 97.0?±?24.0 % of baseline after clamping the cervical internal carotid artery and opening the RA graft bypass, respectively. Cerebral perfusion pressure estimated by the mcBP failed to sustain a critical limit of greater than 70 mmHg under craniotomy in 16 out of 20 (80 %) patients. There was an inverse correlation in mcBP between the baseline and after the placement of the RA graft bypass (r?=?0.66, P?artery (ICA) ligation combined with RA graft bypass. Substantial pressure reductions in cerebral cortical arteries were observed during the cervical internal carotid cross-clamping. Perfusion pressure in peripheral cortical arteries after the placement of the RA graft bypass was comparable to the state before ICA clamping. PMID:24700098

Kazumata, Ken; Kamiyama, Hiroyasu; Ishikawa, Tatsuya; Nakamura, Toshitaka; Terasaka, Shunsuke; Houkin, Kiyohiro

2014-07-01

153

Dual pathway for angiotensin II formation in human internal mammary arteries.  

PubMed

1. Angiotensin converting enzyme (ACE) is thought to be the main enzyme to convert antiotensin I to the vasoactive angiotensin II. Recently, in the human heart, it was found that the majority of angiotensin II formation was due to another enzyme, identified as human heart chymase. In the human vasculature however, the predominance of either ACE or non-ACE conversion of angiotensin I remains unclear. 2. To study the effects of ACE- and chymase-inhibition on angiotensin II formation in human arteries, segments of internal mammary arteries were obtained from 37 patients who underwent coronary bypass surgery. 3. Organ bath experiments showed that 100 microM captopril inhibited slightly the response to angiotensin I (pD2 from 7.09+/-0.11-6.79+/-0.10, P<0.001), while 100 microM captopril nearly abolished the response to [pro10] angiotensin I, a selective substrate for ACE, and the maximum contraction was reduced from 83+/-19%-23+/-17% of the control response (P=0.01). A significant decrease of the pD2 of angiotensin I similar to captopril was observed in the presence of 50 microM chymostatin (pD2 from 7.36+/-0.13-6.99+/-0.15, P<0.039), without influencing the maximum response. In the presence of both inhibitors, effects were much more pronounced than either inhibitor alone, and a 300 times higher dose was needed to yield a significant contraction response to angiotensin I. 4 These results indicate the presence of an ACE and a non-ACE angiontensin II forming pathway in human internal mammary arteries. PMID:9846641

Voors, A A; Pinto, Y M; Buikema, H; Urata, H; Oosterga, M; Rooks, G; Grandjean, J G; Ganten, D; van Gilst, W H

1998-11-01

154

Incomplete biochemical adaptation of vein grafts to the arterial environment in terms of prostacyclin production.  

PubMed

Biochemical (or functional) adaptation of venoarterial grafts has been demonstrated recently. We reexamined one aspect of this biochemical "arterialization" process: prostacyclin (PGI2) production by canine venoarterial autologous grafts and the responsiveness of this biosynthetic pathway to maximal stimulation with substrate enhancement. Four reversed autologous grafts (femoral vein) were interposed into both carotid and femoral arteries in eight dogs. After 12 weeks, the grafts were removed, and radioimmunoassay was used to determine luminal surface production of 6-keto-PGF1 alpha (the stable metabolite of PGI2) in both the basal and stimulated (27 mumol/L arachidonic acid [AA]) states. PGI2 production by the venous autologous grafts was compared with that of control native artery and vein. We confirmed that PGI2 production (measured in nanograms per milliliter) by control artery was greater than vein under both basal conditions (5.8 +/- 0.4 [+/- SEM] vs. 2.7 +/- 0.5, p less than 0.001) and stimulated conditions (8.8 +/- 0.8 vs. 5.5 +/- 0.4, p = 0.002); moreover, AA stimulation significantly increased PGI2 production in both native artery and vein compared with basal PGI2 production. Under basal conditions, graft PGI2 production (6.3 +/- 1.6 ng/ml) was not significantly different than basal arterial levels (p = 0.8) but was higher than basal venous levels (p = 0.05). However, in marked contrast to both native artery and vein, the vein graft flow surface showed no significant response to substrate enhancement with AA: basal (6.3 +/- 1.6 ng/ml) vs. stimulated (5.9 +/- 0.9 ng/ml) (p = 0.8). These observations confirm that canine venoarterial autologous grafts undergo biochemical "arterialization"; however, this process appears to be an incomplete one.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3312650

Cahill, P D; Brown, B A; Handen, C E; Kosek, J C; Miller, D C

1987-11-01

155

Dialysis grafts arterial plug: Retrieval using the tulip sheath device in vitro  

Microsoft Academic Search

The “arterial plug” is a resistant thrombus that frequently persists at the arterial anastomosis of clotted hemodialysis grafts\\u000a following thrombolytic therapy. We studied the physical and morphological characteristics of the plug and determined the feasibility\\u000a of transcatheter removal in vitro using the tulip compression thrombectomy system. Sixteen thrombus plugs were recovered during\\u000a surgical thrombectomy of clotted human dialysis grafts. The

Melhem J. Sharafuddin; Jack L. Titus; Xiaoping Gu; David W. Hunter; Kurt Amplatz

1997-01-01

156

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

Microsoft Academic Search

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

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

2005-01-01

157

Iatrogenic Iliac Artery Rupture: Emergency Management by Longer Stent-Graft on a Shorter Balloon  

SciTech Connect

Rupture of an iliac artery during percutaneous transluminal coronary angioplasty is a rare but potentially devastating complication. We report a case of iatrogenic external iliac artery rupture that was successfully treated by temporary balloon occlusion followed by endovascular stent graft placement in an unusual manner. Limited availability of the hardware necessitated the use of a longer bare stent graft mounted on a relatively shorter balloon.

Trehan, Vijay; Nigam, Arima; Ramakrishnan, S. [G. B. Pant Hospital, Department of Cardiology (India)], E-mail: ramakgmc@rediffmail.com

2007-02-15

158

Hyperhomocysteinemia and Mortality after Coronary Artery Bypass Grafting  

PubMed Central

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

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

2006-01-01

159

Left Internal Mammary Artery Injury Requiring Resuscitative Thoracotomy: A Case Presentation and Review of the Literature  

PubMed Central

Background. Penetrating injuries to the chest and in particular to the heart that results in pericardial tamponade and cardiac arrest requires immediate resuscitative thoracotomy as the only lifesaving technique and should be performed without delay. Objective. To describe an external cardiac tamponade caused by massive tension hemothorax from penetrating injury of the left internal mammary artery (LIMA). Method. A case presentation treated at the Level I trauma center at Hamad General Hospital, in Doha, Qatar and review of the literature on LIMA injuries reported cases. Results. LIMA injury as a cause of hemothorax is not uncommon, but to our knowledge our case is the first massive tension hemothorax with witnessed cardiac arrest reported in the literature requiring emergency thoracotomy, performed in trauma room, with full recovery. Conclusion. Injury to the LIMA with massive tension hemothorax requires immediate resuscitative thoracotomy.

Al Hassani, Ammar; Abdul Rahman, Yassir; Kanbar, Ahad; El-Menyar, Ayman; Al-Aieb, Abubaker; Asim, Mohammad; Latifi, Rifat

2012-01-01

160

Internal mammary artery perforator flap for reconstruction of the chest wall.  

PubMed

We used internal mammary artery perforator (IMAP) flaps from the opposite side for reconstruction of small-to-medium-sized defects in the chest wall. The IMAP flaps were used in two patients who had unhealed, localised ulcers of the chest wall with exposure of the ribs after radical mastectomy. The lesion was excised widely, and the flap, based on a perforator vessel in the second or third intercostal space of the opposite chest wall, was raised. The flap was rotated from 90° to 180° along the vascular axis to the chest wall defect. The donor site was closed primarily. Both flaps showed stable postoperative circulation and survived completely. Defects of the chest wall could be covered with healthy, well-vascularised tissue on one perforator without deep infection. The IMAP flap is a reliable and less invasive option to be considered for medial, localised, reconstruction of the chest wall. PMID:23848424

Takeuchi, Masaki; Sakurai, Hiroyuki

2013-09-01

161

Implantation of completely biological engineered grafts following decellularization into the sheep femoral artery.  

PubMed

The performance of completely biological, decellularized engineered allografts in a sheep model was evaluated to establish clinical potential of these unique arterial allografts. The 4-mm-diameter, 2-3-cm-long grafts were fabricated from fibrin gel remodeled into an aligned tissue tube in vitro by ovine dermal fibroblasts. Decellularization and subsequent storage had little effect on graft properties, with burst pressure exceeding 4000?mmHg and the same compliance as the ovine femoral artery. Grafts were implanted interpositionally in the femoral artery of six sheep (n=9), with contralateral sham controls (n=3). At 8 weeks (n=5) and 24 weeks (n=4), all grafts were patent and showed no evidence of dilatation or mineralization. Mid-graft lumen diameter was unchanged. Extensive recellularization occurred, with most cells expressing ?SMA. Endothelialization was complete by 24 weeks with elastin deposition evident. These completely biological grafts possessed circumferential alignment/mechanical anisotropy characteristic of native arteries and were cultured only 5 weeks prior to decellularization and storage as "off-the-shelf" grafts. PMID:24417686

Syedain, Zeeshan H; Meier, Lee A; Lahti, Mathew T; Johnson, Sandra L; Tranquillo, Robert T

2014-06-01

162

Iliorenal artery bypass grafting to facilitate endovascular abdominal aortic aneurysm repair  

Microsoft Academic Search

Effective endovascular repair of an infrarenal abdominal aortic aneurysm (AAA) requires adequate proximal and distal landing zones to allow secure endograft attachment. We report a patient with an infrarenal AAA originating 3 mm below the left renal artery with cardiac morbidity that precluded open AAA repair. Left renal artery relocation with retroperitoneal iliorenal bypass grafting was performed to lengthen the

Peter H. Lin; Kenneth Madsen; Ruth L. Bush; Alan B. Lumsden

2003-01-01

163

Iatrogenic Main Renal Artery Injury: Treatment by Endovascular Stent-Graft Placement  

SciTech Connect

We report on a patient who presented with perforation of the left main renal artery as a complication of a percutaneous retroperitoneal drainage procedure. Only a small number of cases of iatrogenic main renal artery perforations have been reported, none of them due to a percutaneous drainage attempt. Endovascular treatment by means of a coronary stent-graft was successful.

Heye, Sam, E-mail: sam.heye@uz.kuleuven.ac.be; Vanbeckevoort, Dirk [University Hospitals Gasthuisberg, Department of Radiology (Belgium); Blockmans, Daniel [University Hospitals Gasthuisberg, Department of Internal Medicine (Belgium); Nevelsteen, Andre [University Hospitals Gasthuisberg, Department of Vascular Surgery (Belgium); Maleux, Geert [University Hospitals Gasthuisberg, Department of Radiology (Belgium)

2005-01-15

164

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

Microsoft Academic Search

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

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

1995-01-01

165

Dissecting Aneurysm of the Superior Mesenteric Artery Successfully Treated by Endovascular Stent-Graft Placement  

Microsoft Academic Search

Spontaneous and isolated dissecting aneurysm of the superior mesenteric artery is a rare event that has been successfully treated by surgery in several reported cases. To our knowledge, we present the first case of a patient with spontaneous and isolated dissecting aneurysm of the superior mesenteric artery that was successfully treated by endovascular stent-graft placement.

Masaki Ishida; Noriyuki Kato; Tadanori Hirano; Tomoaki Suzuki; Yu Shomura; Isao Yada; Kan Takeda

2003-01-01

166

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

Microsoft Academic Search

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

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

1989-01-01

167

[Experience of coronary artery bypass grafting with inferior epigastric artery (IEA) and pathological examination of the IEA].  

PubMed

From January to March 1994, coronary artery bypass grafting (CABG) using the inferior epigastric artery (IEA) were performed in 10 patients. The stumps of the IEAs were examined pathologically. 1. Intimal thickening of the IEA was scarcely noted. 2. Internal elastic lamina of the IEA showed good development equivalent to the internal thoracic artery (ITA). 3. Tunica media of the IEA was poor in elastic fibers and rich in smooth muscle cells compared with the ITA. 4. The thickness of intima + media was 150-360 microns, suggesting its low risk of ischemic necrosis in case of free grafting. These results suggested the IEA to be a good graft material applicable for CABG. PMID:7884260

Hayashi, S; Kawaue, Y

1995-01-01

168

Infrascrotal, Perineal, Femorofemoral Bypass for Arterial Graft Infection at the Groin.  

PubMed

HYPOTHESIS: Infrascrotal, perineal, femorofemoral bypass is an acceptable procedure for treating infection of a prosthetic arterial graft limited to a unilateral groin. DESIGN: A consecutive sample clinical study with a mean follow-up of 29 months. SETTING: The surgical department of an academic tertiary care center and an affiliated secondary care center. PATIENTS: Nineteen patients with a mean age of 68 years with prosthetic graft infection at the outflow anastomosis on a femoral artery at the Scarpa triangle underwent an infrascrotal, perineal, femorofemoral bypass, with excision of the graft material limited at the groin. The recipient artery was the profunda femoris artery in 12 cases, the superficial femoral in 5, and the distal common femoral artery in 2. MAIN OUTCOME MEASURES: Cumulative survival, recurrence of sepsis, primary graft patency, and limb salvage rates expressed by standard life-table analysis. RESULTS: Postoperative mortality rate was 5%. Cumulative (SE) survival rate was 65% (11.6%) at 3 years. Cumulative (SE) rate of freedom from recurrent sepsis was 88% (8.6%) at 3 years. Cumulative (SE) primary patency and limb salvage rates were 86% (9.4%) and 91% (7.9%), respectively, at 3 years. CONCLUSION: Femorofemoral bypass with an infrascrotal perineal approach is a valuable procedure for the treatment of femoral arterial graft infection limited at a unilateral groin. PMID:15613291

Illuminati, Giulio; Caliò, Francesco G; D'Urso, Antonio; Giacobbi, Daniela; Papaspyropoulos, Vassilios; Ceccanei, Gianluca

2004-12-01

169

Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 x 2 factorial designed randomised NEO trial  

PubMed Central

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.

2014-01-01

170

[A case report of disappearance of free internal thoracic artery graft stenosis].  

PubMed

We have experienced an interesting case of spontaneous disappearance of stenosis of the injured free internal thoracic artery graft six months after coronary artery bypass grafting. A 61-year-old male underwent coronary bypass surgery with in situ left internal thoracic artery (LITA)-left anterior descending (LAD) and free right internal thoracic artery (RITA)-first diagonal branch (D1) bypass at our hospital. Postoperative angiogram showed the stenosis of the distal portion of the free RITA. We judged it was the injury by the electrocautery when dissecting the RITA. He was admitted to our hospital and received repeat angiography because of recurrence of angina six months after surgery. Repeat angiogram showed the good patency of LITA and complete disappearance of the stenosis of the free RITA. We consider that this case proved the free ITA can be a living graft. PMID:7861069

Yamaguchi, A; Kitamura, N; Irie, H; Ko, T; Kimura, S; Shuntoh, K

1994-12-01

171

Distal end side-to-side anastomoses of sequential vein graft to small target coronary arteries improve intraoperative graft flow  

PubMed Central

Background End-to-side anastomoses to connect the distal end of the great saphenous vein (GSV) to small target coronary arteries are commonly performed in sequential coronary artery bypass grafting (CABG). However, the oversize diameter ratio between the GSV and small target vessels at end-to-side anastomoses might induce adverse hemodynamic condition. The purpose of this study was to describe a distal end side-to-side anastomosis technique and retrospectively compare the effect of distal end side-to-side versus end-to-side anastomosis on graft flow characteristics. Methods We performed side-to-side anastomoses to connect the distal end of the GSV to small target vessels on 30 patients undergoing off-pump sequential CABG in our hospital between October 2012 and July 2013. Among the 30 patients, end-to-side anastomoses at the distal end of the GSV were initially performed on 14 patients; however, due to poor graft flow, those anastomoses were revised into side-to-side anastomoses. We retrospectively compared the intraoperative graft flow characteristics of the end-to-side versus side-to-side anastomoses in the 14 patients. The patient outcomes were also evaluated. Results We found that the side-to-side anastomosis reconstruction improved intraoperative flow and reduced pulsatility index in all the 14 patients significantly. The 16 patients who had the distal end side-to-side anastomoses performed directly also exhibited satisfactory intraoperative graft flow. Three-month postoperative outcomes for all the patients were satisfactory. Conclusions Side-to-side anastomosis at the distal end of sequential vein grafts might be a promising strategy to connect small target coronary arteries to the GSV.

2014-01-01

172

Ventricular assist device outflow graft in congenitally corrected transposition of great arteries - a surgical challenge  

PubMed Central

Congenitally corrected transposition of the great arteries is a complex congenital cardiac anomaly with a wide spectrum of morphologic features and clinical profiles. Most patients are diagnosed late in their life, undergoes surgical repairs, eventually leading to systemic ventricular failure needing heart transplant or mechanical circulatory assistance. As, aorta is located anterior to and left of the PA (Transposition of great arteries), the outflow graft of ventricular assist device traverse across pulmonary artery to reach aorta which poses challenge during further surgical explorations.

2012-01-01

173

Early hemodynamic effects of olprinone hydrochloride after coronary artery bypass grafting  

Microsoft Academic Search

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

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

1998-01-01

174

Long term outcomes of saphaneous vein graft intervention in elderly patients with prior coronary artery bypass graft  

PubMed Central

Objectives To investigate the procedure characteristics and long term follow-up of percutaneous coronary intervention (PCI) for saphaneous vein graft (SVG) lesions in the elderly patients. Methods From December 2005 to December 2011, 84 graft lesions were treated percutaneously. Seventeen were located at proximal anastomosis, 48 were located at SVG body, 19 were located at distal anastomosis. Primary endpoint was defined as major adverse cardiovascular events (MACE, composite of cardiac death, target vessel revascularization, acute myocardial infarction). Results The graft age was 6.7 ± 4.0 years. Most anastomosis lesions (80.0%) presented within one year post coronary artery bypass grafting (CABG). Proximal anastomosis lesion had the lowest successful rate for PCI compared with graft body and distal anastomosis lesions (70.6% vs. 91.7%, 79.0%, P < 0.05). The distal embolic protection device was used in 19.1% of patients, most frequently used in body graft PCI (29.2%, P < 0.01). The diameter of the stent was smallest in distal anastomosis group (2.9 ± 0.4 mm, P < 0.05). The highest post dilatation pressure was required in the proximal anastomosis (17.8 ± 2.7 atm, P < 0.05). The patients were followed up for 24.3 ± 16.9 months. MACE occurred in 18.57% of patients. Incidence of MACE was highest among proximal anastomosis PCI (47.1% vs. body graft PCI 16.7%, distal anastomosis PCI 21.1%; P < 0.05). Old myocardial infarction was the predictive factor for the poor clinical outcomes (P = 0.04). Conclusions PCI of SVG lesions is feasible with lower success rate. PCI of ostial graft anastomosis lesions had the lowest procedure success rate and highest MACE rate compared with graft body and distal anastomosis lesions. Old myocardial infarction was a predictive factor of poor outcomes.

Wang, Ji-Hong; Liu, Wei; Du, Xin; Ma, Chang-Sheng; Wu, Xue-Si

2014-01-01

175

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

PubMed Central

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

Aronson, Doron

2010-01-01

176

Endothelium-dependent responses in autogenous femoral veins grafted into the arterial circulation of the dog.  

PubMed

Endothelium-dependent responses differ in arteries and veins of the dog. Experiments were performed to determine whether chronic grafting of veins into the arterial circulation would alter the endothelium-dependent responses of the veins. Segments of femoral veins were grafted to the femoral artery of the dog. 6 wk after surgery the venous grafts were removed from the dog, cut into rings, and suspended in organ chambers for isometric tension recording. In some rings the endothelial cells were removed. Acetylcholine and alpha 2-adrenergic agonists did not cause endothelium-dependent relaxations in venous grafts. The calcium ionophore (A23187) initiated such relaxations which were not mediated by prostanoids. Endothelium-dependent relaxations were also observed in venous grafts to ADP, thrombin, and arachidonic acid. In segments of graft where myo-intimal hyperplasia was prominent, relaxations to ADP, thrombin, and A23187 were blunted and in some segments contractions were observed. These results demonstrate the ability of the endothelium of venous grafts to initiate changes in tone of the smooth muscle. PMID:2890656

Miller, V M; Reigel, M M; Hollier, L H; Vanhoutte, P M

1987-11-01

177

Stents covered by an autologous arterial graft in porcine coronary arteries: feasibility, vascular injury and effect on neointimal hyperplasia  

Microsoft Academic Search

Objective: The use of stents has improved results after balloon coronary angioplasty. Several materials have been proposed for covering the metallic surface of the stent to reduce the rate of subacute thrombosis and restenosis. In our institution, an autologous arterial graft was used for covering the external surface of a conventional stent. The angiographic and histological response in a porcine

Christodoulos Stefanadis; Konstantinos Toutouzas; Eleftherios Tsiamis; Charalambos Vlachopoulos; Sophia Vaina; Dorothea Tsekoura; Lubna Haldi; Elli Stefanadi; Michael Gravanis; Pavlos Toutouzas

178

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

Microsoft Academic Search

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

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

2002-01-01

179

Adaptive changes in autogenous vein grafts for arterial reconstruction: Clinical Implications  

PubMed Central

For patients with the most severe manifestations of lower extremity arterial occlusive disease, bypass surgery using autogenous vein has been the most durable reconstruction. However the incidence of bypass graft stenosis and graft failure remains substantial and wholesale improvements in patency are lacking. One potential explanation is that stenosis arises not only from over exuberant intimal hyperplasia but also due to insufficient adaptation or remodeling of the vein to the arterial environment. Although in vivo human studies are difficult to conduct, recent advances in imaging technology have made possible a more comprehensive structural examination of vein bypass maturation. This review summarizes recent translational efforts to understand the structural and functional properties of human vein grafts and places it within the context of the rich existing literature of vein graft failure.

Owens, Christopher D.

2009-01-01

180

Endovascular Treatment of Isolated Iliac Artery Aneurysms with Anaconda Stent Graft Limb  

PubMed Central

Isolated aneurysms of the iliac arteries are relatively rare conditions that traditionally have been treated by surgical reconstruction. We report our experience with endovascular treatment of iliac artery aneurysms (IAAs) with Anaconda stent graft limb. Two male patients were found to have 4.5 and 3.6?cm isolated common IAAs, respectively. The endograft was successfully advanced and deployed precisely to the intended position in both cases. In one case the internal iliac artery was embolized. No type I or II endoleak was observed immediately after the procedure. In one patient postimplantation fever (>38°C) and gluteal claudication occurred. After 2?years followup both iliac endovascular stent grafts are patent and without endoleak. Endovascular treatment with Anaconda limb stent graft seems to be a safe and feasible alternative to open surgery.

Karathanos, Christos; Kaperonis, Elias; Xanthopoulos, Dimitrios; Konstantopoulos, Theophanis; Exarchou, Maria; Loupou, Caterini; Papavassiliou, Vassilios

2013-01-01

181

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

Microsoft Academic Search

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

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

2009-01-01

182

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

Microsoft Academic Search

The development of intimal hyperplasia is the major cause of failure of both autologous saphenous vein and synthetic coronary artery bypass grafts. This is partially due to graft-host vessel compliance mismatch. Cellulose and chitosan (CELL:CHIT) are both biocompatible, nontoxic, and naturally occurring biopolymers that have been used extensively for biomedical applications. Elastic properties of membranes made of CELL:CHIT blends with

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

2012-01-01

183

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

PubMed Central

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

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

2013-01-01

184

The upside down Endurant iliac limb stent graft for treatment of a common iliac artery aneurysm.  

PubMed

Endovascular repair of the coverage from the common iliac artery to the external iliac artery after the internal iliac artery embolization has been proven to be a safe and effective treatment in isolated iliac artery aneurysms. But in cases in which the diameter of the proximal sealing zone is larger than that of the distal sealing zone, a reverse-tapered device is needed. We described the off-label use of the Endurant iliac limb stent graft in an upside down configuration to accommodate this diameter mismatch. PMID:24178729

Koike, Yuya; Nishimura, Jun-ichi; Hase, Soichiro; Yamasaki, Motoshige

2014-01-01

185

Coexistence of a Congenital Arteriovenous Fistula of the Left Breast with a True Aneurysm of the Right Internal Mammary Artery  

PubMed Central

Arteriovenous fistulas (AVF) and true aneurysms are uncommon arterial vascular disorders of the breast. The etiology can be either acquired or congenital. Coexistence of a congenital AVF and true aneurysm of internal mammary artery (IMA) branches is a very rare condition. We present a case of congenital AVF and true aneurysm of the IMA in a woman, age 56 years. To the best of our knowledge, this is the first published case of the coexistence of a congenital AVF with a true aneurysm of the breast. The radiologic findings of these rare entities have been reviewed according to the literature.

Cil, Ahmet Said; Bozkurt, Murat; Bozkurt, Duygu Kara; Karabacak, Adem

2013-01-01

186

Endovascular graft bail-out post reconstruction of popliteal artery injury. First case report.  

PubMed

A male patient who sustained a blunt trauma to the right knee and chest resulting in posterior dislocation of the knee joint and avulsion injury to the right popliteal artery (segments II and III) had a vascular repair by interposition saphenous vein graft. Postoperatively an episode of hypotension resulted in thrombotic occlusion of the graft and acute limb ischemia. Graft and distal thrombectomy, though successful, resulted in a stenotic segment with two perforations. To shorten the operating time this was managed by Viabahn Endoprothesis stent-graft through both native popliteal artery and vein graft. Immediate regain of pedal pulses was achieved, and at 6 months follow up Viabahn endograft is still patent, foot well perfused with normal pedal pulses and patient fully active. In complicated popliteal artery injuries, with complex time consuming revascularization procedures, an endovascular graft as a back up or bail-out technique might be a valid option in some selected cases with high anesthetic risk, to shorten operating time. In this context Viabahn endoprosthesis seems to be both efficient and durable on the short term. PMID:21173737

Hussein, E A; Al-Kreedees, A; Saad, A; Wahba, T; Al-Shamimi, S

2010-12-01

187

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

Microsoft Academic Search

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

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

2000-01-01

188

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

PubMed

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

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

2010-01-01

189

Left common iliac artery to inferior vena cava abdominal wall arteriovenous graft for hemodialysis access.  

PubMed

We describe a novel arteriovenous graft configuration in the abdominal wall for hemodialysis in a 51-year-old woman with sickle cell disease. Upper extremity access sites were exhausted, and intrathoracic central veins occluded. Because of diminished quality of the left groin due to scar tissue from previous infected access, inadequate vasculature, and the presence of functional femoral catheter in the right groin with common iliac vein stenosis, we decided to create an arteriovenous graft from the left common iliac artery to the inferior vena cava. Adequate thrill and uneventful postoperative recovery was observed. At 4 months, the patient has been successfully using her graft. PMID:22494692

Zamani, Nader; Anaya-Ayala, Javier E; Ismail, Nyla; Peden, Eric K

2012-08-01

190

Traumatic coronary artery fistula closure with stent graft.  

PubMed

We present a rare case of a symptomatic acquired large coronary fistula and aneurysm secondary to chest trauma that was successfully closed using stent graft. This case is followed by review of the literature. PMID:22891139

Safi, Morteza; Ebrahim, Nematollah Pour; Namazi, Mohammad Hasan; Saadat, Habibollah; Vakili, Hosein; Hekmat, Manuchehr; Movahed, Mohammad Reza

2012-01-01

191

Traumatic Coronary Artery Fistula Closure with Stent Graft  

PubMed Central

We present a rare case of a symptomatic acquired large coronary fistula and aneurysm secondary to chest trauma that was successfully closed using stent graft. This case is followed by review of the literature.

Safi, Morteza; Ebrahim, Nematollah Pour; Namazi, Mohammad Hasan; Saadat, Habibollah; Vakili, Hosein; Hekmat, Manuchehr

2012-01-01

192

Lateral plantar artery bypass grafting: defining the limits of foot revascularization.  

PubMed

We placed 20 bypass grafts to the lateral plantar artery in 18 extremities to salvage feet with wet (12) or dry (six) gangrene; 15 grafts were implanted in men (75%), and five were implanted in women (25%). The median age was 65 years. All except two patients had diabetes; eight were treated with insulin. One patient had Buerger's disease, and another had vasculitis with chronic lymphocytic leukemia. History of smoking (65%), hypertension (53%), heart disease (71%), and osteomyelitis in the foot (35%), were noted. Cultures were positive in 15 gangrenous feet, 11 with gram-negative bacilli. Four long femoroplantar bypasses were placed. Ten short grafts were placed from the popliteal artery, and six jump grafts were placed distal to a femoropopliteal or tibial bypass. Hospital stay ranged from 8 to 38 days (median 16 days), and there were two in-hospital deaths. Transmetatarsal or button toe amputations were performed in nine feet. There were two below-knee amputations, one with a patent graft, for a foot salvage rate of 89% at 2 months. In four instances the gangrenous ulcers took longer than 6 months to heal; all other wounds healed within 6 months. The primary and secondary patency rates were 85% at 1 month, and 73% at 3 months and thereafter. Four of five graft failures occurred in the two legs with repeat bypass graftings. All patients with successful revascularization are able to walk, and seven returned to work full time. PMID:2810537

Andros, G; Harris, R W; Salles-Cunha, S X; Dulawa, L B; Oblath, R W

1989-11-01

193

Functioning pancreas graft with thromboses of splenic and superior mesenteric arteries after simultaneous pancreas-kidney transplantation: a case report.  

PubMed

Graft thrombosis is the most common cause of early graft loss after pancreas transplantation. The grafted pancreas is difficult to salvage after complete thrombosis, especially arterial thrombosis, and graft pancreatectomy is required. We describe a patient presenting with a functioning pancreas graft with thromboses of the splenic artery (SA) and superior mesenteric artery (SMA) after simultaneous pancreas-kidney transplantation (SPK). A 37-year-old woman with a 20-year history of type 1 diabetes mellitus underwent SPK. The pancreaticoduodenal graft was implanted in the right iliac fossa with enteric drainage. A Carrel patch was anastomosed to the recipient's right common iliac artery, and the graft gastroduodenal artery was anastomosed to the common hepatic artery using an arterial I-graft. The donor portal vein was anastomosed to the recipient's inferior vena cava. Four days after surgery, graft thromboses were detected by Doppler ultrasound without increases in the serum amylase and blood glucose levels. Contrast enhanced computed tomography revealed thromboses in the SA, splenic vein and SMA. Selective angiography showed that blood flow was interrupted in the SA and SMA. However, pancreatic graft perfusion was maintained by the I-graft in the head of the pancreas and the transverse pancreatic artery in the body and tail of the pancreas. We performed percutaneous direct thrombolysis and adjuvant thrombolytic therapy. However, we had to stop the thrombolytic therapy because of gastrointestinal hemorrhage. Thereafter, the postoperative course was uneventful and the pancreas graft was functioning with a fasting blood glucose level of 75 mg/dL, HbA1c of 5.1%, and serum C-peptide level of 1.9 ng/mL at 30 months post-transplantation. PMID:24767399

Matsumoto, I; Shinzeki, M; Asari, S; Goto, T; Shirakawa, S; Ajiki, T; Fukumoto, T; Ku, Y

2014-04-01

194

Opening the pleura during internal mammary artery harvesting: advantages and disadvantages  

PubMed Central

Objective To evaluate the findings of previous studies that opening of the pleura during internal mammary artery (IMA) dissection might be an important factor in increasing the operative morbidity. Design A randomized control trial. Setting A university hospital. Patients Two hundred and eighty consecutive patients with no significant pulmonary disease. Intervention Harvesting of the IMA with (130 patients) or without (150 patients) opening the pleura. Main Outcome Measures Comparison of the incidence of pleural effusion, cardiac tamponade, postoperative respiratory complications and the hospital stay. Results Pleural effusion occurred more often in the patients who had opening of the pleura (20% versus 5%); however, none of the patients required tapping. Postoperative bleeding with cardiac tamponade occurred in five patients in the closed pleura group. Six patients in the open pleura group had postoperative bleeding but without tamponade. The average postoperative hospital stay was 7 days for both groups. No significant differences were recorded in postoperative respiratory complications. Conclusions Opening of the pleura during IMA harvesting does not increase the operative morbidity. It may have other advantages and is recommended in most cases of IMA harvesting.

Ali, Idris M.; Lau, Peter; Kinley, C. Edwin; Sanalla, Abulkasim

1996-01-01

195

Pseudoaneurysm of the Common Hepatic Artery: Treatment with a Stent-Graft  

Microsoft Academic Search

We report a case of a pseudoaneurysm of the common hepatic artery treated with a stent-graft in a 67-year-old man. The patient\\u000a presented with severe catheter bleeding through a drain following surgical and interventional procedures performed for therapeutic\\u000a management of a choledochal cholangiocarcinoma. Selective hepatic arteriography showed a pseudoaneurysm close to the origin\\u000a of the gastroduodenal artery. After a preliminary

Enrico Paci; Ettore Antico; Roberto Candelari; Salvatore Alborino; Cristina Marmorale; Eduardo Landi

2000-01-01

196

The use of internal thoracic artery grafts in patients with aortic coarctation.  

PubMed

The choice of conduits for surgical revascularization in patients with aortic coarctation can be puzzling, as the internal thoracic arteries can be dilated, atherosclerotic and unsuitable for grafting. Reports in the literature are controversial: in some cases, the internal thoracic artery was not suitable for revascularization, while in others, it could be used with discordant outcomes. Here, we review the literature on the subject. PMID:23435522

Gaudino, Mario; Farina, Piero; Toesca, Amelia; Bonalumi, Giorgia; Tsiopoulos, Vasileios; Bruno, Piergiorgio; Massetti, Massimo

2013-09-01

197

Stent-grafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy  

Microsoft Academic Search

AIM: To present a series of cases with life-threatening hemorrhage from ruptured hepatic artery pseudoaneu- rysm after pancreaticoduodenectomy (PD) treated with placement of stent-grafts. METHODS: Massive hemorrhage from ruptured hepatic artery pseudoaneurysm after PD in 9 patients (6 men, 3 women) at the age of 23-75 years (mean 48 years), were treated with placement of percutaneous endo- vascular balloon-expandable coronary

Mao-Qiang Wang; Feng-Yong Liu; Feng Duan; Zhi-Jun Wang; Peng Song; Qing-Sheng Fan; Liu FY; Wang MQ

2010-01-01

198

Management of Iatrogenic Rupture of Profunda Femoris Artery after Femoral Fracture Fixation with Stent Graft Implantation  

PubMed Central

Vascular injuries with acute or chronic arterial hemorrhage after femoral shaft fractures are a rare but a life-threatening complication. We observed a case of iatrogenic rupture of the profunda femoris artery after the internal fixation of a femoral shaft fracture. The pseudoaneurysm, presenting with painful expansile swelling and hemodynamic instability, together with the rupture was evident on femoral angiography. Endovascular stent graft placement was performed successfully, and there was no sign or symptom at 9 months’ follow-up.

Varastehravan, Hamidreza; Nough, Hossein; Ansari, Zahra

2010-01-01

199

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

PubMed

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

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

2003-12-01

200

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

PubMed

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

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

2013-08-01

201

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

Microsoft Academic Search

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

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

2010-01-01

202

Successful n-butyl cyanoacrylate embolization of a spontaneous rupture of the internal mammary artery in a patient with myelodysplastic syndrome: report of a case.  

PubMed

Hemomediastinum and hemothorax due to spontaneous internal mammary artery (IMA) rupture is extremely rare, and can be a life-threatening condition. We herein present, to the best of our knowledge, the first case of spontaneous IMA rupture complicating myelodysplastic syndrome, and the first case that was successfully treated by emergency trans-arterial embolization using n-butyl cyanoacrylate. PMID:23161481

Muradi, Akhmadu; Yamaguchi, Masato; Sakamoto, Noriaki; Okada, Takuya; Idoguchi, Koji; Sugimoto, Koji

2014-03-01

203

Implantable arterial grafts from human fibroblasts and fibrin using a multi-graft pulsed flow-stretch bioreactor with noninvasive strength monitoring  

PubMed Central

Tissue-engineered arteries based on entrapment of human dermal fibroblasts in fibrin gel yield completely biological vascular grafts that possess circumferential alignment characteristic of native arteries and essential to their mechanical properties. A bioreactor was developed to condition six grafts in the same culture medium while being subjected to similar cyclic distension and transmural flow resulting from pulsed flow distributed among the graft lumens via a manifold. The lumenal pressure and circumferential stretch were noninvasively monitored and used to calculate stiffness in the range of 80-120 mmHg and then to successfully predict graft burst strength. The length of the graft was incrementally shortened during bioreactor culture to maintain circumferential alignment and achieve mechanical anisotropy comparable to native arteries. After 7-9 weeks of bioreactor culture, the fibrin-based grafts were extensively remodeled by the fibroblasts into circumferentially-aligned tubes of collagen and other extracellular matrix with burst pressures in the range of 1400-1600 mmHg and compliance comparable to native arteries. The tissue suture retention force was also suitable for implantation in the rat model and, with poly(lactic acid) sewing rings entrapped at both ends of the graft, also in the ovine model. The strength achieved with a biological scaffold in such a short duration is unprecedented for an engineered artery.

Syedain, Zeeshan H.; Meier, Lee A.; Bjork, Jason W.; Lee, Ann; Tranquillo, Robert T.

2011-01-01

204

Endovascular Exclusion of Visceral Artery Aneurysms with Stent-Grafts: Technique and Long-Term Follow-up  

Microsoft Academic Search

This paper describes four cases of visceral artery aneurysms (VAAs) successfully treated with endovascular stent-grafts and\\u000a discusses the endovascular approach to VAAs and the long-term results. Four balloon expandable stent-grafts were used to treat\\u000a three splenic artery aneurysms and one bleeding common hepatic artery pseudoaneurysm. The percutaneous access site and the\\u000a materials were chosen on the basis of CT angiography

Michele Rossi; Alberto Rebonato; Laura Greco; Michele Citone; Vincenzo David

2008-01-01

205

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

Microsoft Academic Search

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

Russell E Anderson; Lars-Olof Hansson; Jarle Vaage

1999-01-01

206

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

Microsoft Academic Search

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

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

207

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

Microsoft Academic Search

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

Jan Jesper Andreasen; Vytautas Nekrasas; Claus Dethlefsen

2008-01-01

208

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

Microsoft Academic Search

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

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

209

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

Microsoft Academic Search

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

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

2000-01-01

210

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

Microsoft Academic Search

Objective: The development of endoscopic coronary artery bypass grafting has been limited because of poor visualization and increased technical difficulties in carrying out operations through ports. We investigated whether the use of robotic assisted instruments could minimize these difficulties. Methods: After a period of technical development and training on cadavers (n = 8) with the Intuitive Surgical system (Intuitive Surgical,

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

1999-01-01

211

Symptomatic Internal Carotid Artery Dissecting Pseudoaneurysm: Endovascular Treatment by Stent-Graft  

SciTech Connect

Dissecting pseudoaneurysm of the extracranial portion of the internal carotid artery (ICA) is a usually benign complication of spontaneous ICA dissection. We report a case in which pseudoaneurysm volume enlarged progressively and new clinical symptoms developed 9 months following disease onset. Placement of a coronary stent-graft resulted in immediate complete resolution of clinical symptoms and radiologic restoration of normal flow.

Heye, Sam, E-mail: sam.heye@uz.kuleuven.ac.be; Maleux, Geert [University Hospitals Gasthuisberg, Department of Radiology (Belgium); Vandenberghe, Rik [University Hospitals Gasthuisberg, Department of Neurology (Belgium); Wilms, Guido [University Hospitals Gasthuisberg, Department of Radiology (Belgium)

2005-05-15

212

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

Microsoft Academic Search

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

Borje Sideno; Jarle Vaage

213

Symptomatic internal carotid artery dissecting pseudoaneurysm: endovascular treatment by stent-graft.  

PubMed

Dissecting pseudoaneurysm of the extracranial portion of the internal carotid artery (ICA) is a usually benign complication of spontaneous ICA dissection. We report a case in which pseudoaneurysm volume enlarged progressively and new clinical symptoms developed 9 months following disease onset. Placement of a coronary stent-graft resulted in immediate complete resolution of clinical symptoms and radiologic restoration of normal flow. PMID:15959696

Heye, Sam; Maleux, Geert; Vandenberghe, Rik; Wilms, Guido

2005-01-01

214

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

Microsoft Academic Search

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

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

2004-01-01

215

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

Microsoft Academic Search

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

Arthur A Bert; Steven E Reinert; Arun K Singh

2001-01-01

216

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

PubMed

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

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

2002-01-01

217

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

Microsoft Academic Search

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

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

218

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

Microsoft Academic Search

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

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

1999-01-01

219

Late Results of Autogenous Vein Bypass Grafts in Femoropopliteal Arterial Occlusion  

PubMed Central

The outcome of 185 consecutive autogenous vein bypass grafts for femoro-popliteal occlusions carried out between January 1962 and June 1968 has been reviewed. One patient died at operation and 21 late deaths have occurred since. The overall five-year patency was 61·5%, but was much lower when the popliteal-tibial runoff arteries were diseased. Distal anastomosis of the graft to the popliteal artery below the level of the knee joint also impaired the results, and if this was performed with a graft of minimal diameter less than 5 mm. sustained patency was obtained in only a quarter of the limbs. Nevertheless, where major amputation was imminent owing to advanced ischaemia three out of four limbs were salvaged. ImagesFIG. 1

Baddeley, R. M.; Ashton, F.; Slaney, G.; Barnes, A. D.

1970-01-01

220

Endovascular treatment of isolated common iliac artery aneurysms with short necks using bifurcated stent-grafts.  

PubMed

Elective surgical repair has traditionally been considered to be the treatment of choice for the exclusion of isolated iliac artery aneurysms (IAAs). Recently, endovascular repair has evolved as an alternative to surgical repair, especially in patients at high surgical risk. However, in the absence of sufficient proximal necks, iliac artery aneurysms are not suitable for direct deployment of a tubular-shaped endograft. Here we report two cases of IAAs with short proximal necks that were excluded using an endovascular bifurcated stent-graft. The bifurcated stent-graft was successfully deployed with complete exclusion of the aneurysm. In neither case was there evidence of procedural failures. There were no signs of significant complications. We conclude that endovascular repair of IAAs with short proximal necks is feasible and efficient using an endovascular bifurcated stent-graft. PMID:20664744

Wi, Jin; Ko, Young-Guk; Kim, Jung-Sun; Choi, Donghoon; Hong, Myeong-Ki; Lee, Do-Youn; Jang, Yangsoo; Shim, Won-Heum

2010-07-01

221

Endovascular Treatment of Isolated Common Iliac Artery Aneurysms With Short Necks Using Bifurcated Stent-Grafts  

PubMed Central

Elective surgical repair has traditionally been considered to be the treatment of choice for the exclusion of isolated iliac artery aneurysms (IAAs). Recently, endovascular repair has evolved as an alternative to surgical repair, especially in patients at high surgical risk. However, in the absence of sufficient proximal necks, iliac artery aneurysms are not suitable for direct deployment of a tubular-shaped endograft. Here we report two cases of IAAs with short proximal necks that were excluded using an endovascular bifurcated stent-graft. The bifurcated stent-graft was successfully deployed with complete exclusion of the aneurysm. In neither case was there evidence of procedural failures. There were no signs of significant complications. We conclude that endovascular repair of IAAs with short proximal necks is feasible and efficient using an endovascular bifurcated stent-graft.

Wi, Jin; Kim, Jung-Sun; Choi, Donghoon; Hong, Myeong-Ki; Lee, Do-Youn; Jang, Yangsoo; Shim, Won-Heum

2010-01-01

222

Ventricular assist device outflow graft in congenitally corrected transposition of great arteries - a surgical challenge.  

PubMed

Congenitally corrected transposition of the great arteries is a complex congenital cardiac anomaly with a wide spectrum of morphologic features and clinical profiles. Most patients are diagnosed late in their life, undergoes surgical repairs, eventually leading to systemic ventricular failure needing heart transplant or mechanical circulatory assistance. As, aorta is located anterior to and left of the PA (Transposition of great arteries), the outflow graft of ventricular assist device traverse across pulmonary artery to reach aorta which poses challenge during further surgical explorations. PMID:23013548

Mohite, Prashant N; Popov, Aron F; Garcia, Diana; Hards, Rachel; Zych, Bartlomeij; Khaghani, Asghar; Simon, Andre R

2012-01-01

223

Ultrasonic coronary angioplasty during coronary artery bypass grafting.  

PubMed

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

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

1996-11-15

224

Downstream anastomotic hyperplasia. A mechanism of failure in Dacron arterial grafts.  

PubMed Central

The precise location and progression of anastomotic hyperplasia and its possible relationship to flow disturbances was investigated in femoro-femoral Dacron grafts in 28 dogs. In 13 grafts, the outflow from the end-to-side downstream anastomosis was bidirectional (BDO), and in 15 it was unidirectional (UDO) (distally). Grafts were electively removed at intervals of two to 196 days or at the time of thrombosis. Each anastomosis and adjacent artery was perfusion-fixed and sectioned sagittally. The mean sagittal section was projected onto a digitized pad, and the total area of hyperplasia internal to the arterial internal elastic lamina and within the adjacent graft was integrated by computer. The location of the hyperplasia was compared with previously established sites of flow separation and stagnation. The observation was made that hyperplasia is significantly greater at the downstream, as compared with the upstream, anastomosis in both groups (BDO = p less than 0.001 and UDO = p less than 0.001) (analysis of variance for independent groups). Furthermore, this downstream hyperplasia was progressive with time (BDO p less than 0.01) (UDO p less than 0.01); Spearman Rank Correlation. There was no significant increase in the extent of downstream hyperplasia where flow separation was known to be greater (BDO). Five grafts failed (three BDO, two UDO), as a result of complete occlusion of the downstream anastomosis by fibrous hyperplasia. Transmission electron microscopy showed the hyperplasia to consist of collagen-producing smooth muscle cells. Anastomotic hyperplasia is significantly greater at the downstream anastomosis, is progressive with time, and is the primary cause of failure of Dacron arterial grafts in this model. Quantitative analysis of downstream anastomotic hyperplasia may be a valuable measure of the biocompatibility of Dacron grafts. Images Fig. 2. Fig. 3. Fig. 5. Fig. 6. Fig. 7. Fig. 8.

LoGerfo, F W; Quist, W C; Nowak, M D; Crawshaw, H M; Haudenschild, C C

1983-01-01

225

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

PubMed

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

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

2008-12-01

226

Laparoscopic Procurement of Single Versus Multiple Artery Kidney Allografts: Is Long-Term Graft Survival Affected?  

PubMed Central

Background Living donor kidneys with multiple arteries (MA) are increasingly procured laparoscopically for transplant. Methods We compare long-term graft function and survival of kidneys with single arteries (SA) and MA over a 10-year period. Results There were a total of 218 grafts with SA and 60 grafts with MA. The MA group had longer operative and ischemic times than SA group. There was a small increase in ureteral complication (8.3% vs. 2.3% P=0.06) and a significantly higher incidence of rejection (23.3% vs. 10.1%, P=0.01) in MA group than in SA group. Graft function was lower in MA group than SA group. The 5-year graft survival by Kaplan Meier analysis was better in SA group than in MA group (P=0.023). The estimated graft survivals at 1, 3, and 5 year were 94.4%, 90.6%, and 86% for SA group and 89.6%, 83.2%, and 71.8% for MA group. There was a higher percentage of graft loss from chronic allograft nephropathy in MA group than in SA group (16.7% vs. 5.5%, P=0.01). The presence of MA (vs. SA) was an independent risk for acute rejection (OR 3.60, 95% CI 1.59–8.14, P=0.002) and for graft loss (HR 2.31, 95% CI 1.05–5.09, P=0.038). Conclusion Laparoscopic procurement of living donor kidneys with SA may be associated with a lower risk of rejection, better function, and superior long-term survival when compared with kidneys with MA.

Paramesh, Anil; Zhang, Rubin; Florman, Sandy; Yau, C. Lillian; McGee, Jennifer; Al-Abbas, Haythem; Amatya, Arun; Killackey, Mary; Slakey, Douglas

2010-01-01

227

Endovascular exclusion of popliteal artery aneurysms with expanded polytetrafluoroethylene stent-grafts: early results.  

PubMed

There is increasing interest in using endovascular methods instead of surgical reconstruction to treat popliteal artery aneurysms. Exclusive use of the Viabahn stent-graft, a nitinol stent covered with expanded polytetrafluoroethylene, was assessed in the treatment of patients who presented with popliteal artery aneurysms in the absence of acute limb ischemia. Technical success, endoleaks, graft patency, freedom from amputation, and aneurysm sac flow and size changes were assessed by duplex ultrasound. From June 2004 to March 2006, 16 men (mean age, 76 years; range, 65-83) underwent endovascular exclusion of 23 popliteal artery aneurysms (mean diameter, 2.5 cm; range, 1.3-6.7 cm). Nine lesions had partial thrombus on preprocedural duplex imaging. Nineteen of the 23 limbs treated had at least 2-vessel tibial artery runoff. Procedures were performed under local anesthesia using ipsilateral percutaneous antegrade arterial access. All patients received 75 mg/day of clopidogrel afterward. Follow-up assessments included direct clinical examinations and duplex ultrasonography performed 1, 3, 6, and 12 months after the procedure. Primary patency and amputation-free survival were calculated using Kaplan-Meier analysis. Complete aneurysm exclusion (technical success) was achieved in all cases. During the mean follow-up of 7 months (range, 1-21 months), 22 of 23 treated limbs remained asymptomatic. One stent-graft thrombosis occurred 6 months after the procedure and was successfully treated with percutaneous mechanical thrombectomy, balloon angioplasty of a stent-graft stenosis, and insertion of an uncovered nitinol stent. No popliteal artery aneurysm sac size enlargements or endoleaks were detected. At 12 months, the treated limb mean ankle-brachial index was 1.0 (range, 0.82-1.31) and the primary and secondary patency rates were 93% and 100%, respectively. Early results with Viabahn endovascular stent-graft exclusion of asymptomatic popliteal artery aneurysms are promising. Patient selection for endovascular repair depends on suitable popliteal artery anatomy, extent of aneurysmal degeneration, and quality of tibial arterial runoff. PMID:17202092

Rajasinghe, Hiranya A; Tzilinis, Argyrios; Keller, Theresa; Schafer, Jeff; Urrea, Sandra

228

Monitoring changes in heart tissue temperature and evaluation of graft function after coronary artery bypass grafting surgery.  

PubMed

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

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

229

Carotid Artery Stenosis Associated with Increased Mortality in Patients who Underwent Coronary Artery Bypass Grafting: A Single Center Experience  

PubMed Central

Background: Vascular disease resulting from arteriosclerosis is a severe worldwide health risk. Early diagnosis and intervention is important to control adverse cerebral and cardiovascular events. The aim of this study was to assess the potential predictors of mortality in patients submitted to coronary bypass surgery. Methods: Cohort study included asymptomatic cerebrovascular disease patients scheduled for coronary artery bypass grafting admitted to the cardiology reference center. All patients were submitted to carotid artery ultrasound assessment prior to surgery and were followed up during the entire in-hospital postoperative period. Carotid artery stenosis was considered clinically significant when cross sectional area ?50%. Significance was set at p <0.05. Logistic regression was used to identify independent predictors of mortality. Results: Of 455 patients with a mean age of 62.2 years 65.6% were males. The prevalence of carotid artery stenosis was 18.7%. It was absent in 3.6% of the patients, below 50% in 77.8%, between 50 and 69% in 11.6%, and between 70 and 99% in 6.9%. The carotid artery was occluded in 0.2% of the sample. An overall mortality of 12%, affecting 35 men (P=0.001) with stenosis ?50%. After logistic regression analysis, carotid artery stenosis ?50% was confirmed as being an independent predictor of mortality (P=0.005). Conclusion: In this series carotid artery stenosis showed a high prevalence in the sample assessed and was an independent predictor of mortality.

da Rosa, Marcelo P.; Schwendler, Ricardo; Lopes, Rodrigo; Portal, Vera L.

2013-01-01

230

[Evaluation of inferior epigastric arterial graft from the aspect of angiography].  

PubMed

We evaluated inferior epigastric artery (IEA) from the aspect of preoperative and postoperative grafts angiography. Between January 1994 and february 1995, we could perform preoperative and postoperative graft-angiography for 12 patients in 27 patients who were undergone CABG using IEA graft. They were 7 males and 5 females. The age ranged from 56 to 76 years (mean, 66.2 years). We used 12 IEAs, 8 LITAs, 7 RGEAs and 2 RITAs as artrial grafts. We measured the diameter of arterial grafts in each angiography. The preoperative diameter of IEA was measured at three points; the proximal part (Prox), center (Cent) and bifurcation (Bif). The postoperative diameter of IEA was measured at two points; the proximal part of composite graft (Prox) and the distal part (Dist). The preoperative grafts diameters were IEA-Prox = 2.01 +/- 0.40 mm, IEA-Cent = 1.75 +/- 0.39 mm, IEA-Bif = 1.32 +/- 0.29 mm, LITA-Prox = 2.40 +/- 0.25 mm, LITA-Cent = 2.00 +/- 0.24 mm, LITA-Bif = 1.64 +/- 0.22 mm, RGEA-Prox = 2.72 +/- 0.49 mm, and RGEA-Cent = 2.29 +/- 0.34 mm. RGEA was the largest, the second was RITA, the third was LITA and IEA was the smallest of the four. The diameter of IEA-Prox was almost equal to LITA-Cent. The postoperative grafts diameter were IEA-Prox = 1.85 +/- 0.37 mm, IEA-Dist = 1.67 +/- 0.38 mm, LITA-Prox 2.57 +/- 0.11 mm, LITA-before Y = 2.01 +/- 0.22 mm, LITA-after Y = 1.83 +/- 0.14 mm, RGEA-Prox = 2.70 +/- 0.55 mm and RGEA-Dist = 0.53 mm. RGEA was the largest and RGEA-Dist = 2.34 +/- 0.53 mm. RGEA was the largest and IEA was the smallest. The diameter of LITA was not significantly different between before-Y and after-Y. We conclude in view of the graft diameter, LITA-IEA Y composite graft is the best method for CABG using IEA but IEA graft should be used only to myocardial revascularization to the coronary lesion that does not require high blood flow. PMID:8683166

Uchida, N; Kawaue, Y

1996-01-01

231

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

PubMed

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

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

2009-07-01

232

Acute compartment syndrome related to stent-graft exclusion of a popliteal arterial aneurysm.  

PubMed

The purpose of this morbidity and mortality case report is to discuss a characteristic of the Viabahn (W.L. Gore, Newark, DE) stent-graft deployment as well as a complication related to wire trauma during endovascular exclusion of a popliteal artery aneurysm. We encountered a phenomenon not described in the literature during deployment of a Viabahn stent graft. This necessitated further wire purchase, which resulted in perforation of a branch vessel within the calf. The rapid recognition of the clinical findings and prompt diagnosis of compartment syndrome was essential to early intervention, which prevented further complication and permanent sequelae. PMID:21326474

Miller, Michael J; Stirling, Michael J; Chang, Young H; Smith, Tony P

2007-09-01

233

Endovascular Stent Graft for Treatment of Complicated Spontaneous Dissection of Celiac Artery: Report of Two Cases  

PubMed Central

We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

Kang, Ung Rae; Lee, Young-Hwan

2013-01-01

234

Endovascular stent-graft treatment of traumatic arterial lesions.  

PubMed

Twenty-nine cases of post-traumatic false aneurysms and arteriovenous fistulas (AVF), with a mean follow-up of 24 months (1-65 months), are presented here. Diagnosis was established by color duplex and arteriogram. The time between injury and treatment varied between 3 days and 61 months. Endovascular treatment was accomplished using a covered Palmaz stent [vein, polytetrafluoroethylene (PTFE), or polyester], Corvita endoluminal graft, or a Wallgraft. Complimentary treatment of a branch injury was performed using a detachable balloon in one patient. The initial result was favorable for all patients. One case of asymptomatic stenosis of an iliac stent graft and three occlusions of the stent (one subclavian, one axillary, and one internal carotid) were registered during the follow-up period, and no clinical manifestations of the occlusions were reported. Endovascular treatment of post-traumatic false aneurysms and AVF appears to be a promising alternative for treatment of these lesions. Less pain and disability as well as rapid recovery time and lower cost after endovascular treatment compare favorably to the standard surgical technique. PMID:10072450

Parodi, J C; Schönholz, C; Ferreira, L M; Bergan, J

1999-03-01

235

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

National Technical Information Service (NTIS)

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

C. F. Liu S. Subramanian J. Cromwell

1999-01-01

236

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

Microsoft Academic Search

ObjectivesWe evaluated the effect of African American (AA) and Hispanic American (HA) ethnicity on mortality and complications following coronary artery bypass graft (CABG) surgery in the Veterans Health Administration (VHA).

John S Rumsfeld; Mary E Plomondon; Eric D Peterson; Michael G Shlipak; Charles Maynard; Gary K Grunwald; Frederick L Grover; A. Laurie W Shroyer

2002-01-01

237

Vasoconstrictor activity of novel endothelin peptide, ET-1(1 - 31), in human mammary and coronary arteries in vitro.  

PubMed

1. The ability of the putative chymase product of big endothelin-1 (big ET-1), ET-1(1 - 31), to constrict isolated endothelium-denuded preparations of human coronary and internal mammary artery was determined. 2. pD2 values in coronary and mammary artery respectively were 8.21+/-0.12 (n=14) and 8.55+/-0.11 (n=12) for ET-1, 6.74+/-0.11 (n=16) and 7.10+/-0.08 (n=16) for ET-1(1 - 31) and 6.92+/-0.10 (n=15) and 7.23+/-0.11 (n=12) for big ET-1. ET-1(1 - 31) was significantly less potent than ET-1 (P<0.001, Student's t-test) and equipotent with big ET-1. 3. Vasoconstrictor responses to 100 - 700 nM ET-1(1 - 31) were significantly (P<0.05, Student's paired t-test) attenuated by the ET(A) antagonist PD156707 (100 nM). 4. There was no effect of the ECE inhibitor PD159790 (30 microM), the ECE/NEP inhibitor phosphoramidon (100 microM) or the serine protease inhibitor chymostatin (100 microM) on ET-1(1 - 31) responses in either artery. 5. Radioimmunoassay detected significant levels of mature ET in the bathing medium of coronary (1.6+/-0.5 nM, n=14) and mammary (2.1+/-0.6 nM, n=14) arteries, suggesting that conversion of ET-1(1 - 31) to ET-1 contributed to the observed vasoconstriction. 6. ET-1(1 - 31) competed for specific [(125)I]-ET-1 binding to ET(A) and ET(B) receptors in human left ventricle with a pooled K(D) of 71.6+/-7.0 nM (n=3). 7. Therefore, in human arteries the novel peptide ET-1(1 - 31) mediated vasoconstriction via activation of the ET(A) receptor. The conversion of ET-1(1 - 31) to ET-1, by an as yet unidentified protease, must contribute wholly or partly to the observed constrictor response. Chymase generated ET-1(1 - 31) may therefore represent an alternative precursor for ET-1 production in the human vasculature. PMID:11704658

Maguire, J J; Kuc, R E; Davenport, A P

2001-11-01

238

Does the right internal thoracic artery or saphenous vein graft offer superior revascularization of the right coronary artery?  

PubMed Central

A best evidence topic was written according to a structured protocol. The question addressed was whether the right internal thoracic artery (RITA) provides a superior outcome for revascularization of the right coronary artery (RCA) compared with the saphenous vein graft (SVG). Using a designated search strategy, 226 articles were found, of which five represented the best available evidence. The authors, journal, date, country of publication, study type, patient group studied, relevant outcomes and results were tabulated. Of these five studies, one offered level I evidence (data from a randomized trial) and four were level II studies (reports of observational data). The outcome measures varied considerably, but most included graft patency at varying levels of the follow-up. The randomized data showed strong evidence favouring the SVG, mainly in terms of mid-term patency. With the exception of a large cohort study that demonstrated the superior patency of the RITA compared with the SVG in the right coronary territory, the observational studies showed better results for SVG in graft patency, reintervention and cardiovascular complication rate. Overall, and in view of the methodological limitations and the different weight of evidence among studies, it appears that the SVG may offer a superior outcome for revascularization of the RCA when compared with the RITA.

Mukherjee, Dayal; Cheriyan, Jerry; Kourliouros, Antonios; Athanasiou, Thanos

2012-01-01

239

Intimal hyperplasia in autogenous vein grafts used for arterial bypass: a canine model.  

PubMed

Late vein graft occlusion following myocardial revascularisation is usually the result of progressive intimal hyperplasia which ultimately leads to vein graft thrombosis. Considerable attention has recently been directed towards the development of optimal platelet-inhibiting drug regimens designed to prevent intimal hyperplasia in autogenous vein grafts. This report describes an animal model that reliably reproduces short-term intimal hyperplasia in autogenous vein grafts, thus facilitating the study of platelet-inhibiting drug regimens for the prevention of intimal hyperplasia. 28 segments of undistended jugular vein were implanted end-to-end between bilaterally divided femoral arteries in 14 mongrel dogs. Seven control animals (CON) received a non-lipid diet one week before and for 6 weeks following vein implantation. A further seven animals received a 2% cholesterol diet throughout the study. Serum cholesterol was measured at 4.06 +/- 0.6 mmol X litre-1 in the CON and did not change significantly throughout the study. Serum cholesterol rose from 3.9 +/- 0.4 to 8.5 +/- 0.8 mmol X litre-1 in the lipid-supplemented animals (p less than 0.001). Vein grafts were harvested at 6 weeks and fixed in formaldehyde. Precise measurements of intimal thickness in microns were measured from multiple vein graft cross-sections with a Zeiss computerised interactive image analysing system. A mean of 102 +/- 15 measurements were made from each vein graft cross-section. Intimal thickness of autogenous vein grafts prior to implantation were similar in both groups and measured 4.15 +/- 0.4 micron. Intimal thickness increased in CON animals to 23.3 +/- 3 microns.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3876153

Landymore, R W; Kinley, C E; Cameron, C A

1985-09-01

240

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

PubMed

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

Fragkidis, Alexander; Dimitriou, Alexander; Dougenis, Dimitrios

2012-01-01

241

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

PubMed

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

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

2008-12-01

242

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

PubMed Central

Mortality represents an important outcome measure following coronary artery bypass grafting. Shorter survival times may reflect poor surgical quality and an increased number of costly postoperative complications. Quality control efforts aimed at increasing survival times may be misleading if not properly adjusted for case-mix severity. This paper demonstrates how to construct and cross-validate efficiency-outcome plots for a specified time (e.g., 6-month and 1-year survival) after coronary artery bypass grafting, accounting for baseline cardiovascular risk factors. The application of this approach to regional centers allows for the localization of risk stratification rather than applying overly broad and non-specific models to their patient populations.

Efird, Jimmy T.; O'Neal, Wesley T.; Davies, Stephen W.; O'Neal, Jason B.; Kindell, Linda C.; Anderson, Curtis A.; Chitwood, W. Randolph; Ferguson, T. Bruce; Kypson, Alan P.

2014-01-01

243

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

PubMed Central

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

2012-01-01

244

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

Microsoft Academic Search

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

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

2004-01-01

245

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

Microsoft Academic Search

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

Jan Jesper Andreasen; Vytautas Nekrasas; Claus Dethlefsen

246

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

Microsoft Academic Search

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

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

2001-01-01

247

Human umbilical veins and autogenous veins as canine arterial bypass grafts.  

PubMed Central

Glutaraldehyde treated human umbilical veins (Dardik Biograft) were used to bypass short segments of the femoral artery in 15 dogs and were compared to autogenous jugular veins placed in the contralateral femoral artery of each animal. All 15 autogenous jugular veins remained patent for the four month period of observation whereas thrombosis occurred in seven of 15 umbilical vein grafts. This patency rate of 53% was significantly lower than that observed for autogenous jugular veins (p less than 0.01). Neointimal Fibrous Hyperplasia (NFH) a the proximal anastomosis was responsible for six of the seven umbilical vein graft occlusions. Of the eight patent umbilical veins, five had varying degrees of proximal anastomotic stenosis secondary to NFH. Histological examination of each graft revealed significant fibroblastic proliferation and collagen deposition within the lumen of stenosed and thrombosed grafts. Although human umbilical veins have distinct advantages over other prosthetics, such as availability and flexibility, the incidence of experimental neointimal fibrous hyperplasia causing anastomotic stenosis and thrombosis is prohibitively high. Images Fig. 1. Fig. 2.

Oblath, R W; Buckley, F O; Donnelly, W A; Green, R M; Deweese, J A

1978-01-01

248

Human umbilical veins and autogenous veins as canine arterial bypass grafts.  

PubMed

Glutaraldehyde treated human umbilical veins (Dardik Biograft) were used to bypass short segments of the femoral artery in 15 dogs and were compared to autogenous jugular veins placed in the contralateral femoral artery of each animal. All 15 autogenous jugular veins remained patent for the four month period of observation whereas thrombosis occurred in seven of 15 umbilical vein grafts. This patency rate of 53% was significantly lower than that observed for autogenous jugular veins (p less than 0.01). Neointimal Fibrous Hyperplasia (NFH) a the proximal anastomosis was responsible for six of the seven umbilical vein graft occlusions. Of the eight patent umbilical veins, five had varying degrees of proximal anastomotic stenosis secondary to NFH. Histological examination of each graft revealed significant fibroblastic proliferation and collagen deposition within the lumen of stenosed and thrombosed grafts. Although human umbilical veins have distinct advantages over other prosthetics, such as availability and flexibility, the incidence of experimental neointimal fibrous hyperplasia causing anastomotic stenosis and thrombosis is prohibitively high. PMID:686880

Oblath, R W; Buckley, F O; Donnelly, W A; Green, R M; Deweese, J A

1978-08-01

249

Usefulness of V3-radial artery graft-V4 bypass in bilateral fusiform aneurysms of vertebral artery: case report.  

PubMed

A 55-year-old woman with bilateral vertebral artery (VA) aneurysms was transferred to our hospital. She suffered from a minor stroke. Magnetic resonance imaging (MRI) for the stroke incidentally revealed bilateral VA aneurysms. Due to its size, more observation was recommended, and the patient was found eager to be treated. Both side surgeries were found inappropriate because of severe lower cranial nerve disturbances. The right aneurysm involved the posterior inferior cerebellar artery (PICA) and the V4 segment was deviated to the right side. Therefore, the smaller right aneurysm was treated first with an occipital artery (OA)-PICA bypass and a V3-radial artery graft (RAG)-V4 bypass followed by proximal clipping of the PICA and the right VA. The right VA was successfully remade by RAG and the right aneurysm was not revealed on postoperative examination. By doing so, the opposite aneurysm was able to be eliminated by the parent artery occlusion even by using an interventional radiology (IVR). The V3-RAG-V4 bypass is a useful method for treating bilateral VA aneurysms. This is a new bypass which has not been reported so far to the best of our knowledge. PMID:24477058

Saito, Norihiro; Kamiyama, Hiroyasu; Takizawa, Katsumi; Takebayashi, Seiji; Asano, Takeshi; Kobayashi, Tohru; Kobayashi, Rina; Kubota, Shunsuke; Ito, Yasuhiro

2014-01-01

250

The Prostacyclin Analogue Beraprost Sodium Prevents Occlusion of Bypass Grafts in Patients with Lower Extremity Arterial Occlusive Disease: A 20Year Retrospective Study  

Microsoft Academic Search

Although conventional bypass grafting is commonly used to treat ischemia in lower extremities, graft failure often occurs. This study retrospectively analyzed the factors that affect graft patency to help establish more effective treatment of obstructive arterial disease of the lower limbs. Kaplan-Meier analysis was used to estimate graft patency in 90 legs of 80 patients who underwent femoropopliteal bypass (28

Mikiko Murakami; Masazumi Watanabe; Hitoshi Furukawa; Hideki Nakahara

2005-01-01

251

New Technologies in Coronary Artery Surgery  

PubMed Central

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.

Taggart, David; Nir, Rony-Reuven; Bolotin, Gil

2013-01-01

252

Computed tomographic angiography imaging and clinical implications of internal mammary artery perforator vessels as recipient vessels in autologous breast reconstruction.  

PubMed

The internal mammary artery (IMA) is the standard recipient vessel for autologous breast reconstruction. To save the IMA for bypass surgery, to keep flap pedicles short, and to allow better flap positioning, the IMA perforators were used. Forty-six flaps for immediate breast reconstructions were performed in 39 patients. In the first 22 patients, the decision to use the perforators was clinically based. In the second group of 17 patients, all patients received a thoracic computed tomographic angiography (CTA) to determine the perforators. In 13 flaps (6 deep inferior epigastric artery perforator, 3 superficial inferior epigastric artery, and 4 transverse myocutaneous gracilis), the perforators were used as recipient vessels. Of these flaps, 5 were anastomosed to perforators before the CTA was applied and 8 after the CTA was established. The CTA revealed the IMA and the perforators in detail. In immediate reconstructions, the IMA perforators can be used as recipient vessels. They allow better flap positioning for superficial inferior epigastric artery and transverse myocutaneous gracilis flaps in particular; moreover, it decreases donor site and recipient site morbidity. After introducing the CTA, the perforators were used more frequently for anastomosis. PMID:22868328

Fansa, Hisham; Schirmer, Steffen; Cervelli, Angelika; Gehl, Hans Björn

2013-11-01

253

Late Lower Extremity Ischemia due to Thrombi in an Occluded Graft after Axillary-Femoral Artery Bypass  

PubMed Central

We experienced a rare case of acute ischemia of the lower extremity due to embolism caused by an occluded prosthetic graft late after axillary-femoral artery bypass. A 67-year-old woman developed acute right lower extremity ischemia 7 years after axillary-femoral artery bypass, which had been performed for lower limb ischemia as a complication of acute aortic dissection (Stanford B). The graft was occluded, and the native vessel had re-canalized by the time of the present admission. She was successfully treated by disconnection of the graft followed by revascularization.

Nishizaki, Kazuhiko; Yasukawa, Motoaki; Seki, Toshio

2013-01-01

254

Thoracic Stent Graft with Distal Fenestration for the Superior Mesenteric Artery for Treatment of Thoracic Aortic Aneurysm  

PubMed Central

An 86-year-old man with a 75-mm TAA that terminated just above the celiac artery was treated with a customized Zenith stent graft that had a distal fenestration for the superior mesenteric artery (SMA). Because angiography demonstrated a type IB endoleak, an additional extension stent graft was deployed, and coil embolization of the aneurysmal sac was performed. Three months later, there was no endoleak and good visceral blood flow. Placement of a fenestrated thoracic stent graft with a scallop-like fenestration for the SMA is a promising procedure for the treatment of TAAs with a short distal neck.

2014-01-01

255

Thoracic stent graft with distal fenestration for the superior mesenteric artery for treatment of thoracic aortic aneurysm.  

PubMed

An 86-year-old man with a 75-mm TAA that terminated just above the celiac artery was treated with a customized Zenith stent graft that had a distal fenestration for the superior mesenteric artery (SMA). Because angiography demonstrated a type IB endoleak, an additional extension stent graft was deployed, and coil embolization of the aneurysmal sac was performed. Three months later, there was no endoleak and good visceral blood flow. Placement of a fenestrated thoracic stent graft with a scallop-like fenestration for the SMA is a promising procedure for the treatment of TAAs with a short distal neck. PMID:24995061

Fukunaga, Ryota; Matsumoto, Takuya; Aoyagi, Yukihiko; Matsuda, Daisuke; Tanaka, Shinichi; Okadome, Jun; Morisaki, Koichi; Maehara, Yoshihiko

2014-01-01

256

Case report: Complex internal mammary to pulmonary artery fistula as a cause of hemoptysis in tuberculosis: Diagnosis and endovascular management using ethylene vinyl alcohol copolymer (Onyx)  

PubMed Central

A complex right internal mammary to right pulmonary artery fistula resulting in hemoptysis was successfully treated by embolization with a liquid, nonadhesive, embolic agent - ethylene vinyl alcohol copolymer (Onyx). There were no procedural complications and no recurrence of symptoms has been seen after 2 years of follow-up.

Pierce, Gregory; Ahuja, Chaitanya; Chadha, Meghna

2011-01-01

257

Internal mammary artery and vein: Recipient vessels for free tissue transfer to the head and neck in the vessel-depleted neck  

Microsoft Academic Search

Background. Microvascular free tissue transfer is a standard reconstructive option for postablative defects of the head and neck. However, the success of this surgery requires suitable recipient vessels in the cervical region. This form of reconstruction can be particularly challenging in the vessel- depleted neck. While the internal mammary artery and vein (IMA\\/V) have been used extensively in breast reconstruction,

Mark L. Urken; Kevin M. Higgins; Bryant Lee; Carlin Vickery

2006-01-01

258

Anesthetic management of a patient undergoing liver transplantation who had previous coronary artery bypass grafting using an in situ right gastroepiploic artery  

Microsoft Academic Search

We describe successful anesthetic management during living-donor liver transplantation in a 63-year-old man with previous\\u000a coronary artery bypass grafting (CABG) that employed an in situ right gastroepiploic artery (RGEA). Anesthesia was maintained\\u000a with 1.5% isoflurane in air\\/oxygen and fentanyl. A five-lead electrocardiogram, transesophageal echocardiogram, and pacing\\u000a pulmonary artery catheter evaluated cardiac function. A pacing wire was inserted through the catheter

Hiroaki Murata; Haruka Inoue; Koji Sumikawa

2010-01-01

259

Arterialized cephalic vein as a femoropopliteal bypass graft: A case report.  

PubMed

The overall therapeutic strategy in patients with diabetes mellitus and peripheral arterial disease affecting several arterial segments is problematic. Usually, the greater saphenous vein (GSV) is the gold standard for bypass. However, alternative venous grafts may be necessary when the GSV is not available. The superficial veins of the arm are not suitable for bypass operations in most cases because of anatomical variations, inadequate diameter or very thin walls. However, arterialization of the cephalic vein can dilate and strengthen the walls, thus avoiding postoperative complications. The present patient, whose case was followed for 20 months postoperatively, suffered both from diabetes and peripheral arterial disease in a setting of gangrene and a lack of the GSV. The treament of the patient and the problems it incurred are discussed. The advantages of preoperative temporary arteriovenous shunting to improve the quality of the cephalic vein as an alternative autogenous graft are analyzed. Currently, the patient has excellent postoperative results, with healing of the ulcers and preserved peripheral pulses. PMID:22477332

Stefanov, Georgi; Cheshmedzhiev, Michail; Andreev, Andreia; Denchev, Borislav; Bachvarov, Chavdar; Yordanov, Miroslav; Velinov, Tihomir; Peev, Veselin

2007-01-01

260

Arterialized cephalic vein as a femoropopliteal bypass graft: A case report  

PubMed Central

The overall therapeutic strategy in patients with diabetes mellitus and peripheral arterial disease affecting several arterial segments is problematic. Usually, the greater saphenous vein (GSV) is the gold standard for bypass. However, alternative venous grafts may be necessary when the GSV is not available. The superficial veins of the arm are not suitable for bypass operations in most cases because of anatomical variations, inadequate diameter or very thin walls. However, arterialization of the cephalic vein can dilate and strengthen the walls, thus avoiding postoperative complications. The present patient, whose case was followed for 20 months postoperatively, suffered both from diabetes and peripheral arterial disease in a setting of gangrene and a lack of the GSV. The treament of the patient and the problems it incurred are discussed. The advantages of preoperative temporary arteriovenous shunting to improve the quality of the cephalic vein as an alternative autogenous graft are analyzed. Currently, the patient has excellent postoperative results, with healing of the ulcers and preserved peripheral pulses.

Stefanov, Georgi; Cheshmedzhiev, Michail; Andreev, Andreia; Denchev, Borislav; Bachvarov, Chavdar; Yordanov, Miroslav; Velinov, Tihomir; Peev, Veselin

2007-01-01

261

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

Microsoft Academic Search

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

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

1997-01-01

262

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

Microsoft Academic Search

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

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

2002-01-01

263

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

Microsoft Academic Search

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

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

1999-01-01

264

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

Microsoft Academic Search

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

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

2007-01-01

265

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

Microsoft Academic Search

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

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

2010-01-01

266

Bilateral Renal Artery Aneurysm: Percutaneous Treatment with Stent-Graft Placement  

SciTech Connect

A 51-year-old man with an 8-year history of hypertension (170/115 mmHg with two drugs) and altered renal function (5.6 mg/dl serum creatinine, 101 mg/dl BUN) was referred to our Department to evaluate the renal arteries and rule out renovascular hypertension. Doppler ultrasound and magnetic resonance angiography revealed significant bilateral renal artery stenosis and the presence of bilateral renal artery aneurysms. A self-expandable polytetrafluoroethylene (PTFE)-covered nitinol stent-graft was deployed in each renal artery to treat the stenoses and to exclude the aneurysm. Postprocedural digital subtraction angiography confirmed the resolution of the renal artery stenoses and the complete exclusion of the aneurysms. At the 6 month follow-up, color Doppler confirmed normal patency of the renal arteries with complete exclusion of the aneurysms and significant reduction of the blood pressure (130/85 mmHg with one drug) and serum creatinine levels (2.1 mg/dl)

Gandini, R.; Spinelli, A.; Pampana, E.; Fabiano, S.; Pendenza, G., E-mail: giapende@libero.it; Simonetti, G. [University of Tor Vergata, Department of Diagnostic Imaging and Interventional Radiology (Italy)

2006-10-15

267

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

PubMed Central

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

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

2014-01-01

268

Characterization of evolving biomechanical properties of tissue engineered vascular grafts in the arterial circulation.  

PubMed

We used a murine model to assess the evolving biomechanical properties of tissue engineered vascular grafts (TEVGs) implanted in the arterial circulation. The initial polymeric tubular scaffold was fabricated from poly(lactic acid)(PLA) and coated with a 50:50 copolymer of poly(caprolactone) and poly(lactic acid)(P[PC/LA]). Following seeding with syngeneic bone marrow derived mononuclear cells, TEVGs (n=50) were implanted as aortic interposition grafts in wild-type mice and monitored serially using ultrasound. A custom biaxial mechanical testing device was used to quantify the in vitro circumferential and axial mechanical properties of grafts explanted at 3 or 7 months. At both times, TEVGs were much stiffer than native tissue in both directions. Repeated mechanical testing of some TEVGs treated with elastase or collagenase suggested that elastin did not contribute significantly to the overall stiffness whereas collagen did contribute. Traditional histology and immunostaining revealed smooth muscle cell layers, significant collagen deposition, and increasing elastin production in addition to considerable scaffold at both 3 and 7 months, which likely dominated the high stiffness seen in mechanical testing. These results suggest that PLA has inadequate in vivo degradation, which impairs cell-mediated development of vascular neotissue having properties closer to native arteries. Assessing contributions of individual components, such as elastin and collagen, to the developing neovessel is needed to guide computational modeling that may help to optimize the design of the TEVG. PMID:24702863

Udelsman, Brooks V; Khosravi, Ramak; Miller, Kristin S; Dean, Ethan W; Bersi, Matthew R; Rocco, Kevin; Yi, Tai; Humphrey, Jay D; Breuer, Christopher K

2014-06-27

269

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

PubMed Central

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

Raja, Shahzad G

2012-01-01

270

Anesthetic management of a patient undergoing liver transplantation who had previous coronary artery bypass grafting using an in situ right gastroepiploic artery.  

PubMed

We describe successful anesthetic management during living-donor liver transplantation in a 63-year-old man with previous coronary artery bypass grafting (CABG) that employed an in situ right gastroepiploic artery (RGEA). Anesthesia was maintained with 1.5% isoflurane in air/oxygen and fentanyl. A five-lead electrocardiogram, transesophageal echocardiogram, and pacing pulmonary artery catheter evaluated cardiac function. A pacing wire was inserted through the catheter to prepare for intraoperative severe bradyarrhythmia. Olprinone and nicorandil were continuously infused to prevent decrease in coronary arterial blood flow and the collapse of cardiac function. Avoiding disruption of circulation to coronary arteries through injury or spasm of the RGEA graft and preparing for cardiac insufficiency during liver transplantation of a patient with previous CABG using an in situ RGEA is critical. PMID:20191293

Murata, Hiroaki; Inoue, Haruka; Sumikawa, Koji

2010-04-01

271

SERCA2a gene transfer prevents intimal proliferation in an organ culture of human internal mammary artery.  

PubMed

Coronary restenosis, a major complication of percutaneous balloon angioplasty, results from neointimal proliferation of vascular smooth muscle cells (VSMCs). The sarco/endoplasmic reticulum calcium ATPase 2a isoform (SERCA2a), specific to contractile VSMCs, has been reported previously to be involved in the control of the Ca(2+)-signaling pathways governing proliferation and migration. Moreover, SERCA2a gene transfer was reported to inhibit in vitro VSMC proliferation and to prevent neointimal thickening in a rat carotid injury model. The aim of this study was to evaluate the potential therapeutic interest of SERCA2a gene transfer for prevention of in-stent restenosis using a ex vivo model of human left internal mammary artery (hIMA) intimal thickening. Left hIMAs, obtained at the time of aorto-coronary bypass surgeries, were subjected to balloon dilatation followed by infection for 30 min with adenoviruses encoding either human SERCA2 and green fluorescence protein (GFP) or control gene (?-galactosidase, ?-gal) and GFP. Proliferation of subendothelial VSMCs and neointimal thickening were observed in balloon-injured hIMA maintained 14 days in organ culture under constant pressure and perfusion. SERCA2a gene transfer prevented vascular remodeling and significantly (P<0.01, n=5) reduced neointimal thickening in injured arteries (intima/media ratio was 0.07±0.01 vs 0.40±0.03 in ?-gal-infected arteries). These findings could have potential implications for treatment of pathological in-stent restenosis. PMID:22763406

Lipskaia, L; Hadri, L; Le Prince, P; Esposito, B; Atassi, F; Liang, L; Glorian, M; Limon, I; Lompre, A-M; Lehoux, S; Hajjar, R J

2013-04-01

272

Bypass surgery using a radial artery graft for bilateral extracranial carotid arteries occlusion  

Microsoft Academic Search

A patient presenting with recurrent ischemic attacks was demonstrated to have complete occlusion of the right common and left\\u000a internal carotid arteries. An external carotid angiogram showed a large left superficial temporal artery (STA) supplying both\\u000a sides of the scalp. 123I-IMP single photon emission computed tomography (SPECT) revealed hypoperfusion of the both hemispheres, especially the left\\u000a cerebral hemisphere. An extracranial-intracranial

Eiji Tachibana; Yoshio Suzuki; Tsutomu Harada; Kiyoshi Saito; Sunil K. Gupta; Jun Yoshida

2000-01-01

273

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

NASA Astrophysics Data System (ADS)

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

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

2011-11-01

274

A composed graft for subclavian artery reconstruction in case of redo surgery for aortic coarctation  

PubMed Central

We report the case of a 66-year-old woman admitted to the intensive care unit (ICU) for ongoing dyspnea and hemoptoe. She was operated upon in 1979 for aortic coarctation by the interposition of a 14 mm Dacron prosthesis from the left subclavian artery to descending aorta. Clinical evaluation performed over the years was normal with no signs of cardiac failure or prosthesis malfunctioning. The computed tomography scans (CT) showed a progressive increase of the descending aorta diameters and the onset of a pseudo-aneurysm of 50 mm in diameter. Patient was re-operated through a median sternotomy enlarged by a left thoracotomy and intra-operative findings revealed the pseudo-aneurysm originating from a dehiscence of the proximal suture. In order to allow a safe reconstruction of the dilated subclavian artery, a T-shaped composed graft was confectioned and then sutured to the descending aorta and the subclavian artery, respectively. Post-operative course was uneventful and three months CT scan showed a normal position of the composed graft.

Sansone, Fabrizio; Ravenni, Giacomo; Levantino, Maurizio; Minzioni, Gaetano

2013-01-01

275

Volar plate fixation of recalcitrant scaphoid nonunions with volar carpal artery vascularized bone graft.  

PubMed

Chronic scaphoid fracture nonunion continues to present a significant challenge to the treating orthopedic surgeon. Internal fixation with threaded compression screws leads to high union rates, and is currently the gold standard, but there are certainly circumstances where a scaphoid screw does not provide the stability necessary for nonunion repair. Results using a volar buttress plate have been promising, but have not been described in conjunction with the use of vascularized bone graft. Vascularized bone grafts have been shown to be highly effective in achieving rapid and reproducible rates of union. We describe a novel combination of a vascularized volar distal radius wedge autograft pedicled on the volar carpal artery and volar buttress plating for salvage treatment of chronic scaphoid nonunion. PMID:24275760

Dodds, Seth D; Patterson, Joseph T; Halim, Andrea

2014-03-01

276

Evolution of shear stress, protein expression, and vessel area in an animal model of arterial dilatation in hemodialysis grafts  

PubMed Central

Purpose To evaluate the wall shear stress, protein expression of matrix metalloproteinases-2 (MMP-2), -9 (MMP-9), and the inhibitors (tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), and -2 (TIMP-2)), and vessel area over time in a porcine model for hemodialysis polytetrafluoroethylene (PTFE) grafts. Materials and methods In 21 pigs, subtotal renal infarction was performed and 28 days later, a PTFE graft was placed to connect the carotid artery to the ipsilateral jugular vein. Phase contrast MR was used to measure blood flow and vessel area at 1, 3, 7, and 14 days after graft placement. Wall shear stress was estimated from Poiseuille’s law. Animals were sacrificed at day 3 (N=7), day 7 (N=7), and day 14 (N=7) and expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 were determined at the grafted and control arteries. Results The mean wall shear stress of the grafted artery was higher than the control artery at all time points (P<0.05). It peaked by day 3 and decreased by days 7–14 as the vessel area nearly doubled. By days 7–14, there was a significant increase in active MMP-2 followed by a significant increase in pro and active MMP-9 by day 14 (P<0.05, grafted artery versus control). TIMP-1 expression peaked by day 7 and then decreased while TIMP-2 expression was decreased at days 7–14. Conclusions The wall shear stress of the grafted artery peaks by day 3 with increased MMP-2 activity by days 7–14 followed by pro and active MMP-9 by day 14 and the vessel area nearly doubled.

Misra, Sanjay; Fu, Alex A.; Misra, Khamal D.; Glockner, James F.; Mukhopadyay, Debabrata

2010-01-01

277

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

PubMed Central

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

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

2013-01-01

278

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

Microsoft Academic Search

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

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

2010-01-01

279

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

PubMed

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

John, Lindsay C H

2009-01-01

280

Covered Stent-Graft Treatment of Traumatic Internal Carotid Artery Pseudoaneurysms: A Review  

Microsoft Academic Search

Objective  To review the literature concerning the management with placement of covered stent-grafts of traumatic pseudoaneurysms of\\u000a the extracranial internal carotid artery (ICA) resulting from penetrating craniocervical injuries or skull base fractures.\\u000a \\u000a \\u000a \\u000a Method  We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added\\u000a a new case.\\u000a \\u000a \\u000a \\u000a Results  We identified 20 patients with

Dimitrios Maras; Christos Lioupis; George Magoufis; Nikolaos Tsamopoulos; Konstantinos Moulakakis; Vasilios Andrikopoulos

2006-01-01

281

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

PubMed Central

Pregnancy after myocardial infarction (MI) and coronary artery bypass grafting (CABG), although still rare, is slowly becoming a challenge in everyday clinical practice. In recent decades MI has been observed to occur more frequently in young women. Concurrently an increasing number of women decide to become pregnant at more advanced age. Although pregnancy after MI and CABG may be possible and safe, a multidisciplinary approach involving careful evaluation by the cardiac and obstetric team in each individual is mandatory. Two cases of pregnant women with a history of MI treated with CABG are presented and their management is discussed.

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

2014-01-01

282

Liver transplant using a severely lacerated graft treated by arterial embolization.  

PubMed

Organ shortages present a problem for liver transplant. Use of traumatized livers could be a way of expanding the donor pool. We report the case of a liver transplant we did in which we used a deeply lacerated liver obtained from a donor, previously treated with a super-selective embolization of segment VI-VII arterial branches to control bleeding. At the back table, the lacerations were repaired using fibrin sealant and stitches. Organ reperfusion was homogeneous, without signs of bleeding. The recipient's postoperative course was uneventful. Injured livers, if well selected, may not be considered an absolute contraindication for liver transplant. However, in these cases, arterial embolization must not routinely be used for a graft for a liver transplant. PMID:23432594

Lai, Quirino; Ferretti, Stefano; Rossi, Massimo; Berloco, Pasquale B

2013-08-01

283

Dialysis grafts arterial plug: Retrieval using the tulip sheath device in vitro  

SciTech Connect

The 'arterial plug' is a resistant thrombus that frequently persists at the arterial anastomosis of clotted hemodialysis grafts following thrombolytic therapy. We studied the physical and morphological characteristics of the plug and determined the feasibility of transcatheter removal in vitro using the tulip compression thrombectomy system. Sixteen thrombus plugs were recovered during surgical thrombectomy of clotted human dialysis grafts. The physical and gross physical characteristics of all plugs were analyzed. Eight specimens were evaluated microscopically. Transcatheter compression thrombectomy of eight plugs was attempted in vitro. Each plug was embedded in a polyvinyl tube filled with newly clotted blood and connected to a flow circuit. First, balloon-assisted aspiration thrombectomy (BAT) of soft thrombus was performed, while sparing the distal-most segment containing the plug. The tulip sheath was then introduced facing the 'arterial end' of the tube. The thrombus segment containing the plug was pulled back into the tulip mesh using either a 3 Fr Fogarty balloon catheter or a self-expanding rake. The tulip was closed to compress and remove the trapped plug. Near-complete thrombectomy of soft clot was achieved in all tested tubes. Compression and retrieval of the entire arterial plug was successful in all except one, where only partial compression of the plug occurred, presumably due to fibrotic changes. No fragmentation or embolization occurred in the remaining procedures. Spongy consistency was noted in 94% of the specimens. Microscopic evaluation showed organized layered thrombus with compaction in five plugs. Transcatheter removal of a thrombus plug is feasible in vitro using the tulip compression-thrombectomy system.

Sharafuddin, Melhem J. [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Titus, Jack L. [University of Minnesota Hospital and Clinic, Department of Pathology/Laboratory Medicine (United States); Gu Xiaoping; Hunter, David W.; Amplatz, Kurt [University of Minnesota, Hospital and Clinic, Department of Radiology (United States)

1997-03-15

284

Mechanical properties of completely autologous human tissue engineered blood vessels compared to human saphenous vein and mammary artery  

PubMed Central

We have previously reported initial clinical feasibility with our small diameter tissue engineered blood vessel (TEBV). Here we present in vitro results of the mechanical properties of the TEBVs of the first 25 patients enrolled in an arterio-venous (A-V) shunt safety trial, and compare these properties with those of risk-matched human vein and artery. TEBV average burst pressures (3,490 +/? 892 mmHg, n=230) were higher than native saphenous vein (SV) (1,599 +/? 877 mmHg, n=7), and not significantly different than native internal mammary artery (IMA) (3,196 +/? 1,264 mmHg, n=16). Suture retention strength for the TEBVs (152 +/? 50 gmf) was also not significantly different than IMA (138 +/? 50 gmf). Compliance for the TEBVs prior to implantation (3.4 +/? 1.6 %/100 mmHg) was lower than IMA (11.5 +/? 3.9 %/100 mmHg). By 6 months post-implant, the TEBV compliance (8.8 +/? 4.2 %/100 mmHg, n=5) had increased to values comparable to IMA, and showed no evidence of dilation or aneurysm formation. With clinical time points beyond 21 months as an A-V shunt without intervention, the mechanical tests and subsequent lot release criteria reported here would seem appropriate minimum standards for clinical use of tissue engineered vessels.

Konig, Gerhardt; McAllister, Todd N; Dusserre, Nathalie; Garrido, Sergio A; Iyican, Corey; Marini, Alicia; Fiorillo, Alex; Avila, Hernan; Wystrychowski, Wojciech; Zagalski, Krzysztof; Maruszewski, Marcin; Jones, Alyce Linthurst; Cierpka, Lech; de la Fuente, Luis M; L'Heureux, Nicolas

2009-01-01

285

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

PubMed

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

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

2010-01-01

286

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

Microsoft Academic Search

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

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

287

Bilateral internal thoracic artery grafting in diabetic patients: Perioperative risk analysis Diyabetik hastalarda bilateral internal torasik arter kullan›m›: Perioperatif dönem risk deerlendirmesi  

Microsoft Academic Search

O Ob bjje ec ct tiiv ve e:: Diabetic patients have a higher risk to acquire coronary artery disease at younger ages and vein grafts used in these patients ha- ve a tendency to develop stenosis earlier. No significant differences have been reported between the patency of internal thoracic artery (ITA) grafts in diabetic and non-diabetic patients. However, bilateral ITA

Murat Mert; Cihat Bakay; Ihsan Bak; Alev Arat Özkan; Numan Ali Aydemir

2004-01-01

288

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

PubMed

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

Khan, Habib; Chaubey, Sanjay; Desai, Jatin

2011-05-01

289

Successful Endovascular Management of Intraoperative Graft Limb Occlusion and Iliac Artery Rupture Occurred during Endovascular Abdominal Aortic Aneurysm Repair  

PubMed Central

For high-risk patients, endovascular aortic aneurysm repair (EVAR) is a good option but may lead to serious complications, which should be addressed immediately. A 75-year-old man with a history of abdominal surgery underwent EVAR for an aneurysm of the abdominal aorta and iliac arteries. During EVAR, iliac artery rupture and graft limb occlusion occurred, and they were successfully managed by the additional deployment of an iliac stent graft and balloon thrombectomy, respectively. We, herein, report a rare case of the simultaneous development of the two fatal complications treated by the endovascular technique.

Lim, Jae Hong; Sung, Yong Won; Oh, Se Jin; Moon, Hyeon Jong; Lee, Jeong Sang

2014-01-01

290

Endovascular Repair of Aortoiliac Aneurysm Using Bifurcated Stent Grafts with Sandwich Technique for Preserving the Internal Iliac Artery  

PubMed Central

In this case, we describe a case of a 76-year-old male with extensive aortoiliac aneurysms treated by endovascular aneurysm repair using the sandwich technique in order to preserve left internal iliac artery perfusion. The sandwich technique refers to the deployment of multiple paralleled stent grafts into main distal and side branches in overlapping with a single proximal stent graft. The procedure was successfully performed without complications. Post-procedural CT angiography demonstrated patent stent grafts without any endoleak. The strengths and limitations of the sandwich technique need to be investigated in large-scale, long-term clinical trials.

Kim, Jung-Ho; Lee, Do-Yun; Choi, Donghoon

2013-01-01

291

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

PubMed Central

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

2013-01-01

292

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

PubMed Central

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

Zare, Zahra; Shahsavari, Hooman; Moeini, Mahin

2010-01-01

293

Covered Stent-Graft Treatment of Traumatic Internal Carotid Artery Pseudoaneurysms: A Review  

SciTech Connect

Objective. To review the literature concerning the management with placement of covered stent-grafts of traumatic pseudoaneurysms of the extracranial internal carotid artery (ICA) resulting from penetrating craniocervical injuries or skull base fractures. Method. We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added a new case. Results. We identified 20 patients with traumatic extracranial ICA pseudoaneurysms due to penetrating craniocervical injuries or skull base fractures who had been treated with covered stent-graft implantation. Many discrepancies have been ascertained regarding the anticoagulation therapy. In 3 patients the ICA was totally occluded in the follow-up period, giving an overall occlusion rate 15%. No serious complication was reported as a result of the endovascular procedure. Conclusion. Preliminary results suggest that placement of stent-grafts is a safe and effective method of treating ICA traumatic pseudoaneurysms resulting from penetrating craniocervical injuries or skull base fractures. The immediate results are satisfactory when the procedure takes place with appropriate anticoagulation therapy. The periprocedural morbidity and mortality and the early patency are also acceptable. A surveillance program with appropriate interventions to manage restenosis may improve the long-term patency.

Maras, Dimitrios; Lioupis, Christos [Red Cross Hospital of Athens, Department of Vascular Surgery (Greece)], E-mail: lioupisC@panafonet.gr; Magoufis, George; Tsamopoulos, Nikolaos [Henry Dynant Hospital, Department of Diagnostic and Therapeutic Neuroradiology (Greece); Moulakakis, Konstantinos; Andrikopoulos, Vasilios [The Red Cross Hospital of Athens, Department of Vascular Surgery (Greece)

2006-12-15

294

Modification and Morphology of Human Umbilical Cord Vein as Canine Arterial Bypass Grafts  

PubMed Central

Human umbilical cord veins treated with various concentrations of glutaraldehyde (GA) and ethanol (ET) were used to replace short segments of the infrarenal abdominal artery in 40 dogs. The patency rates were 62.5% (5/8) in Group I; tanned with 1% GA for 24 hours and preserved in the same solution 87.5% (7/8) in Group II; tanned with 1% GA for 24 hours and preserved in 50% ethanol, 100% (8/8) in Group III; tanned in the same manner as Group II, but preserved in 70% ET; 87.5% (7/8) in Group IV; tanned with 0.5% GA for 24 hours and preserved in 50% ET, and 87.5% (7/8) in Group V; tanned as in Group IV but preserved in 70% ET when examined 14 days to 6 months after implantation. Angiographically, most of the anastomotic lines gradually contracted with the lapse of time because of excessive proliferation of connective tissue into the intraluminal surfaces, although the structural integrity of the graft was well preserved. Microscopically, the irregular fibrin membrane covering the entire inner surface of the graft became smoother and thinner with the lapse of time. The pannus increased gradually both in thickness and width. Scanning electron-micrography of the graft revealed that no endothelial cells were found more than 5 mm from the suture lines even 6 months after implantation. Antigenicity of the graft using a complement-dependent cytotoxicity test was effectively suppressed with glutaraldehyde regardless of whether its concentration was 0.5% or 1.0%. Although human umbilical cord vein tanned with 0.5% glutaraldehyde and preserved in 50% ethanol until used was considered to be useful as an arterial substitute, final conclusion could not be drawn since six grafts followed for six months, the longest follow-up, were stenotic. ImagesFig. 1.Fig. 2.Fig. 3.Fig. 4.Fig. 5.Fig. 6.Fig. 7.Fig. 8.Fig. 9.Fig. 10.

Esato, Kensuke; Shintani, Kiyoshi; Yasutake, Shunsuke

1980-01-01

295

Grafting.  

PubMed

Grafting provides a simple way to generate chimeric plants with regions of different genotypes, and thus to assess the cell autonomy of gene action. The technique of grafting has been widely used in other species, but in Arabidopsis, its small size makes the process rather more complicated. However, there are now several well-established grafting procedures available, which we described here, and their use has already contributed greatly to understanding of such processes as shoot branching control, flowering, and disease resistance. PMID:16739566

Bainbridge, Katherine; Bennett, Tom; Turnbull, Colin; Leyser, Ottoline

2006-01-01

296

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

Microsoft Academic Search

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

Doron Aronson; Elazer R. Edelman

2010-01-01

297

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

PubMed Central

Background Advancements in surgical robotic technology over the last two decades have enabled coronary artery bypass grafting to be performed totally endoscopically, and have the potential to significantly change clinical practice in the future. Methods A systematic review of studies reporting clinical outcomes of total endoscopic coronary artery bypass grafting (TECABG) was performed. Results 14 appraised studies included 880 beating heart TECABGs, 360 arrested heart TECABGs, 633 one-vessel operations and 357 two-vessel operations. Patients were generally low-risk. There was a significant learning curve. The weighted means for short-term beating heart and arrested heart TECABG results respectively were: intraoperative exclusion rate of 5.7% and 1.9%, intraoperative conversion rate of 5.6% and 15.0%, all-cause mortality of 1.2% and 0.4%, stroke of 0.7% and 0.8%, myocardial infarction of 0.8% and 1.8%, new onset atrial fibrillation of 10.7% and 5.1% and post-operative reintervention rate of 2.6% and 2.3%. The overall rate of short term postoperative graft patency for beating heart and arrested heart TECABG was 98.3% and 96.4% respectively. Conclusions Appropriate patient selection was important in minimizing the risk of intraoperative and postoperative complications. Short-term outcomes of both beating and arrested heart TECABG were acceptable, but results so far have been heterogeneous. There were fewer studies reporting intermediate to long-term outcomes, but results were encouraging, and further investigation and development of the procedure is warranted.

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

2013-01-01

298

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

PubMed

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

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

2014-02-01

299

Edifoligide and Long-Term Outcomes After Coronary Artery Bypass Grafting: PREVENT IV 5-Year Results  

PubMed Central

Background Edifoligide, an E2F transcription factor decoy, does not prevent vein graft failure or adverse clinical outcomes at 1-year in patients undergoing coronary artery bypass grafting (CABG). We compared the 5-year clinical outcomes of patients in PREVENT IV treated with edifoligide and placebo and to identify predictors of long-term clinical outcomes. Methods A total of 3014 patients undergoing CABG with at least 2 planned vein grafts were enrolled. Kaplan-Meier curves were generated to compare the long-term effects of edifoligide and placebo. A Cox proportional hazards model was constructed to identify factors associated with 5-year post-CABG outcomes. The main outcome measure was death, myocardial infarction (MI), repeat revascularization, and rehospitalization through 5 years. Results Five-year follow-up was complete in 2865 (95.1%) patients. At 5 years, patients randomized to edifoligide and placebo had similar rates of death (11.7% and 10.7%), MI (2.3% and 3.2%), revascularization (14.1% and 13.9%), and rehospitalization (61.6% and 62.5%). The 5-year composite outcome of death, MI, or revascularization occurred at similar frequency in patients assigned to edifoligide and placebo (26.3% and 25.5%; hazard ratio 1.03 [95% confidence interval 0.89–1.18]; P=0.721). Factors associated with death, MI, or revascularization at 5 years included diabetes, sex, worst graft quality, peri-index CABG MI, and ejection fraction. Conclusions Up to a quarter of patients undergoing CABG will have a major cardiac event or repeat revascularization procedure within 5 years of surgery. Edifoligide does not affect outcomes following CABG; however, common identifiable baseline and procedural risk factors are associated with long-term outcomes following CABG.

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

2013-01-01

300

Saccular Coronary Artery Aneurysm and Fistula with Organized Thrombi  

PubMed Central

Saccular coronary artery aneurysm, associated with coronary artery fistula, is a very rare condition. A 48-year-old woman was referred to our hospital for the evaluation of an abnormal shadow on the left cardiac border from a chest X-ray film during regular medical health examination. A huge saccular aneurysm with organized thrombi in the proximal left anterior descending artery (LAD) and coronary artery fistulae from LAD and conus branch of the right coronary artery to pulmonary artery was diagnosed by transthoracic echocardiography, multi-detector computer tomography (MDCT), and coronary angiography. The patient received surgical treatment, including thrombectomy of aneurysm, ligation of the inlet and outlet of aneurysmal sac, coronary artery bypass graft (left internal mammary artery-to-distal LAD), and ligation of fistulae. The postoperative course was uneventful, and postoperative echocardiography and MDCT revealed patent bypass graft; however, a small fistula from proximal LAD across aneurysmal sac to pulmonary artery was observed.

Jeong, Eun Haeng; Bang, Ki Bae; So, Min Suk; Sung, Ki Chul; Kim, Jung Tae; Kong, Joon Hyuk; Kim, Tae Ho

2013-01-01

301

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

Microsoft Academic Search

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

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

2010-01-01

302

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

PubMed

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

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

2014-08-01

303

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

PubMed Central

Patient: Male, 73 Final Diagnosis: Coronary artery thrombosis Symptoms: Angina pectoris • short of breath Medication: — Clinical Procedure: CABG Specialty: Cardiology Objective: Management of emergency care Background: Intra-operative formation of a thrombus in the right heart is rare and might be unrecognized. However, it can be associated with severe consequences, including pulmonary embolism and death. Case Report: We report the case of a 73-year-old man who presented to the cardiologist with angina pectoris and rare shortness of breath. Coronary artery bypass grafting (CABG) was performed due to multi-vessel disease. Because of hemodynamic insufficiency, an intra-operative transesophageal echocardiogram (TEE) was performed and a huge free-floating thrombus was detected. Multiple thrombi were removed from the right heart and pulmonary arteries. The patient died after cardiopulmonary bypass support and 12 hours of intensive care. Conclusions: In this case report, we emphasize the importance of the TEE during the preoperational period and during CABG, as well as in the preoperative evaluation of pulmonary hypertension.

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

2013-01-01

304

Graft vessel wall pathology in a case of hepatic artery pseudo-aneurysm in a liver transplant recipient.  

PubMed

Pseudo-aneurysms (PAs) of the hepatic artery are rare complications of liver transplantation, which are characterized by a high mortality rate. The majority occur within the first 2 months after orthotopic liver transplantation. They become clinically manifest with sudden hypotension, gastrointestinal bleeding, and abnormal liver function test results. Early diagnosis and treatment are essential to prevent life-threatening hemorrhage. Conventional treatment consists of surgical resection and vascular reconstruction, but a feasible treatment option involves an angiographic approach with the positioning of a stent or transarterial coil embolization followed by revascularization. We report a case of posttransplantation hepatic artery PA (HA-PA) with bleeding into the duodenum, diagnosed using abdominal computed tomography (CT). Arterial kinking prevented a covered stent graft from being inserted successfully using X-ray angiography, so the patient underwent emergency surgery in an attempt to exclude the PA and revascularize the organ via an aorto-hepatic bypass with an iliac vascular graft obtained from the donor. The surgical procedure failed due to progressive macroscopic dissection of the HA wall up to the bifurcation. The patient underwent retransplantation but died 25 days later due to multiple-organ failure. Histopathology of the first liver graft confirmed arterial graft dissection and pathological changes in the donor HA wall. PMID:19100495

Adani, G L; Avellini, C; Baccarani, U; Lorenzin, D; Risaliti, A; Gasparini, D; Sponza, M; Vit, A; Terrosu, G; De Anna, D; Bresadola, F; Bresadola, V

2008-12-01

305

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

Microsoft Academic Search

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

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

306

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

Microsoft Academic Search

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

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

2007-01-01

307

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

Microsoft Academic Search

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

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

1999-01-01

308

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

Microsoft Academic Search

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

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

309

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

PubMed Central

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

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

2012-01-01

310

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

Microsoft Academic Search

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

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

1996-01-01

311

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

Microsoft Academic Search

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

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

2002-01-01

312

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

Microsoft Academic Search

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

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

1993-01-01

313

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

NASA Astrophysics Data System (ADS)

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

Sankaran, Sethuraman; Marsden, Alison

2010-11-01

314

Stent-Graft for the Management of Hepatic Artery Rupture Subsequent to Transcatheter Thrombolysis and Angioplasty in a Liver Transplant Recipient  

SciTech Connect

Arterial rupture subsequent to angioplasty occurs in about 5% of cases. Thrombolysis with re-establishment of flow without resolving underlying anatomic defects such as hepatic arterial stenosis leads to re-thrombosis. We present a case of arterial anastomotic rupture after thrombolysis and angioplasty of an underlying anastomotic hepatic arterial stenosis. Both the underlying anatomic defect and the rupture were resolved successfully with placement of a stent-graft, with a resultant patent artery for 1 year after the procedure.

Yamakado, Koichiro, E-mail: yama@clin.medic.mie-u.ac.jp; Nakatsuka, Atsuhiro; Takaki, Haruyuki [Mie University School of Medicine, Department of Radiology (Japan); Usui, Masanobu; Sakurai, Hiroyuki; Isaji, Shuji [Mie University School of Medicine, First Department of Surgery (Japan); Uemoto, Shinji [Kyoto University, Department of Surgery (Japan); Takeda, Kan [Mie University School of Medicine, Department of Radiology (Japan)

2008-07-15

315

Dual perforator propeller internal mammary artery perforator (IMAP) flap for soft-tissue defect of the contralateral clavicular area.  

PubMed

The internal mammary artery perforator (IMAP) flap represents the evolution from axially pedicled flaps (deltopectoral flap) to perforator flaps. Both flaps are typically used for neck and tracheostoma reconstruction in male patients. We present the case of a 68-year-old obese female patient with a right upper thoracic radionecrosis secondary to breast irradiation. Soft-tissue defect measured 12×18 cm. She also complained of left breast hypertrophy. Following radical debridement, a left IMAP flap extending from midline to the anterior axillary fold was raised, based on the second and fourth IMAP vessels. The flap was rotated 180° on its second and fourth perforators to cover the defect and the left breast was reshaped. The flap survived entirely and wound healing was uneventful. Ptosis and breast hypertrophy were corrected at the same time. The IMAP flap can be harvested all the way to the anterior axillary fold and used as a large propeller flap, which makes this flap suitable for contralateral thoracic reconstructions, even in female patients. PMID:22503312

Rüegg, Eva Meia; Lantieri, Laurent; Marchac, Alexandre

2012-10-01

316

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

PubMed

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

Toomey, Matthew

2013-06-01

317

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

PubMed

Generally, patients with prior coronary artery bypass graft (CABG) are often under-represented in acute coronary syndrome (ACS) clinical trials. Nevertheless, there is growing global attention concerning their short- and long-term prognosis. Some reports suggest prior CABG as an independent risk factor for increased mortality, while others report an equal or a more favorable prognosis despite their adverse baseline clinical characteristics. The reasons for this 'risk-mortality paradox' need to be further evaluated. More recent reports showed a significant reduction in in-hospital morbidity and mortality over a 20-year period of follow up that may be attributed to the improvement in surgical CABG techniques and increased use of evidence-based therapies over the past two decades. In the current review we discuss the available literature regarding outcomes of prior CABG patients who are presenting with ACS. PMID:24754442

Al-Aqeedi, Rafid Fayadh; Al Suwaidi, Jassim

2014-06-01

318

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

PubMed Central

Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used.

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

2013-01-01

319

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

PubMed

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

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

2014-01-01

320

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

PubMed Central

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

Archbold, R A; Curzen, N P

2003-01-01

321

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

PubMed Central

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

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

2012-01-01

322

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

PubMed Central

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

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

2013-01-01

323

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

PubMed

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

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

2009-10-01

324

Prevalence of claustrophobia and magnetic resonance imaging after coronary artery bypass graft surgery  

PubMed Central

Background The purpose of this study was to determine the prevalence of claustrophobia in patients undergoing magnetic resonance imaging (MRI) after coronary artery bypass graft (CABG) surgery. Methods After IRB approval, we conducted a substudy of a prospective randomized controlled clinical trial of 311 patients evaluating administration of tranexamic acid and early saphenous vein graft patency with MRI after conventional CABG surgery. Chest tube drainage was measured at 6, 12, and 24 hours after surgery. The rate of transfusion and the amount of red blood cells (RBC), fresh frozen plasma (FFP), and platelets transfused were recorded. Results A total of 237(76%) patients underwent MRI after surgery. 39 (14%, [95% CI, 10.2 to 18.0]) patients experienced severe anxiety caused by a fear of enclosed space in the MRI coil necessitating termination of the procedure. Patients with claustrophobia were on average 5 years younger. They were more likely to have diabetes mellitus and hypertension. Patients with claustrophobia had increased chest tube drainage during the postoperative period. The rate of blood product transfusion was similar between the two groups but patients with claustrophobia who were transfused received significantly more RBC and FFP than patients without claustrophobia. Conclusions Postoperative claustrophobia and anxiety, leading to inability to undergo MRI, may be more common than previously described.

Katznelson, Rita; Djaiani, George N; Minkovich, Leonid; Fedorko, Ludwik; Carroll, Jo; Borger, Michael A; Cusimano, Robert J; Karski, Jacek

2008-01-01

325

Expanded PTFE prostheses as arterial substitutes in humans: late pathological findings in 73 excised grafts.  

PubMed

Through collaboration of surgeons, pathologists and bioengineers at five centers in Canada and France, this study analyzed the late pathology and structural changes in 73 expanded PTFE arterial prostheses harvested from patients at autopsies and reoperations. The degree of tissue encapsulation increased with the duration of implantation but was reduced by the presence of infection. In several cases, the fibrous tissue penetrated the wall of the prosthesis and partitioned off the thin outer layer, thus disrupting the delicate microporous structure of the wall. The presence of aneurysms was observed in models that had no external reinforcing layer and among grafts that apparently suffered from surgical trauma. Wrinkling of grafts was noted at areas of flexion and was often associated with thickening of the external capsule and reduced luminal diameters. Endothelialization was found within only a few millimeters of the anastomoses. The luminal surfaces were generally not well healed. The PTFE structure was usually readily visible under a thin covering of loosely adhering thrombotic deposits. Bacteria were observed in 46% of the cases, even though only 29% were considered clinically infected. The incidence of lipid or cholesterol deposits was high. Avoiding iatrogenic trauma to the external wall of the prosthesis during implantation is important. Those features where design improvements are required to provide longer term structural integrity and dimensional stability in future models of expanded PTFE prostheses should be identified. PMID:3228535

Formichi, M J; Guidoin, R G; Jausseran, J M; Awad, J A; Johnston, K W; King, M W; Eng, P; Courbier, R; Marois, M; Rouleau, C

1988-01-01

326

Prevention of arterial graft spasm in rats using a vasodilator-eluting biodegradable nano-scaled fibre†  

PubMed Central

OBJECTIVES Arterial graft spasm occasionally causes circulatory collapse immediately following coronary artery bypass graft. The aim of this study is to evaluate the efficacy of our developed materials, which were composed of milrinone (phosphodiesterase III inhibitor) or diltiazem (calcium-channel blocker), with nano-scaled fibre made of biodegradable polymer to prevent arterial spasm. METHODS Milrinone- or diltiazem-releasing biodegradable nano-scaled fibres were fabricated by an electrospinning procedure. In vivo milrinone- or diltiazem-releasing tests were performed to confirm the sustained release of the drugs. An in vivo arterial spasm model was established by subcutaneous injection of noradrenalin around the rat femoral artery. Rats were randomly divided into four groups as follows: those that received 5 mg of milrinone-releasing biodegradable nano-scaled fibre (group M, n = 14); 5 mg of diltiazem-releasing biodegradable nano-scaled fibre (group D, n = 12); or those that received fibre without drugs (as a control; group C, n = 14) implanted into the rat femoral artery. In the fourth group, sham operation was performed (group S, n = 10). One day after the implantation, noradrenalin was injected in all groups. The femoral arterial blood flow was measured continuously before and after noradrenalin injection. The maximum blood flow before noradrenalin injection and minimum blood flow after noradrenalin injection were measured. RESULTS In vivo drug-releasing test revealed that milrinone-releasing biodegradable nano-scaled fibre released 78% of milrinone and diltiazem-releasing biodegradable nano-scaled fibre released 50% diltiazem on the first day. The ratios of rat femoral artery blood flow after/before noradrenalin injection in groups M (0.74 ± 0.16) and D (0.72 ± 0.05) were significantly higher than those of groups C (0.54 ± 0.09) and S (0.55 ± 0.16) (P < 0.05). CONCLUSION Noradrenalin-induced rat femoral artery spasm was inhibited by the implantation of milrinone-releasing biodegradable nano-scaled fibre or diltiazem-releasing biodegradable nano-scaled fibre. These results suggested that our materials might be effective for the prevention of arterial graft spasm after coronary artery bypass graft.

Yagami, Kei; Yamawaki-Ogata, Aika; Satake, Makoto; Kaneko, Hiroaki; Oshima, Hideki; Usui, Akihiko; Ueda, Yuichi; Narita, Yuji

2013-01-01

327

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

PubMed Central

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

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

2011-01-01

328

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

PubMed Central

Summary Background To evaluate clinical and laboratorial parameters that predict decreased respiratory function in patients subjected to coronary artery bypass graft surgery (CABG). Material/Methods This was a prospective study evaluating 61 patients subjected to CABG with cardiopulmonary bypass, median sternotomy, and under mechanical ventilation for up to 24 h. One day before surgery, clinical information was recorded. Maximal inspiratory (MIP) and expiratory (MEP) pressures, and expiratory peak flow rate (EPFR) values were assessed 1 day before surgery and on the fifth postoperative day. Student’s t test, 2-way ANOVA, Pearson’s linear correlation, and logistic regression were used for statistical analysis. Results Patients were 63±10 years old, 67% males. Arterial hypertension was found in 75.4% of the patients, diabetes in 31.2%, dyslipidemia in 63.9%, tabagism in 25%, and chronic obstructive pulmonary disease (COPD) in 16.4%. Previous myocardial infarction was found in 67%. Preoperative hemoglobin levels were 12.8±1.71 g/dL. Older individuals had lower preoperative MEP and EPFR values. Preoperatively, positive association was found between hemoglobin levels and maximal respiratory pressures and EPFR values. Patients with both class III angina and COPD presented higher reductions in pulmonary pressures between the preoperative period and the 5th postoperative day. Conclusions Older age and low hemoglobin levels are associated with preoperative low maximal respiratory pressures and EPFR. The combination of severe angina and COPD results in higher postoperative reduction of maximal respiratory pressures for patients who underwent CABG.

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

2012-01-01

329

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

PubMed

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

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

2000-03-01

330

Quality of life in elderly patients following coronary artery bypass grafting  

PubMed Central

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

Bak, Ewelina; Marcisz, Czeslaw

2014-01-01

331

Percutaneous Stent-Graft Repair of a Mycotic Pulmonary Artery Pseudoaneurysm  

SciTech Connect

Ruptured mycotic pulmonary pseudoaneurysm is a lethal complication. Emergent surgical repair is usually recommended, but still associated with a high mortality rate. We present a patient in whom mycotic pulmonary pseudoaneurysm was a complication after surgical lobectomy 2 weeks earlier. This patient had suffered from repeated massive hemoptysis. After emergent surgical repair of the ruptured pulmonary artery stump, another episode of massive hemorrhage occurred. The pulmonary arteriogram revealed a segmental stenosis and a large, wide-necked, lobulated pseudoaneurysm at the left proximal pulmonary artery. We deployed a balloon-expandable stent-graft (48 mm in length mounted on a 12 mm x 40 mm angioplasty balloon) across the stenotic segment and the neck of the pulmonary pseudoaneurysm. Hemostasis was achieved immediately and, under a 4-week antibiotic treatment, patient was transferred to a local hospital for medical care. This case report demonstrates the benefit of minimally invasive endovascular therapy in a critically ill patient. A literature review of the etiology and management of mycotic pulmonary pseudoaneurysm is included.

Chou Meichun; Liang Hueilung, E-mail: hlliang@isca.vghks.gov.tw; Pan Huayban; Yang Chienfang [Kaohsiung Veterans General Hospital, Department of Radiology (China)

2006-10-15

332

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

PubMed

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

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

2013-11-15

333

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

PubMed

It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD. PMID:24855606

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

2014-04-01

334

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

PubMed Central

It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD.

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

2014-01-01

335

Nerve regeneration and elastin formation within poly(glycerol sebacate)-based synthetic arterial grafts one-year post-implantation in a rat model.  

PubMed

The objective of this study was to evaluate the long-term performance of cell-free vascular grafts made from a fast-degrading elastic polymer. We fabricated small arterial grafts from microporous tubes of poly(glycerol sebacate) (PGS) reinforced with polycaprolactone (PCL) nanofibers on the outer surface. Grafts were interpositioned in rat abdominal aortas and characterized at 1 year post-implant. Grafts remodeled into "neoarteries" (regenerated arteries) with similar gross appearance to native rat aortas. Neoarteries mimic arterial tissue architecture with a confluent endothelium and media and adventita-like layers. Patent vessels (80%) showed no significant stenosis, dilation, or calcification. Neoarteries contain nerves and have the same amount of mature elastin as native arteries. Despite some differences in matrix organization, regenerated arteries had similar dynamic mechanical compliance to native arteries in vivo. Neoarteries responded to vasomotor agents, albeit with different magnitude than native aortas. These data suggest that an elastic vascular graft that resorbs quickly has potential to improve the performance of vascular grafts used in small arteries. This design may also promote constructive remodeling in other soft tissues. PMID:24119457

Allen, Robert A; Wu, Wei; Yao, Mingyi; Dutta, Debaditya; Duan, Xinjie; Bachman, Timothy N; Champion, Hunter C; Stolz, Donna B; Robertson, Anne M; Kim, Kang; Isenberg, Jeffrey S; Wang, Yadong

2014-01-01

336

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

PubMed Central

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass (OPCAB) grafting should be considered as an alternative to the conventional on-pump surgery (ONCAB) in patients presenting with acute coronary syndrome (ACS) requiring emergency revascularization. Eighty-two papers were identified by a systematic search, of which nine were judged to best answer the clinical question. Of these, one was a randomized controlled trial and the remaining eight were retrospective observational studies. The author, journal, date, patient group, country of publication, relevant outcomes, results and study weaknesses were tabulated. In total, these nine studies included 3001 patients (n = 817 OPCAB, 2184 ONCAB) undergoing emergency revascularization in the setting of ACS. The timing between the onset of ACS and operative intervention ranged from 6 to 72 h. All cases were categorized as urgent/emergent according to the National confidential enquiry into patient outcome and death classification of intervention. Six studies included patients with preoperative cardiogenic shock; however the majority of patients were haemodynamically stable at the time of surgery. Three out of nine studies showed an improvement in 30-day mortality with OPCAB although the remaining six reveal no significant mortality benefit. No difference in long-term mortality was observed between the two techniques. OPCAB was associated with significantly fewer grafts per patient (six studies) and less complete revascularization (two studies). We conclude that whilst OPCAB may have a beneficial effect on 30-day mortality in haemodynamically stable patients undergoing emergency revascularization, there is a lack of high-quality data with clearly defined patient demographics. Future studies must ensure adequate preoperative matching between OPCAB and ONCAB groups and clearly categorize haemodynamic status, disease pattern and time to surgery in order to determine the patients in whom OPCAB may confer the greatest benefit.

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

2013-01-01

337

Influence of endothelial cell seeding on platelet deposition and patency in small-diameter Dacron arterial grafts  

SciTech Connect

Serial platelet deposition, surface topography, and patency were evaluated in control (N . 28) and endothelial cell-seeded (N . 28) small-diameter (4 mm inner diameter) USCI Dacron grafts implanted in the carotid and femoral arteries of dogs. All dogs received aspirin (325 mg) daily for 2 weeks starting 24 hours prior to graft implantation. Endothelial cell seeding was performed by mixing suspensions of autologous endothelial cells that had been enzymatically harvested from segments of external jugular vein with blood that was used to preclot the prostheses. The platelet deposition on each graft was quantitated by means of indium 111-labeled platelets and technetium 99m-labeled red cells in a dual-isotope platelet-imaging technique. Platelet deposition on seeded grafts 24 hours after implantation was significantly higher than on the controls (p less than 0.05). Two weeks after implantation platelet deposition on seeded prostheses had decreased to a level significantly lower than that on the controls and continued to decline on serial studies up to 7 months. In contrast to seeded grafts, platelet accumulation on control grafts dramatically increased after the withdrawal of aspirin therapy and was associated with a sharp rise in control graft thromboses. Cumulative 7-month patency for seeded prostheses was significantly higher than for the controls (96% and 29%, respectively; p less than 0.001). We conclude that endothelial cell seeding in combination with short-term aspirin therapy is a simple, reliable diameter Dacron prostheses. Abrupt withdrawal of aspirin therapy may be contraindicated in nonseeded control grafts because it results in increased platelet deposition and thrombosis.

Allen, B.T.; Long, J.A.; Clark, R.E.; Sicard, G.A.; Hopkins, K.T.; Welch, M.J.

1984-01-01

338

Anatomical study of the greater palatine artery and related structures of the palatal vault: considerations for palate as the subepithelial connective tissue graft donor site  

Microsoft Academic Search

Palate is considered as a tissue graft donor site for dental surgical procedures. Therefore, the aim of this study was to\\u000a investigate the anatomy of palatal structures, such as greater palatine artery, greater palatine foramen, and incisive fossa,\\u000a in order to consider their topography at planning the graft dimensions and reduce the potential risk of injury of greater\\u000a palatine artery.

Sebastian Krystian Klosek; Thanaporn Rungruang

2009-01-01

339

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

PubMed

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

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

2011-11-01

340

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

PubMed

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

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

2014-02-01

341

Evaluation of Revascularization Subtypes in Octogenarians Undergoing Coronary Artery Bypass Grafting  

PubMed Central

Background Recent data suggest that octogenarians’ long-term survival after complete CABG revascularization is superior to incomplete revascularization. Discriminating between variable definitions of “complete” complicates interpretation of survival data. We aimed to clarify octogenarian long-term survival rates by stratifying revascularization subtypes. Methods and Results From 1986 to 2007, 580 patients 80 to 94 years of age underwent CABG. Functional complete revascularization was defined as at least one graft to all diseased coronary vessels with greater than 50% stenosis. Traditional complete revascularization was defined as one graft to each major arterial system with at least 50% stenosis. Incomplete revascularization was defined as leaving diseased, ungrafted regions. Revascularization was functional in 279 (48%), traditional in 181 (31%), and incomplete in 120 (21%). Long-term survival was evaluated by Kaplan-Meier analysis. Of 537 operative survivors, there were 402 late deaths. Cumulative long-term survival totaled 2,890 patient-years. Late survival (Kaplan-Meier) was similar between functional (6.8 years, mean) and traditional (6.7 years) groups (p=0.51), but diminished with incomplete (4.2 years) revascularization (p=0.007). Survival by group at 5 years was: 59±3% functional, 57±4% traditional, and 45±5% incomplete. Survival at 8 years was: 40±3% functional, 37±4% traditional, and 26±5% incomplete. To minimize selection bias in patients with limited life expectancy, Kaplan-Meier analysis was repeated including only patients with survival greater than 12 months. Survival was again impaired with incomplete revascularization (p=0.04), and there was no difference between functional and traditional complete revascularization (p=0.73). Conclusions Bypassing all diseased arterial vessels after revascularization does not afford significant long-term survival advantage compared to a traditional approach. Incomplete revascularization, related to more extensive disease, is associated with an 18% decline in survival. These data suggest that it is important to avoid incomplete revascularization in octogenarians, but the supplementary endeavor required to perform functional complete revascularization does not improve survival.

Aziz, Abdulhameed; Lee, Anson M.; Pasque, Michael K.; Lawton, Jennifer S.; Moazami, Nader; Damiano, Ralph J.; Moon, Marc R.

2009-01-01

342

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

Microsoft Academic Search

Neuropsychologic impairment in patients undergoing cardiopulmonary bypass may be associated with cerebral blood flow changes arising from different management protocols for carbon dioxide tension during bypass. Seventy patients having coronary artery bypass grafting were randomized to either pH-stat or alpha-stat acid-base management during cardiopulmonary bypass with a membrane oxygenator. In each patient, cerebral blood flow (xenon 133 clearance), middle cerebral

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

1996-01-01

343

Procedure-Induced Acute Common Carotid Artery Perforation Presenting With Airway Obstruction and Successful Treatment by Endovascular Stent Graft  

PubMed Central

A 63-year-old female was admitted to our hospital for catheter ablation during atrial fibrillation. After catheter ablation, the patient was transferred to the cardiac care unit and mechanically ventilated due to dyspnea and hypotension. Imaging showed active bleeding from the right common carotid artery (CCA) with extensive hematoma into the mediastinum. She was successfully treated with a stent graft at the CCA. Further bleeding or neurologic sequel did not occur after treatment.

Lee, Chang Hoon; Park, Jong Seon; Hwang, Ki Won; Lee, Seung-Whan; Park, Seong-Wook

2011-01-01

344

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

Microsoft Academic Search

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

Pavel Zacek; Jan Dominik

2002-01-01

345

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

Microsoft Academic Search

The reinjection of a small dose (40 MBq) of thallium-201 after stress and delayed imaging often shows new redistribution in the regions with persistent defect. To assess whether these segments may represent reversible ischemia, reinjection thallium-201 single-photon emission computed tomography (SPECT) was performed after stress and 3-hour delayed imaging in 24 patients before coronary artery bypass grafting (CABG). The left

H. Ohtani; N. Tamaki; Y. Yonekura; I. H. Mohiuddin; K. Hirata; T. Ban; J. Konishi

1990-01-01

346

The performance of cross-linked acellular arterial scaffolds as vascular grafts; pre-clinical testing in direct and isolation loop circulatory models.  

PubMed

There is a significant need for small diameter vascular grafts to be used in peripheral vascular surgery; however autologous grafts are not always available, synthetic grafts perform poorly and allografts and xenografts degenerate, dilate and calcify after implantation. We hypothesized that chemical stabilization of acellular xenogenic arteries would generate off-the-shelf grafts resistant to thrombosis, dilatation and calcification. To test this hypothesis, we decellularized porcine renal arteries, stabilized elastin with penta-galloyl glucose and collagen with carbodiimide/activated heparin and implanted them as transposition grafts in the abdominal aorta of rats as direct implants and separately as indirect, isolation-loop implants. All implants resulted in high patency and animal survival rates, ubiquitous encapsulation within a vascularized collagenous capsule, and exhibited lack of lumen thrombogenicity and no graft wall calcification. Peri-anastomotic neo-intimal tissue overgrowth was a normal occurrence in direct implants; however this reaction was circumvented in indirect implants. Notably, implantation of non-treated control scaffolds exhibited marked graft dilatation and elastin degeneration; however PGG significantly reduced elastin degradation and prevented aneurismal dilatation of vascular grafts. Overall these results point to the outstanding potential of crosslinked arterial scaffolds as small diameter vascular grafts. PMID:24816365

Pennel, Timothy; Fercana, George; Bezuidenhout, Deon; Simionescu, Agneta; Chuang, Ting-Hsien; Zilla, Peter; Simionescu, Dan

2014-08-01

347

In vivo quantitation of platelet deposition on human peripheral arterial bypass grafts using indium-111-labeled platelets. Effect of dipyridamole and aspirin  

SciTech Connect

Indium-111-labeled autologous platelets, injected 48 hours after operation, were used to evaluate the thrombogenicity of prosthetic material and the effect of platelet inhibitor therapy in vivo. Dacron double-velour (Microvel) aortofemoral artery bifurcation grafts were placed in 16 patients and unilateral polytetrafluoroethylene femoropopliteal grafts were placed in 10 patients. Half the patients in each group received platelet inhibitors before operation (dipyridamole, 100 mg 4 times a day) and after operation (dipyridamole, 75 mg, and acetylsalicylic acid, 325 mg 3 times a day); the rest of the patients served as control subjects. Five-minute scintigrams of the graft region were taken with a gamma camera interfaced with a computer 48, 72, and 96 hours after injection of the labeled platelets. Platelet deposition was estimated from the radioactivities of the grafts and expressed as counts per 100 pixels per microcurie injected. Dipyridamole and aspirin therapy significantly reduced the number of platelets deposited on Dacron grafts and prevented platelet accumulation over 3 days. With the small amount of platelet deposition on polytetrafluoroethylene femoropopliteal artery grafts even in control patients, platelet inhibitor therapy had no demonstrable effect on platelet deposition on these grafts. It is concluded that (1) platelet deposition on vascular grafts in vivo can be quantitated by noninvasive methods, and (2) dipyridamole and aspirin therapy reduced platelet deposition on Dacron aortofemoral artery grafts.

Pumphrey, C.W.; Chesebro, J.H.; Dewanjee, M.K.; Wahner, H.W.; Hollier, L.H.; Pairolero, P.C.; Fuster, V.

1983-03-01

348

Numerical investigation of oxygen mass transfer in a helical-type artery bypass graft.  

PubMed

Local oxygen lack in arterial walls (hypoxia) plays a very important role in the initiation, progression and development of intimal hyperplasia (IH) and thrombosis. Aiming to find out whether a helical-type artery bypass graft (ABG) is hypoxia beneficial, a numerical study was carried out to compare oxygen transport between a helical-type ABG and a conventional-type ABG. The dimensionless mass transfer coefficient (Sherwood number) was introduced to evaluate the oxygen mass transfer distribution and detailed oxygen wall flux was computed. The results show that the intrinsic geometry of a helical-type ABG resulted in improved hypoxia and the oxygen-depleted fluid located proximally to the occluded section as compared with that of a conventional-type ABG. However, benefits aside, distinct double low regions (low wall shear stress (WSS) and hypoxia) which might be most prone to IH and more localised and thicker boundary layer of oxygen-depleted fluid were observed at the helical-type ABG. This may explain why the helical flow plays a detrimental role at some locations in the human body. In addition, it was observed that although low WSS region was always accompanied with low oxygen supply, the oxygen transport rate did not adjust simultaneously with flow. The change in oxygen distribution usually lagged behind the flow change. A physiological WSS region may be associated with hypoxia condition. This study captured the qualitative trend of oxygen distribution in ABGs and the effect of helical geometry on reducing hypoxia, which is useful in the structural design of swirling flow vascular devices. PMID:22794110

Zheng, Tinghui; Wen, Jun; Jiang, Wentao; Deng, Xiaoyan; Fan, Yubo

2014-04-01

349

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

SciTech Connect

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

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

1985-05-01

350

Thrombotic gene polymorphisms and postoperative outcome after coronary artery bypass graft surgery  

PubMed Central

Background Emerging perioperative genomics may influence the direction of risk assessment and surgical strategies in cardiac surgery. The aim of this study was to investigate whether single nucleotide polymorphisms (SNP) affect the clinical presentation and predispose to increased risk for postoperative adverse events in patients undergoing coronary artery bypass grafting surgery (CABG). Methods A total of 220 patients undergoing first-time CABG between January 2005 and May 2008 were screened for factor V gene G1691A (FVL), prothrombin/factor II G20210A (PT G20210A), angiotensin I-converting enzyme insertion/deletion (ACE-ins/del) polymorphisms by PCR and Real Time PCR. End points were defined as death, myocardial infarction, stroke, postoperative bleeding, respiratory and renal insufficiency and event-free survival. Patients were compared to assess for any independent association between genotypes for thrombosis and postoperative phenotypes. Results Among 220 patients, the prevalence of the heterozygous FVL mutation was 10.9% (n = 24), and 3.6% (n = 8) were heterozygous carriers of the PT G20210A mutation. Genotype distribution of ACE-ins/del was 16.6%, 51.9%, and 31.5% in genotypes I/I, I/D, and D/D, respectively. FVL and PT G20210A mutations were associated with higher prevalence of totally occluded coronary arteries (p < 0.001). Furthermore the risk of left ventricular aneurysm formation was significantly higher in FVL heterozygote group compared to FVL G1691G (p = 0.002). ACE D/D genotype was associated with hypertension (p = 0.004), peripheral vascular disease (p = 0.006), and previous myocardial infarction (p = 0.007). Conclusions FVL and PT G20210A genotypes had a higher prevalence of totally occluded vessels potentially as a result of atherothrombotic events. However, none of the genotypes investigated were independently associated with mortality.

2011-01-01

351

Effects of Seasonal Variations on the Outcome of Coronary Artery Bypass Graft Surgery  

PubMed Central

Background: For all the reports on the association between seasons and coronary artery disease, there is a paucity of information on the possible effects of seasonal variations on the outcome of patients after coronary artery bypass grafting surgery (CABG). The aim of this study was to assess the short-term outcome of post-CABG patients in the four different seasons to find any correlation between seasonal variations and the outcome of such patients. Methods: Data on patients who underwent cardiac surgery between 2007 and 2009 were analyzed. In-hospital mortality, length of Intensive Care Unit (ICU) stay, and length of hospital stay in the four different seasons were considered as outcome measures. The EuroSCORE was calculated for all the patients, and the Kruskal-Wallis, Mann-Whitney, Student t, and chi square tests were used as appropriate. Results: Of a total of 402 patients, who underwent CABG during the mentioned period, 292 patients were male (M/F ratio=2.65). There were no differences in terms of mean age, sex ratio, and mean EuroSCORE of the patients between the seasons. The mean length of ICU stay was significantly more in the spring than that of the other seasons (P<0.001), while the difference between the four seasons regarding the mean length of hospital stay did not constitute statistical significance (P=0.22). No effect of seasonal variations was found for the lengths of ICU and hospital stay in the presence of the EuroSCORE after multiple logistic regression analysis (P=0.278, 0.431). Conclusion: Psychological mood changes caused by regional cultural differences rather than environmental factors should be considered in the optimal management of patients after CABG.

Nemati, Mohammad Hassan

2013-01-01

352

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

PubMed Central

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

Seim, Bj?rn Edvard; T?nnessen, Theis; Woldbaek, Per Reidar

2012-01-01

353

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

PubMed Central

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

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

2013-01-01

354

Missed case of sinus venosus atrial septal defect post coronary artery bypass grafting.  

PubMed

We report a case of a 41-year-old Indian man who initially underwent an emergency coronary artery bypass grafting surgery (CABG) after presenting with an anterolateral myocardial infarction.Post-operatively he developed progressively worsening symptoms of right heart failure with increasing abdominal distension and lower limb swelling. Clinically, the patient was in NYHA class 4 heart failure.He was admitted multiple times for the treatment of his heart failure, which was recalcitrant to diuretic therapy.He subsequently underwent an MRI scan, which revealed near transmural myocardial infarction involving mainly the left side of the heart. The right atrium and ventricle were grossly dilated, with moderate to severe right ventricular systolic dysfunction. A sinus venosus atrial septal defect with right-sided partial anomalous pulmonary venous drainange (PAPVD) was noted. He subsequently underwent surgery to repair the sinus venosus atrial septal defect (ASD) as well as re-route the PAPVD to the left atrium (LA). He was discharged on post-operative day 19 with oral diuretics.On follow-up at 1 month, the patient's symptoms had resolved and his clinical status corresponded to NYHA class 1-2. PMID:24884712

De, Sudeep Das; Maung Maung Aye, Winn; Shankar, Sriram

2014-01-01

355

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

PubMed

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

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

2013-12-01

356

Missed case of sinus venosus atrial septal defect post coronary artery bypass grafting  

PubMed Central

We report a case of a 41-year-old Indian man who initially underwent an emergency coronary artery bypass grafting surgery (CABG) after presenting with an anterolateral myocardial infarction. Post-operatively he developed progressively worsening symptoms of right heart failure with increasing abdominal distension and lower limb swelling. Clinically, the patient was in NYHA class 4 heart failure. He was admitted multiple times for the treatment of his heart failure, which was recalcitrant to diuretic therapy. He subsequently underwent an MRI scan, which revealed near transmural myocardial infarction involving mainly the left side of the heart. The right atrium and ventricle were grossly dilated, with moderate to severe right ventricular systolic dysfunction. A sinus venosus atrial septal defect with right-sided partial anomalous pulmonary venous drainange (PAPVD) was noted. He subsequently underwent surgery to repair the sinus venosus atrial septal defect (ASD) as well as re-route the PAPVD to the left atrium (LA). He was discharged on post-operative day 19 with oral diuretics. On follow-up at 1 month, the patient's symptoms had resolved and his clinical status corresponded to NYHA class 1–2.

2014-01-01

357

Bone marrow stem cell transplantation and coronary artery bypass grafting surgery for chronic ischemic myocardiopathy.  

PubMed

We studied 12 consecutive patients with chronic ischemic myocardiopathy treated with bone marrow adult stem cell (ASC) transplantation and coronary artery bypass grafting (CABG). The aim of the study was to evaluate functional class (New York Heart Association), wall motion score index (WMSI), and ejection fraction by echocardiography and to evaluate myocardial perfusion by single-photon emission computed tomography (SPECT). Follow-up evaluations were performed at 3, 6, and 12 months. The results revealed functional class improvement until 12 months, a progressive increase in the ejection fraction of 15% to 20% in the first 6 months, and a progressive increase in the WMSI by 35% to 45% in 12 months. Evaluation of the WMSI in the stem cell and CABG areas separately revealed a similar improvement in the first 3 months and a better progression in the CABG area. SPECT images revealed perfusion improvements in ischemic areas and no difference in fibrous tissue areas. These preliminary results show the safety of the method and its reproducibility. When performed concomitantly with CABG, bone marrow ASC transplantation may improve functional class, ejection fraction, WMSI, and myocardial perfusion. This study will be completed with all patients followed up for 12 months and compared with a control group. PMID:20534416

da Rocha Loures, Danton Richlin; de Souza, Juliano Mendes; Sermann, Oaidia Adelina Nocetti; Farah, Noemi; Rodriguez, Maria Felicitas Niedfeld; Malvezzi, Mariester; Borgonovo, Tamara; Westphal, Ricardo João; Ervilha, Lauro; da Cunha, Claudio Pereira

2010-06-01

358

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

PubMed Central

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

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

2005-01-01

359

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

PubMed

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

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

2004-10-01

360

Albumin Is A Better Predictor of Outcomes Than Body Mass Index Following Coronary Artery Bypass Grafting  

PubMed Central

Objective Body Mass Index (BMI) influences risk in coronary artery bypass grafting (CABG) patients, while albumin, is not collected by the Society of Thoracic Surgeons database. We postulate that preoperative albumin is a better predictor of mortality than BMI following CABG. Methods BMI from patients with serum albumin level within 6 months of isolated CABG between 1995–2010 from our institutional databases were identified. Patients were stratified by National Heart, Lung and Blood Institute (NHLBI) BMI class, and by preoperative albumin. Regression models were used to assess predictors of morbidity and mortality. Results We analyzed 2,794 isolated CABG patients at our institution. Unadjusted mortality was highest with lowest BMI (P?.05), and in patients with 2–3g/dL albumin (P=.02). Ejection fraction (EF) and intra-aortic balloon pump (IABP) use were similar despite BMI; however, EF was lowest and IABP use highest in the 2–3g/dL albumin group (P<.001, respectively). Unlike BMI groups, increasing albumin was associated with lower major complication rates (P=.001). Similarly, adjusted mortality was not influenced by BMI (AOR 0.97, 95%CI 0.93–1.02), but increasing albumin levels reduced the adjusted odds of death (AOR 0.61, 95%CI 0.42–0.90). Conclusions Albumin, more than body mass index, is associated with mortality and morbidity in isolated CABG recipients and may be a better indicator for outcomes.

Bhamidipati, Castigliano M; LaPar, Damien J; Mehta, Gaurav S; Kern, John A; Upchurch, Gilbert R; Kron, Irving L; Ailawadi, Gorav

2011-01-01

361

A Longitudinal Study of Remodeling in a Revised Peripheral Artery Bypass Graft Using 3D Ultrasound Imaging and Computational Hemodynamics  

PubMed Central

We report a study of the role of hemodynamic shear stress in the remodeling and failure of a peripheral artery bypass graft. Three separate scans of a femoral to popliteal above-knee bypass graft were taken over the course of a 16 month period following a revision of the graft. The morphology of the lumen is reconstructed from data obtained by a custom 3D ultrasound system. Numerical simulations are performed with the patient-specific geometries and physiologically realistic flow rates. The ultrasound reconstructions reveal two significant areas of remodeling: a stenosis with over 85% reduction in area, which ultimately caused graft failure, and a poststenotic dilatation or widening of the lumen. Likewise, the simulations reveal a complicated hemodynamic environment within the graft. Preliminary comparisons with in vivo velocimetry also showed qualitative agreement with the flow dynamics observed in the simulations. Two distinct flow features are discerned and are hypothesized to directly initiate the observed in vivo remodeling. First, a flow separation occurs at the stenosis. A low shear recirculation region subsequently develops distal to the stenosis. The low shear region is thought to be conducive to smooth muscle cell proliferation and intimal growth. A poststenotic jet issues from the stenosis and subsequently impinges onto the lumen wall. The lumen dilation is thought to be a direct result of the high shear stress and high frequency pressure fluctuations associated with the jet impingement.

Leotta, Daniel F.; Beach, Kirk W.; Riley, James J.; Aliseda, Alberto

2011-01-01

362

Changes in the cardiac muscle electric activity as a result of Coronary Artery Bypass Graft operation  

NASA Astrophysics Data System (ADS)

Many bioelectric signals have a complex internal structure that can be a rich source of information on the tissue or cell processes. The structure of such signals can be analysed in detail by applying digital methods of signal processing. Therefore, of substantial use in diagnosis of the coronary arterial disease is the method of digital enhancement of increasing signal resolution ECG (NURSE-ECG), permitting detection of temporary changes in the electric potentials in the cardiac muscle in the process of depolarisation. Thanks to the application of NURSE-ECG it has become possible to detect relatively small changes in the electric activity of particular fragments of the cardiac muscle undetectable by the standard ECG method, caused by ischemia, the effect of a drug or infarct. The aim of this study was to identify and analyse changes in the electric activity of the cardiac muscle as a result of the Coronary Artery Bypass Graft (CABG) operation. In this study the method of NURSE-ECG has been applied in order to identify and analyse changes in the electric activity of the cardiac muscle as a result of the CABG operation. In the study performed in cooperation of the Institute of Physics Adam Mickiewicz University and the Strus Hospital, Cardiac Surgery Ward, 37 patients with advanced coronary arterial disease were asked to participate. The patients were examined prior to the operation, on the day after the operation and two months after the operation and a year after the operation. The ECG recordings were subjected to a numerical procedure of resolution enhancement by a NURSE-ECG program to reveal the tentative changes in the electric potential of the cardiac muscle on its depolarisation. Results of the study have shown that the NURSE ECG method can be applied to monitor changes in the electric activity of the cardiac muscle occurring as a result of CABG operation. One the second day after the operation in the majority of patients (70%) a rapid decrease of the total cardiac muscle activity was observed. The NURSE ECG seems to be a promising supplementary method in medical diagnosis. In particular it can be applied for qualification of patients for CABG operation and for verification of the operation effects.

Grajek, Magdalena; Krzyminiewski, Ryszard; Kalawski, Ryszard; Kulczak, Mariusz

2008-01-01

363

Sedative Efficacy of Propofol in Patients Intubated/Ventilated after Coronary Artery Bypass Graft Surgery  

PubMed Central

Background: Sedation after open heart surgery is important in preventing stress on the heart. The unique sedative features of propofol prompted us to evaluate its potential clinical role in the sedation of post-CABG patients. Objectives: To compare propofol-based sedation to midazolam-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU). Patients and Methods: Fifty patients who were admitted to the ICU after CABG surgery was randomized into two groups to receive sedation with either midazolam or propofol infusions; and additional analgesia was administered if required. Inclusion criteria were as follows: patients 40-60 years old, hemodynamic stability, ejection fraction (EF) more than 40%; exclusion criteria included patients who required intra-aortic balloon pump or inotropic drugs post-bypass. The same protocol of anesthetic medications was used in both groups. Depth of sedation was monitored using the Ramsay sedation score (RSS). Invasive mean arterial pressure (MAP) and heart rate (HR), arterial blood gas (ABG) and ventilatory parameters were monitored continuously after the start of study drug and until the patients were extubated. Results: The depth of sedation was almost the same in the two groups (RSS=4.5 in midazolam group vs 4.7 in propofol group; P = 0.259) but the total dose of fentanyl in the midazolam group was significantly more than the propofol group (12.5 mg/hr vs 4 mg/hr) (P = 0.0039). No significant differences were found in MAP (P = 0.51) and HR (P = 0.41) between the groups. The mean extubation time in patients sedated with propofol was shorter than those sedated with midazolam (102 ± 27 min vs 245 ± 42 min, respectively; P < 0.05) but the ICU discharge time was not shorter (47.5 hr vs 36.3 hr, respectively; P = 0.24). Conclusions: Propofol provided a safe and acceptable sedation for post-CABG surgical patients, significantly reduced the requirement for analgesics, and allowed for more rapid tracheal extubation than midazolam but did not result in earlier ICU discharge.

Aghdaii, Nahid; Yazdanian, Frouzan; Faritus, Seyedeh Zahra

2014-01-01

364

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

PubMed Central

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

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

2013-01-01

365

Does Intraoperative Evaluation of Left Ventricular Contractile Reserve Predict Myocardial Viability? A Clinical Study Using Dobutamine Stress Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

To determine the contractile reserve of the left ventricle dur- ing reperfusion as a predictor of myocardial viability in pa- tients undergoing coronary artery bypass graft surgery, we measured the response of left ventricular regional wall mo- tion and thickening by using dobutamine stress echocardi- ography (DSE) after myocardial revascularization. All pa- tients were monitored with radial and pulmonary arterial

Jancqueline M. Leung; Wayne H. Bellows; Darwin Pastor

2004-01-01

366

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

Microsoft Academic Search

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

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

2004-01-01

367

Bovine carotid artery heterografts versus polytetrafluoroethylene grafts. A prospective, randomized study.  

PubMed

A prospective, randomized comparison of BCAH and PTFE vascular access grafts resulted in no statistically significant difference when analyzed for survival rates of complications, types of complications, reasons for failure, and clot salvageability. The results in diabetic patients were similar to those in nondiabetic patients. The majority of retrospective studies and subjective experiences favor PTFE grafts over BCAHs. The explanation may be part that BCAH preceded PTFE grafts into clinical use, and inexperience in the operating room and in the dialysis unit had an effect on BCAH results. A review of impressions of the graft materials indicated a decided preference for PTFE grafts. PMID:6650773

Hurt, A V; Batello-Cruz, M; Skipper, B J; Teaf, S R; Sterling, W A

1983-12-01

368

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

PubMed

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

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

1998-07-01

369

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

PubMed

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

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

2013-12-01

370

Potential advantages of treatment of transplanted saphenous vein aorto-coronary artery bypass grafts with beta irradiation to prevent graft occlusion.  

PubMed

Intimal proliferation or Neointimal hyperplasia (NIH) is a vascular lesion that often arises in arteries after balloon angioplasty or other vessel wall injuries. FIH is a vascular lesion that develops in autologous saphenous vein grafts (SVG) after transplantation into the aorto-coronary circulation or the peripheral vascular circulation. FIH shares elements of smooth muscle migration, proliferation and fibrous tissue deposition in common with nibrointimal proliferation (NIH). Either NIH of a coronary artery or FIH of a SVG obstruct the vascular lumen and result in myocardial dysfunction. Local radiotherapy has been used for several decades to reduce the post-operative recurrence of the fibrovascular proliferations of pterygia and keloids. Similarly, in animal and human experiments, endovascular radiotherapy has been shown to reduce arterial smooth muscle proliferation. Consideration of the similarities of vascular smooth muscle cell proliferation in NIH and FIH leads one to suggest that endovascular beta irradiation can reduce FIH as well as it reduces NIH. The goal of such treatment is to achieve a clinically significant decrease in the morbidity and mortality resulting from SVG occlusions. The potential for large reduction of the consequences of SVG occlusion, the very large number of patients at risk, and the simplicity of the proposed intervention encourages prompt scientific evaluation of this technique. PMID:9209700

Smith, R G

1997-01-01

371

Coronary artery bypass grafting in Canada: What is its rate of use? Which rate is right?  

PubMed Central

We reviewed recent reports from administrative databases and clinical registries addressing the utilization of coronary artery bypass grafting (CABG) in Canada. The Canadian CABG rate per 100,000 people increased from 31.1 to 43.2 between 1981-82 and 1986-87. Between 1981 and 1986 the rate in the United States increased from 69.9 to 95.3 per 100,000, consistently about two times the Canadian rate. Provincial data have shown particular growth in utilization among elderly people. However, in the United States the 1985 CABG rate was twice as high as the aggregated age-specific rates for Ontario and Manitoba among people 65 to 74 years of age and four times higher among those 75 years or more. Limited registry data suggest that the Canadian CABG case mix is similar to the case mix in major US centres and that, utilization growth notwithstanding, the procedure is largely applied to patients who should, in theory, benefit (i.e., those with severe angina, impaired left ventricular function and left main-stem or triple-vessel disease). However, chart audits and registry evaluations using explicit criteria are needed to compare the use of CABG in Canada and the United States. In addition, Canadian data show moderate regional and municipal variations, the 1986-87 rates per 100,000 population in major census metropolitan areas varying from 19.5 to 46.9. Areas with consistently low rates raise particular concerns about impaired access to CABG. Reasons for variations should therefore be a research priority.

Naylor, C D; Ugnat, A M; Weinkauf, D; Anderson, G M; Wielgosz, A

1992-01-01

372

Predicting hospital costs for first-time coronary artery bypass grafting from preoperative and postoperative variables.  

PubMed

To predict hospital costs after coronary artery bypass grafting (CABG) from preoperative characteristics and postoperative complications, 4 analyses of the data were used: (1) a univariate analysis of each preoperative and postoperative variable, (2) a multivariate analysis of the preoperative variables (model 1), (3) a multivariate analysis of the postoperative variables (model 2), and (4) a multivariate analysis of pre- and postoperative variables (model 3). Eight-hundred seven patients who underwent a first-time CABG at Emory University during 1990 were analyzed in this study. Using model 1, the determinants of costs were higher angina grade (p = 0.0006), previous myocardial infarction (p = 0.0133), older age (p = 0.0001), congestive heart failure (p = 0.0001), and a higher number of diseased vessels (p = 0.0001). For model 2, the determinants of costs were adult respiratory distress syndrome (p = 0.0073), intraaortic balloon pumping (p < 0.0001), pneumonia (p < 0.0001), septicemia p < 0.0001), major arrhythmia (p < 0.0001), reexploration for bleeding (p < 0.0001), wound infection (p = 0.0632), neurologic event (p = 0.0013), fluid overload (p = 0.0516), and absence of pericarditis (p = 0.0588). For univariate analysis, the determinants of increased costs were similar to those from models 1 and 2. Although there is considerable variance in hospital costs for any number of complications, utilized resources (costs) increase inexorably as patients have more complications after coronary surgery. The mean cost to the hospital for the 382 patients who underwent CABG and experienced no complications was $16,776.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7942547

Mauldin, P D; Weintraub, W S; Becker, E R

1994-10-15

373

Perioperative outcomes after on- and off-pump coronary artery bypass grafting.  

PubMed

Although numerous reports describe the results of off-pump coronary artery bypass grafting (CABG) at specialized centers and in select patient populations, it remains unclear how off-pump CABG affects real-world patient outcomes. We conducted a large, multicenter observational cohort study of perioperative death and morbidity in on-pump (ON) versus off-pump (OFF) CABG. We reviewed Veterans Affairs Surgical Quality Improvement Program data for all patients (N=65,097) who underwent isolated CABG from October 1997 through April 2011 (intention-to-treat data were available from 2005 onward). The primary outcome was perioperative (30-day or in-hospital) death; the secondary outcomes were perioperative stroke, dialysis dependence, reoperation for bleeding, mechanical circulatory support, myocardial infarction, ventilator support ?48 hr, and mediastinitis. Propensity scores calculated from age, 17 preoperative risk factors, and year of surgery were used to match 8,911 OFF with 26,733 ON patients. In the complete cohort, compared with the ON patients (n=53,468), the OFF patients (n=11,629) had less perioperative death (2.02% vs 2.53%, P=0.0012) and lower incidences of all morbidities except perioperative myocardial infarction. In the matched cohort, perioperative death did not differ significantly between OFF and ON patients (1.94% vs 2.28%, P=0.06), but the OFF group had lower incidences of all morbidities except for perioperative myocardial infarction and mediastinitis. A subgroup intention-to-treat analysis yielded similar but smaller outcome differences between the ON and OFF groups. Off-pump CABG might be associated with decreased operative morbidity but did not affect operative death, compared with on-pump CABG. Future studies should examine the effect of off-pump CABG on long-term outcomes. PMID:24808773

Bakaeen, Faisal G; Chu, Danny; Kelly, Rosemary F; Holman, William L; Jessen, Michael E; Ward, Herbert B

2014-04-01

374

Effect of Obesity on Mortality and Morbidity After Coronary Artery Bypass Grafting Surgery in Iranian Patients  

PubMed Central

Background: Recent years have witnessed the emergence of obesity as a major public health concern. The drastic rise in obesity and its concomitant co-morbidities is a reflection of the recent changes in dietary habits in Iran and many other developing countries. A recent large population study in Tehran reported that 58% and 75% of middle-aged Iranian men and women, respectively, were either overweight or obese. Objectives: Considering the impact of obesity on mortality and morbidity after coronary artery bypass graft surgery (CABG), we sought to investigate the association between central obesity and the body mass index (BMI) and the post-CABG mortality and morbidity in Iranian patients. Patients and Methods: This prospective study was on 235 adult patients scheduled for isolated CABG in a university hospital. The patients were divided in two groups according to BMI ? 30 (obese; n = 60) and BMI < 30 (non-obese; n = 175). In-hospital and late (after 3 months) morbidity and mortality rates were compared between obese and non-obese patients. Results: A total of 235 patients (135 women) with a mean age of 59 ± 9.2 years (range = 29 to 79 years), mean BMI of 27.3 ± 4.2 (range = 17 to 40), and mean waist circumference of 101.2 ± 14.7 cm (range = 55 to 145 cm) were included. By the third postoperative month, wound infection had significantly increased in patients with BMI ? 30 (P = 0.022). In-hospital and late morbidity and mortality rates were comparable between the two groups (P > 0.05). Conclusions: In our patients obesity was a risk factor for wound infection but not atelectasis or the need for intra-aortic balloon pump or re-exploration. Obesity was not associated with increased in-hospital or 3 months mortality rates after CABG.

Ardeshiri, Maryam; Faritous, Zahra; Ojaghi Haghighi, Zahra; Hosseini, Shirin; Baghaei, Ramin

2014-01-01

375

Perioperative Outcomes after On- and Off-Pump Coronary Artery Bypass Grafting  

PubMed Central

Although numerous reports describe the results of off-pump coronary artery bypass grafting (CABG) at specialized centers and in select patient populations, it remains unclear how off-pump CABG affects real-world patient outcomes. We conducted a large, multicenter observational cohort study of perioperative death and morbidity in on-pump (ON) versus off-pump (OFF) CABG. We reviewed Veterans Affairs Surgical Quality Improvement Program data for all patients (N=65,097) who underwent isolated CABG from October 1997 through April 2011 (intention-to-treat data were available from 2005 onward). The primary outcome was perioperative (30-day or in-hospital) death; the secondary outcomes were perioperative stroke, dialysis dependence, reoperation for bleeding, mechanical circulatory support, myocardial infarction, ventilator support ?48 hr, and mediastinitis. Propensity scores calculated from age, 17 preoperative risk factors, and year of surgery were used to match 8,911 OFF with 26,733 ON patients. In the complete cohort, compared with the ON patients (n=53,468), the OFF patients (n=11,629) had less perioperative death (2.02% vs 2.53%, P=0.0012) and lower incidences of all morbidities except perioperative myocardial infarction. In the matched cohort, perioperative death did not differ significantly between OFF and ON patients (1.94% vs 2.28%, P=0.06), but the OFF group had lower incidences of all morbidities except for perioperative myocardial infarction and mediastinitis. A subgroup intention-to-treat analysis yielded similar but smaller outcome differences between the ON and OFF groups. Off-pump CABG might be associated with decreased operative morbidity but did not affect operative death, compared with on-pump CABG. Future studies should examine the effect of off-pump CABG on long-term outcomes.

Bakaeen, Faisal G.; Chu, Danny; Kelly, Rosemary F.; Holman, William L.; Jessen, Michael E.; Ward, Herbert B.

2014-01-01

376

Screening preoperative Peptide biomarkers for predicting postoperative myocardial infarction after coronary artery bypass grafting.  

PubMed

Postoperative myocardial infarction (PMI) is one of the most serious complications of cardiac surgeries. No preoperative biomarker is currently available for predicting PMI after cardiac surgeries. In the present study, we used a phage display peptide library to screen potential preoperative peptide biomarkers for predicting PMI after coronary artery bypass grafting (CABG) surgery. Twenty patients who developed PMI after CABG and 20 age-, sex-, and body mass index-matched patients without PMI after CABG were enrolled as a discovery cohort. Another 50 patients who developed PMI after CABG and 50 randomly selected patients without PMI after CABG were enrolled as a validation cohort to validate the potential peptide biomarkers identified in the discovery cohort. Fifty randomly selected healthy volunteers were also enrolled in the validation phase as a healthy control group. In the discovery/screening phase, 17 out of 20 randomly selected phage clones exhibited specific reaction with purified sera IgG from the PMI group, among which 11 came from the same phage clone with inserted peptide sequence GVIMVIAVSCVF (named PMI-1). In the validation phase, phage ELISA showed that serum IgG from 90% of patients in the PMI group had a positive reaction with PMI-1; in contrast, only 14% and 6% of patients in the non-PMI group and the healthy control group had a positive reaction with PMI-1, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the PMI-1 phage clone to preoperatively identify patients who would develop PMI after CABG were 90.0%, 86.0%, 86.5, 89.5% and 88.0%, respectively. The absorbance value of the PMI-1 phage clone showed statistically significant correlation with the peak postoperative serum cardiac troponin I level (r?=?0.349, p?=?0.012) in the PMI group. In conclusion, we for the first time identified a mimic peptide (PMI-1) with high validity in preoperative prediction of PMI after CABG. PMID:24979051

Jiang, Zhibin; Hu, Ping; Liu, Jianxin; Wang, Dianjun; Jin, Longyu; Hong, Chao

2014-01-01

377

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

PubMed Central

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

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

2010-01-01

378

Screening Preoperative Peptide Biomarkers for Predicting Postoperative Myocardial Infarction after Coronary Artery Bypass Grafting  

PubMed Central

Postoperative myocardial infarction (PMI) is one of the most serious complications of cardiac surgeries. No preoperative biomarker is currently available for predicting PMI after cardiac surgeries. In the present study, we used a phage display peptide library to screen potential preoperative peptide biomarkers for predicting PMI after coronary artery bypass grafting (CABG) surgery. Twenty patients who developed PMI after CABG and 20 age-, sex-, and body mass index-matched patients without PMI after CABG were enrolled as a discovery cohort. Another 50 patients who developed PMI after CABG and 50 randomly selected patients without PMI after CABG were enrolled as a validation cohort to validate the potential peptide biomarkers identified in the discovery cohort. Fifty randomly selected healthy volunteers were also enrolled in the validation phase as a healthy control group. In the discovery/screening phase, 17 out of 20 randomly selected phage clones exhibited specific reaction with purified sera IgG from the PMI group, among which 11 came from the same phage clone with inserted peptide sequence GVIMVIAVSCVF (named PMI-1). In the validation phase, phage ELISA showed that serum IgG from 90% of patients in the PMI group had a positive reaction with PMI-1; in contrast, only 14% and 6% of patients in the non-PMI group and the healthy control group had a positive reaction with PMI-1, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the PMI-1 phage clone to preoperatively identify patients who would develop PMI after CABG were 90.0%, 86.0%, 86.5, 89.5% and 88.0%, respectively. The absorbance value of the PMI-1 phage clone showed statistically significant correlation with the peak postoperative serum cardiac troponin I level (r?=?0.349, p?=?0.012) in the PMI group. In conclusion, we for the first time identified a mimic peptide (PMI-1) with high validity in preoperative prediction of PMI after CABG.

Jiang, Zhibin; Hu, Ping; Liu, Jianxin; Wang, Dianjun; Jin, Longyu; Hong, Chao

2014-01-01

379

Evaluating the relative frequency and predicting factors of acute renal failure following coronary artery bypass grafting  

PubMed Central

BACKGROUND Renal dysfunction or acute renal failure in patients undergoing coronary artery bypass grafting (CABG) is an important cause of morbidity and mortality. The great impact of acute renal failure (ARF) in the outcomes of cardiac surgery demands its study in our population, encouraging to the elaboration of this study, which aimed to identify the incidence and risk factors of ARF after CABG. METHODS Since March 2010 to 2011, 589 patients were studied who underwent CABG in Sina Hospital (Isfahan, Iran). In this cross-sectional study, patients were divided into two groups based on the occurrence of ARF after CABG and measured variables were compared between the two groups was also statistically significant. P value less than 0.05 was set as a significant level. RESULTS A total of 434 men and 155 women were enrolled in the study. The mean age of the study subjects was 57.6 years. ARF was seen in about 22% of patients after CABG. The mean age of ARF group was more than 3 years higher than that in the other group and the difference was significant between the two groups. Serum creatinine level after the surgery was different between the two groups. Moreover, the history of diabetes mellitus was significantly different between the two groups. Pump time comparison also showed was also statistically significant. CONCLUSION Our data showed older patients were more prone to affected by ARF. In addition, diabetic patients should be considered as high risk patients and are more likely to deteriorate by ARF. Despite increased prevalence of renal insufficiency in CABG patients, studies show that in most cases, this is not a serious problem and it is easily treatable. A lower proportion of patients (1.0 to 1.7% in different large series) develop ARF severe enough to require dialysis.

Mirmohammad-Sadeghi, Mohsen; Naghiloo, Ali; Najarzadegan, Mohammad Reza

2013-01-01

380

Myocardial perfusion as an indicator of graft patency after coronary artery bypass surgery. [Thallium 201  

SciTech Connect

Stress and resting myocardial perfusion were assessed in 38 patients who received 96 grafts. Stress perfusion was evaluated with thallium-201 and resting myocardial blood flow distribution with radiolabeled particles. When both stress and rest perfusion were normal, graft patency was 82% (51 of 62 grafts). Graft patency was also high (81%, 13 of 16) in areas where stress perfusion abnormalities resolved or become less apparent at rest. However, when stress perfusion defects remained unchanged at rest, the graf was likely to be occuluded (73%, 11 of 15). Maintenance of normal rest perfusion or improvement of rest perfusion postoperatively was also associated with a high graft patency rate (80%, 35 of 44), whereas the development of new rest perfusion defects postoperatively implied graft occlusion (86%, six of seven).

Kolibash, A.J.; Call, T.D.; Bush, C.A.; Tetalman, M.R.; Lewis, R.P.

1980-05-01

381

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

PubMed

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

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

2014-01-01

382

A meta-analysis of minimally invasive versus traditional open vein harvest technique for coronary artery bypass graft surgery.  

PubMed

The long saphenous vein remains the most commonly used conduit in coronary artery bypass surgery. Vein harvest is a critical component of this operation with significant morbidity associated with large leg wounds from open techniques. Here, we analyse the available literature comparing minimally invasive techniques vs. the traditional open method for vein harvest. A systematic literature search of Medline, Embase and Cochrane databases was performed using the following terms; 'saphenous vein', 'coronary artery bypass', 'tissue and organ harvesting' and 'endoscopic'. Relevant papers were then analysed using Statsdirect software. There was significantly reduced leg wound infection, leg wound haematoma and postoperative pain in the minimally invasive group. There was no statistical difference between the groups for vein harvest time, length of hospital stay and incidence of vein injury. There was a significantly reduced long-term graft patency in veins harvested by a minimally invasive technique. The results of this meta-analysis demonstrate the operative advantages of minimally invasive techniques for the purposes of vein harvest in coronary artery bypass surgery. However, further studies are required to look at long-term graft patency following minimally invasive vein harvest as this remains a major concern. PMID:19942633

Markar, Sheraz R; Kutty, Ramesh; Edmonds, Lyn; Sadat, Umar; Nair, Sukumaran

2010-02-01

383

Fenestrated Stent Graft Repair of Abdominal Aortic Aneurysm: Hemodynamic Analysis of the Effect of Fenestrated Stents on the Renal Arteries  

PubMed Central

Objective We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Materials and Methods Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients' treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Results Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Conclusion Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair.

Chaichana, Thanapong

2010-01-01

384

[The surgical technique of heart displacement during off-pump coronary artery bypass grafting in the exposure of the anastomotic site of posterior descending artery].  

PubMed

Heart displacement during off-pump coronary artery bypass grafting (OPCAB) is necessary to expose the anastomotic site. However, such displacement causes hemodynamic deterioration especially in the exposure of the circumflex branches and posterior descending artery (PDA). In this study we present two different cardiac positioning for the exposure of the anastomotic site of PDA. To expose the mid-portion of PDA the heart is vertically displaced by fixing the suction cup of the heart positioner on apex. To expose the proximal portion of PDA the suction cup is attached on the acute margin of the right ventricle (off apex). By using these 2 different techniques properly, hemodynamic deterioration can be avoided during OPCAB for PDA. PMID:12910941

Nishimura, Y; Okamura, Y; Fujiwara, K; Sekii, H; Yamamoto, S; Tonda, H; Toguchi, K

2003-07-01

385

Acute kidney injury associated with rhabdomyolysis after coronary artery bypass graft: a case report and review of the literatures  

PubMed Central

Background Post-operative rhabdomyolysis is a well-known complication, especially after bariatric and orthopaedic surgeries. There are few published reports of rhabdomyolysis following cardiac surgery. Acute kidney injury had been distinguished as a serious complication of cardiac surgery. We report a case of 55-years-old male patient who developed rhabdomyolysis precipitated acute kidney injury after coronary artery bypass graft. Case presentation The patient underwent urgent coronary artery bypass graft surgery, with a long duration of surgery due to technical difficulty during grafting. He developed rhabdomyolysis induced acute kidney injury necessitating hemodialysis. The patient in turn developed heart failure, which along with acute kidney injury lead to prolonged ventilation. There was supervening sepsis with prolonged intensive care unity stay and eventually prolonged hospitalization. The peak creatine kinase level was 39000 IU/mL and peak myoglobin was 40000 ng/ml. Reviewing the patient, surgery was prolonged due to technical difficulties encountered during grafting, leading to rhabdomyolysis induced acute kidney injury. The pre-operative use of statins by the patient could also have contributed to the development of rhabdomyolysis. He developed post-operative right heart failure and sepsis. The patient’s renal function gradually improved over 4 week’s duration. Favorable outcome could be achieved but after prolonged course of renal replacement therapy in the form of hemodialysis. Conclusion Prolonged duration of surgery is a well-recognized risk factor in the development of rhabdomyolysis. Early recognition of rhabdomyolysis induced acute kidney injury is important in reducing the post-operative morbidity and mortality in patients. A protocol based approach could be applied for early recognition and management.

2014-01-01

386

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

Microsoft Academic Search

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

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

2003-01-01

387

[Coronary Artery Spasm Induced by Neuroleptic Malignant Syndrome During Off-pump Coronary Artery Bypass Grafting;Report of a Case].  

PubMed

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

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

2014-03-01

388

Vascular smooth muscle contraction\\/relaxation of rat carotid artery is not altered by bone grafting substitutes in vitro  

Microsoft Academic Search

Purpose  The aim of this study was to explore the effects of various bone grafting substitutes (Osteosponge®, Perioglas®, Tutoplast\\u000a ®, and Surgibone®) on vascular smooth muscle tonus.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Bilateral carotid arteries were removed from rats and contraction\\/relaxation of isolated vessel rings were measured before\\u000a and after contact with the biomaterials and then, for dose-dependent epinephrine and papaverin administrations, by a force\\u000a displacement

Ahmet Atila Ertan; Nilufer Celebi Beriat; Aylin Gürpinar; Mehmet Ali Onur; Murat Cavit Cehreli

2010-01-01

389

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

PubMed

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

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

2008-04-01

390

Accuracy of serial myocardial perfusion scintigraphy with /sup 201/Tl for prediction of graft patency early and late after coronary artery bypass surgery. A controlled prospective study  

SciTech Connect

To assess the accuracy of serial myocardial perfusion scintigraphy with /sup 201/Tl to predict graft patency early and late coronary artery bypass surgery, rest and exercise /sup 201/Tl and coronary arteriography were performed preoperatively and 2 weeks and 1 year after operation. The scintigraphic results were compared with graft patency, symptoms, left ventricular function and physical work capacity in a consecutive series of 55 patients with a total of 154 grafts. Serial /sup 201/Tl had an 80% sensitivity, 88% specificity and 86% overall accuracy in detecting or excluding graft occlusion, which was predicted by reversible ischemia as well as persistent new scar segments. Occluded grafts were correctly localized by /sup 201/Tl scintigraphy in 61%. Postoperative apical /sup 201/Tl defects were frequent (two-thirds of cases), and were the result of intraoperative transapical venting of the left ventricle. After coronary bypass graft surgery, ejection fraction at rest was unchanged. Left ventricular end-diastolic pressure and physical work capacity improved significantly. In the presence of new perfusion defects detected postoperatively, physical work capacity was reduced significantly. New /sup 201/Tl defects in addition to typical or atypical angina provided a high probability of graft occlusion, while in the absence of new /sup 201/Tl defects all grafts were patent in more than 90% of patients, all of whom had no or only atypical chest pain. We conclude that serial /sup 201/Tl imaging after coronary artery bypass surgery is an accurate noninvasive method that can be used routinely to assess graft function, to localize spatially occluded grafts and to identify patients with a high likelihood of graft occlusion who may need invasive studies.

Pfisterer, M.; Emmenegger, H.; Schmitt, H.E.; Mueller-Brand, J.; Hasse, J.; Graedel, E.; Laver, M.B.; Burckhardt, D.; Burkart, F.

1982-11-01

391

Impact of dual antiplatelet therapy on outcomes among aspirin-resistant patients following coronary artery bypass grafting.  

PubMed

Coronary artery bypass grafting is pivotal in the contemporary management of complex coronary artery disease. Interpatient variability to antiplatelet agents, however, harbors the potential to compromise the revascularization benefit by increasing the incidence of adverse events. This study was designed to define the impact of dual antiplatelet therapy (dAPT) on clinical outcomes among aspirin-resistant patients who underwent coronary artery surgery. We randomly assigned 219 aspirin-resistant patients according to multiple electrode aggregometry to receive clopidogrel (75 mg) plus aspirin (300 mg) or aspirin-monotherapy (300 mg). The primary end point was a composite outcome of all-cause death, nonfatal myocardial infarction, stroke, or cardiovascular hospitalization assessed at 6 months postoperatively. The primary end point occurred in 6% of patients assigned to dAPT and 10% of patients randomized to aspirin-monotherapy (relative risk 0.61, 95% confidence interval 0.25 to 1.51, p = 0.33). No significant treatment effect was noted in the occurrence of the safety end point. The total incidence of bleeding events was 25% and 19% in the dAPT and aspirin-monotherapy groups, respectively (relative risk 1.34, 95% confidence interval 0.80 to 2.23, p = 0.33). In the subgroup analysis, dAPT led to lower rates of adverse events in patients with a body mass index >30 kg/m(2) (0% vs 18%, p <0.01) and those <65 years (0% vs 10%, p = 0.02). In conclusion, the addition of clopidogrel in patients found to be aspirin resistant after coronary artery bypass grafting did not reduce the incidence of adverse events, nor did it increase the number of recorded bleeding events. dAPT did, however, lower the incidence of the primary end point in obese patients and those <65 years. PMID:24666617

Gasparovic, Hrvoje; Petricevic, Mate; Kopjar, Tomislav; Djuric, Zeljko; Svetina, Lucija; Biocina, Bojan

2014-05-15

392

Risk factors for endotracheal re-intubation following coronary artery bypass grafting  

PubMed Central

Background Endotracheal re-intubation following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for re-intubation following CABG. This study aimed to evaluate the independent risk factors for re-intubation following CABG. Methods The pre-, intra-, and post-operative materials in patients who had selective and isolated CABG performed on them from January 2004 to July 2012 in our hospital were analyzed retrospectively. Unvariate analysis and logistic regression were used to analyze the risk factor of postoperative re-intubation following CABG. Results Among the 1,244 patients investigated, 97 cases suffered from postoperative re-intubation, and the incidence rate of postoperative re-intubation was 7.8%. The in-hospital mortality in the re-intubation group was significantly higher than that in the non-re-intubation group (9.3% versus 1.4%, P?=?0.004). Re-intubation also correlated with many negative outcomes such as pneumonia, tracheotomy, acute renal failure, infection of incision, prolonged mechanical ventilation time, prolonged intensive care unit (ICU) stay and prolonged hospital stay. The most commonly cause of re-intubation after CABG was hypoxemia due to cardiogenic and noncardiogenic disease, which accounted for 72.2%. The relative factors of postoperative re-intubation were tested through unvariate analysis and logistic regression, and the associated factors were obtained. The associated factors for re-intubation following CABG included preoperative chronic obstructive pulmonary disease (COPD) (OR?=?2.134, 95% CI?=?1.472-2.967), preoperative congestive heart failure (CHF) (OR?=?2.325, 95% CI?=?1.512-3.121), postoperative relative hypoxemia (OR?=?2.743, 95% CI?=?1.657-3.326), postoperative acute kidney injury (AKI) (OR?=?2.976, 95% CI?=?2.127-4.023), postoperative total mechanical ventilation time (OR?=?1.976, 95% CI?=?1.347-2.645). Conclusion Preoperative COPD, preoperative CHF, postoperative relative hypoxemia, postoperative AKI and postoperative total mechanical ventilation time were five independent risk factors for re-intubation following CABG.

2013-01-01

393

Surgical site infections following coronary artery bypass graft procedures: 10 years of surveillance data  

PubMed Central

Background Surgical site infections following coronary artery bypass graft (CABG) procedures pose substantial burden on patients and healthcare systems. This study aims to describe the incidence of surgical site infections and causative pathogens following CABG surgery over the period 2003–2012, and to identify risk factors for complex sternal site infections. Methods Routine computerised surveillance data were collected from three public hospitals in Queensland, Australia in which CABG surgery was performed between 2003 and 2012. Surgical site infection rates were calculated by types of infection (superficial/complex) and incision sites (sternal/harvest sites). Patient and procedural characteristics were evaluated as risk factors for complex sternal site infections using a logistic regression model. Results There were 1,702 surgical site infections (518 at sternal sites and 1,184 at harvest sites) following 14,546 CABG procedures performed. Among 732 pathogens isolated, Methicillin-sensitive Staphylococcus aureus accounted for 28.3% of the isolates, Pseudomonas aeruginosa 18.3%, methicillin-resistant Staphylococcus aureus 14.6%, and Enterobacter species 6.7%. Proportions of Gram-negative bacteria elevated from 37.8% in 2003 to 61.8% in 2009, followed by a reduction to 42.4% in 2012. Crude rates of complex sternal site infections increased over the reporting period, ranging from 0.7% in 2004 to 2.6% in 2011. Two factors associated with increased risk of complex sternal site infections were identified: patients with an ASA (American Society of Anaesthesiologists) score of 4 or 5 (reference score of 3, OR 1.83, 95% CI 1.36-2.47) and absence of documentation of antibiotic prophylaxis (OR 2.03, 95% CI 1.12-3.69). Conclusions Compared with previous studies, our data indicate the importance of Gram-negative organisms as causative agents for surgical site infections following CABG surgery. An increase in complex sternal site infection rates can be partially explained by the increasing proportion of patients with more severe underlying disease.

2014-01-01

394

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

PubMed Central

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

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

2013-01-01

395

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

PubMed Central

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

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

2001-01-01

396

Bilateral Vertebral Artery Dissecting Aneurysms Presenting with Subarachnoid Hemorrhage Treated by Staged Coil Trapping and Covered Stents Graft  

PubMed Central

The treatment of bilateral vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid hemorrhage (SAH) is still challenging. The authors report a rare case of bilateral VADA treated with coil trapping of ruptured VADA and covered stents implantation after multiple unsuccessful stent assisted coiling of the contralateral unruptured VADA. A 44-year-old woman was admitted to our hospital because of severe headache and sudden stuporous consciousness. Brain CT showed thick SAH and intraventricular hemorrhage. Cerebral angiography demonstrated bilateral VADA. Based on the SAH pattern and aneurysm configurations, the right VADA was considered ruptured. This was trapped with endovascular coils without difficulty. One month later, the contralateral unruptured VADA was protected using a stent-within-a-stent technique, but marked enlargement of the left VADA was detected by 8-months follow-up angiography. Subsequently two times coil packing for pseudosacs resulted in near complete occlusion of left VADA. However, it continued to grow. Covered stents graft below the posterior inferior cerebellar artery (PICA) origin and a coronary stent implantation across the origin of the PICA resulted in near complete obliteration of the VADA. Covered stent graft can be used as a last therapeutic option for the management of VADA, which requires absolute preservation of VA flow.

Shim, Jai-Joon; Kim, Sung-Ho; Chang, Jae-Chil

2012-01-01

397

Results of coronary artery bypass grafting alone and combined with surgical ventricular reconstruction for ischemic heart failure.  

PubMed

In this study, we included 236 patients with ischemic heart failure and ejection fraction (EF) <35% who underwent surgical treatment. Patients were randomized in two groups. There were 116 patients who underwent coronary artery bypass grafting (CABG) with surgical ventricular reconstruction (SVR) and 120 patients who underwent CABG alone. The hospital mortality rate was 5.8% after isolated CABG and 3.5% after CABG combined with SVR. All survivors had follow-up investigation from four months to five years, with a mean follow-up time of 31±13 months. The mean New York Heart Association (NYHA) functional class decreased from 2.9±0.5 to 2.2±0.7 one year after CABG and from 3.1±0.4 to 2.0±0.6 one year after CABG with SVR. We showed that left ventricular reconstruction significantly decreased EDV from 237±52 to 176±30 and correspondingly increased EF from 32±6 to 39±9. However, after isolated CABG EF did not increase significantly (32±7 preoperatively and 34±11 postoperatively). One- and three-year rates were 95% and 78% after SVR with CABG and 83% and 78% after CABG alone. Despite the more aggressive surgical strategy, left ventricular reconstruction did not increase operative mortality and early results were significantly effective compared with coronary artery bypass grafting alone. PMID:21402600

Marchenko, Andrey; Chernyavsky, Alexander; Efendiev, Vidady; Volokitina, Tanya; Karaskov, Alexander

2011-07-01

398

Saphenous vein graft failure and clinical outcomes: Toward a surrogate end point in patients following coronary artery bypass surgery?  

PubMed Central

Saphenous vein graft (SVG) failure is a common finding in patients following coronary artery bypass graft (CABG) surgery. In the literature SVG failure rates have been reported from 25 to over 50% within 10 years. Although common, it remains unclear to what extent SVG failure affects clinical outcome, due to differences in definition, patient selection and follow-up. Particularly the lack of agreement on a universal definition makes comparisons between studies, and therefore generalizability of associations with outcomes, challenging. We suggest using a definition of SVG failure that is based on imaging as well as clinical parameters, that includes reporting SVG failure on both graft and patient level. The use of non-invasive imaging may help improve follow-up rates, and provide a more accurate picture of the real incidence and clinical impact of SVG failure. Given the lack of supportive evidence showing a consistent association between SVG failure and major adverse cardiovascular events, SVG failure should not be considered a valid surrogate endpoint at this time.

Harskamp, Ralf E.; Williams, Judson B.; Hill, Ronald C.; de Winter, Robbert J.; Alexander, John H.; Lopes, Renato D.

2014-01-01

399

Retrograde versus antegrade delivery of cardioplegic solution in myocardial revascularization. A clinical trial in patients with three-vessel coronary artery disease who underwent myocardial revascularization with extensive use of the internal mammary artery.  

PubMed

The effects of retrograde and antegrade delivery of cardioplegic solution on myocardial function were evaluated and compared in 60 patients who underwent myocardial revascularization. All patients had three-vessel coronary artery disease, and the revascularization was done with extensive use of the internal mammary artery. Seventy-five percent of the distal anastomoses were performed with the internal mammary artery. Myocardial protection consisted of St. Thomas' Hospital cardioplegic solution, topical slushed ice, and systemic hypothermia (28 degrees C). The patients were randomly separated into two groups: group A (n = 30), who received antegrade cardioplegia, and group B (n = 30), who received retrograde cardioplegia. With the exception of the total dose of cardioplegic solution (p = 0.02), there was no significant difference between the two groups that concerned septal myocardial temperature at the moment of asystole and after infusion of the total dose of cardioplegic solution. Cardiac function was assessed before and after the patient was weaned from cardiopulmonary bypass. In the immediate postoperative period there was a significant increase in right atrial pressure of the patients who underwent antegrade cardioplegia. For the other registered parameters there was no significant difference either in the immediate postoperative period or 6 hours later. Release of creatine kinase MB isoenzyme was the same in the two groups. Clinical outcome in terms of mortality, prevalence of perioperative infarction, prevalence of low cardiac output, and rhythm and conduction disturbances was similar in both groups. Technical problems related to cannulation and decannulation of the coronary sinus were not encountered. Multivariate analysis showed that occlusion of the left anterior descending coronary artery (p = 0.012) is an essential contraindication of antegrade delivery of cardioplegic solution. Analysis of the patients with an occlusion of the left anterior descending coronary