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1

Sequential internal mammary artery grafts: clinical and angiographic assessment.  

PubMed

Between January 1988 and August 1992, the internal mammary artery was used as a sequential graft to the left anterior descending artery and/or diagonal branch in 34 patients. One patient died in hospital. After surgery all survivors were free from angina for a follow-up of up to 4 years. Recatheterization was performed in 33 patients within 1 year of surgery. Postoperative angiography showed that 65 anastomoses (98%) were patent, but three patent grafts (5%) between the proximal and distal sequential anastomoses showed 'string sign'. It is important to prevent 'string sign' in sequential grafting. It is considered that sequential internal mammary artery grafting should be limited to coronary arteries with severe stenosis that divides anastomosed coronary arteries into two. PMID:8076130

Tashiro, T; Todo, K; Haruta, Y; Yasunaga, H; Tachikawa, Y

1993-12-01

2

A meta-analysis comparing bilateral internal mammary artery with left internal mammary artery for coronary artery bypass grafting  

PubMed Central

Background Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over left internal mammary artery (LIMA) for coronary artery bypass grafting (CABG). We performed an updated meta-analysis of published studies comparing BIMA versus LIMA in CABG operations and assessed differences in long-term survival. Methods Electronic searches for studies comparing BIMA versus LIMA were performed using three databases from 1972 to December 2012. Studies with at least four years of follow-up and at least 100 patients in each group were included for review. We used a random-effect model and pooled hazard ratios from across all included studies. Results No randomized controlled trials and 27 observational studies totaling 79,063 patients (19,277 BIMA, 59,786 LIMA) were included for final analysis. The BIMA group demonstrated significantly better long-term survival than the LIMA group [hazard ratio, 0.78; confidence interval, 0.72-0.84; P<0.00001]. Conclusions In an updated meta-analysis, we demonstrate an increase in long-term survival in patients receiving BIMA as a primary grafting strategy over those receiving a LIMA. Although no randomized controlled trials were included in this meta-analysis, the survival benefit seen with a BIMA cannot be overlooked when determining which operation to perform in CABG patients. Until the long-term results of the ART trial are published, we offer best available evidence in favor of BIMA over LIMA for CABG surgery.

Zhao, Shan; Tian, David H.; Taggart, David P.; Yan, Tristan D.

2013-01-01

3

Effect of pleurotomy on pulmonary function after coronary artery bypass grafting with internal mammary artery.  

PubMed

Coronary artery by-pass grafting with internal mammary artery (IMA) has become the graft conduit of choice, due to improved survival and its long term patency rate. However, some studies have shown that, in comparison with saphenous vein grafts, after IMA grafting, there is increased postoperative impairment of pulmonary function, possibly due to the frequent performance of pleurotomy. In 57 consecutive patients, admitted for elective CABG with IMA, we prospectively evaluated the early (2nd and 6th day) postoperative chest X-ray complications and the late (2 months) respiratory function tests changes. Thirty-two patients had been subjected to pleurotomy (group 1) and 25 not (group 2). The incidence of pulmonary atelectasis and pleural effusion in 2nd and in 6th postoperative days was not different in the two groups: 22 vs. 19%, 74 vs. 52% in 2nd, and 29 vs. 19%, 48 vs. 38% in 6th postoperative day respectively. The incidence of elevated hemidiaphragm in 6th postoperative day was not different in the two groups (18.5 vs. 14%). Two months after surgery the mean values of spirometric tests were significantly lower than the preoperative values: VC from 88.5 +/- 1.26 to 80 +/- 1.65% of predicted, P < 0.001, FEV1 from 96.1 +/- 1.27 to 84.7 +/- 1.73% of predicted, P < 0.001, MEF50 from 84.9 +/- 3.14 to 69.2 +/- 3.18% of predicted, P < 0.001. No significant changes were detected in RV and in AaPO2.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7938791

Rolla, G; Fogliati, P; Bucca, C; Brussino, L; Di Rosa, E; Di Summa, M; Comoglio, C; Malara, D; Ottino, G M

1994-07-01

4

Beating heart bentall procedure for late type A aortic dissection in a patient with in-situ bilateral mammary artery bypass grafts.  

PubMed

We report a case of a patient who had a type A aortic dissection after previous coronary bypass grafting. The in-situ right mammary artery had been anastomosed with the left anterior descending artery, the left mammary artery had been anastomosed to the obtuse marginal, and a vein graft had been used for the right coronary artery. All grafts were patent. The patients underwent a Bentall procedure on perfused heart. PMID:20536996

Dell'Amore, Andrea; Fedeli, Corrado; Zanoni, Silvia; Albertini, Alberto

2010-05-01

5

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

PubMed Central

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.???Keywords: blood flow; coronary artery disease; coronary artery bypass graft; echocardiography

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

2001-01-01

6

Dopexamine increases internal mammary artery blood flow following coronary artery bypass grafting  

Microsoft Academic Search

Objective: Vasoactive agents and inotropes influence conduit-coronary blood flow following coronary artery bypass grafting (CABG). It was hypothesized that dopexamine hydrochloride, a dopamine A-1 (DA-1) and ?2 agonist would increase conduit-coronary blood flow. A prospective randomized double blind clinical trial was carried out to test this hypothesis. DA-1 receptors have previously been localized to human left ventricle. Methods: Twenty-six American

Michael J. Flynn; Desmond Winters; Patrick Breen; Gerry O'Sullivan; George Shorten; Damien O'Connell; Aonghus O'Donnell; Thomas Aherne

2003-01-01

7

Hemodynamic Effects of Left Upper Extremity Arteriovenous Fistula on Ipsilateral Internal Mammary Coronary Artery Bypass Graft.  

PubMed

Objective?Arteriovenous fistula (AVF) in patients undergoing hemodialysis (HD) may cause coronary left internal mammary artery (IMA) steal. This phenomenon was demonstrated by few prospective studies with limited number of patients and case reports. We aimed to demonstrate with a relatively larger patient population that the AVF may cause ipsilateral IMA steal.Methods?We included 22 prospective patients undergoing HD who had left IMA to left anterior descending artery graft and left upper limb AVF. Right IMA was taken as control. Flows were assessed by using color Doppler ultrasonography.Results?The mean age was 57.8?±?9 years. Statistically nonsignificant increases in AVF flow and decreases in left IMA flow were observed during HD compared with pre-HD. Moreover, fistula localization did not affect median left IMA flows (for peak systolic velocity [PSV] 43.7 versus 70 cm/s, respectively; p?=?0.7, and for end diastolic velocity [EDV] 3.4 versus 6.5 cm/s, respectively; p?=?0.7). We have not detected significant difference in left IMA flows during HD (median values of PSV 58.4 versus 68.4 cm/s, respectively; p?=?0.1, and EDV 6.4 versus 4.4 cm/s, respectively; p?=?0.08). Only three patients experienced dialysis-induced reduction of ipsilateral IMA flow that was accompanied by evidence of hypokinesia of the anterior left ventricular wall without clinical angina.Conclusions?Hemodynamically affected left IMA flow by ipsilateral upper extremity AVF may cause steal phenomenon. Hemodynamic differences between left and right IMAs in patients undergoing HD via left wrist and brachial fistulae are limited. PMID:23344763

Coskun, Isa; Colkesen, Yucel; Altay, Hakan; Ozkan, Ugur; Demirturk, O Saim; Gulcan, Oner; Guvener, Murat

2013-01-23

8

Differential reactivity of human mammary artery and saphenous vein to prostaglandin E2: Implication for cardiovascular grafts  

PubMed Central

BACKGROUND AND PURPOSE Human internal mammary arteries (IMA) and saphenous veins (SV) are frequently used for coronary artery bypass graft surgery. Intra- and postoperatively, the bypass grafts are exposed to inflammatory conditions, under which there is a striking increase in the synthesis of prostaglandin E2 (PGE2). In this context, the physiological response of these vascular grafts to PGE2 is highly relevant. The aim of this study was thus to characterize the PGE2 receptor subtypes (EP1, EP2, EP3 or EP4) involved in modulation of the vascular tone in these two vessels. EXPERIMENTAL APPROACH Rings of IMA and SV were prepared from 48 patients. The rings were mounted in organ baths for isometric recording of tension, and a pharmacological study was performed, together with associated reverse transcriptase PCR and immunohistochemistry experiments. KEY RESULTS PGE2 induced contractions of IMA (Emax= 1.43 ± 0.20 g; pEC50= 7.50 ± 0.10); contractions were also observed with the EP3 receptor agonists, sulprostone, 17-phenyl-PGE2, misoprostol or ONO-AE-248. In contrast, PGE2 induced relaxation of the precontracted SV (Emax=–0.22 ± 0.02 g; pEC50= 7.14 ± 0.09), as did the EP4 receptor agonist, ONO-AE1-329. These results were confirmed by the use of selective EP receptor antagonists (GW627368X, L-826266, ONO-8713, SC-51322) and by molecular biology and immunostaining. CONCLUSIONS AND IMPLICATIONS PGE2 induced potent and opposite effects on the human vascular segments used for grafting, namely vasoconstriction of the IMA and vasodilatation of the SV via EP3 and EP4 receptors respectively. These observations suggest that EP3 and EP4 receptors could constitute therapeutic targets to increase vascular graft patency.

Foudi, N; Kotelevets, L; Gomez, I; Louedec, L; Longrois, D; Chastre, E; Norel, X

2011-01-01

9

Breast necrosis following harvest of internal mammary artery  

Microsoft Academic Search

The use of internal mammary artery is well established not only in cardiac surgery for coronary artery bypass grafting but also in plastic surgery for breast reconstruction with free autologus tissue. The complications that follow harvest of internal mammary artery for heart surgery usually relate to the wound. This case report documents the first case of complete breast infarction following

A Rashid; M Haj Basheer; K Khan

2004-01-01

10

Bilateral internal mammary arteries: evidence and technical considerations.  

PubMed

Bilateral internal mammary artery (BIMA) grafts are used for coronary revascularisation by only a minority of surgeons, despite a growing body of evidence suggesting improved survival when compared to use of only one internal mammary artery with additional saphenous vein grafts. Herein we review the evidence supporting revascularisation with BIMA and suggest reasons why the majority of surgeons use only one internal mammary artery. We discuss technical considerations, various graft combinations and the use of BIMA to facilitate anaortic off-pump coronary artery bypass (OPCAB). PMID:23977638

Vallely, Michael P; Edelman, J James B; Wilson, Michael K

2013-07-01

11

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

12

Bilateral internal thoracic artery grafting  

PubMed Central

The effectiveness of the left internal mammary artery graft to the anterior descending coronary artery as a surgical strategy has been shown to improve the survival rate and decrease the risk of adverse cardiac events in patients undergoing coronary bypass surgery. These clinical benefits appear to be related to the superior short and long-term patency rates of the internal thoracic artery graft. Although the advantages of using of both internal thoracic arteries (ITA) for bypass grafting have taken longer to prove, recent results from multiple data sets now support these findings. The major advantage of bilateral ITA grafting appears to be improved survival rate, while the disadvantages of complex ITA grafting include the increased complexity of operation, and an increased risk of wound complications. While these short-term disadvantages have been mitigated in contemporary surgical practice, they have not eliminated. Bilateral ITA grafting should be considered the procedure of choice for patients undergoing coronary bypass surgery that have a predicted survival rate of longer than ten years.

2013-01-01

13

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

14

The Vasodilator Effects of Clevidipine on Human Internal Mammary Artery  

Microsoft Academic Search

Endothelial dysfunction and platelet activation with thromboxane release may contribute to spasm or al- terations in internal mammary artery (IMA) graft flow during coronary artery surgery. Clevidipine, an ultrashort-acting dihydropyridine calcium channel blocker, is undergoing clinical development, but there are little data regarding its effects on human vascula- ture. We investigated the effects of clevidipine on hu- man IMA obtained

Catherine Huraux; Tetsuji Makita; Fania Szlam; Margareta Nordlander; Jerrold H. Levy

1997-01-01

15

Spontaneous left main coronary artery dissection, possibly due to cystic medial necrosis found in the internal mammary arteries.  

PubMed

A 55-year-old male without previous medical history developed chest pain. Coronary catheterization showed left main coronary dissection. Coronary artery bypass grafting was performed using bilateral internal mammary arteries, which were very fragile. The specimens of the internal mammary arteries sent for pathology showed cystic medial necrosis. PMID:19602495

Hirose, Hitoshi; Matsunaga, Iwao; Anjun, Waqas; Strong, Michael D

2009-07-14

16

Arterial grafts: clinical classification and pharmacological management  

PubMed Central

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.

2013-01-01

17

[Angina pectoris due to coronary-subclavian steal syndrome caused by the LIMA graft in the patient after CABG with the use of the right and left mammary artery].  

PubMed

We present a case of a patient with unstable angina pectoris two years after coronary artery by-pass graft surgery with the use of the right and left mammary artery. The symptoms were caused by the critical RIMA stenosis and coronary-subclavian steal syndrome through the LIMA graft. Unsuccessful attempt of percutaneous angioplasty of the closed left subclavian artery was made. The angioplasty of the proximal part of the RIMA with the implantation of a drug eluting stent followed by the angioplasty of both left circumflex artery and obtuse marginal artery with the implantation of bare metal stents was performed. These procedures resulted in disappearance of anginal symptoms. Neurological examination did not reveal any signs of vertebrobasilar steal. PMID:22528725

Balak, Wojciech; Sinkiewicz, W?adys?aw; Krzanowski, Marek; Wróbel, Wojciech; Sinkiewicz, Anna; Banach, Joanna; Soba?ski, Piotr; Suppan, Karol

2012-01-01

18

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

Microsoft Academic Search

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

Valavanur A Subramanian; John C McCabe; Charles M Geller

1997-01-01

19

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

20

Effects of potassium channel opener aprikalim on the receptor-mediated vasoconstriction in the human internal mammary artery  

Microsoft Academic Search

Background. Arterial grafts for coronary artery bypass grafting such as the internal mammary artery (IMA) may develop spasm perioperatively. The purpose of this study was to investigate the effects of the potassium channel opener, aprikalim, on the receptor-mediated vasoconstriction in the human IMA in vitro.Methods. We studied 160 IMA rings taken from coronary artery surgery in organ baths. The interaction

Ming-Hui Liu; H. Storm Floten; Anthony P Furnary; Anthony P. C Yim; Guo-Wei He

2001-01-01

21

Avoidance of patent anterior grafts at revisional coronary artery surgery: use of a lateral thoracotomy approach.  

PubMed Central

The use of a right or left lateral thoracotomy is described as an alternative approach to revisional coronary artery surgery for patients with patent anterior grafts. Five patients underwent successful revisional coronary artery grafting with a total of three internal mammary artery grafts and three saphenous vein grafts. This is a safe technique in patients for whom repeat median sternotomy is potentially hazardous, notably those with patent anterior grafts or close apposition of the heart to the sternal table. Images

Walker, W S; Sang, C T

1986-01-01

22

Ischemia induced by coronary steal through a patent mammary artery side branch: a role for embolization.  

PubMed

Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting. The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing. Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients. PMID:23809629

Moreno, Nuno; da Silva Castro, Alexandra; Pereira, Adriana; Silva, Joćo Carlos; Almeida, Pedro Bernardo; Andrade, Aurora; Maciel, Maria Jślia; Pinto, Paula

2013-06-25

23

Breast reduction surgery after coronary artery bypass grafting  

Microsoft Academic Search

Breast reduction surgery is a frequently performed procedure. Older patients presenting for this surgery may have previously\\u000a undergone coronary artery bypass grafting with harvesting of one or both internal mammary arteries. This may compromise the\\u000a blood supply to the breast. Limiting medial dissection during breast reduction surgery in these women is prudent to prevent\\u000a breast necrosis. A case illustrating this

Amir Ismail; Afshin Mosahebi; Venkat Ramakrishnan

2007-01-01

24

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

25

Protection of the internal mammary artery pedicle with polytetrafluoroethylene membrane.  

PubMed

With increasing frequency, reoperative coronary artery bypass surgery is being performed in the setting of a patent internal mammary artery (IMA) graft. Injury to the IMA graft at reoperation can result in ischemic myocardial injury and cardiac arrest. This descriptive laboratory study examined use of a polytetrafluoroethylene (PTFE) membrane wrap to protect the IMA pedicle during sternal reentry. Six pigs (25-30 kg) underwent median sternotomy and takedown of left and right IMAs. Grafts were implanted in the epicardium by a modified Vineberg procedure. In each animal, one IMA was wrapped circumferentially with PTFE, while the contralateral bare IMA served as the control. Redo sternotomy was performed 3 months later. Severe adhesions between chest wall, myocardium, and bare IMA grafts were encountered in six of six animals. PTFE-wrapped IMAs were easily identified by appearance and by palpation. There was no adherence between PTFE membranes and surrounding tissue, nor was there evidence of cellular infiltration, disruption, or contraction of the membrane. Most notably, PTFE membranes could not be cut or injured with the electrocautery, since they are electrical nonconductors. This study demonstrates that PTFE membrane: (1) is relatively inert and incites minimal surrounding tissue reaction; and (2) is impenetrable to electrocautery injury. Further studies are necessary to determine the impact of PTFE membrane on IMA graft patency and wound infection. PTFE membrane may prove clinically useful in protecting patent IMA pedicles during reoperative cardiac surgery. PMID:8286870

Zehr, K J; Lee, P C; Poston, R S; Gillinov, A M; Hruban, R H; Cameron, D E

1993-11-01

26

Clinical experience with the right gastroepiploic artery in coronary artery bypass grafting.  

PubMed

The excellent long-term results with the internal mammary artery for coronary artery bypass grafting have prompted the search for other conduits with similar characteristics. From December 1989 to December 1991, the right gastroepiploic artery (RGEA) has been used as an in situ graft to the posterior descending coronary artery in 51 patients at the Montreal Heart Institute. The patients' age averaged 50 +/- 11 years. Three-vessel coronary artery disease was present in 41 patients and two-vessel disease in the remaining 10 patients. In all but 1 patient, bilateral internal mammary artery grafting was performed in addition to RGEA grafting. The number of grafts per patient averaged 3.2 +/- 0.8. There was no operative mortality. Morbidity was minimal with only myocardial infarction and a pleural effusion in 1 patient. In 1 patient, a splenectomy had to be performed because of iatrogenic tear during dissection of the RGEA. The average hospital stay was 8.2 +/- 2.6 days. Enteral nutrition was resumed on average 2 days after operation. Angiographic evaluation of RGEA grafts was performed before discharge or within the first month after surgery in 31 patients. In 28 patients (28/31, 90%) the RGEA graft was patent, two grafts were occluded, and in the remaining patient, the graft could not be visualized due to technical difficulties during angiography. A second angiographic evaluation was performed in 5 patients, 1 year after operation. Four RGEAs were patent and 1 was occluded. Clinical follow-up averaged 4 months (range 1 to 15 months).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8239804

Perrault, L P; Carrier, M; Hébert, Y; Hudon, G; Cartier, R; Leclerc, Y; Pelletier, L C

1993-11-01

27

Iatrogenic left internal mammary artery to great cardiac vein anastomosis treated with coil embolization.  

PubMed

Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach. PMID:21430997

Jung, Il Soon; Jeong, Jin-Ok; Kim, Song Soo; Shin, Byung Seok; Shin, Sung Kyun; Park, Yong Kyu; Jin, Seon-Ah; Ahn, Kye Taek; Seong, In-Whan

2011-02-28

28

Robotically-Assisted Coronary Artery Bypass Grafting  

PubMed Central

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

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

2010-01-01

29

Robotically-assisted coronary artery bypass grafting.  

PubMed

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

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

2010-03-18

30

Risks of using internal thoracic artery grafts in patients in chronic hemodialysis via upper extremity arteriovenous fistula  

Microsoft Academic Search

Background—In patients in chronic hemodialysis via upper extremity arteriovenous fistula in whom ipsilateral internal thoracic artery graft was used for myocardial revascularization, hemodynamic interference between the fistula and the graft during dialysis can be hypothesized. Methods and Results—In 5 patients undergoing chronic hemodialysis via upper extremity arteriovenous fistula, ipsilateral to an internal thoracic to left anterior descending graft mammary flow

Mario Gaudino; Michele Serricchio; Nicola Luciani

2003-01-01

31

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

32

Coronary artery bypass grafting using a bifurcating radial artery.  

PubMed

A 61-year-old man with angina pectoris was admitted for elective coronary artery bypass grafting. The left anterior descending artery, and the two posterolateral branches (PLA1 and PLA2) of the circumflex artery required bypass grafting. At operation, the distal portion of the left radial artery was found to bifurcate, both branches having an equal size. We decided to use the bifurcating radial artery as a conduit for bypass grafting to the branches of the left circumflex artery. One distal end of the radial artery was subsequently anastomosed to the PLA1 branch and the other distal end was anastomosed to PLA2. Postoperative coronary angiography showed both branches of the radial artery to have good patency. PMID:17670123

Sakaguchi, Hisashi; Kunitomo, Ryuji; Tsurusaki, Shigeyuki; Kawasuji, Michio

2003-12-01

33

Brachial plexus injury as an unusual complication of coronary artery bypass graft surgery  

PubMed Central

Brachial plexus injury is an unusual and under-recognised complication of coronary artery bypass grafting especially when internal mammary artery harvesting takes place. It is believed to be due to sternal retraction resulting in compression of the brachial plexus. Although the majority of cases are transient, there are cases where the injury is permanent and may have severe implications as illustrated in the accompanying case history.

Chong, A; Clarke, C; Dimitri, W; Lip, G

2003-01-01

34

Testing and treatment of arterial graft thrombosis.  

PubMed

The in vivo technique of Sauvage et al for determining prosthetic arterial graft thrombogenicity was employed in the sheep carotid model using 4 mm commercial expanded polytetrafluoroethylene (Gore-Tex) grafts. Expanded polytetrafluoroethylene was found to be thrombogenic at 4 hours of low flow in this model. At 24 hours all of these grafts were totally occluded at low flow rates. Intravenous use of ibuprofen (Motrin), a thromboxane inhibitor, in this model markedly reduced occlusion and thrombogenicity at 4 and 24 hours. All grafts were patent at 24 hours when ibuprofen was used. PMID:7258507

Carson, S; Demling, R; Esquivel, C; Talken, L; Tillman, P

1981-07-01

35

Coronary subclavian steal syndrome causing acute myocardial infarction in a patient undergoing coronary-artery bypass grafting.  

PubMed

Coronary subclavian steal syndrome with retrograde blood flow in the left internal mammary-coronary bypass graft is a rare but severe complication of cardiac surgery. The authors present a case of a 68-year-old man after coronary-artery bypass grafting using an internal mammary artery. He had been suffering from angina pectoris for the last several years before surgery. The patient was resuscitated at home by emergency medical service because of primary ventricular fibrillation due to an acute myocardial infarction 5 years after surgery. An occlusion of the left subclavian artery with the retrograde blood flow in the left internal mammary coronary bypass was found. This could have been the cause of insufficiency in coronary blood flow and ischemia of the myocardial muscle. The subclavian artery occlusion was successfully treated with percutaneous transluminal angioplasty and implantation of 2 stents. The patient remained free of any symptoms 2 years after this procedure. PMID:22969810

Mandak, Jiri; Lojik, Miroslav; Tuna, Martin; Chek, James Lago

2012-08-30

36

Coronary Subclavian Steal Syndrome Causing Acute Myocardial Infarction in a Patient Undergoing Coronary-Artery Bypass Grafting  

PubMed Central

Coronary subclavian steal syndrome with retrograde blood flow in the left internal mammary-coronary bypass graft is a rare but severe complication of cardiac surgery. The authors present a case of a 68-year-old man after coronary-artery bypass grafting using an internal mammary artery. He had been suffering from angina pectoris for the last several years before surgery. The patient was resuscitated at home by emergency medical service because of primary ventricular fibrillation due to an acute myocardial infarction 5 years after surgery. An occlusion of the left subclavian artery with the retrograde blood flow in the left internal mammary coronary bypass was found. This could have been the cause of insufficiency in coronary blood flow and ischemia of the myocardial muscle. The subclavian artery occlusion was successfully treated with percutaneous transluminal angioplasty and implantation of 2 stents. The patient remained free of any symptoms 2 years after this procedure.

Mandak, Jiri; Lojik, Miroslav; Tuna, Martin; Chek, James Lago

2012-01-01

37

Early and late outcome of skeletonised bilateral internal mammary arteries anastomosed to the left coronary system  

PubMed Central

Objectives: To investigate in a retrospective study the technical aspects of using the in situ bilateral internal mammary arteries (IMAs), with the right IMA (RIMA) used for revascularisation of the circumflex system, and to evaluate early and late outcome. Materials and methods: Between January 1997 and July 2003, 552 consecutive patients underwent grafting of the circumflex artery system with an in situ skeletonised RIMA routed through the transverse sinus (eventually retrocaval). Mean (SD) age was 63.8 (11) years. 331 (60%) patients underwent total arterial myocardial revascularisation. Mean follow up was 26 (9) months. Results: The success rate of skeletonised RIMA grafting to the circumflex branch was 100%. There were 19 (3.4%) in-hospital deaths. Perioperative myocardial infarction occurred in 12 (2.2%) patients. In 155 patients undergoing postoperative angiography, two had an occluded RIMA and a string-like phenomenon was seen in three RIMA and one left IMA (LIMA). Three RIMA and three LIMA had stenotic lesions. The patency rates of RIMA and LIMA were 94% and 97.4%, respectively. Strong predictors of non-functional IMA grafts were a recipient coronary artery diameter of < 1.5 mm (p ?=? 0.022), < 60% stenosis of the recipient coronary artery (p ?=? 0.015), diffuse stenotic lesions of the recipient coronary artery (p ?=? 0.018), and a small IMA calibre (p ?=? 0.0001). Cumulative actuarial survival at three years was 96.4% and event-free cumulative survival was 93.8%. Conclusions: Use of the bilateral IMAs offers the possibility of constructing various configurations, making total arterial myocardial revascularisation possible with a minimum number of arterial conduits. Use of the skeletonised RIMA through the transverse sinus and eventually retrocavally can reach most branches of the circumflex system and is associated with an excellent patency rate. Patients who received bilateral IMA grafts for left coronary system revascularisation had improved early and late outcomes and decreased risk of death, reoperation, and angioplasty.

Bonacchi, M; Battaglia, F; Prifti, E; Leacche, M; Nathan, N S; Sani, G; Popoff, G

2005-01-01

38

The internal mammary artery and vein as recipient vessels for microvascular breast reconstruction.  

PubMed

Current recipient vessels for microvascular breast reconstruction include the internal mammary and the thoracodorsal systems. This review will focus on the advantages of the internal mammary artery and vein and reasons for their preference. PMID:22531410

Nahabedian, Maurice

2012-05-01

39

Superior mesenteric artery aneurysm stent graft  

Microsoft Academic Search

Visceral artery aneurysms represent 0.1% to 0.2% of all vascular aneurysms. They are mostly asymptomatic, but rupture is associated\\u000a with a high mortality rate. We present a case of an asymptomatic aneurysm of the proximal superior mesenteric artery in a\\u000a 64-year-old man that was successfully treated by implantation of a covered stent graft. The use of endovascular techniques\\u000a to manage

R. Drescher; O. Köster; T. von Rothenburg

2006-01-01

40

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

41

Pancreaticoduodenectomy after coronary artery bypass grafting with use of an in situ right gastroepiploic artery graft.  

PubMed

Nowadays more old and comorbid patients, such as patients with a history of multiple coronary artery bypass grafting (CABG), are surgical candidates for pancreaticoduodenectomy. Harvesting of the right gastroepiploic artery (RGEA) is one of the most commonly used methods when multiple CABGs are required. We report a case of pancreaticoduodenectomy performed in a patient who had the RGEA used as an in situ graft for CABG. The RGEA was successfully preserved, with an uneventful postoperative course. PMID:23644709

Turcanu, Mihail; Addeo, Pietro; Rosso, Edoardo; Bachellier, Philippe

2013-05-03

42

Preventing Deep Wound Infection after Coronary Artery Bypass Grafting  

PubMed Central

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

Bryan, Charles S.; Yarbrough, William M.

2013-01-01

43

Thermal preconditioning protects the human internal mammary artery from hypoxia/re-oxygenation-induced damage.  

PubMed

1. Preconditioning has been demonstrated to ameliorate ischaemia/reperfusion injury in several cells and tissues. Therefore, in the present study we investigated whether preconditioning of human bypass grafts, internal mammary artery (IMA) and saphenous vein (SV) induces heat shock protein (Hsp) expression and reduces apoptosis in response to subsequent hypoxia/re-oxygenation damage in both vessels. 2. Internal mammary artery and SV rings, obtained from 30 patients (median age 66.5 years) undergoing coronary artery bypass grafting, were either incubated for 30 min at 42 degrees C (preconditioned) or kept in a standard incubator at 37 degrees C (not preconditioned). Six hours later, graft segments were exposed to 90 min hypoxia followed by a 30 min re-oxygenation period. Western blot, real-time quantative polymerase chain reaction analysis and apoptosis detection by the Terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labelling method were performed. 3. Heat-preconditioned IMA showed significantly increased protein expression of Hsp72 after hypoxia/re-oxygenation treatment compared with controls (median 9.1 vs 5.0 microg/mg total protein; P = 0.048). Expression of Hsp73 was weak and Hsp60 was not detectable in the IMA. 4. In the SV, neither protein nor mRNA expression of Hsp were significantly different between preconditioned and not preconditioned veins. 5. There were significantly fewer apoptotic cells in the intima of the preconditioned compared with not preconditioned IMA (P = 0.041) after hypoxia/re-oxygenation injury, whereas in the SV apoptosis was not significantly prevented by preconditioning. 6. Mild heat preconditioning before hypoxia/re-oxygenation injury is a stimulus for Hsp72 protein expression and a reduction in apoptosis in the human IMA. PMID:16789924

Hammerer-Lercher, Angelika; Haeusler, Christa; Prelog, Martina; Bonatti, Johannes; Hoefer, Daniel; Ruttmann, Elfriede; Laufer, Guenther; Werner, Ernst R; Dirnhofer, Stephan; Puschendorf, Bernd; Mair, Johannes

2006-07-01

44

Importance of the third arterial graft in multiple arterial grafting strategies  

PubMed Central

Background The long-term benefit of multiple arterial grafts for coronary artery bypass (CABG) is not clear. This protocol was elaborated to see if multiple arterial grafts would provide better long-term outcomes when compared with conventional strategies. Methods Prospective data was collected for 588 patients undergoing isolated CABG between 1985 and 1995. We analyzed long term survival and freedom from cardiac death. The analysis compared patients with BITA grafting receiving a right gastro-epiploic artery (RGEA) versus those receiving a saphenous vein graft (SVG) as a third conduit. Cox proportional hazards modelling was used to adjust for relevant confounders. Results The mean age was 59±9 years and 49% received BITA. Mean follow-up was 16.1±5.4 years. Multivariable analysis revealed in that patients receiving the RGEA as a third conduit had superior overall survival (HR, 0.46; P=0.015) and cardiac survival (HR, 0.20; P=0.005) compared to those receiving an SVG. Conclusions In our experience, the use of multiple arterial grafting is independently associated with superior outcomes. Furthermore, the use of a third arterial conduit targeted to the RCA should be considered to improve long-term survival.

2013-01-01

45

Early experience with the inferior epigastric artery in coronary artery bypass grafting. A word of caution.  

PubMed

The excellent results with the internal thoracic artery for coronary artery bypass grafting have prompted the search for other arterial conduits. From November 1991 to February 1992, 18 patients underwent coronary artery bypass grafting with the use of inferior epigastric artery grafts. Patients' ages averaged 52 +/- 9 years. Bilateral internal thoracic artery grafts were used in 17 patients (17/18, 94%) and a free graft with one inferior epigastric artery was used in each patient. The inferior epigastric artery grafts were anastomosed to the right coronary artery (n = 9), a marginal circumflex artery (n = 4), and to a diagonal artery (n = 5). Three patients had abdominal wound complication related to harvesting of the inferior epigastric artery. Immediate postoperative angiographic evaluation of inferior epigastric artery grafts showed that eight grafts were patent (8/14, 57%). Four of the occluded inferior epigastric arteries were grafted to the right coronary artery and one to the second marginal circumflex coronary artery. Because of the low patency rate of inferior epigastric artery grafts, a word of caution is necessary in the selection of patients. At the present time, the inferior epigastric artery appears to be an interesting alternative only in patients who have no other available conduits. PMID:8231217

Perrault, L P; Carrier, M; Hebert, Y; Cartier, R; Leclerc, Y; Pelletier, L C

1993-11-01

46

Why is the mammary artery so special and what protects it from atherosclerosis?  

PubMed

The internal mammary artery (IMA) grafts have been associated with long-term patency and improved survival as compared to saphenous vein grafts (SVGs). Early failure of IMA is attributed to poor surgical technique and less with thrombosis. Similarly, bypass surgery especially with the use of IMA has also been shown to be superior at 1-year as well as over five years compared to percutaneous procedures, including the use of drug-eluting stents for the treatment of coronary artery disease. The superiority of IMAs over SVGs can be attributed to its striking resistance to the development of atherosclerosis. Structurally its endothelial layer shows fewer fenestrations, lower intercellular junction permeability, greater anti-thrombotic molecules such as heparin sulfate and tissue plasminogen activator, and higher endothelial nitric oxide production, which are some of the unique ways that make the IMA impervious to the transfer of lipoproteins, which are responsible for the development of atherosclerosis. A better comprehension of the molecular resistance to the generation of adhesion molecules that are involved in the transfer of inflammatory cells into the arterial wall that also induce smooth muscle cell proliferation is needed. This basic understanding is crucial to championing the use of IMA as the first line of defense for the treatment of coronary artery disease. PMID:23977631

Otsuka, Fumiyuki; Yahagi, Kazuyuki; Sakakura, Kenichi; Virmani, Renu

2013-07-01

47

Why is the mammary artery so special and what protects it from atherosclerosis?  

PubMed Central

The internal mammary artery (IMA) grafts have been associated with long-term patency and improved survival as compared to saphenous vein grafts (SVGs). Early failure of IMA is attributed to poor surgical technique and less with thrombosis. Similarly, bypass surgery especially with the use of IMA has also been shown to be superior at 1-year as well as over five years compared to percutaneous procedures, including the use of drug-eluting stents for the treatment of coronary artery disease. The superiority of IMAs over SVGs can be attributed to its striking resistance to the development of atherosclerosis. Structurally its endothelial layer shows fewer fenestrations, lower intercellular junction permeability, greater anti-thrombotic molecules such as heparin sulfate and tissue plasminogen activator, and higher endothelial nitric oxide production, which are some of the unique ways that make the IMA impervious to the transfer of lipoproteins, which are responsible for the development of atherosclerosis. A better comprehension of the molecular resistance to the generation of adhesion molecules that are involved in the transfer of inflammatory cells into the arterial wall that also induce smooth muscle cell proliferation is needed. This basic understanding is crucial to championing the use of IMA as the first line of defense for the treatment of coronary artery disease.

Otsuka, Fumiyuki; Yahagi, Kazuyuki; Sakakura, Kenichi

2013-01-01

48

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

49

Stent graft repair of visceral artery aneurysms  

Microsoft Academic Search

Endovascular techniques with coil embolization have been used in certain visceral aneurysm cases, often resulting in sacrifice of the involved visceral vessel and end-organ thrombosis. We describe two cases in which stent grafts were used to treat these aneurysms, allowing preservation of visceral artery and end-organ flow while completely excluding the aneurysm. Case 1 was a 50-year-old morbidly obese woman

Robert A. Larson; Jeffrey Solomon; Jeffrey P. Carpenter

2002-01-01

50

Late fiber deterioration in Dacron arterial grafts.  

PubMed Central

The occurrence of late fiber deterioration was examined in 493 Dacron arterial prostheses. Grafts implanted were of four types: 137 Meadox Wesolowski Weavenit (WN), 71 Golaski Microknit (MK), 70 USCI Sauvage(Tm) external velour non-crimped (EVNC), and 215 USCI Sauvage external velour random-crimped (EVRC). Prostheses had been implanted for three to 15.3 years; no defects were detected prior to three years. Deterioration occurred in 15 of 493 grafts (mean incidence: 3%). Between 4.9% and 5.8% of patients had graft deterioration-nearly the same incidence in all four types of grafts. Deterioration consisted of thinning and breakage of yarn filaments, causing development of holes and, in some cases, graft dilatation. Dilatation did not always precede filament breakage. Broken filament ends were either tapered or square-ended, suggesting that modes of breakage. Tensile strength tests howed that fibers sometimes weakened nonuniformly within a specimen. Fiber breakage was associated with crimp ridges. The findings suggest that manufacturing variations probably reduce fiber resistance to mechanical fatigue. Other contributing factors may include storage conditions, sterilization methods, handling, and the degradative effects of tissue fluids and enzymes. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7.

Berger, K; Sauvage, L R

1981-01-01

51

Unligated left internal mammary artery side branch resulting in coronary artery steal syndrome.  

PubMed

Whether internal mammary artery side branches have the potential for hemodynamically significant flow steal in cases of postcoronary surgery ischemia remains a controversial issue. We present a case in which coil embolization of two unligated side branches resulted in symptomatic improvement and resolution of ischemia as evidenced by myoview imaging.? PMID:21951036

Chalvatzoulis, Eleftherios; Ananiadou, Olga; Madesis, Athanasios; Christoforidis, Theofilos; Katsaridis, Vasilios; Drossos, George

2011-09-01

52

Thoracoscopic approach of the internal mammary artery (IMA): a training model in pigs.  

PubMed

Endoscopic internal mammary artery (IMA) approach represents a well-established procedure in coronary bypass surgery. However, such techniques require highly trained skills that need to be mastered in experimental models before taken into the clinic. To attain such skills, our aim was to develop a training model of thoracoscopic approach for harvesting of the IMA in pig. Ten pigs of either sex, weighing 20-28 kg, were used. The thoracic cavity was accessed with the animal in a lateral decubit position, through two ports of 10 mm and 1 of 5 mm, inserted on the anterior and posterior axillary lines immediately below the infrascapular angle into the pleural cavity, and a 30 degrees Hopkins II telescope. The internal mammary artery (IMA) was identified and dissected from its origin in the subclavian artery until its distal part where it becomes the deep superior epigastric artery. Afterward, the arterial segment was clipped and harvested. The mean operative time was 73 min. Postoperative survival at 72 hours was 100% and 90% at 4 weeks. A mean length of 3.2 cm of IMA graft was obtained (2.8-4 cm). The pig IMA has no intercostal branches; thus, the mobilization of the vessel being greatly facilitated. The procedure has two critical steps: the proper trocar insertion and the dissection of the middle one-third of the IMA. Endoscopic-assisted IMA, harvesting in pigs, represents a useful tool for training in minimally invasive heart surgery and supports further development toward other clinical applications. PMID:18561271

Jiga, Lucian P; Cristian, Horia; Blidisel, Alexandru; Sandra, Flavius; Nistor, Alexandru; Hoinoiu, Bogdan; Dornean, Vlad; Ionac, Mihai

2008-01-01

53

Motexafin lutetium in graft coronary artery disease  

NASA Astrophysics Data System (ADS)

Graft coronary artery disease (GCAD) is the chief complication following cardiac transplantation. Presently, there are limited treatment options. Insights into more expedient diagnosis and amelioration, if only partially, of GCAD are fervently sought. The selectivity of Antrin Injection (Lu-Tex) with subsequent photoactivation has been evaluated in several preclinical atherosclerosis models. The inhibitory effect of Lu-Tex induced photosensitization was demonstrated with human bypass coronary smooth muscle cells. The biodistribution of Lu-Tex was evaluated in a rat model of heterotopic cardiac allografts 60 days following transplantation. Lu-Tex was retained in the cardiac allograft, exhibiting a five-fold increase in retention between the allograft and native heart. These findings lead us to suggest that further studies are warranted to ascertain the merits of Lu-Tex for the diagnosis and possible attenuation of chronic graft vascular disease.

Woodburn, Kathryn W.; Rodriquez, Shari L.; Yamaguchi, Atsushi; Hayase, Motoya; Robbins, Robert C.; Kessel, David

2000-03-01

54

Coronary artery bypass grafting in Native Americans  

Microsoft Academic Search

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

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

2001-01-01

55

Detection of Helicobacter pylori DNA in Aortic and Left Internal Mammary Artery Biopsies  

PubMed Central

We investigated the relationship between acute coronary ischemia and the presence of Helicobacter pylori DNA in aortic regions that were absent macroscopic atheromatous plaques. The study group (Group 1) consisted of 42 patients who underwent coronary artery bypass grafting. Biopsy samples were obtained from 2 different locations: from regions of the aorta that were free (macroscopically) of atheromatous plaque (Group 1A), and from the internal mammary artery (Group 1B). The control group (Group 2) of 10 patients who had no atherosclerotic vascular disease provided aortic tissue samples for comparison. The real-time polymerase chain reaction method was used to detect H. pylori DNA in all biopsy samples. Eleven of 42 aortic tissue samples (26%) in Group 1A were positive for H. pylori DNA. Neither biopsies from the left internal mammary arteries of those patients nor biopsies from the aortas of the control group (Group 2) were positive for H. pylori DNA. There was a statistically significant difference between 1A and 1B in terms of H. pylori positivity (P=0.001). In Group 1 as a whole, acute coronary ischemia was more prevalent in the H. pylori-positive patients than in the H. pylori-negative patients (P=0.001). To our knowledge, this is the 1st study to investigate the detection of H. pylori DNA in aortic biopsy samples that are macroscopically free of atheromatous plaque. Such detection in patients who have atherosclerotic coronary artery disease could be an important indication of the role of microorganisms in the pathogenesis of atherosclerosis.

Iriz, Erkan; Cirak, Meltem Yalinay; Engin, Evren Doruk; Zor, Mustafa Hakan; Erer, Dilek; Ozdogan, Mehmet Emin; Turet, Sevgi; Yener, Ali

2008-01-01

56

Rho-kinase inhibitors prevent agonist-induced vasospasm in human internal mammary artery  

PubMed Central

Vasospasm of arterial conduits used for coronary artery surgery is an important cause of graft failure and is likely to result partly from raised levels of vasoconstrictor substances such as thromboxane A2 and endothelin-1. Our aim was to find pharmacological agents that could prevent agonist-induced vasospasm. Isometric tension was recorded from discarded segments of human left internal mammary artery (LIMA). Submaximal contraction evoked by the thromboxane A2 mimetic U46619 (10?nM) was not inhibited by a blocker of store- and receptor-operated Ca2+ channels (30??M SKF96365) in the presence of diltiazem. Furthermore, contractions to ?1?nM U46619 were preserved when extracellular Ca2+ was reduced from 2.5?mM to 60?nM. Thus, sustained U46619-evoked contraction occurred without Ca2+ influx. We hypothesized that contraction might occur via Rho-kinase-mediated Ca2+-sensitization of myofilaments. Inhibitors of Rho-kinase (Y27632 and HA1077) were profound relaxants. If contraction was pre-evoked by 10?nM U46619, Y27632 and HA1077 caused full relaxation with EC50s of 1.67±0.22??M and 3.58±0.35??M respectively. Y27632 was also effective if applied before U46619, but was less potent. Y27632 abolished contraction evoked by endothelin-1 and significantly reduced resting tone in the absence of a vasoconstrictor. Rho-kinase-mediated Ca2+-sensitization appears to be a major mechanism of vasoconstriction in human LIMA. Rho-kinase inhibitors may have an important role in preventing vasospasm in arterial grafts used for coronary artery surgery.

Batchelor, Timothy J P; Sadaba, J Rafael; Ishola, Adekunle; Pacaud, Pierre; Munsch, Christopher M; Beech, David J

2001-01-01

57

Unusual complications of coronary artery bypass graft surgery.  

PubMed

Complications after coronary artery bypass grafting are myriad and are to a certain extent operator dependent. The investigators report 2 unusual cases of inadvertent aortocoronary fistula after coronary artery bypass grafting that escaped routine detection. In conclusion, the development of heart failure led to the detection of this rare complication. PMID:17145231

Khunnawat, Chotikorn; Mukerji, Siddharth; Abela, George S; Thakur, Ranjan K

2006-10-25

58

Two-stage reconstruction of infected deep median sternotomy wound with an intercostal pedicled oblique rectus abdominis musculocutaneous flap after coronary artery bypass grafting.  

PubMed

Median sternotomy wounds infected after coronary artery bypass grafting with bilateral internal mammary arteries are generally poor in condition, cannot be debrided adequately, and are limited in flap selection for reconstruction. The authors treated 2 patients with two-stage reconstruction using a modified superior-based rectus abdominis musculocutaneous flap. First, simple debridement was performed with the goal of preserving the internal mammary artery grafts. Then, delayed reconstruction with the oblique rectus abdominis musculocutaneous flap supplied by the superior epigastric and seventh intercostal vessels was performed. Despite ligature of the bilateral internal mammary arteries at their full length, the large oblique skin paddle designed along the angiosome as far as the midaxillary line survived almost completely in both patients, resulting in cessation of pus discharge. The circulation to the superior epigastric and intercostal vessels might be reinforced because of the delay phenomenon. Two-stage reconstruction with a superior pedicled oblique rectus abdominis musculocutaneous flap presents a successful resolution of infected median sternotomy wounds after coronary artery bypass grafting with sacrifice of bilateral internal mammary arteries. PMID:14520073

Mochizuki, Yasushi; Okazaki, Mutsumi; Kurashina, Reiko; Kano, Mayuko

2003-10-01

59

Abdominal perfusion pressure and coronary arterial perfusion pressure in patients undergoing coronary artery bypass graft surgery  

PubMed Central

Abdominal perfusion pressure (APP) is defined as the difference between the mean arterial pressure and the intra-abdominal pressure (IAP). IAP elevation results in various side effects, including a decrease in coronary arterial perfusion pressure (CoPP). The present study analyzed the relationship between APP and CoPP in patients undergoing extracorporeal circulation (ECC). The patient population selected for the present study comprised 45 adult patients with a mean (± SD) age of 65.9±7.21 years (range 42 to 80 years), undergoing coronary artery bypass grafting with ECC and normovolemic hemodilution under general anesthesia. CoPP was measured as the difference between mean arterial pressure and pulmonary capillary wedge pressure. APP and CoPP were measured at seven time points (TPs): before surgery after the induction of anesthesia (TP1), during internal mammary artery preparation (TP2), 10 min after the heart-lung machine disconnection (TP3), after completion of the procedure but before sending the patient to the postoperative intensive care unit (TP4), 1 h after surgery (TP5), 6 h after surgery (TP6) and 18 h after the procedure (TP7). TP1 was considered to be the baseline value. IAP increased from TP3 to TP7; APP decreased at TP3 and TP4; there were no significant changes in CoPP. Significant correlations between APP and CoPP were observed at all TPs. Moreover, IAP correlated with CoPP at TP2 and TP4. Additionally, there was a strong overall correlation between APP and CoPP (P<0.001, r=0.9598). The present study arrived at two major conclusions: that ECC resulted in IAP elevation and that APP was strongly correlated with CoPP.

Dabrowski, Wojciech; Wacinski, Piotr; Visconti, Jozef

2009-01-01

60

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

61

Coronary Artery Bypass Grafting in Idiopathic Thrombocytopenia  

PubMed Central

Patients with idiopathic thrombocytopenic purpura have safely undergone cardiac surgical procedures; however, platelets were transfused in 20 of 24 reported instances, and no point-of-care testing of coagulation status was performed. Herein, we report the case of a patient with idiopathic thrombocytopenic purpura who required urgent coronary artery bypass grafting and intra-aortic balloon pump support. Rotational thromboelastometry was used as a point-of-care test of the patient's coagulation status. No preoperative prophylactic transfusion of allogeneic platelets was necessary, and in fact the patient required no allogeneic blood products during his hospitalization. We believe that point-of-care coagulation tests such as thromboelastometry warrant further evaluation regarding their usefulness in the clinical decision of whether to transfuse platelets and other blood products.

Rossi, Michele; Lewis, Michael; Hutchinson, Nevil

2010-01-01

62

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

63

Semi-skeletonized internal mammary grafts and phrenic nerve injury: cause-and-effect analysis.  

PubMed

Phrenic nerve injury after cardiac surgery increases postoperative pulmonary complications. The purpose of this study was to analyze the causes and effects of phrenic nerve injury after cardiac surgery. Prospectively collected data on 2084 consecutive patients who underwent cardiac surgery from Jan. 1995 to Feb. 2002 were analyzed. Twenty-eight preoperative and operation related variables were subjected to logistic analysis with the end point being phrenic nerve injury. Then phrenic nerve injury and 6 perioperative morbidities were included in the analysis as variables to determine their independent predictive value for perioperative pulmonary morbidity. An identical approach was used to identify the independent risk factors for perioperative mortality. There were 53 phrenic nerve injuries (2.5%). There was no phrenic nerve injury in non-coronary surgery or coronary surgery using conduits other than the internal mammary artery. The independent risk factors for phrenic nerve injury were the use of internal mammary artery (Odds ratio (OR) = 14.5) and thepresence of chronic obstructive pulmonary disease (OR = 2.9). Phrenic nerve injury was an independent risk factor (OR = 8.1) for perioperative pulmonary morbidities but not for perioperative mortality. Use of semi-skeletonized internal mammary artery harvesting technique and drawing attention to possible vascular or mechanical causes of phrenic nerve injury may reduce its occurrence. Unilateral phrenic nerve injury, although rarely life-threatening, is an independent risk factor for postoperative respiratory complications. When harvesting internal mammary arteries, it should be kept in mind avoiding stretching, compromising, or inadvertently dissecting phrenic nerve is as important as avoiding damage of internal mammary artery itself. PMID:17120747

Deng, Yongzhi; Sun, Zongquan; Ma, Jie; Paterson, Hugh S

2006-01-01

64

[Bilateral injuries of the internal mammary artery following blunt thoracic trauma].  

PubMed

Injuries of the internal mammary artery after blunt thoracic trauma are rare but potentially fatal. A specific characteristic of these injuries is that they can become symptomatic even after a delay of several weeks. This article reports on the diagnosis and treatment of a 41-year-old motorcycle rider who suffered bilateral injuries of the internal mammary artery after a motorcycle accident without any additional bony lesions. PMID:20574751

Betsch, M; Jungbluth, P; Grassmann, J-P; Fürst, G; Windolf, J; Wild, M

2010-09-01

65

Comparison of left internal mammary artery diameter before and after left stellate ganglion block.  

PubMed

Aims and Objectives: Left internal mammary artery (LIMA) is the preferred arterial conduit for coronary artery bypass grafting. Various pharmacological agents are known to increase LIMA blood flow. Sympathetic blockade mediated by stellate ganglion block (SGB) has been used to provide vasodilatation in the upper extremities and in the treatment of refractory angina. We investigated effect of left stellate ganglion block (LSGB) on LIMA diameter. Materials and Methods: In 30 diagnosed patients of triple vessel coronary artery disease, LSGB was given under fluoroscopic guidance by C6 transverse process approach using 10 ml of 1% lignocaine. LIMA diameter was measured before and 20 min after the block at 2 nd , 3 rd , 4 th and at 5 th rib level. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded before and 20 min after the block. Results: The LIMA diameter increased significantly at 2 nd (2.56 ± 0.39 vs. 2.99 ± 0.40; P < 0.0001), 3 rd (2.46 ± 0.38 vs. 2.90 ± 0.40; P < 0.0001), 4 th (2.39 ± 0.38 vs. 2.84 ± 0.41; P < 0.0001) and 5 th rib level (2.35 ± 0.38 vs. 2.78 ± 0.40; P < 0.0001). No statistically significant change occurred in HR, SBP, DBP and MAP before and 20 min after LSGB. Conclusions: LSGB significantly increased the LIMA diameter. The LSGB can be considered as an alternative to topical and systemic vasodilators for reducing vasospasm of LIMA. PMID:24107689

Gopal, Divya; Singh, Naveen G; Jagadeesh, A M; Ture, Ajay; Thimmarayappa, Ashwini

66

Right gastroepiploic artery used for coronary artery bypass grafting. Evaluation of flow characteristics and size.  

PubMed

Questions remain concerning the physiologic capabilities of the right gastroepiploic artery as a bypass graft in the clinical setting. Our last 90 consecutive pedicle right gastroepiploic artery grafts were prepared with intraluminal papaverine and verapamil. Our series comprised 81 male and 9 female patients with average body surface areas of 1.92 m2. Ages ranged from 11 to 79 years (mean 57.2 years). A second to fourth revascularization was undertaken in 32 patients (35.5%). The following arteries were bypassed: posterior descending artery, 63; right coronary artery, 23; distal right, 4; circumflex, 2; left anterior descending, 1; and diagonal, 1. Free flow rates ranged from 42 to 660 ml/min (mean 179.96 ml/min). Internal diameters measured 1.5 to 4.0 mm (mean 2.20 mm) at the anastomotic sites. Pedicle lengths ranged from 16 to 26 cm (mean 19.2 cm). Inotropic support was required in 11 patients (12%) and had no adverse effects on right gastroepiploic artery grafts. There were 2 hospital deaths (2.2%). Angina has recurred in 6 patients. One patient with cardiomyopathy required transplantation 2 years after coronary bypass grafting. Repeat angiography showed widely patent grafts in 18 patients and generalized narrowing in 4 grafts. In only 2 patients of our total experience has right gastroepiploic artery grafting been aborted because of inadequate conduit size. One right gastroepiploic artery had visible atherosclerosis. This study shows that distal right gastroepiploic artery sizes are comparable with sizes of target coronary arteries. However, neither flow nor size is as consistent when compared with internal thoracic artery grafts. Higher flow rates are related to graft anatomic characteristics and larger body surface areas. Spasm, secondary to harvest in these vasoreactive grafts, can be managed appropriately by intraluminal vasodilating drugs. However, use of the right gastroepiploic artery should be avoided in a setting with possible competition of flow. PMID:8412249

Mills, N L; Hockmuth, D R; Everson, C T; Robart, C C

1993-10-01

67

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

68

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 ...

69

Computer-Aided Patient-Specific Coronary Artery Graft Design Improvements Using CFD Coupled Shape Optimizer.  

PubMed

This study aims to (i) demonstrate the efficacy of a new surgical planning framework for complex cardiovascular reconstructions, (ii) develop a computational fluid dynamics (CFD) coupled multi-dimensional shape optimization method to aid patient-specific coronary artery by-pass graft (CABG) design and, (iii) compare the hemodynamic efficiency of the sequential CABG, i.e., raising a daughter parallel branch from the parent CABG in patient-specific 3D settings. Hemodynamic efficiency of patient-specific complete revascularization scenarios for right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) bypasses were investigated in comparison to the stenosis condition. Multivariate 2D constraint optimization was applied on the left internal mammary artery (LIMA) graft, which was parameterized based on actual surgical settings extracted from 2D CT slices. The objective function was set to minimize the local variation of wall shear stress (WSS) and other hemodynamic indices (energy dissipation, flow deviation angle, average WSS, and vorticity) that correlate with performance of the graft and risk of re-stenosis at the anastomosis zone. Once the optimized 2D graft shape was obtained, it was translated to 3D using an in-house "sketch-based" interactive anatomical editing tool. The final graft design was evaluated using an experimentally validated second-order non-Newtonian CFD solver incorporating resistance based outlet boundary conditions. 3D patient-specific simulations for the healthy coronary anatomy produced realistic coronary flows. All revascularization techniques restored coronary perfusions to the healthy baseline. Multi-scale evaluation of the optimized LIMA graft enabled significant wall shear stress gradient (WSSG) relief (~34%). In comparison to original LIMA graft, sequential graft also lowered the WSSG by 15% proximal to LAD and diagonal bifurcation. The proposed sketch-based surgical planning paradigm evaluated the selected coronary bypass surgery procedures based on acute hemodynamic readjustments of aorta-CA flow. This methodology may provide a rational to aid surgical decision making in time-critical, patient-specific CA bypass operations before in vivo execution. PMID:22448203

Dur, Onur; Coskun, Sinan Tolga; Coskun, Kasim Oguz; Frakes, David; Kara, Levent Burak; Pekkan, Kerem

2010-11-18

70

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

Microsoft Academic Search

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

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

2010-01-01

71

Coronary Artery Bypass Grafting in Native Americans  

PubMed Central

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

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

2001-01-01

72

Free splenic artery used in aortocoronary bypass.  

PubMed

Many alternative bypass conduits for coronary revascularization have been used since the introduction of the saphenous vein. The internal mammary artery has demonstrated superior long-term patency rates compared with vein grafts. Other arterial grafts previously investigated include the right gastroepiploic artery, inferior epigastric artery, radial artery, and splenic artery. This case reports bypass using a free splenic artery and a pedicled right gastroepiploic artery, each with successful postoperative patency. PMID:8417668

Mueller, D K; Blakeman, B P; Pickleman, J

1993-01-01

73

Treatment of Secondary Stent-Graft Collapse After Endovascular Stent-Grafting for Iliac Artery Pseudoaneurysms  

SciTech Connect

We report the case of a patient who developed an asymptomatic pseudoaneurysm in the left external iliac artery after transplant nephrectomy. The pseudoaneurysm most probably arose as a suture aneurysm from the external iliac artery after removal of the graft renal artery. Obviously we can not exclude the possibility it was a true aneurysm, although this seems much less likely. The pseudoaneurysm was detected during a routine CT scan and was treated interventionally with a stent-graft. One month later the asymptomatic patient underwent a vascular ultrasound examination including color Doppler, power Doppler, and B-flow as a routine control. An endoleak with collapse of the stent-graft was diagnosed. There was no evidence of stent infection. At a reintervention, the pseudoaneurysm was successfully treated using two uncovered Palmaz stents at the proximal and distal edge of the stent graft. Peri- and post-interventional ultrasound and CT angiography confirmed the exclusion of the aneurysm without an endoleak.

Clevert, D.-A. [Institute of Clinical Radiology, University of Munich - Grosshadern Campus (Germany)], E-mail: clevert@web.de; Stickel, M.; Steitz, H.-O.; Kopp, R. [University of Munich, Department of Surgery, Klinikum Grosshadern (Germany); Strautz, T.; Flach, P.; Johnson, T. [Institute of Clinical Radiology, University of Munich - Grosshadern Campus (Germany); Jung, E.M. [Klinikum Passau, Department of Diagnostic Radiology (Germany); Jauch, K.W. [University of Munich, Department of Surgery, Klinikum Grosshadern (Germany); Reiser, M. [Institute of Clinical Radiology, University of Munich - Grosshadern Campus (Germany)

2007-02-15

74

Factors influencing acute thrombus formation on carotid artery vascular grafts  

SciTech Connect

Scintillation camera imaging of 111Indium-labeled platelets has been used to measure acute thrombus formation on modified expanded Teflon (ePTFE) vascular grafts placed in the carotid arteries of normal baboons. Platelet deposition plateaued over 2 hr postoperatively and occurred primarily at the graft-vessel anastomoses. A positive correlation was found between the circulating platelet count in individual animals and the extent of early platelet thrombus deposition. Unmodified ePTFE grafts accumulated 4.6 +/- 1.2 x 10(9) platelets per graft, or 2.3 +/- 0.71 x 10(9) platelets per anastomosis. Acutely, platelet accumulation was reduced versus control graft results by coating the graft lumenal surfaces with a smooth layer of silicone rubber polymer (0.60 +/- 0.19 x 10(9) platelets per anastomosis; P less than 0.02) but not by coating the grafts using a plasma polymer based on methane, which did not modify graft texture (8.2 +/- 1.7 x 10(9) platelets per graft; P greater than 0.10). The benefit of the silicone rubber coating persisted for at least 48 hr. However, longer term patency was not preserved because 10 of 12 grafts placed had failed within 1 to 2 months.

Torem, S.; Schneider, P.A.; Paxton, L.D.; Yasuda, H.; Hanson, S.R.

1988-10-01

75

Radial artery grafting in women improves 15-year survival.  

PubMed

OBJECTIVES: Radial artery (RA) grafting has a clear survival advantage after coronary artery bypass grafting (CABG) in studies with predominantly male populations, but the impact on women's long-term survival is unclear. We sought to determine if the reported long-term survival benefit of RA versus saphenous vein (SV) grafting in the general CABG population is valid for women. METHODS: Between 1995 and 2010, 1339 female patients were alive 30 days after primary, isolated CABG with left internal thoracic artery (LITA) and additional RA or SV conduits as needed. Patients were evaluated based on RA use: 332 patients had RA and 1007 patients had SV. Of these, 283 RA patients were matched to SV counterparts using a nonparsimonious propensity model based on 45 patient variables. RESULTS: Kaplan-Meier estimated survivals for the matched RA women at 1, 5, 10, and 15 years were 99%, 93%, 80%, and 70% versus 97%, 87%, 72%, and 58% for the SV women (log rank, P = .018). For symptomatic patients, overall RA patency was 80%, which was not different from the LITA patency rate of 84% but was superior to the SV conduits patency rate of 56% (P < .001). CONCLUSIONS: In women undergoing CABG with LITA grafting, use of an RA graft improves survival compared with use of an SV graft. PMID:23122697

Dimitrova, Kamellia R; Hoffman, Darryl M; Geller, Charles M; Ko, Wilson; Lucido, David J; Dincheva, Gabriela R; Tranbaugh, Robert F

2012-11-01

76

An unusual case of bilateral subclavian-carotid artery graft occlusion with coronary steal syndrome managed in the cath lab.  

PubMed

A 65-year-old man, s/p coronary bypass surgery (CABG) with left internal mammary artery (LIMA) to the left anterior descending (LAD) artery 12 years previously, presented to his local hospital with left upper extremity pain, dizziness, falls, and chest pain. At the outside hospital, a proximal total left subclavian occlusion was found and the patient underwent left subclavian artery to common carotid artery (SCA-CCA) bypass surgery. Shortly thereafter, the patient developed right subclavian thrombosis, and underwent right SCA-CCA bypass surgery. Twenty days later, coronary steal symptoms recurred; troponin levels were elevated and ultrasound exam revealed bilateral SCA-CCA graft occlusion. The patient was then transferred to a tertiary care facility with a diagnosis of non-ST elevation myocardial infarct (NSTEMI). A successful endovascular procedure was performed in the cardiac catheterization laboratory with the use of coronary chronic total occlusion (CTO) devices, to treat the coronary steal syndrome. PMID:23293182

Wisneski, Andrew D; Beyer, Anna T; Shunk, Kendrick A

2013-01-01

77

Priority of revascularization in patients with graft enteric fistulas, infected arteries, or infected arterial prostheses.  

PubMed Central

Patients with arterial infections, infected arterial prostheses, or graft enteric erosions or fistulas have high amputation and mortality rates after treatment. An unresolved therapeutic question is whether remote ("extra-anatomic") bypass should precede or follow removal of the infected artery or prosthesis. None of the ten patients reported here who had a remote bypass inserted first developed distal limb ischemia or infection of the remote bypass. Literature review of patients with aortic prosthetic infections revealed a mortality of 71% (10/14) if infected graft removal preceded remote bypass and 26% (6/23) if remote bypass was first. Patients with graft enteric erosions or fistulas had a mortality of 53% (40/75) if graft removal was first and 17% (5/29) if remote bypass was first. Subsequent infection of the remote bypass was rare. Therefore, when possible, remote bypass with a prosthetic graft should precede removal of an infected artery, an infected arterial prosthesis, a graft enteric erosion, or a graft enteric fistula.

Trout, H H; Kozloff, L; Giordano, J M

1984-01-01

78

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

79

Do internal mammary artery side-branches have the potential for haemodynamically significant flow steal?  

Microsoft Academic Search

Objective: To evaluate the potential for flow steal of the internal mammary artery (IMA) side-branches at rest and in case of dilatation of their vascular bed (as probably occurs during physical exercise). Methods: Transthoracic echo-Doppler evaluation of IMA flow was performed preoperatively in 40 patients undergoing myocardial revascularization. IMA flow was measured at rest and in condition of peripheral vasodilatation

Mario Gaudino; Michele Serricchio; Paolo Tondi; Franco Glieca; Piergiorgio Bruno; Gianfederico Possati; Paolo Pola

2010-01-01

80

Do internal mammary artery side-branches have the potential for haemodynamically significant flow steal?  

Microsoft Academic Search

Objective: To evaluate the potential for flow steal of the internal mammary artery (IMA) side-branches at rest and in case of dilatation of their vascular bed (as probably occurs during physical exercise). Methods: Transthoracic echo-Doppler evaluation of IMA flow was performed preoperatively in 40 patients undergoing myocardial revascularization. IMA flow was measured at rest and in condition of peripheral vasodilatation

Mario Gaudino; Michele Serricchio; Paolo Tondi; Franco Glieca; Piergiorgio Bruno; Gianfederico Possati; Paolo Pola

1999-01-01

81

Neointimal Hyperplasia after Stenting in a Human Mammary Artery Organ Culture  

Microsoft Academic Search

Although the use of stents has limited the incidence of restenosis, in-stent restenosis remains an important problem. In-stent restenosis is the result of a healing process that induced neointimal hyperplasia through mechanisms that are still not understood. The aim of this study was to analyze the histological consequences of the healing process following stent implantation. Internal mammary arteries from atheroslerotic

P. Guérin; F. Rondeau; G. Grimandi; M. F. Heymann; D. Heymann; P. Pillet; O. Al Habash; G. Loirand; P. Pacaud; D. Crochet

2004-01-01

82

Waiting Time and Mortality After Elective Coronary Artery Bypass Grafting  

Microsoft Academic Search

Background. Limited resources for coronary artery by- pass grafting (CABG) results in waiting times, prioriti- zation between patients, and to mortality among the patients on the waiting list. Waiting time is an indepen- dent predictor for mortality on the waiting list, but it is not clear if the waiting time also influences outcome after CABG. Methods. The study population was

Helena Rexius; Gunnar Brandrup-Wognsen; Anders Jeppsson

2010-01-01

83

Atrial fibrillation after coronary artery bypass grafting without cardiopulmonary bypass  

Microsoft Academic Search

Objective: Atrial fibrillation is the most common complication after heart surgery. It rarely has a fatal outcome but causes patient instability, prolongs hospital stay, or even is the reason for perioperative infarction. Although conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass has excellent short-term and long-term results, the number of coronary operations on a beating heart without cardiopulmonary bypass

Janusz Siebert; Jan Rogowski; Dariusz Jagielak; Lech Anisimowicz; Romuald Lango; Miroslawa Narkiewicz

2000-01-01

84

Endovascular Stent-Grafting for Infected Iliac Artery Pseudoaneurysms  

SciTech Connect

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 methicillin-resistant Staphylococcus aureus was cultured, followed by rupture of the right external iliac artery. The second case is that of a 60-year-old man who had a pseudoaneurysm of the left common iliac artery, which was contiguous with a left psoas muscle abscess, from which Streptococcus agalactiae was cultured. Both patients were successfully treated with only a stent-graft and antibiotic therapy, and remained symptom-free 12 months and 10 months later. Although endovascular stent-grafting should not be considered standard therapy for infected aneurysms, our cases suggest that it can result in repair of infected aneurysms even in the uncontrolled active stage.

Sanada, Junichiro, E-mail: sanadaj@rad.m.kanazawa-u.ac.jp; Matsui, Osamu [Kanazawa University School of Medicine, Department of Radiology (Japan); Arakawa, Fumitaka; Tawara, Mari [Toyama Red Cross Hospital, Department of Radiology (Japan); Endo, Tamao [Kanazawa University School of Medicine, Department of Radiology (Japan); Ito, Hiroshi [Noto General Hospital, Department of Radiology (Japan); Ushijima, Satoshi [Noto General Hospital, Department of Surgery (Japan); Endo, Masamitsu [National Hospital of Kanazawa, Department of Cardiovascular Surgery (Japan); Ikeda, Masahiro; Miyazu, Katsuyuki [Toyama Red Cross Hospital, Department of Cardiovascular Surgery (Japan)

2005-01-15

85

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

86

Preventing deep wound infection after coronary artery bypass grafting: a review.  

PubMed

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

Bryan, Charles S; Yarbrough, William M

2013-01-01

87

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

Microsoft Academic Search

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

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

2009-01-01

88

Radial artery as a second arterial graft in the elderly and both sexes  

PubMed Central

Background Use of multiple arterial grafts for surgical coronary revascularization remains limited in scope worldwide, and is disproportionately low in two growing segments of coronary artery disease patients—women and the elderly. While a prevailing practice, this trend is not supported by objective data. This report discusses two recent reports that support the liberal use of the radial artery (RA) as a second arterial conduit, in the elderly and irrespective of sex, instead of the conventional operation based on a single internal thoracic artery (ITA) with additional vein grafts. Methods From 1996 to 2007, 6,384 patients underwent primary, non-salvage emergency coronary artery bypass grafting with at least 2 complete grafts (including one ITA graft) were included in the present analysis. Those with bilateral ITA, ITA-only grafts, or concomitant valve/aortic surgery were excluded. 2,605 patients aged 70 or greater were further included in a subsequent analysis. Patients were further matched on propensity score models based on ITA/RA versus ITA/saphenous vein (SV) grafts. Results 69% of all included patients were male. Propensity models yielded 1,416 ITA/RA and ITA/SV matched pairs in men and 567 pairs in women. Operative mortality was similar for both graft combinations in men and women, while late mortality was significantly lower for ITA/RA subcohorts in both sexes. Matched Kaplan-Meier cumulative mortality was significantly better for ITA/RA irrespective of sex (men: risk reduction (RR) =0.65, P<0.001; women: RR=0.75, P=0.045). In patients aged 70 years or older, operative death was essentially identical for ITA/RA vs. ITA/SV (2.31% vs. 2.31%; P=0.880). Patients undergoing ITA/RA grafting had significantly better unadjusted 12-year survival. In 480 elderly matched pairs, cumulative mortality at 1, 5, and 10 years was significantly better for the ITA/RA cohort. Conclusion The discussed data showed a clinically significant improvement in intermediate (1-5 years) and late (>5 years) survival with multiple arterial grafts in female and male patients and in the elderly. The latter was true for both the septuagenarian and octogenarian subgroups. Importantly, the choice of the RA as the second arterial conduit seems to be associated with low associated perioperative risks, and avoids the potential for sternal healing complications due to bilateral ITA dissection in certain patients.

Abou-Arraj, Nadeem E.; Schwann, Thomas A.

2013-01-01

89

Cases of Common Carotid Artery Pseudoaneurysm Treated by Stent Graft  

PubMed Central

Common carotid artery (CCA) pseudoaneurysms are rare and potentially lethal, and adequate treatment is warranted in order to prevent rupture or neurologic sequelae. The causes of CCA pseudoaneurysm include blunt or penetrating trauma, infection, and vasculitis, as well as iatrogenic and unknown causes. Previously, surgery was the standard treatment for pseudoaneurysm. However, endovascular surgical approaches such as stent graft or coiling have become effective alternatives with minimal morbidity and high success rates. Here, we report two cases of CCA pseudoaneurysms that were successfully treated by stent graft and review the current literature.

Kim, Hee Ok; Ji, Yong Bae; Lee, Seung Hwan; Jung, Cheolkyu; Tae, Kyung

2012-01-01

90

Cases of common carotid artery pseudoaneurysm treated by stent graft.  

PubMed

Common carotid artery (CCA) pseudoaneurysms are rare and potentially lethal, and adequate treatment is warranted in order to prevent rupture or neurologic sequelae. The causes of CCA pseudoaneurysm include blunt or penetrating trauma, infection, and vasculitis, as well as iatrogenic and unknown causes. Previously, surgery was the standard treatment for pseudoaneurysm. However, endovascular surgical approaches such as stent graft or coiling have become effective alternatives with minimal morbidity and high success rates. Here, we report two cases of CCA pseudoaneurysms that were successfully treated by stent graft and review the current literature. PMID:22953119

Kim, Hee Ok; Ji, Yong Bae; Lee, Seung Hwan; Jung, Cheolkyu; Tae, Kyung

2012-05-08

91

Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study  

PubMed Central

OBJECTIVE—To expand the benefits of the minimally invasive direct coronary artery bypass (MIDCAB) concept to patients with multivessel disease, a hybrid procedure combining surgical revascularisation of the left anterior descending artery with interventional procedures for additional coronary lesions has recently been introduced. Preliminary results in patients undergoing this hybrid procedure are presented.?DESIGN AND PATIENTS—Since December 1996, 35 patients (29 male, 6 female, mean (SD) age 56.7 (17) years) underwent a hybrid revascularisation performed as a primary MIDCAB procedure for grafting of the left anterior descending artery with the left internal mammary artery, followed by staged angioplasty and stenting of additional coronary lesions.?RESULTS—After MIDCAB grafting the postoperative course was uneventful in all patients. Coronary reangiography after a median of seven days revealed patent and functioning left internal mammary artery grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty and occasional stenting (n = 14), a total of 47 lesions were treated successfully. Procedure related complications did not occur. All patients remained free from angina and no stress ECG changes were recorded.?CONCLUSIONS—The preliminary results of this hybrid approach to myocardial revascularisation suggest that this is a safe and effective procedure for complete revascularisation in selected patients with multivessel disease. Elderly and reoperative patients with significant comorbidity may benefit especially from such hybrid procedures by avoiding cardiopulmonary bypass and mid sternotomy.???Keywords: hybrid revascularisation; minimally invasive cardiac surgery; interventional treatment; multivessel revascularisation

Wittwer, T; Cremer, J; Boonstra, P; Grandjean, J; Mariani, M; Mugge, A; Drexler, H; den Heijer, P; Leitner, E; Hepp, A; Wehr, M; Haverich, A

2000-01-01

92

Immunocytochemical features of obstructed saphenous vein coronary artery bypass grafts.  

PubMed Central

The peroxidase-immunoperoxidase immunocytochemical method was used on 27 saphenous vein coronary artery bypass grafts, which had been resected because of recurrent angina, to identify in situ cellular and humoral elements possibly associated with graft occlusion. Immunostaining was performed on paraffin wax embedded control saphenous vein and graft sections incubated directly with primary antibodies against von Willebrand antigen (vWFAg), fibronectin, fibrinogen, leucocyte common antigen (LCA), lysozyme, vimentin, desmin, platelet factor 4, and thrombospondin. Antigens were visualised by a chromogen providing an orange-red immunoprecipitate at the site of epitope localisation. The intraluminal, amorphous exudate present in most grafts was not composed simply of fibrin or fibrinogen, as previously thought, but was a multiprotein complex including wWFAg, fibronectin, thrombospondin and platelet factor 4. Along with macrophages, these components probably enter the graft after haemodynamic, physical, and chemical injury to, and disruption of, the endothelial cell. Progressive myointimal proliferation and fibrosis of these grafts may be local repetitive responses to macrophages and platelets, cells previously known to participate in vascular disease. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5

Brody, J I; Pickering, N J; Fink, G B

1989-01-01

93

Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy  

PubMed Central

Background The advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure. Clinical case A simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma. Diagnosis Postoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease. Treatment We successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients.

2012-01-01

94

Impact of Intact Pleura during Left Internal Mammary Artery Harvesting on Clinical Outcome  

PubMed Central

Background: Pleurotomy during coronary artery bypass grafting (CABG) may cause post-operative events, mostly pulmonary complications. In this study, we evaluated the influence of pleurotomy during CABG on the clinical outcome following left internal mammary artery (LIMA) harvesting. Methods: Between March and August 2009, 102 patients who underwent cardiac surgery were enrolled in this study and divided into two groups: group A (n = 48, 36 male and 12 female patients at a mean age of 56.5 ± 11.2 years) underwent routine CABG and pleurotomy and group B (n = 54, 46 male and 8 female patients at a mean age of 55.4 ± 10.3 years) had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events. Results: The incidence of postoperative pericardial effusion was similar between the groups, but the incidence of postoperative pulmonary complications such as pleural effusion (except for mild pleural effusion) on the second (no: 10.4%, mild: 41.7%, moderate: 45.8% and severe: 2.1% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) and fifth postoperative days (no: 27.1%, mild: 33.3%, moderate: 35.4%, and severe: 4.2% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) was significantly lower in group B (p value < 0.001 and p value = 0.007, respectively). Also, the incidence of atelectasis (except for mild atelectasis) on the second (no: 2.1%, mild: 22.9%, moderate: 72.9%, and severe: 2.1% in group A versus no: 9.2%, mild: 59.3%, moderate: 31.5%, and severe: 0 in group B) and fifth postoperative days (no: 22.9%, mild: 39.6%, moderate: 35.4%, and severe: 2.1% in group A versus no: 39.6%, mild: 49.1%, moderate: 11.3%, and severe: 0 in group B) was significantly higher in group A (p value < 0.001 and p value = 0.004, respectively). Postoperative partial oxygen pressure and O2 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A (p value = 0.017). Amount of bleeding (p value = 0.008) and duration of hospitalization (p value = 0.002) were significantly higher in group A than those in group B. Conclusion: Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion.

Ghavidel, Alireza Alizadeh; Noorizadeh, Eskandar; Pouraliakbar, Hamidreza; Mirmesdagh, Yalda; Hosseini, Saeid; Asgari, Behnam; Dehaki, Mahyar Gholamour

2013-01-01

95

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

PubMed

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

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

2012-01-02

96

Effect of aspirin in coronary artery bypass grafting  

Microsoft Academic Search

Objectives: To evaluate the effect of aspirin (ASA) therapy on postoperative blood loss, transfusion requirements, reoperation for bleeding, duration of stay in the intensive care unit and in the hospital in a selected population undergoing a first coronary artery bypass grafting (CABG) surgery.Design: Prospective observational study in consecutive patients during a 3-month period.Setting: A teaching cardiothoracic center.Participants: Two hundred forty

Alain Vuylsteke; Amo Oduro; Emil Cardan; Ray D. Latimer

1997-01-01

97

An arteriovenous fistula between the internal mammary artery and the pulmonary vein following blunt chest trauma.  

PubMed

A 67-year-old man suffered a traffic accident and was transferred to an emergency hospital close to the scene. He was diagnosed to have bilateral pneumohemothorax with a lung contusion, an anterior fracture dislocation of the C6-vertebra and a cervical cord injury at the level of C7. On the 48th day, massive hemoptysis was suddenly recognized. He was transferred in a state of shock to our hospital to undergo hemostasis for the bleeding. On the day of admission, a selective arteriogram showed extravasation from the left bronchial artery, for which embolization was carried out using Gelfoam. In spite of this treatment, his hemoptysis continued. On the next day, a selective left internal mammary arteriogram showed an arteriovenous fistula between the left internal mammary artery and the left pulmonary vein without any apparent extravasation. The arteriovenous fistula was successfully embolized using platinum fiber coils. The patient no longer demonstrated any hemoptysis after embolization. PMID:15772731

Ito, T; Sakamoto, Toshihisa; Norio, Hirofumi; Kaji, Tatsumi; Okada, Yoshiaki

98

An Arteriovenous Fistula Between the Internal Mammary Artery and the Pulmonary Vein Following Blunt Chest Trauma  

SciTech Connect

A 67-year-old man suffered a traffic accident and was transferred to an emergency hospital close to the scene. He was diagnosed to have bilateral pneumohemothorax with a lung contusion, an anterior fracture dislocation of the C6-vertebra and a cervical cord injury at the level of C7. On the 48th day, massive hemoptysis was suddenly recognized. He was transferred in a state of shock to our hospital to undergo hemostasis for the bleeding. On the day of admission, a selective arteriogram showed extravasation from the left bronchial artery, for which embolization was carried out using Gelfoam. In spite of this treatment, his hemoptysis continued. On the next day, a selective left internal mammary arteriogram showed an arteriovenous fistula between the left internal mammary artery and the left pulmonary vein without any apparent extravasation. The arteriovenous fistula was successfully embolized using platinum fiber coils. The patient no longer demonstrated any hemoptysis after embolization.

Ito, T., E-mail: grd1404@gr.ndmc.ac.jp; Sakamoto, Toshihisa; Norio, Hirofumi [National Defense Medical College, Department of Traumatology and Critical Care Medicine (Japan); Kaji, Tatsumi [National Defense Medical College, Department of Radiology (Japan); Okada, Yoshiaki [National Defense Medical College, Department of Traumatology and Critical Care Medicine (Japan)

2005-01-15

99

Angiographic evaluation of post-sternotomy arteriovenous fistula of the internal mammary artery and vein  

Microsoft Academic Search

An arteriovenous fistula of the right internal mammary artery and vein following median sternotomy was demonstrated by angiography.\\u000a This surgical complication has not been previously reported in the literature, despite the recent increase in cardiac surgery\\u000a via median sternotomy. Clinical and radiologic awareness of this iatrogenic shunt and of its potential delayed appearance\\u000a and cardiovascular effects are important. Arteriovenous fistulas

Harold E. Longmaid; Michael Jay; David Phillips

1980-01-01

100

Comparison of Radial Artery and Saphenous Vein Composite Y Grafts during Off-pump Coronary Artery Bypass  

PubMed Central

Background The safety and efficacy of arterial composite grafts for total arterial revascularization have been demonstrated. The saphenous vein (SV) is a widely used graft because of its accessibility, sufficient length, and ease of manipulation. Our aim was to compare mid-term outcomes of saphenous vein Y-grafts with radial artery Y-grafts joined by anastomosis to the left internal thoracic artery. Materials and Methods Records of off-pump coronary artery bypass grafting with composite Y-grafts based on the left internal thoracic artery technique in 552 patients were analyzed retrospectively. After propensity score matching, 79 radial arterial (RA) composite grafts (RA group) and 79 saphenous vein composite grafts (SV group) were compared. The duration of mean follow-up was 24.6±14.6 months (range, 1 to 55 months). Results There were no differences in surgical mortality, all-cause mortality, or morbidity among the groups. Rates of 4-year survival were 91.7% and 96.3% in the RA and SV groups, respectively (p=0.519). The coronary reintervention-free survival rate and freedom from major adverse cardiovascular or cerebrovascular events were similar in the two groups (p=0.685, p=0.564). Conclusion Construction of composite Y-grafts using the radial artery or saphenous vein showed similar mid-term results. Long-term follow-up and randomized trials will be needed to confirm our present conclusions.

Wi, Jin-Hong; Joo, Hyun-Chel; Youn, Young-Nam; Song, Suk-Won; Kim, Tae Hoon

2013-01-01

101

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

102

Elevation of miR-221 and -222 in the internal mammary arteries of diabetic subjects and normalization with metformin.  

PubMed

Diabetes is a major risk factor for cardiovascular disease and is associated with increased intimal thickening and accelerated vascular smooth muscle cell (VSMC) proliferation. We measured the expression of two microRNAs that promote intimal thickening, miR-221/222, and mRNA encoding a downstream target, p27(Kip1), in internal mammary artery (IMA) segments collected from 37 subjects undergoing coronary artery bypass grafting. The segments were stratified into three groups: non-diabetic subjects (ND), diabetic subjects not on metformin (DMMet-), and diabetic subjects on metformin (DMMet+). The DMMet- group exhibited a significant increase in miR-221/222 and decrease in p27(Kip1) mRNA compared to both the ND and DMMet+ groups. miR-221/222 levels inversely correlated with metformin dose. VSMCs isolated from the IMAs of the DMMet- group proliferate at a faster rate than those of the ND and DMMet+ groups. Further studies into the importance of miR-221/222 in the increased intimal thickening observed in diabetic subjects is warranted. PMID:23648338

Coleman, Chasity B; Lightell, Daniel J; Moss, Stephanie C; Bates, Michael; Parrino, Patrick E; Woods, T Cooper

2013-05-03

103

Early postoperative angiographic assessment of radial artery grafts used for coronary artery bypass grafting  

Microsoft Academic Search

Despite a revival of interest in using the radial artery as an alternative conduit for myocardial revascularization, little angiographic documentation of early postoperative results has been presented, particularly in North America. Accordingly, 60 of 150 patients who underwent coronary artery bypass with radial arteries from November 1993 to July 1995 have had postoperative cardiac catheterization at our institution. The patency

Alan H. Chen; Tatsuya Nakao; Richard F. Brodman; Mark Greenberg; Richard Charney; Mark Menegus; Michael Johnson; Richard Grose; Rosemary Frame; Eric C. Hu; Hong-Keun Choi; Steven Safyer

1996-01-01

104

Hemodynamic and functional consequences of radial artery removal for coronary artery bypass grafting.  

PubMed

Five years after surgery the echo-Doppler characteristics of the forearm circulation and the transcutaneous oxygen and carbon dioxide pressures of the operated and control arm were determined at rest and under conditions of hand exercise in 34 patients who received a radial artery graft for myocardial revascularization. Doppler measurements showed the ulnar compensation to radial artery removal, and transcutaneous measurements demonstrated a moderate degree of exercise-induced hand ischemia on the operated site. PMID:10614806

Serricchio, M; Gaudino, M; Tondi, P; Gasbarrini, A; Gerardino, L; Santoliquido, A; Pola, P; Possati, G

1999-12-01

105

Interaction between vasodilators and vasopressin in internal mammary artery and clinical significance  

Microsoft Academic Search

Background. Arginine vasopressin (AVP) has recently been demonstrated as an alternative in the treatment of severe refractory vasodilatation in coronary artery bypass grafting. However, AVP may be a spasmogen for graft spasm. We compared the in vitro antispastic effect among calcium-channel antagonists (nifedipine, diltiazem, and verapamil), nitroglycerin, and the highly selective AVP (V1) receptor antagonist [1-deaminopenicillamine, 4-valine, 8-d-arginine] vasopressin.Methods. Human

Wei Wei; H. Storm Floten; Guo-Wei He

2002-01-01

106

Non-invasive evaluation of mammary artery flow reserve and adequacy to increased myocardial oxygen demand 1 Presented as a poster at the 11th Annual Meeting of the European Association for Cardiothoracic Surgery, Copenhagen, September 28–October 1, 1997. 1  

Microsoft Academic Search

Objective: To evaluate the flow reserve and adequacy to meet myocardial requests in stress conditions of mammary artery-left anterior descending (IMA-LAD) grafts using a non-invasive method. Methods: Patients (20) with angiographic evidence of normofunctioning left IMA-LAD grafts were submitted to dypiridamole Tl201 myocardial scintigraphy and concomitant transthoracic echo-doppler evaluation of the IMA flow at a mean interval of 32.5 months

Mario Gaudino; Michele Serricchio; Paolo Tondi; Franco Glieca; Alessandro Giordano; Carlo Trani; Paolo Pola; Gianfederico Possati

1998-01-01

107

Porcelain aorta in coronary artery bypass graft operations: an alternative approach.  

PubMed

Porcelain aorta represents a serious condition for coronary artery bypass graft operations. Here we describe a simple technique to avoid any aortic manipulation during an off-pump coronary artery bypass graft procedure. The right internal thoracic artery is used as the source of blood inflow for single or sequential venous grafts. We have used this technique with good results in 5 elderly patients with eggshell aorta. PMID:12821438

Rescigno, Giuseppe; Pensa, Pier Maria; Muti, Mauro; Chiarella, Mario; Lamarra, Mauro; Noera, Giorgio

2003-01-01

108

Atherosclerotic involvement of the radial artery in patients with coronary artery disease and its relation with midterm radial artery graft patency and endothelial function  

Microsoft Academic Search

BackgroundThe radial artery has recently been proposed as an alternative arterial conduit for surgical myocardial revascularization. This study was conceived to evaluate the degree of atherosclerotic involvement of the radial artery in patients with coronary artery disease and the eventual influence of a subtle degree of preoperative atherosclerosis on the midterm results of radial artery grafts.

Mario Gaudino; Paolo Tondi; Michele Serricchio; Paola Spatuzza; Angelo Santoliquido; Roberto Flora; Fabiana Girola; Giuseppe Nasso; Paolo Pola; Gianfederico Possati

2003-01-01

109

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

Microsoft Academic Search

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

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

2002-01-01

110

Effect of lipid exposure on graft patency and clinical outcomes: arteries and veins are different.  

PubMed

OBJECTIVES: We evaluated the influence of lipid exposure upon conduit patency in long-term follow-up after primary CABG. METHODS: From a prospectively compiled database, we identified 1207 grafts (436 SV and 771 mixed arterial grafts) among 413 CABG patients with 9.4 ± 2.4 years of follow-up (range 3-13). Surveillance angiography was performed as part of a randomized trial. All available lipid assays were collected from pathology laboratories, and from these, mean annualized lipid exposure was calculated for total cholesterol, HDL, LDL and triglycerides. Angiographical and clinical data were analysed against lipid exposure. Graft failure was defined as occlusion, string sign or >80% stenosis. RESULTS: Six thousand and seventy-seven lipid measurements were obtained, and there were 154 failed grafts. Three hundred and eleven patients received at least one vein graft, and all 413 patients received at least one arterial graft. Overall, only HDL levels were inversely correlated with graft failure, with total cholesterol and LDL showing no associations in a mixed pool of arterial and venous grafts. To assess whether total/LDL cholesterol had no effect or were exerting competing effects in arteries and veins, separate multivariate analyses were performed. Venous graft failure was associated with increased total cholesterol/HDL (P = 0.006) and LDL/HDL (P = 0.032). By contrast, elevated total cholesterol was correlated with a reduced risk of arterial graft failure (OR for graft failure 0.705, P = 0.023) with increasing LDL cholesterol following a similar trend (OR for graft failure 0.729, P = 0.051). CONCLUSION: Sub-fractions of dyslipidaemia known to be risk factors for native vessel disease appear to similarly influence vein grafts. Arterial conduits are at least more resistant to the effects of high lipid exposure, and appear to be protective. These results favour the use of arterial grafts in patients with poorly controlled dyslipidaemia. PMID:23671205

Zhu, Ying Yan; Hayward, Philip A R; Hare, David L; Reid, Christopher; Stewart, Andrew G; Buxton, Brian F

2013-05-12

111

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

Microsoft Academic Search

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

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

2003-01-01

112

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

113

Phrenic and diaphragm function after coronary artery bypass grafting.  

PubMed Central

We studied respiratory mechanics and phrenic nerve and diaphragm function in 12 patients on the day before and eight to 13 days after coronary artery bypass grafting. The average vital capacity, functional residual capacity, and total lung capacity decreased by 20.5%, 9.5%, and 14.7% respectively after operation. Eleven patients showed less negative maximum inspiratory mouth pressures at any given lung volume after surgery and the magnitude of the change correlated with the reduction in total lung capacity. In 11 of the 12 patients the conduction times of the right and left phrenic nerves did not change substantially after operation and the ratio of inspiratory electrical activity (Edi) of left and right hemidiaphragms was similar before and after the procedure. One patient, however, showed a considerable increase in left phrenic nerve conduction time and a reduction in the left to right Edi ratio postoperatively. In three patients diaphragm function was also assessed by changes in transdiaphragmatic pressure during supramaximal phrenic nerve stimulation and voluntary increase in inspired volume; in none of the three patients did the transdiaphragmatic pressure swings show any significant change in the postoperative period. These data indicate that phrenic nerve paralysis only occasionally accounts for the postoperative loss of lung volume after coronary artery bypass grafting surgery. The mechanism of these abnormalities therefore remains to be determined.

Estenne, M; Yernault, J C; De Smet, J M; De Troyer, A

1985-01-01

114

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

115

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

116

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

117

Internal thoracic artery flow competition: studies in a canine H-graft model  

Microsoft Academic Search

Objective: Internal thoracic artery (ITA) flow competition is a diversion of graft flow through intact ITA branches with a net decrease in perfusion to the grafted coronary. Although a widely acknowledged phenomenon, the conditions under which flow competition occurs have not been established. This is examined in a canine H-graft model. Methods: Eight dogs had a right ITA segment interposed

William E Cohn; Marc Ruel; Jian Ping Zhang; Frank W Sellke; Robert G Johnson

2003-01-01

118

Internal thoracic artery flow competition: studies in a canine H-graft model  

Microsoft Academic Search

Objective: Internal thoracic artery (ITA) flow competition is a diversion of graft flow through intact ITA branches with a net decrease in perfusion to the grafted coronary. Although a widely acknowledged phenomenon, the conditions under which flow competition occurs have not been established. This is examined in a canine H-graft model. Methods: Eight dogs had a right ITA segment interposed

William E. Cohn; Marc Ruel; Jian Ping Zhang; Frank W. Sellke; Robert G. Johnson

2010-01-01

119

Intravenous amiodarone for prevention of atrial fibrillation after coronary artery bypass grafting  

Microsoft Academic Search

Background. Atrial fibrillation occurs in 10% to 40% of patients who undergo coronary artery bypass grafting. This prospective study assesses the safety and efficacy of low-dose intravenous amiodarone in the prevention of atrial fibrillation after coronary artery bypass grafting.Methods. One hundred forty patients were randomly divided into two groups: an amiodarone group (n = 74) receiving intravenous amiadarone in a

Shih-Huang Lee; Che-Ming Chang; Ming-Jen Lu; Ren-Jen Lee; Jun-Jack Cheng; Chi-Ren Hung; Shih-Ann Chen

2000-01-01

120

Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting  

Microsoft Academic Search

Objective: Diabetes mellitus is a risk factor for death after coronary artery bypass grafting. Its relative risk may be related to the level of perioperative hyperglycemia. We hypothesized that strict glucose control with a continuous insulin infusion in the perioperative period would reduce hospital mortality. Methods: All patients with diabetes undergoing coronary artery bypass grafting (n = 3554) were treated

Anthony P. Furnary; Guangqiang Gao; Gary L. Grunkemeier; YingXing Wu; Kathryn J. Zerr; Stephen O. Bookin; H. Storm Floten; Albert Starr

2003-01-01

121

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

122

Spontaneous coronary artery dissection in pregnancy requiring emergency caesarean delivery followed by coronary artery bypass grafting.  

PubMed

Spontaneous coronary artery dissection is a rare and often fatal condition of pregnancy. The long-term morbidity is unknown, but a small cohort of patients develop severe ventricular dysfunction as a consequence. We describe a 37-week gestation parturient who presented with cardiogenic shock secondary to spontaneous left main coronary artery dissection. Despite rapid diagnosis, stabilisation with an intra-aortic balloon pump and prompt transfer to a tertiary centre for emergency caesarean delivery and coronary artery bypass grafting, the patient developed a severe postoperative dilated ischaemic cardiomyopathy. There is little information about the long-term outcomes and the specific anaesthesia management of combined emergency caesarean delivery and cardiac surgery in pregnancy for spontaneous coronary artery dissection. Therefore, we outline our multidisciplinary management of this critically ill pregnant woman. PMID:23530793

Weinberg, L; Ong, M; Tan, C O; McDonnell, N J; Lo, C; Chiam, E

2013-03-01

123

Effects of potassium channel opener KRN4884 on human conduit arteries used as coronary bypass grafts  

PubMed Central

Aims The effects of a new potassium channel opener KRN4884 on human arteries have not been studied. This study was designed to investigate the effects of KRN4884 on the human internal mammary artery (IMA) in order to provide information on possible clinical applications of KRN4884 for preventing and relieving vasospasm of arterial grafts in coronary artery bypass grafting. Methods IMA segments (n = 140) taken from patients undergoing coronary surgery were studied in the organ chamber. Concentration-relaxation curves for KRN4884 were established in the IMA precontracted with noradrenaline (NA), 5-hydroxytryptamine (5-HT), angiotensin II (ANG II), and endothelin-1 (ET-1). The effect of glibenclamide (GBC) on the KRN4884-induced relaxation was also examined in NA or 5-HT-precontracted IMA. Concentration-contraction curves for the four vasoconstrictors were constructed without/with pretreatment of KNR4884 (1 or 30 µm) for 15 min. Results KRN4884 induced less relaxation (P < 0.05) in the precontraction induced by ET-1 (72.9 ± 5.5%) than by ANG II (94.2 ± 3.2%) or NA (93.7 ± 4.1%) with lower EC50 (P < 0.05) for ANG II (?8.54 ± 0.54 log m) than that for NA (?6.14 ± 0.15 log M) or ET-1 (?6.69 ± 0.34 log m). The relaxation in the IMA pretreated with GBC was less than that in control (P < 0.05). KRN4884-pretreatment significantly reduced the contraction (P < 0.05) induced by NA (151.3 ± 18.4% vs 82.7 ± 8.7%), 5-HT (82.7 ± 12.2% vs 30.1 ± 7.3%), and ANG II (24.3 ± 6.3% vs 5.4 ± 1.6%), but did not significantly reduce the contraction induced by ET-1 (P > 0.05). Conclusion KRN4884 has marked vasorelaxant effects on the human IMA contracted by a variety of vasoconstrictors and the effect is vasoconstrictor-selective.

Ren, Zhen; Floten, Storm; Furnary, Anthony; Liu, Minghui; Gately, Hugh; Swanson, Jeffrey; Ahmad, Aftab; Yim, Anthony P C; He, Guo-Wei

2000-01-01

124

Imaging of coronary artery bypass grafts by computed tomography coronary angiography.  

PubMed

In recent years, computed tomography coronary angiography is commonly performed as a follow-up examination after coronary artery bypass graft surgery. Coronary grafts owing to their minimal motion are well visualized by computed tomography coronary angiography, allowing radiologists to assess their patency noninvasively with very high diagnostic accuracy. The purpose of this pictorial essay is to provide an excellent overview of the anatomy and findings concerning coronary artery bypass grafts. PMID:24159923

Laspas, Fotios; Roussakis, Arkadios; Kritikos, Nikolaos; Mourmouris, Christos; Efthimiadou, Roxani; Andreou, John

125

State of the vein grafts, native coronary arteries, and myocardium and principal cause of death in patients dying after aortocoronary bypass grafting.  

PubMed Central

Fifty five patients with 108 coronary bypass saphenous vein grafts were studied at necropsy. The mean duration of the grafts was 153 days (SD 516). The luminal narrowing of the native coronary arteries proximal to, at, and distal to the vein graft anastomoses and the narrowing of the non-grafted arteries were evaluated planimetrically. Twenty nine per cent of coronary arteries distal to graft anastomoses showed at least 76% narrowing and 50-75% occlusion was seen in 39% of such arteries. Fifty three per cent of non-grafted arteries showed at least 76% luminal narrowing and 26% had 50-75% narrowing. Six patients (11%) had surgically induced dissection of coronary arteries. Seventy seven vein grafts (71%) showed no appreciable luminal narrowing. Problems related to operative technique caused 30% of the deaths. Images

Rose, A G

1985-01-01

126

Thromboxane Receptor Stimulation Suppresses Guanylate Cyclase-Mediated Relaxation of Radial Arteries  

Microsoft Academic Search

Background. The internal mammary artery (IMA) and the radial artery (RA) are routinely used in coronary artery bypass grafting. However, RA grafts have a higher incidence of postoperative vasospasm and comparatively poor patency rates. The present study was undertaken to investigate the signaling pathways mediating contraction and relaxation in the IMA and RA with the aim of better understanding the

Muhammad Arshad; Venkataramana Vijay; Beverly C. Floyd; Mohan R. Sarabu; Michael S. Wolin; Sachin A. Gupte

2010-01-01

127

Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery  

Microsoft Academic Search

Anemia is an indisputable finding in patients scheduled for coronary artery bypass graft (CABG) that can occur any time preoperatively.\\u000a In presence of severe coronary artery disease, anemia can dramatically affect surgical outcomes. Therefore, we conducted this\\u000a study to determine the effect of low preoperative hemoglobin (Hgb) on postoperative outcome in patients who underwent coronary\\u000a artery bypass graft (CABG). In

Mahmood Shirzad; Abbasali Karimi; Samaneh Dowlatshahi; Seyed Hossein Ahmadi; Saeed Davoodi; Mehrab Marzban; Namvar Movahedi; Kyomars Abbasi; Mokhtar Tazik; Mahmood Sheikh Fathollahi

2010-01-01

128

Diabetes in patients undergoing coronary artery bypass grafting. Impact on perioperative outcome.  

PubMed

Diabetes mellitus is an established risk factor related to significant morbidity and mortality after coronary artery bypass grafting. Data on 9682 patients undergoing coronary artery bypass grafting either with (n=8917) or without cardiopulmonary bypass (off-pump coronary artery bypass grafting; n=765) were subjected to an univariate analysis to identify potential associations between diabetes mellitus and 26 a priori selected perioperative outcome variables. Those having a significant association with diabetes were then subjected to a stepwise logistic regression model to identify the impact of diabetes as compared to additional 22 different a priori chosen patient related risk factors and treatment variables. Prevalence of outcome variables independently associated with diabetes has been determined in the subgroup of diabetics undergoing coronary artery bypass grafting with cardiopulmonary bypass or off-pump coronary artery bypass grafting surgery to evaluate the effect of avoiding cardiopulmonary bypass on perioperative patient outcome. Diabetes mellitus was defined as glucose intolerance either treated dietary, with oral hypoglycemics or with insulin. According to this definition of diabetes mellitus we found an overall prevalence of 37.1% (coronary artery bypass grafting with cardiopulmonary bypass: 37.5%; off-pump coronary artery bypass grafting: 32.5%). Eleven outcome variables having a significant association with diabetes were identified. Diabetes could be identified as an independent predictor of postoperative delirium, renal dysfunction and respiratory insufficiency. Prevalence of these three variables was lower in diabetics undergoing off-pump coronary artery bypass grafting as in those undergoing coronary artery bypass grafting with cardiopulmonary bypass surgery reaching statistical significance with regard to postoperative delirium and respiratory insufficiency. In conclusion, diabetes mellitus is a significant independent predictor for three postoperative outcome variables in coronary artery bypass surgery. Avoiding cardiopulmonary bypass in diabetics seems to have a beneficial effect. PMID:16142517

Bucerius, J; Gummert, J F; Walther, T; Doll, N; Barten, M J; Falk, V; Mohr, F W

2005-09-01

129

Simultaneous hybrid revascularization by bilateral carotid stenting and coronary artery bypass grafting.  

PubMed

Management of patient with concomitant severe coronary and carotid artery disease is challenging. The combined or staged surgical revascularization is burdened by an high risk of morbidity and mortality. Carotid artery stenting (CAS) has been recently introduced as an alternative revascularization approach. We describe a case of simultaneous hybrid revascularization by CAS followed by immediate coronary artery bypass graft (CABG) in a patient with a severe coronary artery disease and bilateral carotid artery stenosis. © 2010 Wiley-Liss, Inc. PMID:21207421

Visconti, Gabriella; Marino, Luigi; Briguori, Carlo

2011-01-01

130

Protective effect of dexmedetomidine in coronary artery bypass grafting surgery  

PubMed Central

The aim of this study was to observe the impact of dexmedetomidine on postoperative myocardial injury in patients undergoing off-pump coronary artery bypass (OPCAB) grafting. One hundred and sixty-two patients who were undergoing OPCAB surgery were randomly divided into control and dexmedetomidine groups (groups C and Dex, respectively). Following the first vascular anastomosis grafting, the patients in group Dex received a continuous intravenous infusion of 0.2–0.5 ?g/kg/h dexmedetomidine, until they were transferred to the Cardiac Surgery intensive care unit (ICU) for 12 h. Patients in group C received physiological saline intraoperatively and an intravenous infusion of 2–4 mg/kg/h isopropylphenol for postoperative sedation. Invasive arterial pressure and heart rate were continuously monitored for 5 min subsequent to entry into the operating theatre (T0), immediately following surgery (T1), 12 h post-surgery (T2), 24 h post-surgery(T3), 48 h post-surgery(T4) and 72 h post-surgery (T5). Blood samples were taken to determine the plasma levels of cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) at each time point. At 72 h post-surgery, a dynamic electrocardiogram was monitored. The blood pressure, heart rate, levels of cTnI, CK-MB, norepinephrine and cortisol, and postoperative arrhythmic events in the patients in group Dex all decreased compared with those in group C. The duration of mechanical ventilation and ICU residence time were also shorter than those in the control group (P<0.05). Dexmedetomidine reduced post-surgical myocardial injury in patients who had undergone OPCAB surgery.

REN, JIANJUN; ZHANG, HUIJUN; HUANG, LINING; LIU, YUE; LIU, FENGQIN; DONG, ZHENMING

2013-01-01

131

A novel technique for pulmonary endarterectomy in the presence of patent coronary artery bypass grafts.  

PubMed

Pulmonary endarterectomy (PEA) is the definitive surgical treatment for chronic thromboembolic pulmonary hypertension, with excellent short- and long-term results. PEA following previous coronary artery bypass graft surgery carries a risk of damage to patent grafts, as well as the risk of inadequate myocardial protection, especially when a patent pedicled internal thoracic artery graft is present. We report a technique where PEA may be safely and successfully accomplished ensuring, adequate clearance of bilateral pulmonary thromboembolic disease via a right pulmonary arteriotomy, avoiding the patent bypass grafts overlying the pulmonary trunk, while ensuring adequate myocardial protection. PMID:22323497

Mahesh, Balakrishnan; Nwaejike, Nnamdi; Dunning, John J; Jenkins, David P

2012-02-08

132

Effect of vacuum-assisted closure on blood flow in the peristernal thoracic wall after internal mammary artery harvesting  

Microsoft Academic Search

Objective: Vacuum-assisted closure (VAC) is a recently introduced method for the treatment of poststernotomy mediastinitis. The aim was to examine the effects of VAC negative pressure on peristernal soft tissue blood flow after internal mammary artery harvesting. Methods: Microvascular blood flow was measured using laser Doppler velocimetry in a porcine sternotomy wound model. The effect of VAC negative pressure on

Rainer Petzina; Lotta Gustafsson; Arash Mokhtari; Richard Ingemansson; Malin Malmsjö

2006-01-01

133

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

134

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

135

Diagnosis of arterial prosthetic graft infection by /sup 111/In oxine white blood cell scans  

SciTech Connect

Early and accurate diagnosis of infected prosthetic arterial grafts is difficult, despite the application of diverse diagnostic modalities. Delay in making the diagnosis is largely responsible for the high amputation and mortality rates associated with this complication. In nine patients with suspected graft infections, /sup 111/In white blood cell scanning was useful and accurate. Graft infection was proved in five cases and ruled out in three. One false-positive scan was due to a sigmoid diverticular abscess overlying the graft. /sup 111/In white blood cell scans may improve the accuracy of diagnosing infected prosthetic grafts, which may result in better limb and patient salvage rates.

McKeown, P.P.; Miller, D.C.; Jamieson, S.W.; Mitchell, R.S.; Reitz, B.A.; Olcott, C.; Mehigan, J.T.; Silberstein, R.J.; McDougall, I.R.

1982-08-01

136

Randomized trial of fondaparinux versus heparin to prevent graft failure after coronary artery bypass grafting: the Fonda CABG study.  

PubMed

We sought to assess the feasibility of comparing the efficacy and safety of fondaparinux versus heparin for prevention of graft failure and major CV events in patients undergoing coronary artery bypass grafting (CABG). Patients undergoing CABG were randomized to receive postoperative injections of fondaparinux or heparin in-hospital. After discharge, the fondaparinux group received fondaparinux and the heparin group received placebo injections for 30 days post surgery. Efficacy outcomes were graft failure, death, MI, and stroke at 30 days. Safety outcomes were bleeding, transfusion, and reoperation. 100 patients were recruited, 99 were randomized, 49 received fondaparinux and 50 received heparin. CT angiography was performed in 97% of patients. 188 grafts in the treatment group and 189 grafts in the heparin group were imaged. A similar proportion of patients treated with fondaparinux compared with heparin had at least one occluded graft (18.8% fondaparinux vs. 14.9% heparin, P = 0.62) and a similar number of grafts were occluded in each treatment group (all grafts: 4.8% vs. 4.8%, P = 0.99; saphenous vein grafts 4.2% vs. 4.2%, P = 0.98). There was no difference between treatment groups in death, MI, stroke, bleeding events, or reoperation. One in 10 patients undergoing CABG had at least one occluded graft at 30 days and one in 20 grafts is occluded by 30 days. Fondaparinux appears to be a safe alternative to heparin after CABG and it is feasible to conduct a definitive RCT using CT angiography to evaluate the effect of fondaparinux treatment on graft patency. PMID:21748448

Sun, Jack C J; Teoh, Kevin H T; Sheth, Tej; Landry, David; Jung, Hyejung; Warkentin, Theodore E; Yusuf, Salim; Lamy, Andre; Eikelboom, John W

2011-10-01

137

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting  

Microsoft Academic Search

We report a rare case of pulmonary embolism (PE) caused by a carbon dioxide (CO2) blower during off-pump coronary artery bypass grafting (OPCAB). When the anastomosis of the right internal thoracic artery\\u000a to left anterior descending artery was performed, the operator tore the right ventricle outflow track (RVOT) that was adjacent\\u000a to the left anterior descending artery. Immediately after the

Naoyuki Hirata; Noriaki Kanaya; Yutaka Yamazaki; Hajime Sonoda; Akiyoshi Namiki

2010-01-01

138

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

139

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

PubMed

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

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

2011-03-28

140

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

PubMed

Abstract 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

2013-07-15

141

The effect of distal sepsis on arterial grafts: An experimental study  

Microsoft Academic Search

Summary  Prosthetic infection following recon-structive vascular operations is an infrequent but often fatal complication which generally\\u000a persists until the graft is removed. It is accepted that infection arises from operative contamination, bacteraemic seeding\\u000a or an abscess or a viscus eroding into the graft. This study investigates the role played by distal limb sepsis on arterial\\u000a grafts placed in the groin of

W. A. Tanner; D. Acton; E. C. Moorehouse; D. Bouchier-Hayes

1984-01-01

142

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

143

Aprotinin for Primary Coronary Artery Bypass Grafting: A Multicenter Trial of Three Dose Regimens  

Microsoft Academic Search

Background. High-dose aprotinin reduces transfusion requirements in patients undergoing coronary artery bypass grafting, but the safety and effectiveness of smaller doses is unclear. Furthermore, patient selection criteria for optimal use of the drug are not well defined.Methods. Seven hundred and four first-time coronary artery bypass grafting patients were randomized to receive one of three doses of aprotinin (high, low, and

John H. Lemmer; Emery W. Dilling; Jeremy R. Morton; Jeffrey B. Rich; Francis Robicsek; Donald L. Bricker; Charles B. Hantler; Jack G. Copeland; John L. Ochsner; Pat O. Daily; Charles W. Whitten; George P. Noon; Rosemarie Maddi

1996-01-01

144

Long-term chest wall discomfort in women after coronary artery bypass grafting  

Microsoft Academic Search

OBJECTIVE: The purpose of the study was to determine the occurrence of long-term chest wall discomfort in women after coronary artery bypass grafting.DESIGN: Prospective repeated-measures design.SETTING: Posthospitalization.SAMPLE: Fifty-one women who had undergone coronary artery bypass grafting. Data were collected at 12 and 18 months by self-report and data collection instruments.INSTRUMENTS: Life Orientation Test, Satisfaction with Life Scale, Profile of Mood

Meredeth A. Rowe; Kathleen B. King

1998-01-01

145

Stent-Graft Repair of a Large Cervical Internal Carotid Artery Pseudoaneurysm Causing Dysphagia  

SciTech Connect

Pseudoaneurysms of the cervical internal carotid artery (ICA) are rare and most frequently result from trauma, infection, or sometimes spontaneously. They have the potential to cause life-threatening hemorrhage; thus, their immediate management is necessary. Endovascular treatment by stent graft placement in the affected artery appears to be a safe and effective treatment option. We present a case of a child who presented with neck swelling and dysphagia caused by a ruptured cervical ICA pseudoaneurysm which was managed by stent graft placement.

Gupta, Vivek, E-mail: drvivekgupta.pgi@gmail.com; Niranjan, Khandelwal; Rawat, Lokesh [Postgraduate Institute of Medical Education and Research, Department of Radiodiagnosis and Imaging (India); Gupta, A. K. [Postgraduate Institute of Medical Education and Research, Department of Otolaryngology (India)

2009-05-15

146

Intimal hyperplasia and hemodynamic factors in arterial bypass and arteriovenous grafts: a review.  

PubMed

Stenosis at the graft-vein junction caused by intimal hyperplasia (IH) is the major cause of failure of vascular access grafts used for hemodialysis. There is a strong relationship between hemodynamic factors and formation of IH. The hemodynamic pattern and the location of IH are different in arterial bypass grafts (ABGs) compared with arteriovenous grafts (AVGs). In an ABG, end-to-side anastomosis of the expanded polytetrafluoroethylene graft and artery produces hemodynamic changes around the junction. IH develops at the arterial floor and the toe and heel of the distal anastomosis. Low shear stress and oscillating shear forces at the arterial floor and the heel plus a high wall sheer stress (WSS) gradient at the toe probably promote IH development. Compliance mismatch between the graft and artery causes turbulence that may contribute to IH formation. The blood flow rate in AVGs is 5-10 times greater than that in ABGs. High flow causes turbulence that injures endothelial cells and eventually results in IH. The peak WSS in AVGs is about 6 N/m(2), much higher than that in ABGs. Excessively high WSS may effect IH formation in AVGs. Several venous cuff or patch anastomotic designs have been used in attempts to regulate hemodynamic factors in grafts. In ABGs, these designs appear to help decrease IH formation. In AVGs, however, they generally have not improved patency rates. In a high-flow system such as an AVG, more drastic changes in anastomotic design may be required. PMID:14691664

Haruguchi, Hiroaki; Teraoka, Satoshi

2003-01-01

147

A Comparison of Interposition and Femoropopliteal Bypass Grafts in the Management of Popliteal Artery Trauma  

PubMed Central

Background: Peripheral vascular injury associated with lower limb trauma is a well-known emergency. The experience for the management of popliteal artery trauma have mainly come from managing the traumas of military personnels during Iran-Iraq war. The present study compared the effects of two currently-used surgical techniques in the management of popliteal trauma, namley femoropopliteal bypass graft and interposition vein graft on limb salvage. Methods: A retrospective review of 40 patients with popliteal artery trauma admitted to the trauma unit of a university teaching hospital during 2003 to 2008. The patients had undergone femoropopliteal bypass graft (n=26) or interposition vein graft (n=14) for the management of popliteal trauma. Results: The amputation rate among patients managed by femoropopliteal bypass or interposition vein graft was 35.7% and 61.5%, respectively. Knee stability among patients managed by interposition graft group was 57.7% and in those managed by femoropopliteal bypass graft was 85.7%. Conclusion: The rates of knee stability achieved by the employed techniques indicate that femoropopliteal bypass vein graft is superior, and therefore, preferable to the interposition vein graft in the management of popliteal artery trauma.

Mohammadzade, Mohammad Ali; Mohammadzade, Maryam; Herfatkar, Mohammad Rasul

2011-01-01

148

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

149

The incidence of renal artery stenosis in the patients referred for coronary artery bypass grafting.  

PubMed

Multivessel coronary disease or peripheral arterial disease is the clinical clue to diagnosis of renal artery stenosis (RAS). RAS is considered equivalent to coronary artery disease in terms of cardiovascular risk. In this study, we evaluated the incidence of RAS in the patients who were proposed to undergo coronary artery bypass grafting (CABG). Diagnostic evaluations of coronary arteriography and renal artery angiography were performed during the same procedure; the patients who were proposed for CABG in terms of CAD anatomy and clinical manifestation were enrolled. RAS was evaluated and a diameter stenosis of ?50% was considered as significant RAS; significant RAS patients were divided into five groups. The five groups of RAS were as follows: (1) unilateral RAS ?50-70%, (2) unilateral RAS ?70%, (3) bilateral RAS ?50-70%, (4) one-renal-artery stenosis ?50-70%, contralateral RAS ?70%, and (5) bilateral renal artery stenosis ?70%. A total of 151 patients were enrolled, and RAS (?50% stenosis in either or both renal arteries) was identified in 47.02% (71/151) patients. Unilateral RAS ?50-70% was identified in 16.6% (25/151) patients, unilateral RAS ?70% in 4.6% (7/151) patients, bilateral RAS ?50-70% in 7.9% (12/151) patients, one-renal-artery stenosis ?50-70% and contralateral RAS ?70% in 7.9% (12/151) patients, and bilateral RAS ?70% was in 9.9%(15/151) patients. The incidence of RAS was 29.03% (18/62) in patients aged ?60 years, 60% (36/60) in patients aged >60 and ?70 years, and 58.62% (17/29) in patients aged >70 years. The incidence of RAS was significantly higher in patients aged >60 - ?70, and >70 years than patients aged ?60 years (P = 0.001 and P = 0.007, respectively). There was a trend that the incidence of RAS in patients with hypertension [HTN, 50.40% (64/127)] was higher than those without HTN (29.17%, 7/24), with P = 0.056. The incidence of RAS was 47.02% in patients who were proposed for CABG; bilateral RAS of ?70% was 9.9%. Older age and HTN were associated with RAS in patients who were referred for CABG. This study indicates that the incidence of RAS was high in the patients referred for CABG, and the renal function should be taken care of. PMID:22279337

Liang, F; Hu, D Y; Wu, M Y; Li, T C; Tang, C Z; Wang, J Y; Lu, C L

2012-01-01

150

The incidence of renal artery stenosis in the patients referred for coronary artery bypass grafting  

PubMed Central

Multivessel coronary disease or peripheral arterial disease is the clinical clue to diagnosis of renal artery stenosis (RAS). RAS is considered equivalent to coronary artery disease in terms of cardiovascular risk. In this study, we evaluated the incidence of RAS in the patients who were proposed to undergo coronary artery bypass grafting (CABG). Diagnostic evaluations of coronary arteriography and renal artery angiography were performed during the same procedure; the patients who were proposed for CABG in terms of CAD anatomy and clinical manifestation were enrolled. RAS was evaluated and a diameter stenosis of ?50% was considered as significant RAS; significant RAS patients were divided into five groups. The five groups of RAS were as follows: (1) unilateral RAS ?50–70%, (2) unilateral RAS ?70%, (3) bilateral RAS ?50–70%, (4) one-renal-artery stenosis ?50–70%, contralateral RAS ?70%, and (5) bilateral renal artery stenosis ?70%. A total of 151 patients were enrolled, and RAS (?50% stenosis in either or both renal arteries) was identified in 47.02% (71/151) patients. Unilateral RAS ?50–70% was identified in 16.6% (25/151) patients, unilateral RAS ?70% in 4.6% (7/151) patients, bilateral RAS ?50–70% in 7.9% (12/151) patients, one-renal-artery stenosis ?50–70% and contralateral RAS ?70% in 7.9% (12/151) patients, and bilateral RAS ?70% was in 9.9%(15/151) patients. The incidence of RAS was 29.03% (18/62) in patients aged ?60 years, 60% (36/60) in patients aged >60 and ?70 years, and 58.62% (17/29) in patients aged >70 years. The incidence of RAS was significantly higher in patients aged >60 - ?70, and >70 years than patients aged ?60 years (P = 0.001 and P = 0.007, respectively). There was a trend that the incidence of RAS in patients with hypertension [HTN, 50.40% (64/127)] was higher than those without HTN (29.17%, 7/24), with P = 0.056. The incidence of RAS was 47.02% in patients who were proposed for CABG; bilateral RAS of ?70% was 9.9%. Older age and HTN were associated with RAS in patients who were referred for CABG. This study indicates that the incidence of RAS was high in the patients referred for CABG, and the renal function should be taken care of.

Liang, F.; Hu, D. Y.; Wu, M. Y.; Li, T. C.; Tang, C. Z.; Wang, J. Y.; Lu, C. L.

2012-01-01

151

Acute ischemic syndromes following coronary artery bypass graft surgery.  

PubMed

Coronary artery bypass graft (CABG) surgery, performed for the control of angina pectoris, leads to postoperative relief from symptoms in most patients. Amelioration of ischemia and improvement in exercise capacity after CABG are well documented. However, patients currently undergoing CABG are more complex than in the past--they are older and are maintained on medical therapy for longer periods. A large number of these patients have had one or more previous myocardial revascularization procedures. The post-operative period would appear to be a time of vulnerability for coronary events. However, previous investigators have focused on the pre- and intraoperative aspects of peri-CABG ischemia. Outcome data suggest that the postoperative interval is at least equally important as a determinant of short- and long-term morbidity and mortality. We discuss the epidemiology, etiology, pathophysiology, and treatment of ischemic syndromes in the postoperative period after CABG. In addition, we review recent data from a series of 14 patients, observed at our institution, who underwent cardiac catheterization and, in some cases, angioplasty of the culprit vessel in the immediate postoperative period. PMID:9755378

Hirsch, W S; Ledley, G S; Kotler, M N

1998-09-01

152

Clinical Outcome of Urgent Coronary Artery Bypass Grafting  

PubMed Central

Urgent coronary artery bypass grafting (CABG) has a higher mortality rate than elective CABG. The purpose of this study was to evaluate the clinical outcome of urgent CABG. From July 1992 to May 2005, 104 patients underwent urgent CABG. All patients required an urgent surgical revascularization within 24 hr of diagnostic coronary angiography. In-hospital mortality after urgent CABG was 17.3% (18/104). We compared preoperative characteristics and postoperative clinical outcomes between the survival group (n=86) and the mortality group (n=18). The mean age was 61.7 yr (range, 35-83). The most common cause of mortality was low cardiac output. The independent preoperative risk factors of mortality included advanced age (>70 yr) (OR=3.998, p=0.046), preoperative shock status (OR=6.542, p=0.011), and low ejection fraction (<40%) (OR=4.492, p=0.034). Other risk factors of mortality included prolonged cardiopulmonary bypass time, prolonged ventilator use, and extended intensive care unit stay. The 10-yr actuarial survival rate was 61%. Although the operative mortality rate was high after urgent CABG, a favorable long-term clinical outcome can be expected if the patients survive.

Kim, Do-Kyun; Yoo, Kyung-Jong; Hong, You Sun; Chang, Byung-Chul

2007-01-01

153

Transit Time Flowmetry in Coronary Artery Bypass Grafting-experience at Queen Alia Heart Institute, Jordan  

PubMed Central

Objectives To assess the results of transit time flowmetry (TTF) on a consecutive group of coronary artery bypass grafting (CABG) patients at Queen Alia Heart Institute. Methods Intraoperative flow measurements of a consecutive group of 436 CABG patients. The flow pattern for each coronary artery system was assessed including mean flows, pulsatility index (PI) and the need for revision. Results A total of 1394 grafts in 436 patients were assessed (3.2 grafts per patient), wherein 100 grafts showed inadequate flowmetry results (7.2%); most of which were in the circumflex and right coronary artery systems with a percentage of 9.4% and the least in the LAD system with a percentage of 4.4%. The mean flow of grafts to the LAD system was 33.4±5.3 mL/min with a PI of 2.4±0.4; while the mean for grafts to the circumflex artery system was 35.1±7.2 mL/min with a PI of 3.5±0.7. The mean for the right coronary artery was 38.4±5.9 mL/min with a PI of 2.6±0.6. Revisions occurred in five patients (1.1%). Suboptimal grafts to the LAD system exhibited a flow of 14.1±7.4 mL/min with a PI of 6.9±1.7. While for the circumflex system a flow of 5.5±3.6 mL/min was reported with a PI of 10.4±7.8; and for the right coronary system a flow of 7.2±5.3 mL/min with a PI of 9.1±5.7 was reported. Conclusion Grafts to the LAD system showed the best flowmetry results compared to grafts to the circumflex and right coronary systems. A proportion of poor grafts were revised.

Harahsheh, Basel

2012-01-01

154

Use of an audible ultrasonic flowmeter to locate deeply buried coronary arteries for off-pump coronary artery bypass grafting.  

PubMed

In patients with coronary arteries that are deeply buried in the myocardium and fat, it is difficult and sometimes risky to expose them for off-pump coronary artery bypass grafting (OPCAB), leading to unavoidable conversion to conventional coronary artery bypass grafting (C-CABG) to ensure their safety. We have developed a new search procedure for these coronary arteries using a dedicated ultrasonic flowmeter with a small tip probe for OPCAB. This technique enables the identification of intramuscular and intra-fat coronary arteries that are less diseased and thus more suited for bypass surgery instead of switching to C-CABG. We believe this procedure will not only improve the quality of OPCAB but also expand its indication. PMID:16519133

Kikuchi, Keita; Makuuchi, Haruo; Murakami, Hiroshi; Suzuki, Takamaro; Oono, Makoto; Chiba, Kiyoshi

2006-02-01

155

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

Microsoft Academic Search

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

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

2002-01-01

156

Fistula from right internal mammary artery to superior vena cava after use of a laser sheath to extract a pacemaker lead.  

PubMed

A 55-year-old woman presented with dyspnea on exertion due to a right internal mammary artery-to-superior vena cava arteriovenous fistula that occurred after pacemaker lead extraction with a laser sheath. The fistula was successfully repaired by placing a covered stent in the right internal mammary artery. In this unusual location, endovascular stenting is a reasonable alternative to coil embolization or surgical repair of an arteriovenous fistula resulting from laser lead extraction. PMID:23109780

Azpurua, Federico E; Dougherty, Kathryn G; Massumi, Ali; Strickman, Neil E

2012-01-01

157

Fistula from Right Internal Mammary Artery to Superior Vena Cava after Use of a Laser Sheath to Extract a Pacemaker Lead  

PubMed Central

A 55-year-old woman presented with dyspnea on exertion due to a right internal mammary artery-to-superior vena cava arteriovenous fistula that occurred after pacemaker lead extraction with a laser sheath. The fistula was successfully repaired by placing a covered stent in the right internal mammary artery. In this unusual location, endovascular stenting is a reasonable alternative to coil embolization or surgical repair of an arteriovenous fistula resulting from laser lead extraction.

Azpurua, Federico E.; Dougherty, Kathryn G.; Massumi, Ali; Strickman, Neil E.

2012-01-01

158

Successful endografting with simultaneous visceral artery bypass grafting for severely calcified thoracoabdominal aortic aneurysm  

Microsoft Academic Search

We present two cases of severely calcified thoracoabdominal aortic aneurysm treated by means of endografting with a retrograde aortomesenteric bifurcated bypass graft reconstructing the celiac axis and superior mesenteric artery. To avoid spinal ischemia, we monitored evoked spinal cord potential and performed an occlusion test of the intercostal arteries using a retrievable stentgraft. No change in evoked spinal cord potential

Yoshiko Watanabe; Shin Ishimaru; Satoshi Kawaguchi; Taro Shimazaki; Yoshihiko Yokoi; Mikihiko Ito; Yukio Obitsu; Mikio Ishikawa

2002-01-01

159

Endovascular stent graft repair of iatrogenic popliteal artery injuries--a report of 2 cases.  

PubMed

Popliteal artery injury during total knee replacement (TKR) is rare. We report 2 cases of post-TKR popliteal artery occlusions treated endovascularly with Viabahn stent grafts. Long-term duplex follow-up and secondary re-intervention may be necessary. PMID:22504510

Kovacs, Flora; Pollock, J Graham; DeNunzio, Mario

2012-04-12

160

Perioperative coronary artery spasm leading to myocardial ischaemia after vein graft surgery.  

PubMed Central

Coronary artery spasm has been recognised recently as a possible cause of perioperative myocardial ischaemia after coronary artery bypass grafting. We report on one case and review the published reports. We emphasise the clinical picture of the patient who is liable to have spasm and the necessity for a prompt diagnosis and correct treatment. Images

Zingone, B; Salvi, A; Branchini, B

1983-01-01

161

Radial artery flow-through graft: A new conduit for limb salvage  

Microsoft Academic Search

Objective Patients with severe peripheral occlusive disease may present especially challenging problems because of previous bypass surgery, location of ulcers, or extremely poor runoff. We used the radial artery with its overlying skin flap as a bypass conduit, called the radial artery flow-through (RAFT) graft in 10 such patients. Methods From November 1999 to January 2002, 10 patients had limb-threatening

Victoria J. Teodorescu; Jin K. Chun; Nicholas J. Morrisey; Peter L. Faries; Larry H. Hollier; Michael L. Marin

2003-01-01

162

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

163

Improved outcomes in coronary artery bypass grafting with beating-heart techniques  

Microsoft Academic Search

Objective: Although improved outcomes for selected patients by elimination of cardiopulmonary bypass have been demonstrated, a benefit for all patients undergoing coronary artery bypass grafting by all surgeons has yet to be definitively proved. Methods: We reviewed our experience with beating-heart surgery from its inception in January 1995 through December 2000. A total of 12,540 patients underwent isolated coronary artery

Michael Mack; Donna Bachand; Tea Acuff; James Edgerton; Syma Prince; Todd Dewey; Mitchell Magee

2002-01-01

164

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

Microsoft Academic Search

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

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

165

Aortic valve replacement after previous coronary artery bypass grafting: a case report.  

PubMed

We experienced a case of aortic valve replacement after previous coronary artery bypass grafting with patent bypass grafts. Based on the retrosternal anatomy assessed by preoperative angiography and thoracic computed tomography, aortic valve replacement was performed through a median resternotomy. After careful dissection of the right side of the heart and the ascending aorta, cardiopulmonary bypass was established with cannulation of the ascending aorta and bicaval venous cannulation. The patent bypass grafts were dissected only as required for clamping and were clamped during cardiac arrest. After aortic valve replacement, the patient was uneventfully weaned from cardiopulmonary bypass and had a good postoperative recovery. It is important that surgeons have a meticulous strategy for reducing the risks associated with operating on patients with patent bypass grafts. We report on the surgical management of patients undergoing aortic valve replacement after previous coronary artery bypass grafting, including careful planning during the first operation. PMID:23877203

Suzuki, Shigemitsu; Nakamura, Katsuhiko; Takagi, Kazumi; Kashikie, Hideyuki; Akaiwa, Keiichi

2013-07-22

166

Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta  

Microsoft Academic Search

Purpose: This prospective, observational study determined the long-term outcome in patients with abdominal aortic infection (primary or prosthetic graft) who were treated with simultaneous aortic\\/graft excision and cryopreserved arterial allograft reconstruction. Methods: From April 1992 to March 2000, patients with abdominal aortic infection underwent complete or partial excision of the infected aorta\\/prosthetic graft and cryopreserved arterial allograft reconstruction. Arterial allografts

Guy Lesčche; Yves Castier; Marie-Dominique Petit; Patrick Bertrand; Michel Kitzis; Sacha Mussot; Mathieu Besnard; Olivier Cerceau

2001-01-01

167

Coronary Arteries Bypass Grafting Surgery in Elderly Patients  

PubMed Central

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

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

2013-01-01

168

Aspirin and Postoperative Bleeding After Coronary Artery Bypass Grafting  

PubMed Central

Objective To evaluate the relationship between aspirin ingestion and postoperative bleeding complications, and to test the hypothesis that there is a subset of patients who are aspirin hyperresponders with a proclivity toward platelet dysfunction. Summary Background Data Despite numerous retrospective and prospective analyses, it is still controversial as to whether aspirin ingestion before coronary artery bypass grafting (CABG) is associated with significant postoperative bleeding. Methods Between January 1995 and December 1999, the records of 2,606 consecutive patients undergoing CABG were reviewed to identify patients with a history of aspirin ingestion up until the time of surgery. Aspirin ingestion was correlated with postoperative blood transfusion using multivariate analysis. In a subset of preoperative aspirin users (n = 40), bleeding times were measured before and after aspirin use. Flow cytometry was performed in another cohort of patients with known heart disease (n = 30) to determine the effect of aspirin on platelet surface receptors. Results During the 5-year study period, 63% of the CABG patients were identified as aspirin users. Among these, 23.1% required blood transfusions compared with 19% for the nonusers. Non-red blood cell transfusions were more common in aspirin users, as was reexploration for bleeding. Stratification of these results according to the frequency of aspirin use showed that aspirin is an independent multivariate predictor of postoperative blood transfusion only in high-risk patients. In the prospective studies, aspirin treatment resulted in a significant increase in the template bleeding time, an increase in platelet PAR-1 thrombin receptor activity, and a decrease in the binding of platelets to monocytes. Conclusions The findings support the hypothesis that aspirin is associated with a greater likelihood of postoperative bleeding. A platelet function testing algorithm that combines preoperative risk factor assessment, template bleeding times, and flow cytometry may allow the identification of aspirin hyperresponders who are at increased risk for bleeding.

Ferraris, Victor A.; Ferraris, Suellen P.; Joseph, Oji; Wehner, Paulette; Mentzer, Robert M.

2002-01-01

169

Development of Decellularized Human Umbilical Arteries as Small-Diameter Vascular Grafts  

PubMed Central

Objective Developing a tissue-engineered small-diameter (<6?mm) vascular graft for reconstructive surgery has remained a challenge for the past several decades. This study was conducted to develop a decellularized umbilical artery and to evaluate its composition, endothelial cell compatibility, mechanical properties, and in vivo stability for potential use as a small-diameter vascular graft. Methods and Results Human umbilical arteries were isolated and decellularized by incubation in CHAPS and sodium dodecyl sulfate buffers followed by incubation in endothelial growth media-2. Decellularized umbilical arteries were completely devoid of cellular and nuclear material while retaining the integrity of extracellular collagenous matrix. The mechanical strength of the decellularized umbilical artery as assessed by its burst pressure in vitro showed no significant change from its native form. Decellularized umbilical arteries supported endothelial adherence as indicated by the re-endotheliazation with a monolayer of human umbilical vein endothelial cells. Furthermore, decellularized vessels that were implanted into nude rats as abdominal aorta interposition grafts remained mechanically intact and patent for up to 8 weeks. Conclusion Decellularized human umbilical arteries preserved the extracellular matrix, supported endothelialization, and retained function in vivo for up to 8 weeks. These properties suggest the potential use of decellularized umbilical arteries as small-diameter vascular grafts.

Gui, Liqiong; Muto, Akihito; Chan, Stephen A.; Breuer, Christopher K.

2009-01-01

170

Stent-Graft Placement for Femoral Artery Pseudoaneurysm in a Patient with Idiopathic Multiple Arterial Aneurysmal Disease  

SciTech Connect

A 34-year-old man presenting with a left inguinal mass was diagnosed as having idiopathic multiple aneurysmal disease and pseudoaneurysm of a left superficial femoral artery. A stent-graft was successfully deployed percutaneously at the left superficial femoral artery pseudoaneurysm. Less invasive treatment should be used to avoid vascular complications in patients with idiopathic multiple aneurysmal disease, especially in those who have a progressive course or a history of prior complications after surgical repair.

Koo, Bon Kwon; Choi, Donghoon; Kwon, Kihwan; Jang, Yangsoo; Shim, Won-Heum; Cho, Seung-Yun [Cardiology Division, YonseiCardiovascular Hospital and Cardiovascular Research Institute (Korea, Republic of); Lee, Do Yun [Department of Radiology, Yonsei University Collegeof Medicine, C.P.O. Box 8044, Seoul (Korea, Republic of)

2002-12-15

171

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

PubMed Central

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

Malinska, Agnieszka; Nowicki, Michal; Misterski, Marcin; Ostalska-Nowicka, Danuta; Jemielity, Marek

2012-01-01

172

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

173

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

174

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

PubMed Central

AIM: To present a series of cases with life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm 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 endovascular balloon-expandable coronary stent-grafts. All patients were not suitable for embolization because of a non-patent portal vein. One or more stent-grafts, ranging 3-6 mm in diameter and 16-55 mm in length, were placed to exclude ruptured pseudoaneurysm. Follow-up data, including clinical condition, liver function tests, and Doppler ultrasound examination, were recorded at the outpatient clinic. RESULTS: Immediate technical success was achieved in all the 9 patients. All stent-grafts were deployed in the intended position for immediate cessation of bleeding and preservation of satisfactory hepatic arterial blood flow. No significant procedure-related complications occurred. Recurrent bleeding occurred in 2 patients at 16 and 24 h, respectively, after placement of stent-grafts and treated with surgical revision. One patient died of sepsis 12 d after the interventional procedure. The remaining 6 patients were survived when they were discharged. The mean follow-up time was 10.5 mo (range 4-16 mo). No patient had recurrent bleeding after discharge. Doppler ultrasound examination verified the patency of hepatic artery and stent-grafts during the follow-up. CONCLUSION: Placement of stent-grafts is an effective and safe procedure for acute life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm.

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

2010-01-01

175

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

176

Effect of a selective thromboxane synthase inhibitor on arterial graft patency and platelet deposition in dogs  

SciTech Connect

This study examined the effect of selective thromboxane synthase inhibition and nonselective cyclooxygenase inhibition on vascular graft patency and indium 111-labeled platelet deposition in 35 mongrel dogs undergoing carotid artery replacement with 4 mm X 4 cm polytetrafluoroethylene (PTFE) (one side) and Dacron (opposite side) end-to-end grafts. Aspirin-dipyridamole therapy improved one-week graft patency, from 46% in untreated dogs to 93% in treated dogs. Thromboxane synthase inhibition (U-63557A) improved graft patency in these dogs to 81%. Both drug treatments reduced platelet deposition on Dacron and PTFE grafts by 48% to 68% compared with control dogs. Dacron grafts accumulated significantly more platelets than PTFE grafts but had comparable patency rates. Low-dose aspirin therapy had no significant effect on either graft patency or platelet deposition. All treatment groups showed a 60% to 76% reduction in serum thromboxane B2, but only thromboxane synthase inhibitor treatment increased plasma 6-keto-prostaglandin F1 alpha by 100%. Selective thromboxane synthase inhibition improved small-caliber prosthetic graft patency to the same extent as did conventional cyclooxygenase inhibition in this preliminary study.

McDaniel, M.D.; Huntsman, W.T.; Miett, T.O.; Cronenwett, J.L.

1987-08-01

177

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

178

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

2012-04-10

179

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

Microsoft Academic Search

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

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

1998-01-01

180

Cardiac rehabilitation after coronary artery bypass graft surgery: its effect on ischaemia, functional capacity, and a multivariate index of prognosis  

Microsoft Academic Search

Objective: To assess the effect of cardiac rehabilitation on indices of ischaemia, functional capacity, and exercise test derived indices of prognosis in patients who undergo coronary artery bypass grafting (CABG).Patients and Methods : Prospective study of 150 consecutive cardiac rehabilitation patients who underwent coronary artery bypass grafting (CABG). Patients entered a hospital-based multidimensional cardiac rehabilitation programme with at least 2

R. Sharma; A. A. McLeod

2001-01-01

181

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

182

Ex vivo carbon monoxide delivery inhibits intimal hyperplasia in arterialized vein grafts  

PubMed Central

Aims Veins are still the best conduits available for arterial bypass surgery. When these arterialized vein grafts fail, it is often due to the development of intimal hyperplasia (IH). We investigated the feasibility and efficacy of the ex vivo pre-treatment of vein grafts with soluble carbon monoxide (CO) in the inhibition of IH. Methods and results The inferior vena cava was excised from donor rats and placed as an interposition graft into the abdominal aorta of syngeneic rats. Prior to implantation, vein grafts were stored in cold Lactated Ringer (LR) solution with or without CO saturation (bubbling of 100% CO) for 2 h. Three and 6 weeks following grafting, vein grafts treated with cold LR for 2 h developed IH, whereas grafts implanted immediately after harvest demonstrated significantly less IH. Treatment in CO-saturated LR significantly inhibited IH and reduced vascular endothelial cell (VEC) apoptosis. Electron microscopy revealed improved VEC integrity with less platelet/white blood cell aggregation in CO-treated grafts. The effects of CO in preventing IH were associated with activation of hypoxia inducible factor-1? (HIF-1?) and an increase in vascular endothelial growth factor (VEGF) expression at 3–6 h after grafting. Treatment with a HIF-1? inhibitor completely abrogated the induction of VEGF by CO and reversed the protective effects of CO on prevention of IH. Conclusion Ex vivo treatment of vein grafts in CO-saturated LR preserved VEC integrity perioperatively and significantly reduced neointima formation. These effects appear to be mediated through the activation of the HIF1?/VEGF pathway.

Nakao, Atsunori; Huang, Chien-Sheng; Stolz, Donna B.; Wang, Yinna; Franks, Jonathan M.; Tochigi, Naobumi; Billiar, Timothy R.; Toyoda, Yoshiya; Tzeng, Edith; McCurry, Kenneth R.

2011-01-01

183

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

SciTech Connect

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

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

1989-06-15

184

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

185

Pulmonary oxygen transfer deficits of diabetic origin in patients undergoing coronary artery bypass grafting  

Microsoft Academic Search

The objective of this study was to determine the effects of a diabetic disposition on pulmonary gas exchange by examining 72 patients who underwent coronary artery bypass grafting (CABG), using the arterial\\/alveolar oxygen tension ratio [(a\\/a)Po2] as a criterion. Patients were divided into a diabetic (DM) group and a nondiabetic (non-DM) group. The postoperative blood gases and hemodynamic data measured

Shuji Seki; Hideo Yoshida; Osamu Ooba; Shigeru Teramoto; Yoshiaki Komoto

1993-01-01

186

Chronic epigastric blood collection after coronary artery bypass grafting: case report.  

PubMed

A clinical case of epigastric pain 3 months after coronary artery bypass grafting (CABG) is presented. The CT finding of an abdominal mass with thick wall, internal horizontal by-gravity level and linear contrast enhancement at the border between the two different components was correctly interpreted for a chronic hematoma with separation of the formed blood elements from blood serum; in particular, the linear contrast enhancement was related to an artery-feeding vessel. PMID:14585567

Aliprandi, Alberto; Fausto, Alfonso; Mossuto, Eugenio; Menicanti, Lorenzo; Sardanelli, Francesco

187

Intraoperative anastomotic site detection and assessment of LIMA-to-LAD anastomosis by epicardial ultrasound in off-pump coronary artery bypass grafting--a prospective single-blinded study.  

PubMed

The study was done to detect the optimal site of left anterior descending (LAD) artery for grafting and for the assessment of geometrical and anatomical characteristics of left internal mammary artery (LIMA)-to-LAD artery anastomosis in elective off-pump coronary artery bypass grafting surgery. Fifteen consecutive patients who underwent coronary artery bypass graft (CABG) were included in the study. All the operations were performed by a single surgeon. Epicardial ultrasound probe was placed at the site of grafting for scanning and the site of anastomosis selected. The anticipated target site selected by the surgeon was scanned for patency, size, septal perforator branches, and presence of plaque and calcification. The surgeon identified the LAD artery in 12 patients. In three patients, the LAD artery was not visible. However, with epicardial ultrasound, the LAD artery was identified in all patients. In 6 of 15 patients, the anticipated target anastomotic site was changed to a clear segment either due to the presence of perforators or plaques or calcifications. In all 15 patients, the surgeon scored the anastomosis as good, based on his or her experience independent of the ultrasound image. The anastomotic score by the cardiac anesthesiologist showed 5 anastomoses with satisfactory results and 10 anastomoses with good results. The study demonstrates that epicardial ultrasound scanning with a 10-MHz transducer provides reliable information in choosing the proper anastomotic site and allows proper visualization of LIMA-to-LAD anastomosis. All these measurements are easily obtained without risk of any complications and the method is not time consuming. PMID:20826964

Ravulapalli, Harish Babu; Karthekeyan, Ranjith B; Vakumudi, Mahesh; Srigiri, Ramesh; Saldanha, Richard; Sulaiman, Sajith

188

Hemodynamically significant arterial inflow stenosis in dysfunctional hemodialysis arteriovenous fistulae and grafts.  

PubMed

Purpose: Hemodynamically significant arterial inflow stenosis in dysfunctional fistulae and grafts is poorly understood. No reliable clinical methods exist to detect arterial inflow stenosis. In this study, we assessed the accuracy of a novel screening method to detect arterial inflow stenosis in dysfunctional fistulae and grafts following successful juxta-anastomotic and venous outflow intervention. Methods: We prospectively evaluated all patients (N= 204) referred to our academic center for angiographic evaluation of a dysfunctional dialysis fistula/graft from May 1, 2006 to June 30, 2007. Following successful angioplasty/stenting of the venous outflow and juxta-anastomotic areas, patients were screened for arterial inflow stenosis. The screening method involved detection of 1) weak thrill, or sluggish blood flow on the post-intervention angiogram, 2) low mean arterial blood pressures in the dialysis access arm compared to the contralateral arm, and 3) inadequate blood flow at the first hemodialysis session post-intervention. If patients screened positive for any of these, they were further evaluated for arterial inflow stenosis. Results: Fifteen patients (15/204) were positive for arterial inflow stenosis on screening study. Eleven of those 15 had arterial stenosis on angiography, giving our screening method a positive predictive value of 73.3%. Eight patients were successfully treated by angioplasty/stenting. Two patients successfully underwent surgical intervention. Two year patency of revascularization was 91% (10/11). Conclusions: Hemodynamically significant arterial inflow stenosis occurs and can be detected by simple clinical methods. Interventions for correction of the arterial inflow stenosis are successful.

PMID:22729525

Wu, Steven; Joe, Jennifer M; Covarrubias, Diego A; Kalva, Sanjeeva P

2012-10-01

189

Are metallic markers necessary for coronary artery bypass grafts? A study using X-ray computed tomography and selective graft angiography  

Microsoft Academic Search

Using X-ray computed tomography (CT) and selective graft angiography, the authors studied the necessity of metallic markers in coronary artery bypass grafts on 45 patients (mean age 57.2 years) with 87 saphenous vein grafts. Eight patients had 17 markers. X-ray CT was performed after surgery using an apparatus with a 1-second scanning time. Noncontrast X-ray CT was performed on horizontal

Eiji Tamiya; Yukiko Imai; Nobuhiko Ito; Hiroshi Ikenouchi; Yoshiyuki Hada; Kimihiro Tanaka; Yoshihiro Murota; Takeshi Ando; Akira Furuse; Ken-ichi Asano

1999-01-01

190

Left Carotid-to-Subclavian Artery Bypass Grafting for Recurrent Angina Caused by Coronary-Subclavian Steal Syndrome.  

PubMed

A 60-year-old man visited the outpatient clinic due to one month of recurrent exertional chest pain. Eleven years earlier he had undergone off-pump coronary artery bypass grafting using bilateral internal thoracic artery (ITA) Y-composite grafts based on the left ITA. Preoperative coronary angiography showed patent distal graft anastomoses and visualized the left ITA retrogradely. The arch aortography revealed near-total occlusion of the left subclavian artery at the level of the ostium. The patient underwent left carotid-to-subclavian artery bypass grafting using a 6 mm vascular conduit. Postoperative computed tomographic angiography revealed a patent bypass conduit between the left common carotid artery and left subclavian artery. The patient was discharged on postoperative day 4 with no symptoms or signs of myocardial ischemia. PMID:23423828

Kim, Min-Seok; Paeng, Jin Chul; Kim, Ki-Bong; Hwang, Ho Young

2013-02-06

191

Spiral CT During Selective Accessory Renal Artery Angiography: Assessment of Vascular Territory Before Aortic Stent-Grafting  

SciTech Connect

We evaluated the vascular territory of accessory renal arteries in cases where the vessel might be overlapped by an aortic stent-graft. Spiral CT during selective accessory renal artery angiography was performed in four patients with abdominal aortic aneurysms (including one with a horseshoe kidney). The volume of the vascular territory of each renal artery was measured using a software program provided by the CT unit manufacturer. The supernumerary renal arteries perfused 32%, 37%, 15%, and 16% of the total renal mass, respectively. In two patients, stent-grafts were implanted, which resulted in occlusion of the supernumerary renal artery. The volume of the renal infarction was equal to the volume perfused by the artery as calculated before implantation of the stent-graft.The method proposed is accurate for estimating the size of the expected renal infarction. It might help to determine whether placement of a stent-graft is acceptable.

Dorffner, Roland; Thurnher, Siegfried; Prokesch, Rupert; Youssefzadeh, Soraya [Department of Radiology, University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Hoelzenbein, Thomas [Department of Vascular Surgery, University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Lammer, Johannes [Department of Radiology, University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

1998-03-15

192

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting.  

PubMed

We report a rare case of pulmonary embolism (PE) caused by a carbon dioxide (CO2) blower during off-pump coronary artery bypass grafting (OPCAB). When the anastomosis of the right internal thoracic artery to left anterior descending artery was performed, the operator tore the right ventricle outflow track (RVOT) that was adjacent to the left anterior descending artery. Immediately after the anastomosis and repair of the torn RVOT with CO2 blower, the systolic pulmonary artery pressure (PAP) increased from 28 to 64 mmHg, and end-tidal CO2 decreased from 32 to 12 mmHg. Because transesophageal echocardiograph (TEE) showed numerous gas bubbles in the main pulmonary artery, we diagnosed PE caused by invasion of CO2 gas bubbles via the torn RVOT. Although a CO2 blower is useful to enhance visualization of the anastomosis during OPCAB, it should not be used for the venous system because it may cause CO2 embolism. PMID:20175289

Hirata, Naoyuki; Kanaya, Noriaki; Yamazaki, Yutaka; Sonoda, Hajime; Namiki, Akiyoshi

2010-02-01

193

Robotically assisted microsurgery for endoscopic coronary artery bypass grafting  

Microsoft Academic Search

Background. As minimally invasive approaches to cardiac surgery have expanded, a significant number of limitations have become apparent, particularly the lack of adequate precision with standard endoscopic instruments. We hypothesized that the use of robotics would eliminate some of these limitations.Methods. Twenty-five coronary anastomoses on an isolated porcine heart, using an arterial conduit to the left anterior descending artery, were

Edward R Stephenson; Sachin Sankholkar; Christopher T Ducko; Ralph J Damiano

1998-01-01

194

Utility of nuclear stress imaging for detecting coronary artery bypass graft disease  

PubMed Central

Background The value of Single Photon Emission Computed Tomography stress myocardial perfusion imaging (SPECT-MPI) for detecting graft disease after coronary artery bypass surgery (CABG) has not been studied prospectively in an unselected cohort. Methods Radial Artery Versus Saphenous Vein Graft Study is a Veterans Affairs Cooperative Study to determine graft patency rates after CABG surgery. Seventy-nine participants agreed to SPECT-MPI within 24 hours of their coronary angiogram, one-year after CABG. The choice of the stress protocol was made at the discretion of the nuclear radiologist and was either a symptom-limited exercise test (n?=?68) or an adenosine infusion (n?=?11). The SPECT-MPI results were interpreted independent of the angiographic results and estimates of sensitivity, specificity and accuracy were based on the prediction of a graft stenosis of ?70% on coronary angiogram. Results A significant stenosis was present in 38 (48%) of 79 patients and 56 (22%) of 251 grafts. In those stress tests with an optimal exercise heart rate response (>80% maximum predicted heart rate) (n?=?26) sensitivity, specificity and accuracy of SPECT-MPI for predicting the graft stenosis was 77%, 69% and 73% respectively. With adenosine (n?=?11) it was 75%, 57% and 64%, respectively. Among participants with a suboptimal exercise heart rate response, the sensitivity of SPECT-MPI for predicting a graft stenosis was <50%. The accuracy of SPECT-MPI for detecting graft disease did not vary significantly with ischemic territory. Conclusions Under optimal stress conditions, SPECT-MPI has a good sensitivity and accuracy for detecting graft disease in an unselected patient population 1?year post-CABG.

2012-01-01

195

Geometry assessment of coronary artery anastomoses with construction errors by epicardial ultrasound  

Microsoft Academic Search

Objective: There is concern about the quality of the distal anastomosis in off-pump coronary artery bypass grafting. We investigated the impact of specific construction errors on anastomotic geometry using epicardial ultrasound. Methods: Twelve ex vivo pressure perfused porcine and five isolated post-mortem human hearts were used to construct 35 internal mammary artery to coronary artery anastomoses, either without šn ¼

Thomas C. Dessing; Ricardo P. J. Budde; Rudy Meijer; Patricia F. A. Bakker; Cornelius Borst; Paul F. Grundeman

2010-01-01

196

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

197

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 discusses the endovascular approach to VAAs and the long-term results. Four balloon expandable stent-grafts were used to treat three splenic artery aneurysms and one bleeding common hepatic artery pseudoaneurysm. The percutaneous access site and the materials were chosen on the basis of CT angiography

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

2008-01-01

198

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

199

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

200

Impact of Diabetic Retinopathy on Cardiac Outcome After Coronary Artery Bypass Graft Surgery: Prospective Observational Study  

Microsoft Academic Search

Background. Diabetic retinopathy is a manifestation of more severe diabetes. We sought to assess the impact of diabetic retinopathy on cardiac outcome of coronary artery bypass graft surgery (CABG). Methods. We prospectively assessed the status of the retina of 74 consecutive diabetics who were referred for first-time CABG, and compared cardiac outcome of CABG in diabetics with retinopathy with that

Takayuki Ono; Takeki Ohashi; Teiji Asakura; Nagara Ono; Minoru Ono; Noboru Motomura; Shinichi Takamoto

2006-01-01

201

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

Microsoft Academic Search

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

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

2010-01-01

202

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

Microsoft Academic Search

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

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

2008-01-01

203

Neurocognitive Sequelae Following Coronary Artery Bypass GraftA Research Agenda for Behavioral Scientists  

Microsoft Academic Search

Several studies have demonstrated that a sizeable proportion of patients undergoing coronary artery bypass graft (CABG) demonstrate persistent declines in cognitive functioning. However, several important questions remain regarding cognitive changes following CABG. First, can patients vulnerable to cognitive decline after CABG be identified, providing valuable information that can be factored into clinical decisions? Second, the specificity of CABG as a

C. Keith Haddock; Walker S. Carlos Poston; Jennifer E. Taylor

2003-01-01

204

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

Microsoft Academic Search

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

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

1997-01-01

205

Role of Intraoperative Transesophageal Echocardiography in Patients Having Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

BackgroundPrevious studies have shown that intraoperative transesophageal echocardiography provides important preoperative and postoperative information in various cardiac and noncardiac surgeries that may alter patient management and outcome. The role of intraoperative transesophageal echocardiography in patients in whom isolated coronary artery bypass graft surgery is anticipated has been reported only in small selected groups. This study was designed to prospectively evaluate

Fatema E. Qaddoura; Martin D. Abel; Karen L. Mecklenburg; Krishnaswamy Chandrasekaran; Hartzell V. Schaff; Kenton J. Zehr; Thoralf M. Sundt; Roger L. Click

2004-01-01

206

Deep circumflex iliac artery flap combined with a costochondral graft for mandibular reconstruction  

Microsoft Academic Search

Our aim was to use the deep circumflex iliac artery (DCIA) flap together with a costochondral graft as a safe and reliable bone flap for routine reconstruction of the mandibular body and the temporomandibular joint (TMJ). Five patients with benign tumours of the mandible had segmental mandibulectomy including the condyle, and this was reconstructed in one stage using the DCIA

Qu Xingzhou; Zhang Chenping; Zhong Laiping; Ruan Min; Zhou Shanghui; Wang Mingyi

207

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

Microsoft Academic Search

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

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

208

Further reduction in stroke after off-pump coronary artery bypass grafting: a 10-year experience  

Microsoft Academic Search

Background. Perioperative stroke is a devastating complication after coronary artery bypass grafting (CABG). The reported incidence of neurologic complications after conventional CABG is 3% to 7%. With improved monitoring and surgical techniques, we have been able to achieve a drastic reduction in the stroke rate in our institution. This study evaluates the incidence of neurologic sequelae in patients who underwent

Naresh Trehan; Manisha Mishra; Om Prakash Sharma; Anil Mishra; Ravi R Kasliwal

2001-01-01

209

Myocardial redox state during coronary artery bypass grafting assessed with microdialysis  

Microsoft Academic Search

Purpose Microdialysis allows the biochemical analysis of interstitial fluids of nearly every organ as a bedside procedure. This technique could be useful to reveal data about the myocardial metabolism during cardiopulmonary bypass in human coronary artery bypass graft (CABG) surgery.Methods In 17 patients undergoing CABG a myocardial microdialysis catheter (CMA 70, CMA\\/Microdialysis AB, Sweden) was inserted in the apical region

Ludger Bahlmann; Martin Misfeld; Stephan Klaus; Alexander Leptien; Matthias Heringlake; Peter Schmucker; Hans-Hinrich Sievers; Urban Ungerstedt; Ernst-Guenther Kraatz

2004-01-01

210

Predicting the Risk of Death from Heart Failure After Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

Heart failure is the most common cause of death among coronary artery bypass graft (CABG) patients. In addi- tion, most variation in observed mortality rates for CABG surgery is explained by fatal heart failure. The purpose of this study was to develop a clinical risk assessment tool so that clinicians can rapidly and easily assess the risk of fatal heart

Stephen D. Surgenor; Stephen J. Lahey; Reed Quinn; David C. Charlesworth; Lawrence J. Dacey; Robert A. Clough; Bruce J. Leavitt; Gordon R. Defoe; Mary Fillinger; William C. Nugent

2001-01-01

211

Coronary artery bypass grafts and MDCT imaging: what to know and what to look for.  

PubMed

Multi-detector row CT (MDCT) scanners with high spatial and temporal resolutions are now available and are increasingly used for non-invasive assessment of vascular disease, including coronary arteries and coronary artery bypass grafts (CABG). Follow-up of patients who have previously undergone surgical revascularization for coronary artery disease is nowadays one of the main applications of MDCT. Thanks to the continuous technical evolution of the CT scanners, it is now possible to scan the heart and the full anatomic extent of grafts with sub-millimeter slice-thickness within a single breath-hold. In the evaluation of these patients, it is important for the radiologist to be familiar with the different types of grafts and surgical techniques to know the main characteristics of each graft type and what to look for in the assessment of a patient who has undergone coronary artery surgical revascularization. This review summarizes some surgical aspects, the biological characteristics of conduits, and the main technical MDCT features, and describes the CABG anatomy together with some typical CT findings. PMID:17874112

Marano, Riccardo; Liguori, Carlo; Rinaldi, Pierluigi; Storto, Maria Luigia; Politi, Marco Angelo; Savino, Giancarlo; Bonomo, Lorenzo

2007-09-15

212

Functional status outcomes of patients with a coronary artery bypass graft over time  

Microsoft Academic Search

OBJECTIVE: To examine functional status outcomes among patients with a coronary artery bypass graft (CABG) over time (ie, at baseline; 3 months, 6 months, and 12 months after surgery) and the impact of selected patient characteristics (ie, age, sex, comorbidities, and cardiac rehabilitation participation) on functional outcomes.DESIGN: A prospective, repeated-measures design was used to examine functional status in patients with

Susan Barnason; Lani Zimmerman; Angie Anderson; Shirley Mohr-Burt; Janet Nieveen

2000-01-01

213

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

Microsoft Academic Search

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

Hitoshi Hirose

2004-01-01

214

The return of clinically evident ischemia after coronary artery bypass grafting  

Microsoft Academic Search

Although survival after coronary artery bypass grafting (CABG) is the most serious outcome information, the quality of life in living patients is largely determined by the freedom from ischemic events. The return of angina, acute myocardial infarct and sudden death were studied in a large (n = 5880) population of patients undergoing CABG between 1971 and 1987. The freedom from

P. Sergeant; E. Lesaffre; W. Flameng; R. Suy; E. Blackstone

2010-01-01

215

Preexisting Cognitive Impairment in Patients Scheduled for Elective Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

BACKGROUND: An accurate assessment of the prevalence of cognitive impairment in patients scheduled for coronary artery bypass graft (CABG) surgery is necessary if valid assumptions regarding cognitive change are to be made. Such an assessment requires the use of a healthy control group free of cardiovascular disease. METHODS: In a retrospective observational study, 349 patients scheduled for CABG surgery underwent

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

2007-01-01

216

Marriage and Long-Term Survival After Coronary Artery Bypass Grafting  

Microsoft Academic Search

Objective: To examine the effects of marital status and marital satisfaction on survival after coronary artery bypass grafting (CABG). Methods: Participants were 225 people who had CABG between 1987 and 1990. Marital status at the time of surgery and marital satisfaction 1 year after surgery were used to predict survival 15 years after surgery. Results: Married people were 2.5 times

Kathleen B. King; Harry T. Reis

2012-01-01

217

Factors excercising an influence on recovery of hibernating myocardium after coronary artery bypass grafting  

Microsoft Academic Search

Objective: Coronary artery bypass grafting (CABG) in patients with endstage coronary disease (CAD) significantly improves symptoms and prolongs life expectancy. Left ventricular function is also improved in some patients, but not in others. Factors which influence functional recovery of hibernating myocardium after revascularization are at present under investigation. Methods: From 3\\/2000 to 8\\/2002, we analyzed 41 patients with an ejection

Harald Hausmann; Rudolf Meyer; Henryk Siniawski; Reinhard Pregla; Matthias Gutberlet; Holger Amthauer; Roland Felix; Roland Hetzer

2004-01-01

218

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

219

Non-invasive assessment of coronary artery bypass graft patency using 16-slice computed tomography angiography  

Microsoft Academic Search

BACKGROUND: Invasive coronary angiography is the gold standard means of imaging bypass vessels and carries a small but potentially serious risk of local vascular complications, including myocardial infarction, stroke and death. We evaluated computed tomography as a non-invasive means of assessing graft patency. METHODS: Fifty patients with previous coronary artery bypass surgery who were listed for diagnostic coronary angiography underwent

Emma S Houslay; Tristan Lawton; Anshuman Sengupta; Neal G Uren; Graham McKillop; David E Newby

2007-01-01

220

Coronary artery bypass graft operations can be performed safely in obese patients  

Microsoft Academic Search

Objectives: Obesity is a major public health problem with an increasing prevalence. Although coronary artery bypass grafting (CABG) operations are now performed with low morbidity and mortality rates, obesity is still assumed to be an important risk factor for morbidity and mortality at these operations but there is no precise approach to define it as a risk factor. The aim

Gökēen Orhan; Ye?im Biēer; Serap Aykut Aka; Murat Sargin; Serap ?im?ek; ?ahin ?enay; Zuhal Aykaē; E. Ergin Eren

2004-01-01

221

Coronary artery bypass graft operations can be performed safely in obese patients  

Microsoft Academic Search

Objectives: Obesity is a major public health problem with an increasing prevalence. Although coronary artery bypass grafting (CABG) operations are now performed with low morbidity and mortality rates, obesity is still assumed to be an important risk factor for morbidity and mortality at these operations but there is no precise approach to define it as a risk factor. The aim

Gokcen Orhan; Yesim Bicer; Serap Aykut Aka; Murat Sargina; Serap Simsek; Sahin Senaya; Zuhal Aykac; E. Ergin Eren

222

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

223

Impact of a history of diabetes mellitus on quality of life after coronary artery bypass grafting  

Microsoft Academic Search

Aim: To describe the improvement in various aspects of quality of life (QoL) after coronary artery bypass grafting (CABG), in relation to a previous history of diabetes mellitus. Patients: All patients from western Sweden who underwent CABG between 1988 and 1991 without simultaneous valve surgery. Methods: Patients were approached with three questionnaires: The Physical Activity Score, the Nottingham Health Profile

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

1997-01-01

224

Aggressive preoperative use of intraaortic balloon pump in elderly patients undergoing coronary artery bypass grafting  

Microsoft Academic Search

Background. The use of the intraaortic balloon pump (IABP) in patients undergoing coronary artery bypass grafting has been traditionally associated with a high complication rate and adverse outcomes. However, recent reports show that many of these catastrophic outcomes can be avoided by preoperatively placing the IABP in high-risk patients. To further validate these reports, we defined a set of liberal

Dan E Gutfinger; Richard A Ott; Mark Miller; Arthur Selvan; Michele A Codini; Hossein Alimadadian; Teresa M Tanner

1999-01-01

225

Influence of the practice physical activity in the coronary artery bypass graft surgery results  

Microsoft Academic Search

Objective: To evaluate the fr equency changes of physical activity practice in pre- and postoperative of the patients submitted to coronary artery bypass graft surgery (CABG) and the frequency influence on the physical activity practice in the patients' preoperative prognosis. Methods: Cases studies of 55 patients submitted to CABG divided into active and sedentary regarding physical activity practices. Result s:

Rosane Maria NERY; Juarez Neuhaus BARBISAN; Mahmud Ismail MAHMUD

2007-01-01

226

Surgical strategies in patients at high risk for stroke undergoing coronary artery bypass grafting  

Microsoft Academic Search

Background. Perioperative stroke represents one of the major complications following coronary artery bypass grafting (CABG). The present study was designed to evaluate the use of an individualized surgical approach for reducing neurological injury in patients undergoing CABG at high risk of stroke from aortic atherosclerosis or carotid disease.Methods. Between January 1993 and June 1999, 6,138 patients undergoing elective CABG were

Naresh Trehan; Manisha Mishra; Ravi R Kasliwal; Anil Mishra

2000-01-01

227

Coronary artery bypass graft surgery in the elderly patients  

Microsoft Academic Search

The purpose of this retrospective study was to determine the results of coronary artery surgery in the elderly patients and\\u000a to compare the outcome with a younger group. Two hundred thirteen patients aged 70 years and older who underwent on-pump coronary\\u000a artery surgery were retrospectively studied and data were compared with those of 524 patients aged 50–69. The groups were

Gursel Levent Oktar; Veli Yildirim Imren; Dilek Erer; Erkan Iriz; Levent Gokgoz; Halim Soncul

2009-01-01

228

Oral intake of hydrogen-rich water inhibits intimal hyperplasia in arterialized vein grafts in rats  

PubMed Central

Aims Arterialized vein grafts often fail due to intimal hyperplasia. Hydrogen potently protects organs and cells from many insults via its anti-inflammatory and antioxidant properties. We investigated the efficacy of oral administration of hydrogen-rich water (HW) for prevention of intimal hyperplasia. Methods and results The inferior vena cava was excised, stored in cold Ringer solution for 2 h, and placed as an interposition graft in the abdominal aorta of syngeneic Lewis rats. HW was generated by immersing a magnesium stick in tap water (Mg + 2H2O ? Mg (OH)2 + H2). Beginning on the day of graft implantation, recipients were given tap water [regular water (RW)], HW or HW that had been subsequently degassed water (DW). Six weeks after grafting, the grafts in the rats given RW or DW had developed intimal hyperplasia, accompanied by increased oxidative injury. HW significantly suppressed intimal hyperplasia. One week after grafting, the grafts in HW-treated rats exhibited improved endothelial integrity with less platelet and white blood cell aggregation. Up-regulation of the mRNAs for intracellular adhesion molecules was attenuated in the vein grafts of the rats receiving HW. Activation of p38 mitogen-activated protein kinase, matrix metalloproteinase (MMP)-2, and MMP-9 was also significantly inhibited in grafts receiving HW. In rat smooth muscle cell (A7r5) cultures, hydrogen treatment for 24 h reduced smooth muscle cell migration. Conclusion Drinking HW significantly reduced neointima formation after vein grafting in rats. Drinking HW may have therapeutic value as a novel therapy for intimal hyperplasia and could easily be incorporated into daily life.

Sun, Qiang; Kawamura, Tomohiro; Masutani, Kosuke; Peng, Ximei; Sun, Qing; Stolz, Donna B.; Pribis, John P.; Billiar, Timothy R.; Sun, Xuejun; Bermudez, Christian A.; Toyoda, Yoshiya; Nakao, Atsunori

2012-01-01

229

Mechanisms of vein graft adaptation to the arterial circulation: Insights into the neointimal algorithm and management strategies  

PubMed Central

For patients with coronary artery disease or limb ischemia, placement of a vein graft as a conduit for a bypass is an important and generally durable strategy among the options for arterial reconstructive surgery. Vein grafts adapt to the arterial environment; limited formation of intimal hyperplasia in the vein graft wall is thought to be an important component of successful vein graft adaptation. However, it is also known that abnormal, or uncontrolled, adaptation may lead to abnormal vessel wall remodeling with excessive neointimal hyperplasia, and ultimately vein graft failure and clinical complications. Therefore, understanding the venous-specific pathophysiological and molecular mechanisms of vein graft adaptation are important for clinical vein graft management. Of particular importance, it is currently unknown whether several specific distinct molecular differences in venous mechanisms of adaptation exist that are distinct from arterial post-injury responses; in particular, the participation of the venous marker Eph-B4 and the vascular protective molecule Nogo-B may be involved in mechanisms of vessel remodeling specific to the vein. In this review, we describe 1) venous biology from embryonic development to the mature quiescent state; 2) sequential pathologies of vein graft neointima formation; and 3) novel candidates for strategies of vein graft management. We believe that the scientific inquiry of venous-specific adaptation mechanisms will ultimately provide improvements in vein graft outcomes.

Muto, Akihito; Model, Lynn; Ziegler, Kenneth; Eghbalieh, Sammy D.D.; Dardik, Alan

2013-01-01

230

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

PubMed Central

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

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

2013-01-01

231

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

232

Superior Mesenteric Artery Stent-graft Placement in a Patient with Pseudoaneurysm Developing from a Pancreatic Pseudocyst  

SciTech Connect

Pseudoaneurysm is a relatively rare but serious complication of pancreatitis which is often fatal. We report successful stent-graft placement in the superior mesenteric artery in a 45-year-old man with a pancreatic pseudocyst that grew during therapy for chronic pancreatitis and developed into a pseudoaneurysm. After a stent graft was inserted in the superior mesenteric artery, the pseudoaneurysm disappeared and no further complications developed. Stent-graft placement was considered to be a useful therapy for pseudoaneurysms in the superior mesenteric arterial region.

Ogino, H.; Banno, T.; Sato, Y.; Hara, M.; Shibamoto, Y. [Nagoya City University School of Medicine 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Department of Radiology (Japan)

2004-01-15

233

Outcomes of total aortic arch replacement with coronary artery bypass grafting.  

PubMed

There are few reports regarding outcomes of total aortic arch replacement (TAAR) with concomitant coronary artery bypass grafting (CABG). This study aimed to analyze outcomes after total arch replacement with CABG in our institute. Between July 2006 and December 2010, 126 patients underwent elective total arch replacement with or without CABG. Of these patients, 56 had concomitant CABG. The mean age was 73.9±5.6 years. Fifteen patients were female. Six patients had chronic aortic dissection, and two patients had previous aortic operations. Total arch replacement was performed with selective cerebral perfusion and the elephant trunk procedure. The mean number of coronary anastomoses was 1.9±1.0. An internal thoracic artery (ITA) and saphenous vein graft were used in 37 (66.1%) and 47 (83.9%) patients, respectively. Only the anastomosis between the in-situ ITA and the left anterior descending artery (LADA) was performed after declamping the aorta using the on-pump beating technique. Operative mortality was 3.6%. Stroke occurred in 7.1% of patients. Early graft patency of bypass grafts was 100%. Composite outcomes of mortality and the rate of major complications of patients with CABG was 19.6%. TAAR with CABG can be safely performed with favorable outcomes. PMID:21632864

Fukui, Toshihiro; Shimokawa, Tomoki; Tabata, Minoru; Takanashi, Shuichiro

2011-06-01

234

Improvement of functional recovery of transected peripheral nerve by means of artery grafts filled with diclofenac.  

PubMed

The objective was to assess the effect of topically administered diclofenac on peripheral nerve regeneration and functional recovery. Eighty male healthy white Wistar rats were divided into four experimental groups (n = 20), randomly: In transected group (TC), left sciatic nerve was transected and stumps were fixed in the adjacent muscle. In treatment group defect was bridged using an artery graft (AG/DICLO) filled with 10 ?L diclofenac (0.1 mg/kg). In artery graft group (AG), the graft was filled with phosphate-buffered saline alone. In sham-operated group (SHAM), sciatic nerve was exposed and manipulated. Each group was subdivided into four subgroups of five animals each and regenerated nerve fibers were studied 4, 8, 12 and 16 weeks after surgery. Behavioral testing, sciatic nerve functional study, gastrocnemius muscle mass and morphometric indices confirmed faster recovery of regenerated axons in AG/DICLO than AG group (p < 0.05). In immunohistochemistry, location of reactions to S-100 in AG/DICLO was clearly more positive than that in AG group. When loaded in an artery graft, diclofenac improved functional recovery and morphometric indices of sciatic nerve. Topical application of this readily available agent offers the benefit of cost savings as well as avoiding the complications associated with systemic administration. PMID:23354315

Mohammadi, Rahim; Hirsaee, Mohammad-Adel; Amini, Keyvan

2013-01-23

235

Stent-Graft Treatment for Bleeding Superior Mesenteric Artery Pseudoaneurysm After Pancreaticoduodenectomy  

SciTech Connect

We report two cases of intraperitoneal bleeding from superior mesenteric artery (SMA) pseudoaneurysm after pancreaticoduodenectomy for pancreatic head carcinoma. In both cases, a stent-graft was deployed on the main SMA to exclude pseudoaneurysm and to preserve blood flow to the bowel. Bleeding stopped after the procedure. One patient was able to be discharged but died from carcinoma recurrence 4 months later. The other patient died of sepsis and stent-graft infection 5 months later. These patients remained free of intraperitoneal rebleeding during the follow-up period.

Suzuki, Kojiro, E-mail: kojiro@med.nagoya-u.ac.jp; Mori, Yoshine; Komada, Tomohiro; Matsushima, Masaya; Ota, Toyohiro; Naganawa, Shinji [Nagoya University Graduate School of Medicine, Department of Radiology (Japan)

2009-07-15

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

On-Pump Versus Off-Pump Coronary Artery Bypass Grafting in Diabetic Patients: A Propensity Score Analysis  

Microsoft Academic Search

BackgroundDiabetic patients are recognized as being at high risk for adverse outcomes after coronary artery bypass grafting. We evaluated our outcomes in diabetic patients to compare the effect of off-pump with on-pump coronary revascularization.

Arun K. Srinivasan; Antony D. Grayson; Brian M. Fabri

2004-01-01

238

Management of Proximal Iliac Artery Injury during Lumbar Discectomy with Stent Graft  

PubMed Central

Iatrogenic vascular injuries during lumbar disc surgery may occur rarely but they are serious complications, which can be fatal without appropriate management. Prompt diagnosis and management of these complications are imperative to prevent a desperate outcome. A 72-year-old female with proximal left common iliac artery iatrogenic injury during lumbar discectomy was successfully treated by percutaneous deployment of a stent graft in an emergency setting. Postprocedural angiogram demonstrated complete exclusion of the iliac artery laceration. The patient became hemodynamically stable. Two weeks later she complained of vascular claudication. Follow-up angiography revealed decreased arterial flow in the opposite common iliac artery. An additional kissing stent was inserted into the right common iliac artery and the symptoms of vascular claudication disappeared. Endovascular stenting offers a safe and effective method for the treatment of an iatrogenic arterial laceration, particularly in a critical condition. But, the contralateral iliac arterial flow should be kept intact in case of proximal iliac artery injury. Otherwise, additional treatments may be needed.

Jin, Sung Cheol; Park, Sang Woo

2012-01-01

239

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

240

Off pump coronary artery bypass surgery in a Nigerian teaching hospital  

PubMed Central

Coronary Artery Bypass Grafting has not been previously reported in the Nigeria Medical Literature. We report the case performed in our institution of a 56 year old Nigerian female who underwent Off Pump Coronary Artery Bypass Surgery (OPCAB) for an ostial lesion of the Left Anterior Descending Coronary Artery. The Left Internal Mammary Artery was successfully anastomosed to the Left Anterior Descending Coronary Artery. The patient was discharged home after 2 weeks, following correction of problems with glycemic control.

Sanusi, Michael; Falase, Bode; Ismail, Salisu; Majekodunmi, Adetinuwe; Johnson, Adeyemi; Ajose, Ifeoluwa; Oke, David

2013-01-01

241

Off pump coronary artery bypass surgery in a Nigerian teaching hospital.  

PubMed

Coronary artery bypass grafting has not been previously reported in the Nigeria medical literature. We report the case performed in our institution of a 56 year old Nigerian female who underwent off pump coronary artery bypass surgery (OPCAB) for an ostial lesion of the left anterior descending coronary artery. The left internal mammary artery was successfully anastomosed to the left anterior descending coronary artery. The patient was discharged home after 2 weeks, following correction of problems with glycemic control. PMID:23734267

Sanusi, Michael; Falase, Bode; Ismail, Salisu; Majekodunmi, Adetinuwe; Johnson, Adeyemi; Ajose, Ifeoluwa; Oke, David

2013-03-28

242

Coronary artery bypass grafting: Part 1--the evolution over the first 50 years.  

PubMed

Surgical treatment for angina pectoris was first proposed in 1899. Decades of experimental surgery for coronary artery disease finally led to the introduction of coronary artery bypass grafting (CABG) in 1964. Now that we are approaching 50 years of CABG experience, it is appropriate to summarize the advancement of CABG into a procedure that is safe and efficient. This review provides a historical recapitulation of experimental surgery, the evolution of the surgical techniques and the utilization of CABG. Furthermore, data on contemporary clinical outcomes are discussed. PMID:24086085

Head, Stuart J; Kieser, Teresa M; Falk, Volkmar; Huysmans, Hans A; Kappetein, A Pieter

2013-10-01

243

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

PubMed

There have been several reports of gas embolism occurring during off-pump coronary artery bypass graft (OPCAB) surgery. However, all these cases of air embolism were associated with the repair of venous circulation, using a CO(2) blower. In this report, we describe a rare case of air embolism in the coronary arteries associated with the use of a CO(2) blower during OPCAB. There was no injury to the veins during OPCAB. The air embolism was treated successfully with cardiopulmonary bypass. PMID:22870370

Chang, Choo-Hoon; Shin, Young Hee; Cho, Hyun-Sung

2012-07-24

244

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

Microsoft Academic Search

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

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

245

Fear and in-hospital social support for coronary artery bypass grafting patients on the day before surgery  

Microsoft Academic Search

The purpose of this study was to ascertain the amount of in-hospital social support received by coronary artery bypass grafting patients and the impact of this support on their feelings of fear and anxiety. As adapted from Kahn's theory, social support was understood as emotional, informational and tangible support. The bypass grafting fear scale was developed to measure the fear,

Meeri Koivula; Marja-Terttu Tarkka; Matti Tarkka; Pekka Laippala; Marita Paunonen-Ilmonen

2002-01-01

246

Comparison of reversed, nonreversed translocated, and in situ vein grafts in arterial revascularization: Techniques, cumulative patency, versatility, and durability  

Microsoft Academic Search

Since Carrell and Guthrie used the reversed saphenous vein graft for arterial reconstruction in 1906 [1], this technique has undergone several technical modifications to earn its popularity and credibility [2–4]. Vein preparation has also been refined to attain optimal preservation of histocytologic integrity in order to improve graft patency [6–12]. Notwithstanding the periodical enthusiasm to substitute saphenous vein with biologic

V. S. Sottiurai

1999-01-01

247

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

Microsoft Academic Search

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

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

2009-01-01

248

Gender is an essential determinant of blood transfusion in patients undergoing coronary artery bypass graft procedure  

Microsoft Academic Search

Study Objective: To determine factors that account for gender difference in the need for blood transfusion in coronary artery bypass graft (CABG) patients.Design: Retrospective study of consecutive patients.Setting: Anesthesiology department of a teaching hospital.Patients: 253 CABG patients (163 males and 90 females).Interventions: Packed red blood cells (PRBCs), platelets, and fresh frozen plasma (FFP) were transfused depending on the need of

Ketan Shevde; Murali Pagala; Ananth Kashikar; Changa Tyagaraj; Noreen Shahbaz; Mohammad Iqbal; Raghu Idupuganti

2000-01-01

249

A Comparison of Clonidine with Conventional Preanesthetic Medication in Patients Undergoing Coronary Artery Bypass Grafting  

Microsoft Academic Search

In this controlled study, we compared clonidine with conventional premeditation in 35 patients undergoing coronary artery bypass grafting (CABG). After premed- ication with clonidine 5 pg\\/kg PO (Group C, n = ll), lorazepam 60 pg\\/kg PO (Group L, rz = 13), or morphine 0.1 mg\\/kg plus scopolamine 6 pg\\/kg IM (Group M, n = ll), sedation, anxiety, and quality of

Ian R. Thomson; Mark D. Peterson; Robert J. Hudson

1998-01-01

250

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

251

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

Microsoft Academic Search

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

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

2009-01-01

252

Remote intermittent ischemia before coronary artery bypass graft surgery: a strategy to reduce injury and inflammation?  

Microsoft Academic Search

Perioperative myocardial ischemia contributes to postoperative morbidity and mortality. Remote intermittent ischemia (RI)\\u000a has been shown to benefit patients undergoing coronary artery bypass graft (CABG) surgery by decreasing postoperative cardiac\\u000a troponin levels. In addition, there is evidence that volatile anesthetics may provide myocardial protection. In this prospective\\u000a randomized controlled trial we tested the hypothesis that RI is cardioprotective under a

Partheeban Karuppasamy; Sanjay Chaubey; Tracy Dew; Rebecca Musto; Roy Sherwood; Jatin Desai; Lindsay John; Ajay M. Shah; Michael S. Marber; Gudrun Kunst

2011-01-01

253

Effect of dietary supplementation with n-3 fatty acids on coronary artery bypass graft patency  

Microsoft Academic Search

Epidemiologic and experimental data suggest that a high dietary intake of long-chain polyunsaturated n-3 fatty acids may reduce the risk of atherothrombotic disease. In a randomized, controlled study, 610 patients undergoing coronary artery bypass grafting were assigned either to a fish oil group, receiving 4 g\\/day of fish oil concentrate, or to a control group. All patients received antithrombotic treatment,

Jan Eritsland; Harald Arnesen; Knut Grųnseth; Nils B. Fjeld; Michael Abdelnoor

1996-01-01

254

Late Outcome of Coronary Artery Bypass Grafting in Young Versus Older Patients  

Microsoft Academic Search

Background. We compared long-term results of coronary artery bypass grafting between 1976 and 1988 in 176 patients 40 years old or younger with a matched control group of 176 patients 25 to 30 years older.Methods. Mean age was 37.4 ± 2.7 years (± standard deviation) in the study group and 64.2 ± 2.9 years in the control group. Matching criteria

Isabella Rohrer-Gubler; Urs Niederhauser; Marko I Turina

1998-01-01

255

Hemodynamics and gas exchange during carbon dioxide insufflation for totally endoscopic coronary artery bypass grafting  

Microsoft Academic Search

Background. In addition to single-lung ventilation (SLV), positive-pressure CO2 insufflation is mandatory for totally endoscopic coronary artery bypass grafting. Studies on the effects of unilateral CO2 insufflation on hemodynamics produced controversial results, and bilateral insufflation has not been studied to our knowledge. The present study sought to investigate hemodynamics and gas exchange during unilateral and bilateral CO2 insufflation in patients

Christian Byhahn; Stephan Mierdl; Dirk Meininger; Gerhard Wimmer-Greinecker; Georg Matheis; Klaus Westphal

2001-01-01

256

Coronary artery bypass graft and mitral valvuloplasty in a patient with isolated ventricular non-compaction.  

PubMed

A case of isolated ventricular non-compaction associated to three-vessel disease and a mitral regurgitation is described. The patient underwent triple coronary artery bypass graft and restrictive mitral annuloplasty. The postoperative course was unsuccessful despite the very depressed left ventricular (LV) function. At two years follow-up, no major adverse cardiac event has occurred and the LV function was slightly improved. PMID:20547705

Salati, Maurizio; Di Mauro, Alessandra; Bregasi, Alda; Mattioli, Roberto

2010-06-14

257

New technologies in coronary artery surgery.  

PubMed

Coronary artery disease remains the leading cause of death in developed countries. Major recent studies such as SYNTAX and FREEDOM have confirmed that coronary artery bypass grafting (CABG) remains the gold standard treatment in terms of survival and freedom from myocardial infarction and the need for repeat revascularization. The current review explores the use of new technologies and future directions in coronary artery surgery, through 1) stressing the importance of multiple arterial conduits and especially the use of bilateral mammary artery; 2) discussing the advantages and disadvantages of off-pump coronary artery bypass; 3) presenting additional techniques, e.g. minimally invasive direct coronary artery bypass grafting, hybrid, and robotic-assisted CABG; and, finally, 4) debating a novel external stenting technique for saphenous vein grafts. PMID:23908868

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

2013-07-25

258

Treatment of post-liver transplant hepatic artery pseudoaneurysm with balloon angioplasty after failed stent graft placement.  

PubMed

Hepatic artery pseudoaneurysm is a rare complication following liver transplantation but can lead to life threatening hemorrhage if not treated effectively and in a timely manner. We describe a hepatic artery pseudoaneurysm that occurred after liver transplantation in a 53-year-old woman. The pseudoaneurysm was initially treated by implantation of a balloon-expandable covered stent-graft, but an endoleak was observed 6 days later. The endoleak was successfully resolved by further balloon angioplasty, which expanded the cylindrical stent to a conical stent, matching the anatomy of the anastomotic hepatic artery. Follow-up ultrasound examinations demonstrated patent hepatic arteries, with no evidence of pseudoaneurysm. Balloon-expandable covered stent-graft may be utilized to treat hepatic artery pseudoaneurysm following liver transplantation, due to the remodeling ability of stent-grafts, enabling them to fit the diseased vessels. PMID:22766148

Lu, Ning-Ning; Huang, Qiang; Wang, Jian-Feng; Wei, Bao-Jie; Gao, Kun; Zhai, Ren-You

2012-07-04

259

A prospective randomized study of three expanded polytetrafluoroethylene (PTFE) grafts as small arterial substitutes.  

PubMed Central

A prospective, double-blind, randomized study was performed to determine the relative patency rate of polytetrafluoroethylene (PTFE) grafts, Gore-Tex, Impra, and a Surgikos prototype PTFE graft. The 48 grafts (40 x 4 mm) replaced excised segments of femoral arteries in adult mongrel dogs, whose mean weight was 20.6 +/- 0.9 kg; the grafts were removed after 12 weeks. Sterile technique and antibiotic therapy were included in the study. Anticoagulation was not employed. Anastomoses were performed with 6 = 0 polypropylene. Angiographic assessment of each anastomosis was made at surgery and prior to sacrifice. Patency was assessed daily by palpation and Doppler flow signals, as well as angiographically, prior to sacrifice. The overall patency rate was 62.5%. There were no statistically significant differences in patency rates among the three groups (Gore-Tex, 56%; Impra, 75%, Surgikos, 56%). Histologic evaluation revealed incomplete neointima formation and significant pannus formation in all three types of grafts without any significant discernible difference among them. The results suggest that further experimental evaluation of PTFE, as a small vessel substitute, is indicated prior to its use clinically in preference to autogenous vein. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6.

Hastings, O M; Jain, K M; Hobson, R W; Swan, K G

1978-01-01

260

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

261

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

2012-07-05

262

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

Microsoft Academic Search

BACKGROUND: Many health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG) surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods. METHODS: We used a population-based registry to identify patients with established coronary artery disease

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

2008-01-01

263

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

SciTech Connect

This paper describes four cases of visceral artery aneurysms (VAAs) successfully treated with endovascular stent-grafts and discusses the endovascular approach to VAAs and the long-term results. Four balloon expandable stent-grafts were used to treat three splenic artery aneurysms and one bleeding common hepatic artery pseudoaneurysm. The percutaneous access site and the materials were chosen on the basis of CT angiography findings. In all cases the aneurysms were successfully excluded. In one case a splenic infarction occurred, with nonrelevant clinical findings. At 16- to 24-month follow-up three patients had patent stents and complete exclusion and shrinkage of the aneurysms. One patient died due to pancreatitis and sepsis, 16 days after successful stenting and exclusion of a bleeding pseudoaneurysm. We conclude that endovascular treatment using covered stent-grafts is a valid therapeutic option for VAAs. Multislice CT preoperative study helps in planning stent-graft positioning.

Rossi, Michele; Rebonato, Alberto, E-mail: albertorebonato@libero.it; Greco, Laura; Citone, Michele; David, Vincenzo [S. Andrea, University Hospital 'La Sapienza', Interventional Radiology Unit, Radiology Department (Italy)

2008-01-15

264

Functional properties of fresh and cryopreserved carotid and femoral arteries, and of venous and synthetic grafts: comparison with arteries from normotensive and hypertensive patients.  

PubMed

The ideal arterial graft must share identical functional properties with the host artery. Surgical reconstruction of the common carotid artery (CA) is performed in several clinical situations, using expanded polytetrafluoroethylene prosthesis (ePTFE) or saphenous vein (SV) grafts. At date there is interest in obtaining an arterial graft that improves the results of that nowadays available. The use of a fresh or cryopreserved/defrosted artery appears as an interesting alternative. However, if the fresh and cryopreserved/defrosted arteries allow an adequate viscoelastic and functional matching with the host arteries needs to be established. The aims were to compare the viscoelastic and functional performance of: (1) conduits used in CA reconstruction (SV and ePTFE) with those of the fresh and cryopreserved/ defrosted CA and femoral arteries (FA), and (2) normotensive and hypertensive patients' arteries with those of the arterial substitutes in vitro analyzed. Pressure, diameter and wall thickness of the CA were recorded in 15 normotensive and 15 hypertensive patients (in vivo studies), and in SV, fresh and cryopreserved/defrosted CA and FA (obtained from 15 donors), and ePTFE segments (in vitro studies). From stress-strain relationship we calculated elastic and viscous modulus, and the characteristic impedance. The local buffer and conduit functions were quantified as the viscous/elastic quotient and the inverse of the characteristic impedance. Fresh and cryopreserved/defrosted CA and FA were more alike, both in viscoelastic and functional levels, respect to normotensive and hypertensive patients' arteries, than the ePTFE and SV grafts. CA and FA cryografts could be considered an important alternative for carotid reconstruction. PMID:16826454

Santana, Daniel Bia; Armentano, Ricardo L; Zócalo, Yanina; Pérez Cįmpos, Héctor; Cabrera, Fischer Edmundo I; Graf, Sebastiįn; Saldķas, Maria; Silva, Walter; Alvarez, Inés

2007-01-01

265

Indium-111 platelet imaging for detection of platelet deposition in abdominal aneurysms and prosthetic arterial grafts  

SciTech Connect

Thirty-four platelet imaging studies were performed in 23 patients to determine whether platelet deposition could be detected in patients with vascular aneurysms (18 patients) or in patients in whom Dacron prosthetic grafts had been placed (5 patients). In patients in whom abnormal platelet deposition was detected, the effect of administration of platelet-active drugs on platelet deposition was examined. Of the 18 patients with an aneurysm, 12 had equivocally positive studies on initial imaging and 2 had equivocally positive images. Of five patients with Dacron arterial grafts in place, four had diffuse platelet deposition in the grafts; the fifth patient had a platelet deposition only in a pseudoaneurysm. Eight patients with an abdominal aneurysm and positive or equivocally positive baseline images were restudied during platelet-active drug therapy either with aspirin plus dipyridamole (seven patients) or with sulfinpyrazone (four patients). No patient studied during treatment with aspirin plus dipyridamole had detectably decreased platelet deposition compared with baseline determinations. In contrast, two of four patients studied while receiving sulfinpyrazone showed decreased platelet deposition. Thus, platelet imaging may be of value for studying platelet physiology in vivo and for assessing platelet-active drugs and the thrombogenicity of prosthetic graft materials in human beings.

Ritchie, J.L.; Stratton, J.R.; Thiele, B.; Haminton, G.W.; Warrick, L.N.; Huang, T.W.; Harker, L.A.

1981-04-01

266

Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting.  

PubMed

Spasm of the saphenous vein frequently occurs during harvesting from the leg and high-pressure distension is required to restore an adequate diameter for grafting. Forceful distention has been shown to damage the intima and media and may predispose to subsequent occlusion of the vein graft. Various pharmacologic vasodilators are capable of relaxing veins; in this study, we carried out a systematic investigation to determine the appropriate agents and concentrations for use during vein graft operations. In organ baths, human saphenous vein segments were contracted with potassium or a thromboxane mimetic, and vasodilator agents were then applied. Glyceryl trinitrate, 7.2 micrograms/mL, or papaverine hydrochloride, 11.9 micrograms/mL, caused 80% to 100% relaxation of contraction induced by potassium or thromboxane. Verapamil, 15.5 micrograms/mL, relaxed the potassium contraction by 100% and the thromboxane contraction by 75%. Comparison of the time course of action showed that glyceryl trinitrate had a rapid onset and a short duration of maximal action, whereas verapamil (like papaverine) had delayed onset and a long duration. A mixture of glyceryl trinitrate and verapamil combined rapid onset with long duration of action. We now use a mixture of glyceryl trinitrate and verapamil (pH 7.4) topically and intraluminally during harvesting of the saphenous vein to provide a relaxed conduit for coronary artery bypass grafting. PMID:8494433

He, G W; Rosenfeldt, F L; Angus, J A

1993-05-01

267

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

268

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

PubMed

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. PMID:23438625

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

2012-12-26

269

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

270

Steal phenomenon from mammary side branches: when does it occur?  

Microsoft Academic Search

Background. The hemodynamic significance of patent mammary graft side branches is still controversial. This study was designed to evaluate the potential for flow steal of patent mammary side branches in different hemodynamic conditions.Methods. Echo-Doppler measurement of mammary graft flow was performed at rest and after dipyridamole-induced coronary vasodilatation in 10 patients with angiographic demonstration of evident mammary graft side branches

Mario Gaudino; Michele Serricchio; Franco Glieca; Piergiorgio Bruno; Paolo Tondi; Alessandro Giordano; Carlo Trani; Maria Lucia Calcagni; Paolo Pola; Gianfederico Possati

1998-01-01

271

Spontaneous dissection of the left main coronary artery: a case report and review of the literature.  

PubMed

Primary spontaneous coronary artery dissection is an unusual occurrence. There have been less than 150 cases reported in world literature. This process frequently occurs in relatively young women, particularly in the peripartum or early postpartum period. This article reports the clinical course of one patient with primary spontaneous left main coronary artery dissection who was treated with coronary artery bypass grafting. To our knowledge, it is the second case to be treated with the use of left internal mammary artery. PMID:8969385

Atay, Y; Ya?di, T; Türko?lu, C; Altinti?, A; Büket, S

272

Minimized extracorporeal circulation for the robotic totally endoscopic coronary artery bypass grafting hybrid procedure  

PubMed Central

Robotically assisted totally endoscopic coronary artery bypass grafting (TECAB) can be performed on the beating heart with cardiopulmonary bypass support in high-risk patients or patients for whom technical difficulties are expected with a complete off-pump approach. To minimize the inflammatory response and reduce the requirement for transfusion, minimized extracorporeal circulation is an attractive option for robotic TECAB procedures. The present report describes a case for which minimized extra-corporeal circulation was used for the first time in TECAB performed using the da Vinci telemanipulation system.

Lehr, Eric J; Odonkor, Patrick; Reyes, Peter; Bonatti, Johannes

2010-01-01

273

[Pericardial defect incidentaly noticed during off-pump coronary artery bypass grafting; report of a case].  

PubMed

We experienced a rare case of congenital pericardial defect incidentally found during off-pump coronary artery bypass grafting (CABG)[OPCAB]. We performed off-pump for a 61-year-old man. He was asymptomatic but was noted to have an abnormal chest X-ray showing the enlarged heart. He had right ventricule lifting upward and apex shifting far to left side. Partial absence of the left pericardium was found. The surgery was technically more demanding than usual, because of heart rotation and inadequate pericardial stitch. PMID:23445654

Nakamura, Ken; Uchida, Tetsuro; Mizumoto, Masahiro; Miyazaki, Ryota; Kim, Cholsu; Yoshimura, Yukihiro; Sadahiro, Mitsuaki

2013-03-01

274

Acute pulmonary embolectomy three days following a coronary artery bypass graft procedure.  

PubMed

Pulmonary embolism is very rarely reported early after cardiac surgery, most probably due to full heparinisation during cardiopulmonary bypass. We report a 66-year-old man without thromboembolic history who presented three days after a coronary artery bypass grafting procedure with acute dyspnoea and haemodynamic instability. A CT scan confirmed paracentral bilateral pulmonary embolism requiring an urgent and successful embolectomy. Review of the literature confirms that pulmonary embolism may occur in up to 3% of post-cardiopulmonary bypass patients. The possibility of pulmonary embolism must be taken into consideration in post-cardiopulmonary bypass patients with acute onset of chest pain and respiratory insufficiency. PMID:17444325

Kuklinski, D; Tevaearai, H T; Eckstein, F S; Carrel, T P

2007-04-01

275

Necrotizing fasciitis following endoscopic harvesting of the greater saphenous vein for coronary artery bypass graft.  

PubMed

The greater saphenous vein (GSV) remains the most commonly harvested conduit for revascularization in coronary artery bypass grafting (CABG). Published literature shows that minimally invasive vein harvesting techniques have a significantly lower incidence of wound infection rates than conventional open vein harvesting techniques have. We report a case of necrotizing fasciitis, an infection with a mortality rate of 30% to 50%, after endoscopic harvesting of the greater saphenous vein to be used as a conduit in a CABG procedure. Though minimally invasive vein harvesting techniques have advantages of smaller incisions and a decreased overall rate of wound infection, clinicians should be aware of this potentially lethal infection that may occur. PMID:21902951

Liliav, Benjamin; Yakoub, Danny; Kasabian, Armen

276

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

277

Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms  

SciTech Connect

Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non-contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47-2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.

Okada, Takuya, E-mail: okabone@gmail.com; Yamaguchi, Masato [Kobe University Graduate School of Medicine, Department of Radiology (Japan); Kitagawa, Atsushi [Kobe University Graduate School of Medicine, Center for Endovascular Therapy (Japan); Kawasaki, Ryota [Hyogo Brain and Heart Center, Department of Radiology (Japan); Nomura, Yoshikatsu [Kobe University Graduate School of Medicine, Center for Endovascular Therapy (Japan); Okita, Yutaka [Kobe University Graduate School of Medicine, Department of Cardiovascular Surgery (Japan); Sugimura, Kazuro; Sugimoto, Koji [Kobe University Graduate School of Medicine, Department of Radiology (Japan)

2012-02-15

278

Tungsten-rhenium suture needles with improved properties for coronary artery bypass graft surgery.  

PubMed

Suture needles are essential instruments for performing blood vessel anastomosis in coronary artery bypass graft (CABG) surgeries. Exceptional needle performance is needed now as never before because of the increasing prevalence of elderly patients with advanced stages of coronary disease and calcified tissue. The various properties that affect the performance of suture needles used in CABG surgery are reviewed and recent progress towards improving needle performance through the use of tungsten-rhenium alloys and novel lubricous needle coatings is presented. Substantial enhancement of properties beyond those exhibited by commercially available stainless steel suture needles has been made, including an approximate 40% increase in strength, 100% increase in stiffness, and superior multiple pass penetration performance in both synthetic rubber media and human cadaver carotid arteries (p < 0.01). PMID:20574974

Cichocki, Frank R; Maurer, Robert E; Bar, S Neil

2010-08-01

279

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

2013-02-21

280

Prospective randomized clinical study of arterial pumps used for routine on pump coronary bypass grafting.  

PubMed

In a number of studies, centrifugal blood pumps--in comparison with roller pumps--have been shown to attenuate trauma to blood components. Nevertheless, the impact of these results on the postoperative course needs to be discussed controversially. In a prospective randomized study, 240 consecutive adult patients underwent elective myocardial revascularization with cardiopulmonary bypass employing five different pumps (Roller, Avecor, Sarns, Rotaflow, Bio-Medicus). We analyzed clinical course, blood loss, damage of blood components, and impairment of the hemostatic system. The study population was homogenous with respect to age, gender, myocardial function, and operative data. No differences were found with respect to time of ventilation, duration of intensive care stay, hospitalization, and laboratory data. The choice of arterial pump during standard extracorporeal bypass for elective coronary artery bypass grafting is no matter of concern. PMID:21269302

Keyser, Andreas; Hilker, Michael K; Diez, Claudius; Philipp, Alois; Foltan, Maik; Schmid, Christof

2011-01-27

281

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

PubMed Central

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

2013-01-01

282

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

283

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

2009-12-29

284

Intra-arterial Methylprednisolone Infusion in Treatment-Resistant Graft-Versus-Host Disease  

SciTech Connect

Acute graft-versus-host disease (GVHD) is a potentially fatal complication following allogeneic hematopoietic stem cell transplant. Standard primary therapy for acute GVHD includes systemic steroids, often in combination with other agents. Unfortunately, primary treatment failure is common and carries a high mortality. There is no generally accepted secondary therapy for acute GVHD. Although few data on localized therapy for GVHD have been published, intra-arterial injection of high-dose corticosteroids may be a viable option. We treated 11 patients with steroid-resistant GVHD using a single administration of intra-arterial high-dose methylprednisolone. Three patients (27%) died periprocedurally. Four patients (36%) had a partial response to intra-arterial treatment and were discharged on total parenteral nutrition and oral medication. Four patients (36%) had a complete response and were discharged on oral diet and oral medication. No immediate treatment or procedure-related complications were noted. Twenty-seven percent of patients survived long-term. Our preliminary results suggest that regional intra-arterial treatment of steroid-resistant GVHD is a safe and potentially viable secondary therapy in primary treatment-resistant GVHD.

Weintraub, Joshua L., E-mail: Joshua.Weintraub@mssm.edu; Belanger, Adam R.; Sung, Chris C.; Stangl, P. Anondo; Nowakowski, F. Scott; Lookstein, Robert L. [Mount Sinai Medical Center, Department of Vascular and Interventional Radiology (United States)

2010-06-15

285

The severity of atherosclerosis at sites of plaque rupture with occlusive thrombosis in saphenous vein coronary artery bypass grafts.  

PubMed

Atherosclerotic plaque rupture with superimposed thrombosis is recognized as the lesion causing late, acute, thrombotic saphenous vein coronary artery bypass graft (CABG) occlusion. To determine the severity of atherosclerosis at the site of plaque rupture, 68 saphenous vein CABGs removed at the time of reoperation or at autopsy were studied. The study population consisted of 57 men, 64 +/- 9 years old, and nine women, 70 +/- 10 years old. The duration of graft implantation was 7.9 +/- 2.7 years (mean +/- S.D.). All CABGs were dissected from the hearts, fixed, decalcified, cut at 2 to 3 mm intervals, and processed routinely for histologic examination. A planimeter was used to measure total vessel, plaque, thrombus, and luminal cross-sectional areas at the site of plaque rupture with thrombosis in sections projected at 13.8 power magnification. At the site of atherosclerotic plaque rupture with superimposed thrombosis, the degree of stenosis due to plaque was: 90 +/- 11% for the right coronary artery grafts (n = 19); 94 +/- 7% for the left anterior descending artery grafts (n = 41), and 90 +/- 14% for the left circumflex artery (n = 8) grafts. Thus in saphenous vein CABGs, atherosclerotic plaque rupture with thrombosis usually occurs at sites of severe narrowing (mean = 93%) by preexisting atherosclerotic plaque. PMID:1927881

Qiao, J H; Walts, A E; Fishbein, M C

1991-10-01

286

Angiographic evaluation of the luminal changes in the radial artery graft in coronary artery bypass surgery: a concern over the long-term patency  

Microsoft Academic Search

Objective: The radial artery graft (RA) still involves two unsolved problems, namely, vasospasm and intimal hyperplasia, although satisfactory early and mid-term outcomes have been obtained recently. Methods: Two hundred patients underwent coronary artery bypass surgery with RA between October,1996 and December,2000. We made a comparison of the luminal diameters at early and mid-term periods in 23 patients who underwent mid-term

Masahiro Ikeda; Hirokazu Ohashi; Yasushi Tsutsumi; Katsuaki Hige; Takahiro Kawai; Masateru Ohnaka

2002-01-01

287

Angiographic evaluation of the luminal changes in the radial artery graft in coronary artery bypass surgery: a concern over the long-term patency  

Microsoft Academic Search

Objective: The radial artery graft (RA) still involves two unsolved problems, namely, vasospasm and intimal hyperplasia, although satisfactory early and mid-term outcomes have been obtained recently. Methods: Two hundred patients underwent coronary artery bypass surgery with RA between October,1996 and December,2000. We made a comparison of the luminal diameters at early and mid-term periods in 23 patients who underwent mid-term

Masahiro Ikeda; Hirokazu Ohashi; Yasushi Tsutsumi; Katsuaki Hige; Takahiro Kawai; Masateru Ohnaka

2010-01-01

288

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

289

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

290

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

291

Influence of the haemodynamic parameters on the repartition of the flow between an artery and its graft.  

PubMed

The aim of this study was to investigate the repartition of the flow between an artery and its graft for several values of the geometric and dynamic parameters (length and severity of the stenosis, Reynolds number and frequency pulse value). The model, fabricated in silicone, was included in an hydrodynamic test bench, allowing to reproduce physiological conditions. Our study showed that the severity of the stenosis was the most influent parameter on the repartition of the flow; in particular, a 75% severity was necessary to obtain a repartition 70-30% between the graft and the artery. PMID:3323352

Rieu, R; Bano, S; Pelissier, R; Bergeron, P; Reggi, M; Courbier, R

292

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

293

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

Microsoft Academic Search

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

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

2003-01-01

294

Cardiac output measurement by transpulmonary versus conventional thermodilution technique in intensive care patients after coronary artery bypass grafting  

Microsoft Academic Search

Objective: The aim of the present study was to evaluate the correlation, accuracy, and precision of transpulmonary thermodilution cardiac output (CO) measurement. For this purpose, this technique was compared with the clinical gold standard, the CO measurement by pulmonary artery catheter in patients after coronary artery bypass grafting (CABG).Design: A prospective clinical study.Setting: A university medical center.Participants: Seventy-five patients in

René Gust; André Gottschalk; Harald Bauer; Bernd W. Böttiger; Hubert Böhrer; Eike Martin

1998-01-01

295

[Use of the radial artery for coronary artery bypass. A new experience after 20 years].  

PubMed

Twenty years after its first introduction by A. Carpentier, the use of the radial artery (RA) for coronary bypass was reinvestigated because of unexpected good long term results in some patients. Since July 1989, 158 patients (pts) underwent myocardial revascularization using 189 RA grafts (31 pts received 2 grafts). The left internal mammary artery (LIMA) was concomitantly used as a pedicled graft in 151 cases and the right internal mammary artery (RIMA) in 31 cases, a free IMA graft was used in 29 cases and a saphenous vein graft in 40 cases. A mean of 2.8 graft/pt was performed. The target artery receiving the RA was: circumflex (n = 93), diagonal (n = 39), right coronary (n = 47) and LAD (n = 10). Two patients died (1.3%) and three presented a perioperative myocardial infarct (2.5%). Sternal wound infection was noted in three cases of double IMA implant. No ischemia of the hand was observed. All patients received diltiazem started intraoperatively and continued after discharge. In addition, aspirin (100 mg/day) was given at discharge. Early angiographic controls (< 3 weeks) were obtained in the first 60 consecutive patients and revealed: 73/73 patent RA grafts, 58/58 patent LIMA grafts, 16/16 patent RIMA grafts, 15/19 patent free IMA grafts and 10/11 patent vein grafts. Six patients presented a localized narrowing of the RA conduit unrelated to the anastomotic lines (spasm). Late angiographic control (6 to 24 months) was obtained after a mean follow-up of 11 months in 37 patients: 42/46 RA grafts were patent (91.3%) and free of spasm and 4 were occluded.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8024369

Acar, C; Farge, A; Chardigny, C; Beyssen, B; Pagny, J Y; Grare, P; Fabiani, J N; Deloche, A; Guermonprez, J L; Carpentier, A

1993-12-01

296

Mid-Aortic Syndrome in a 3-Year-Old Girl Successfully Treated by Aorto-Aortic Grafting and Renal Artery Implantation into the Graft  

PubMed Central

Mid-aortic syndrome, an uncommon acquired or congenital condition characterized by segmental narrowing of the abdominal or distal descending thoracic aorta, is frequently accompanied by ostial stenosis of the aorta's branches. If left untreated, it can result in life-threatening complications secondary to severe hypertension. We report the case of a 3-year-old girl with congenital mid-aortic syndrome, who was diagnosed by chance in the course of a viral illness, and whose high blood pressure values were first dismissed as inaccurate. Attempts to achieve medical or endovascular control of her hypertension were unsuccessful. She was thereafter successfully treated by aorto–aortic bypass grafting, resection of the stenotic segments of both renal arteries, and implantation of the patent arterial segments into the graft.

Levart, Tanja Kersnik; Klokocovnik, Tomislav

2012-01-01

297

[Coronary artery bypass-grafting using interrupted anastomosis with the U-clip].  

PubMed

For coronary artery anastomosis, the continuous suture technique is generally used because it is easy to perform, there is less anastomotic leakage, and a shorter anastomotic time compared with the interrupted suture technique. However, with this technique there is a potential risk of anastomotic stenosis caused by the purse-string effect, which does not occur with the interrupted suture technique. The U-Clip device was designed to facilitate the interrupted suture technique in coronary anastomosis by eliminating the need for suture management, knot tying, and surgical assistance. The device employs the superelastic properties of nitinol and two components: 1. a needle/suture delivery system, and 2. a detachable nitinol self-closing wire. We used this device successfully for LITA-LAD anastomosis in MIDCAB. When this device is applied to small caliber conduits, such as the internal thoracic arteries and the gastroepiploic artery, the side-to-side anastomosis can reduce the anastomotic leakage more efficiently, since the coronary incision and graft incision can be perfectly matched. The U-Clip facilitates coronary anastomosis by simplifying and decreasing the amount of manipulation and complexity required in minimally invasive CABG procedures. Nitinol technology also has potential in robotic and endoscopic surgical applications. PMID:11712367

Niinami, H; Takeuchi, Y; Ichikawa, S; Ban, T; Higashita, R; Suda, Y; Suzuki, S

2001-11-01

298

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

299

Cardiac Troponin I Concentrations, but Not Electrocardiographic Results, Predict an Extended Hospital Stay after Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

Background: Cardiac damage in coronary artery graft (CABG) surgery is an important contributor to postop- erative cardiac dysfunction and delayed hospital dis- charge. Currently, no simple method exists for its quan- tification. Methods: In a prospective study of 300 patients having routine CABG surgery, we compared cardiac troponin I (cTnI) concentrations at 6 and 24 h after surgery with electrocardiographic

Robert F. Salamonsen; Hans-Gerhard Schneider; Michael Bailey; Andrew J. Taylor

300

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

301

The Effects of Case Management on Clinical Nutrition Practice for the Coronary Artery Bypass Graft Surgery Patient  

Microsoft Academic Search

Case Management is a systemic clinical process which provides quality patient care within a predetermined time frame established by dianostic related groups. To achieve our goals, critical care paths were developed for selected diagnostic related groups. The pilot diagnostic related group for case management was the coronary artery bypass graft, which is a high volume case type. Collaboration with an

W. R. Neely

1995-01-01

302

Superior Mesenteric Artery Pseudoaneurysm Following Pancreaticoduodenectomy: Management by Endovascular Stent-Graft Placement and Transluminal Thrombin Injection  

SciTech Connect

Superior mesenteric artery (SMA) pseudoaneurysm formation is a rare and potentially fatal postoperative complication. Herein we present a case of a large post-pancreaticoduodenectomy SMA pseudoaneurysm that required thrombin injection after initial stent-graft deployment to accomplish complete pseudoaneurysm occlusion.

Wallace, Michael J. [University of Texas M.D. Anderson Cancer Center, Department of Diagnostic Radiology (United States)], E-mail: mwallace@mdanderson.org; Choi, Eugene [University of Texas M.D. Anderson Cancer Center, Department of Surgical Oncology (United States); McRae, Stephen; Madoff, David C.; Ahrar, Kamran [University of Texas M.D. Anderson Cancer Center, Department of Diagnostic Radiology (United States); Pisters, Peter [University of Texas M.D. Anderson Cancer Center, Department of Surgical Oncology (United States)

2007-06-15

303

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

Microsoft Academic Search

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

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

2011-01-01

304

Impact of Body Mass Index on In-Hospital Mortality and Morbidity after Coronary Artery Bypass Grafting Surgery  

Microsoft Academic Search

Background: Obesity is a common risk factor for morbidity and mortality after cardiac surgery. However, the relationship between obesity and postoperative risk has not been fully defined. Methods: A prospective study of 1015 consecutive patients undergoing isolated coronary artery bypass grafting (CABG) was carried out. Body mass index (BMI) was used as the measure of obesity and was categorized as

Forouzan Yazdanian; Seyedeh Zahra Faritous; Gholamali Mollasadeghi

305

The results of combination of coronary artery bypass grafting with circular plasty of left ventricular and mitral valve annuloplasty  

Microsoft Academic Search

Summary. Background. Patients with ischemic cardiomyopathy (ICMP) represent a severe loss ontractile function of left ventricular (LV) because of remodeling of fibrous skeleton of the heart with following dilatation of LV. The aim of this study was to evaluate the results of surgical treatment of patients with ICMP, who had underwent coronary artery bypass grafting (CABG) and new methods of

Jurij Ostrovsky; Aleksej Ostrovsky; Ivan Sidorenko

306

National surveillance of surgical site infections after coronary artery bypass grafting in Norway: incidence and risk factors  

Microsoft Academic Search

Objective: A mandatory national surveillance system for surgical site infections (SSIs) following certain surgical procedures, including coronary artery bypass grafting (CABG), was introduced in Norway in 2005. The objectives of this study were to measure national baseline incidence rates of SSIs after CABG, describe the characteristics of the patients and procedures, and identify possible risk factors for infection. Methods: In

Thale Cathrine Berg; Knut E. Kjųrstad; Per Espen Akselsen; Bjųrn Edvard Seim; Hege Line Lųwer; Maryann Nesset Stenvik; Nina Kristine Sorknes; Hanne-Merete Eriksen

307

Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: A prospective randomized controlled trial  

Microsoft Academic Search

Introduction: We undertook a prospective, randomized, controlled clinical trial to evaluate morbidity outcomes and safety of a modified anesthetic technique to provide shorter sedation and early extubation (1 to 6 hours) than those of the conventional anesthetic protocol used for prolonged sedation and extubation (12 to 22 hours) in patients after coronary artery bypass grafting. Methods: One hundred twenty patients

Davy C. H. Cheng; Jacek Karski; Charles Peniston; Buvanendran Asokumar; Ganesh Raveendran; Jo Carroll; Hillary Nierenberg; Sandra Roger; Don Mickle; Jeff Tong; J. Zelovitsky; Tirone David; Alan Sandler

1996-01-01

308

Simple Index to Predict Likelihood of Skilled Nursing Facility Admission After Coronary Artery Bypass Grafting Among Older Patients  

Microsoft Academic Search

Background. Acceptable short-term mortality rates for elderly patients undergoing coronary artery bypass graft- ing (CABG) are reported in the literature. However, rather than death, older patients considering CABG are generally most concerned about a postoperative loss of functional independence. To address this concern, we describe an index that predicts a patient's likelihood of admission to a skilled nursing facility (SNF)

David C. Chang; David L. Joyce; Angela Shoher; David D. Yuh

2010-01-01

309

Changes in health-related quality of life and functional capacity following coronary artery bypass graft surgery  

Microsoft Academic Search

Objective: Improvement in survival and quality of life are the primary indications for coronary artery bypass graft (CABG) operations. Among elderly patients the main goal of surgery is not necessarily to prolong life, but to improve the health-related quality of life. Factors associated with mortality and morbidity following CABG surgery have been well defined, but the quality of life and

Otso Järvinen; Timo Saarinen; Juhani Julkunen; Heini Huhtala; Matti R. Tarkka

2003-01-01

310

A pilot study of blood antioxidant and free radical marker profiles in patients awaiting coronary artery bypass grafting  

Microsoft Academic Search

Coronary artery bypass grafting (CABG) carries a high risk of acute pancreatitis. We report a pilot study to investigate whether pre-existing oxidative stress might underlie this susceptibility, in that a burst of free radical activity not only accompanies the reperfusion stage of CABG but seems to be a pivotal step in the pathogenesis of pancreatitis. Samples of peripheral venous blood

M. Gu; H. Love; D. Schofield; W. Turkie; N. Odom; J. M. Braganza

1996-01-01

311

Incidence, Topography, Predictors and Long-Term Survival After Stroke in Patients Undergoing Coronary Artery Bypass Grafting  

Microsoft Academic Search

Background. Previous studies on stroke after coronary artery bypass grafting (CABG) provide limited data about the timing (early vs delayed) of this event and findings of brain imaging analysis. This information is of significant importance because it provides insight into the etiology of stroke, potentially allowing the develop- ment of preventive measures. This study analyzed the incidence and timing of

Farzan Filsoufi; Parwis B. Rahmanian; Javier G. Castillo; David Bronster; David H. Adams

2010-01-01

312

Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): incidence, risk factors and mortality  

Microsoft Academic Search

BACKGROUND: Sternal wound infection (SWI) is an uncommon but potentially life-threatening complication of cardiac surgery. Predisposing factors for SWI are multiple with varied frequencies in different studies. The purpose of this study was to assess the incidence, risk factors, and mortality of SWI after coronary artery bypass grafting (CABG) at Tehran Heart Center. METHODS: This study prospectively evaluated multiple risk

Abbas Salehi Omran; Abbasali Karimi; S Hossein Ahmadi; Setareh Davoodi; Mehrab Marzban; Namvar Movahedi; Kyomars Abbasi; Mohammad Ali Boroumand; Saeed Davoodi; Naghmeh Moshtaghi

2007-01-01

313

Deep Sternal Wound Infection after Coronary Artery Bypass Grafting Markedly Increases Hospital Length of Stay: Estimates from Community Hospitals  

Microsoft Academic Search

BACKGROUND: Despite improved use of peri-operative antibiotic prophylaxis, surgical site infections following coronary artery bypass grafting (CABG) continue to occur, with high case-fatality rates and costs. Few data are currently available on the impact of deep sternal wound infections (DSWI) on length of hospital stay, and no such data exist for community hospitals (as opposed to teaching hospitals). We assessed

C. Kirchner; J. Daley; A. Kim; H. Zhang; Y. Mitina; E. Abrutyn

2004-01-01

314

Risk of Restenosis and Health Status Outcomes for Patients Undergoing Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

Background—Previous comparisons of percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) surgery have demonstrated similar survival but have also generally found better health status outcomes (symptoms, function, and quality of life) with CABG. The principal limitation of PCI has been the occurrence of restenosis. No previous studies comparing the health status outcomes of PCI and CABG have examined

John A. Spertus; Ravi Nerella; Richard Kettlekamp; John House; Steve Marso; A. Michael Borkon; John S. Rumsfeld

2010-01-01

315

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

316

Long-Term Mortality of Coronary Artery Bypass Graft Surgery and Bare-Metal Stenting  

PubMed Central

Background There is little information on the relative survival of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention with stenting with follow-up longer than 5 years. This study tested the hypothesis that CABG surgery is associated with lower risk of long-term (8-year) mortality than stenting with bare-metal stents for multivessel coronary disease. Methods We identified 18,359 patients with multivessel disease who underwent isolated CABG surgery and 13,377 patients who received BMS in 1999–2000 in New York, and followed their vital status through 2007 using the National Death Index. We matched CABG and stent patients on the number of diseased coronary vessels, proximal left anterior descending (LAD) artery disease, and propensity of undergoing CABG surgery based on numerous patient characteristics, and compared the survival after the two procedures. Results In the 7,235 pairs of matched patients, the overall 8-year survival rates were 78.0% for CABG surgery and 71.2% for stenting (hazard ratio = 0.68, 95% confidence interval: 0.64 to 0.74, P<0.001). For anatomic groups classified by the number of diseased vessels and proximal LAD involvement, the hazard ratios ranged from 0.53 (P<0.001) for patients with 3-vessel disease involving proximal LAD artery disease to 0.78 (P=0.05) for patients with 2-vessel disease but no disease in the LAD artery. A lower risk of death after CABG surgery was observed in all subgroups stratified by a number of baseline risk factors. Conclusions CABG surgery is associated with lower risk of death than stenting with bare-metal stents for multivessel coronary disease.

Wu, Chuntao; Zhao, Songyang; Wechsler, Andrew S.; Lahey, Stephen; Walford, Gary; Culliford, Alfred T.; Gold, Jeffrey P.; Smith, Craig R.; Holmes, David R.; King, Spencer B.; Higgins, Robert S.D.; Jordan, Desmond; Hannan, Edward L.

2012-01-01

317

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

318

Racial Differences in Survival among Hemodialysis Patients after Coronary Artery Bypass Grafting  

PubMed Central

The aim of this study was to examine racial differences in long-term survival among hemodialysis patients after coronary artery bypass grafting (CABG). To our knowledge this has not been previously addressed in the literature. Black and white hemodialysis patients undergoing first-time, isolated CABG procedures between 1992 and 2011 were compared. Survival probabilities were computed using the Kaplan-Meier product-limit method and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. A total of 207 (2%) patients were on hemodialysis at the time of CABG. White (n = 80) hemodialysis patients had significantly decreased 5-year survival compared with black (n = 127) patients (adjusted HR = 1.9, 95% CI = 1.2–2.8). Our finding provides useful outcome information for surgeons, primary care providers, and their patients.

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

2013-01-01

319

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

320

Management of patients with hematological malignancies undergoing coronary artery bypass grafting.  

PubMed

The number of patients with a previously diagnosed malignancy who need cardiac surgery is increasing. Patients with hematological malignancies represent only 0.38% of all patients undergoing cardiac surgery. The literature in this subset of patients is limited to only a few retrospective case series, with limited number of patients undergoing emergency cardiac surgery. We describe three cases with hematological malignancies namely chronic myelogenous leukemia, acute promyelocytic leukemia and chronic lymphocytic leukemia presenting for coronary artery bypass grafting (CABG). Two patients were taken up for emergency CABG in view of ongoing ischemia, one of them was on preoperative intra-aortic balloon pump support. No mortality was observed. Two patients needed transfusion of blood products which was guided by thromboelastography. One patient developed superficial sternal wound infection requiring antibiotic therapy. PMID:23287086

Borde, Deepak; Gandhe, Uday; Hargave, Neha; Pandey, Kaushal

321

Autologous bone marrow cell transplantation combined with off-pump coronary artery bypass grafting in patients with ischemic cardiomyopathy  

PubMed Central

Background Clinical studies have demonstrated that intracoronary or intramyocardial transplantation of bone marrow mononuclear cells (BMMNCs) into ischemic myocardium improves cardiac function. The objective of the present study was to evaluate the safety and feasibility of intramyocardial BMMNC transplantation into nongraftable areas in combination with off-pump coronary artery bypass grafting in patients with ischemic cardiomyopathy. Methods Five male patients with myocardial infarction lasting for more than 1 month and with nongraftable myocardium received autologous mononuclear cell transplantation during off-pump coronary artery bypass grafting. Autologous bone marrow was aspirated from the iliac crest. BMMNCs (mean 1.6, standard error [SE] 0.3 × 109) including CD34-positive cells (mean 6.8, SE 1.1 × 106) and AC133-positive cells (mean 3.1, SE 1.7 × 106) were injected into the nongraftable ischemic myocardium. Heart function was evaluated with the use of echocardiography, and myocardial perfusion was examined with single photon emission computed tomography technetium-99mTc sestamibi scans. Results Two months after cell transplantation, the mean ejection fraction had increased by 7.4%, SE 1.9% (p = 0.016) compared with that before cell transplantation and off-pump coronary artery bypass grafting. The increase in ejection fraction was not correlated with the number of transplanted total mononuclear cells, CD34-positive cells and AC133-positive cells. Myocardial perfusion at the cell-transplanted area increased after cell transplantation and off-pump coronary artery bypass grafting. No arrhythmia was observed. Conclusion The present clinical study suggests that intramyocardial transplantation of autologous BMMNCs into the ischemic area during off-pump coronary artery bypass grafting is both feasible and safe and has beneficial effects on cardiac function.

Yoo, Kyung-Jong; Kim, Hyun-Ok; Kwak, Young-Lan; Kang, Seok-Min; Jang, Yang-Soo; Lim, Sang-Hyun; Hwang, Ki-Chul; Cho, Seung-Woo; Yang, Yoon-Sun; Li, Ren-Ke; Kim, Byung-Soo

2008-01-01

322

Exercise-based cardiac rehabilitation improves hemodynamic responses after coronary artery bypass graft surgery  

PubMed Central

BACKGROUND: Cardiovascular disorders are an important public health problem worldwide. They are also the leading cause of mortality and morbidity. Therefore, American Heart Association proposed cardiac rehabilitation program as an essential part of care for cardiac patients to improve functional capacity. The aim of this study was to evaluate the effectiveness of cardiac rehabilitation program on functional status and some hemodynamic responses in patients after coronary artery bypass graft (CABG) surgery. METHODS: Thirty two patients were selected for this study. All patients underwent cardiac surgery two months before admission. They were allocated to two groups. While the rehabilitation group (n =17, mean age: 62 ± 12 years) completed the cardiac rehabilitation program for two months, the reference group (n = 15, mean age: 58.5 ± 12.5 years) did not have any supervised physical activity during this period. Cardiac rehabilitation program consisted of exercise, nutritional, psychological consultation and risk factor management. At the beginning of the study, functional capacity of patients was evaluated by exercise test, 6-minute walking test and echocardiography. Functional capacity was evaluated for a second time after two months of cardiac rehabilitation. Data were analyzed by SPSS15. For comparing the mean of outcomes, Mann-Whitney test and Wilcoxon signed ranks test were used. RESULTS: As a result of cardiac rehabilitation, a significant improvement was observed in the distance walked in the rehabilitation group (P < 0.01) compared to the reference group (P = 0.33). It also caused a significant development in hemodynamic responses to exercise such as resting and maximum systolic and diastolic blood pressure, resting and maximum heart rate, ejection fraction and rate pressure product. CONCLUSION: Cardiac rehabilitation significantly improves functional capacity and some hemodynamic responses post coronary artery bypass grafting. Therefore, patients need to be referred to rehabilitation units.

Ghashghaei, Fatemeh Esteki; Sadeghi, Masoumeh; Marandi, Seyed Mohammad; Ghashghaei, Samira Esteki

2012-01-01

323

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

324

Geometry assessment of coronary artery anastomoses with construction errors by epicardial ultrasound  

Microsoft Academic Search

Objective: There is concern about the quality of the distal anastomosis in off-pump coronary artery bypass grafting. We investigated the impact of specific construction errors on anastomotic geometry using epicardial ultrasound. Methods: Twelve ex vivo pressure perfused porcine and five isolated post-mortem human hearts were used to construct 35 internal mammary artery to coronary artery anastomoses, either without (n=7) or

Thomas C Dessing; Ricardo P. J Budde; Rudy Meijer; Patricia F. A Bakker; Cornelius Borst; Paul F Gründeman

2004-01-01

325

A short segment intracranial-intracranial jump graft bypass followed by proximal arterial occlusion for a distal MCA aneurysm  

PubMed Central

Background: To describe the use of a short segment cortical intracranial–intracranial (IC–IC) bypass for the treatment of a distal middle cerebral artery (MCA) aneurysm. Case Description: A 54-year-old woman presented with a loss of consciousness followed by multiple seizures and was found to have a partially thrombosed distal MCA aneurysm. This possibly mycotic aneurysm was treated by creating a short segment jump graft between a normal cortical artery and a nearby cortical branch arising from the aneurysmal M3 arterial segment. The bypass allowed for subsequent occlusion of the aneurysmal vessel without ischemic consequence. At surgery, the anterior division of the superficial temporal artery (STA) was exposed and dissected. Intraoperative angiography was utilized to localize a cortical artery arising from the involved segment as well as a nearby cortical artery arising from a distinct, uninvolved MCA branch. A segment of the STA was harvested, and then 10-0 suture was utilized to anastomose this short segment, to both the involved and normal cortical arteries. This created a short jump graft allowing for subsequent sacrifice of the diseased artery. Following surgery, the patient immediately underwent coil embolization of the aneurysm back into the parent artery resulting in local vascular sacrifice. The remainder of the patient's hospital course was uneventful. She was discharged home in good condition. Conclusions: We suggest that cortical IC–IC bypass followed by endovascular arterial sacrifice as performed in our case represents a simple and safe option for treating unclippable distal MCA aneurysms including mycotic lesions.

Nussbaum, Leslie; Defillo, Archie; Zelensky, Andrea; Nussbaum, Eric S.

2011-01-01

326

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

SciTech Connect

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

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

1983-05-01

327

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

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

Restoration of Failed Renal Graft Function After Successful Angioplasty of Pressure-Resistant Renal Artery Stenosis Using a Cutting Balloon: A Case Report  

SciTech Connect

This study is the report of a 37-year-old male with a transplanted kidney from a 3.5-year-old donor: the graft had two arteries transplanted with an aortic patch to an external iliac artery. Four months after transplantation, the graft function deteriorated, together with the development of hypertension. Stenosis of both graft arteries was detected and the patient was referred for angioplasty. The angiographic result was suboptimal, nevertheless, the graft function improved and was more or less stable (serum creatinine, 160-200 {mu}mol/l) for 4 years, along with persistently difficult-to-control hypertension. Five years after transplantation, the graft function deteriorated again and severe graft artery restenosis was detected. The restenosis did not respond to dilatation, graft function failed, hypertension decompensated, and left ventricular failure developed. The patient required dialysis. A cutting balloon angioplasty opened the artery, and kidney function was restored after a few days: the serum creatinine level dropped to 140-160 {mu}mol/l, and the glomerular filtration rate (creatinine clearance) to 0.65 ml/min/1.73 m{sup 2}. The graft function has now been stable for more than 2 years, however, the hypertension is still difficult to control.

Peregrin, J. H., E-mail: jape@medicon.c [Institute for Clinical and Experimental Medicine, Department of Diagnostic and Interventional Radiology (Czech Republic); Buergelova, M. [Institute for Clinical and Experimental Medicine, Department of Nephrology (Czech Republic)

2009-05-15

330

A Risk Score for Predicting Long-Term Mortality Following Coronary Artery Bypass Graft Surgery  

PubMed Central

Background No simplified bedside risk scores have been created to predict long-term mortality after coronary artery bypass graft (CABG) surgery. Methods and Results The New York State’s Cardiac Surgery Reporting System was used to identify 8,597 patients who underwent isolated CABG surgery in July-December 2000. The National Death Index was used to ascertain patients’ vital status through December 31, 2007. A Cox proportional hazards model was fit to predict death following CABG surgery using pre-procedural risk factors. Then points were assigned to significant predictors of death based on the values of their regression coefficients. For each possible point total, the predicted risks of death at years 1, 3, 5, and 7 were calculated. It was found that the 7-year mortality rate was 24.2% in the study population. Significant predictors of death included age, body mass index, ejection fraction, unstable hemodynamic state or shock, left main coronary artery disease, cerebrovascular disease, peripheral arterial disease, congestive heart failure, malignant ventricular arrhythmia, chronic obstructive pulmonary disease, diabetes, renal failure, and history of open heart surgery. The points assigned to these risk factors ranged from 1 to 7; and possible point totals for each patient ranged from 0 to 28. The observed and predicted risks of death at years 1, 3, 5, and 7 across patient groups stratified by point totals were highly correlated. Conclusions The simplified risk score accurately predicted the risk of mortality following CABG surgery, and can be used for informed consent and as an aid in determining treatment choice.

Wu, Chuntao; Camacho, Fabian T.; Wechsler, Andrew S.; Lahey, Stephen; Culliford, Alfred T.; Jordan, Desmond; Gold, Jeffrey P.; Higgins, Robert S. D.; Smith, Craig R.; Hannan, Edward L.

2012-01-01

331

Ten-year Echo-Doppler evaluation of forearm circulation following radial artery removal for coronary artery bypass grafting  

Microsoft Academic Search

Objective: To investigate the chronic consequences of radial artery removal for coronary artery bypass surgery on the forearm circulation. Methods: Thirty-nine patients submitted to radial artery removal for coronary artery bypass were submitted to serial Echo-Doppler evaluation of the flow and morphology of the forearm arteries until 10 years follow-up. Results: The peak systolic velocity of the ulnar artery of

Mario Gaudino; Franco Glieca; Nicola Luciani; Gianfranca Losasso; Paolo Tondi; Michele Serricchio; Paolo Pola; Gianfederico Possati

2006-01-01

332

A survey of current myocardial protection practices during coronary artery bypass grafting.  

PubMed Central

OBJECTIVE: To identify current myocardial protection strategies for coronary artery bypass grafting (CABG) across the UK and Ireland. METHODS: A questionnaire survey of 15 questions was sent to practising cardiac surgeons between June and October 2002. The list of surgeons was obtained from the Society of Cardiothoracic Surgeons of Great Britain and Ireland database and they were contacted by postal and electronic mail. RESULTS: 118 (73.7%) out of 160 surgeons responded to the survey. 61 (51.7%) perform CABG on-pump (ONCAB) while 10 (8.5%) practice off-pump CABG (OPCAB). 47 (39.8%) perform either depending on individual cases. Of the 108 surgeons performing ONCAB, 91 (84.3%) use cardioplegia while 17 (15.7%) use cross-clamp and fibrillation techniques. Of those using cardioplegia, 76 (83.5%) use blood cardioplegia, 15 (19.7%) use warm-blood and 60 (78.9%) use cold-blood cardioplegia. 15(16.5%) use crystalloid cardioplegia. Retrograde cardioplegia is used by 23 (25.2%). We find an interesting variation of practice in relation to specifics like warm induction, graft cardioplegia, hot-shot, single cross-clamp, hypothermia and venting procedures. An overwhelming majority of surgeons performing OPCAB use the Octopus stabiliser (n=44, 77.2%) with some others preferring the Genzyme system. Supplementary stabilisation is not commonly used. While most OPCAB surgeons use intracoronary shunts (n=51), some prefer blockers (n=9) and others use coronary sloops (n=36). Ischaemic preconditioning is not commonly practised. Several surgeons have changed their practice of myocardial protection in the last 5 years (n=45). CONCLUSIONS: This survey gives us an interesting insight into current myocardial protection practices in the UK and Ireland and may be useful for future reference.

Karthik, S.; Grayson, A. D.; Oo, A. Y.; Fabri, B. M.

2004-01-01

333

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

334

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

335

Emergency Stent Grafting After Unsuccessful Surgical Repair of a Mycotic Common Femoral Artery Pseudoaneurysm in a Drug Abuser  

SciTech Connect

Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.

Lupattelli, Tommaso, E-mail: tommaso.lupattelli@multimedica.i [Multimedica IRCCS, Department of Interventional Radiology (Italy); Garaci, Francesco Giuseppe [University of Tor Vergata, Department of Radiology and Interventional Radiology (Italy); Basile, Antonio [Ospedale Ferrarotto, Department of Diagnostic and Interventional Radiology (Italy); Minnella, Daniela Paola; Casini, Andrea; Clerissi, Jacques [Multimedica IRCCS, Department of Interventional Radiology (Italy)

2009-03-15

336

Aorta non-touch coronary artery bypass grafting after total arch replacement for acute type A aortic dissection.  

PubMed

We report successful surgical treatment of coronary artery disease (CAD) in a 53-year-old man. The man was admitted to our hospital due to severe anterior chest pain. He had a surgical history of total arch replacement for acute type A dissection 10 years previously. Angiography showed triple-vessel disease and partial dissection of the descending aorta. To avoid excessive excision and to perform surgery safely, we chose aorta non-touch techniques for coronary artery bypass grafting (CABG). The postoperative course was uneventful and the patient was discharged 30 days after surgery. PMID:19666654

Takahashi, Yosuke; Tsutsumi, Yasushi; Monta, Osamu; Ohashi, Hirokazu

2009-08-07

337

Carotid-subclavian bypass grafting with polytetrafluoroethylene grafts for symptomatic subclavian artery stenosis or occlusion: A 20-year experience  

Microsoft Academic Search

Background and Purpose: Since the advent of subclavian artery percutaneous transluminal angioplasty\\/stenting, several authorities advocate it as the treatment of choice for patients with subclavian artery disease, claiming results equal to or better than those of reconstructive vascular surgery. However, most of their quoted surgical series included patients who may have other brachiocephalic disease who were treated nonuniformly by means

Ali F. AbuRahma; Patrick A. Robinson; Tucker G. Jennings

2000-01-01

338

Mineralocorticoid receptor expression in human venous smooth muscle cells: a potential role for aldosterone signaling in vein graft arterialization  

PubMed Central

Experimental studies have suggested a role for the local renin-angiotensin-aldosterone system in the response to vascular injury. Clinical data support that aldosterone, via activation of the mineralocorticoid receptor (MR), is an important mediator of vascular damage in humans with cardiovascular disease. In mineralocorticoid-sensitive target tissue, aldosterone specificity for MR is conferred enzymatically by the cortisol-inactivating enzyme 11?-hydroxysteroid-dehydrogenase-2 (11?HSD2). However, the role of MR/aldosterone signaling in the venous system has not been explored. We hypothesized that MR expression and signaling in venous smooth muscle cells contributes to the arterialization of venous conduits and the injury response in vein bypass grafts. MR immunostaining was observed in all samples of excised human peripheral vein graft lesions and in explanted experimental rabbit carotid interposition vein grafts, with minimal staining in control greater saphenous vein. We also found upregulated transcriptional expression of both MR and 11?HSD2 in human vein graft and rabbit vein graft, whereas control greater saphenous vein expressed minimal MR and no detectable 11?HSD2. The expression of MR and 11?HSD2 was confirmed in cultured human saphenous venous smooth muscle cells (hSVSMCs). Using an adenovirus containing a MR response element-driven reporter gene, we demonstrate that MR in hSVSMCs is capable of mediating aldosterone-induced gene activation. The functional significance for MR signaling in hSVSMCs is supported by the aldosterone-induced increase of angiotensin II type-1 receptor gene expression that was inhibited by the MR antagonist spironolactone. The upregulation of MR and 11?HSD2 suggests that aldosterone-mediated tissue injury plays a role in vein graft arterialization.

Bafford, Richard; Sui, Xin Xin; Park, Min; Miyahara, Takuya; Newfell, Brenna G.; Jaffe, Iris Z.; Romero, Jose R.; Adler, Gail K.; Williams, Gordon H.; Khalil, Raouf A.

2011-01-01

339

Successful covered stent-graft exclusion of carotid artery pseudo-aneurysm: two case reports and review of literature.  

PubMed

Postendarterectomy carotid artery pseudo-aneurysm (CPA) is a relatively infrequent complication with an estimated incidence of 0.3%-0.6%. A report from a single center experience on open-surgical repair of CPA has shown the associated high morbidity and mortality. Endovascular therapy is emerging as a safer alternative to open-surgical therapy. We describe two cases of CPA treated with commercially available Viabahn stent graft system (Gore AL, Flagstaff, AZ). PMID:17484973

Ahuja, Vanita; Tefera, Girma

2007-05-01

340

Control algorithms for active relative motion cancelling for robotic assisted off-pump coronary artery bypass graft surgery  

Microsoft Academic Search

Use of intelligent robotic tools promises an alternative and superior way of performing off-pump coronary artery bypass graft (CABG) surgery. In the robotic-assisted surgical paradigm proposed, the conventional surgical tools are replaced with robotic instruments which are under direct control of the surgeon through teleoperation. The robotic tools actively cancel the relative motion between the surgical instruments and the point-of-interest

M. Cenk Cavusoł; Jason Rotella; Wyatt S. Newman; Sangeun Choi; Jeff Ustin; S. Shankar Sastry

2005-01-01

341

Influence of combined zero-balanced and modified ultrafiltration on the systemic inflammatory response during coronary artery bypass grafting  

Microsoft Academic Search

Objective: To evaluate whether combined zero-balanced and modified ultrafiltration affects the systemic inflammatory response in coronary artery bypass graft (CABG) patients.Design: Randomized and controlled.Setting: University-affiliated heart center.Participants: Forty-three patients scheduled for elective CABG.Interventions: In the ultrafiltration group (UF group; n = 21), zero-balanced ultrafiltration was performed during rewarming and modified ultrafiltration immediately after the end of cardiopulmonary bypass (CPB). A

Peter Tassani; Josef A. Richter; Gregory P. Eising; Andreas Barankay; Sigmund L. Braun; Christoph H. Haehnel; Paul Spaeth; Hubert Schad; Hans Meisner

1999-01-01

342

Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a prospective study  

Microsoft Academic Search

Objective: Clopidogrel decreases recurrent ischemic events and improves intracoronary stent patency. There are scarce data on the effect of short-term and long-term clopidogrel on symptom recurrence and adverse cardiac events following off-pump coronary artery bypass graft surgery (OPCAB). Methods: Postoperative antiplatelet medication use was prospectively evaluated in 591 OPCAB patients. Clopidogrel was administered for 30 days in 186 patients and

Ahmet Tayfun Gurbuz; Ayhan A. Zia; Ali Can Vuran; Haiyan Cui; Aydin Aytac

2006-01-01

343

Perioperative myocardial infarction has negative impact on health-related quality of life following coronary artery bypass graft surgery  

Microsoft Academic Search

Objective: Perioperative myocardial infarction (PMI) is a well-described complication of coronary artery bypass grafting (CABG). Data on its effect on patients' subsequent health-related quality of life (QOL) and on other related consequences is deficient. The aim here was to evaluate in a prospective follow-up design the risk factors for and consequences of PMI and especially its possible impact on health-related

Otso Järvinen; Juhani Julkunen; Timo Saarinen; Jari Laurikka; Heini Huhtala; Matti R. Tarkka

2004-01-01

344

Risk stratification in the elderly patient after coronary artery bypass grafting: The prognostic value of radionuclide cineangiography  

Microsoft Academic Search

Background  Recent data have shown that assessment of left ventricular function by radionuclide cineangiography (RNCA) predicts survival\\u000a and cardiac events among non-age-selected patients who have previously undergone coronary artery bypass grafting (CABG). However,\\u000a the prognostic value of this noninvasive approach is not known for elderly patients who now undergo CABG with progressively\\u000a increasing frequency and who survive longer because of operation.

Phyllis G. Supino; James B. Wallis; Gregory Chlouverakis; Jeffrey S. Borer

1994-01-01

345

Ten-year Echo-Doppler evaluation of forearm circulation following radial artery removal for coronary artery bypass grafting  

Microsoft Academic Search

Objective: To investigate the chronic consequences of radial artery removal for coronary artery bypass surgery on the forearm circulation. Methods: Thirty-ninepatients submitted to radial artery removal for coronaryartery bypass were submitted to serial Echo-Doppler evaluationof the flow and morphology of the forearm arteries until 10 years follow-up. Results: The peak systolic velocity of the ulnar artery of the operated side

Mario Gaudino; Franco Glieca; Nicola Luciani; Gianfranca Losasso; Paolo Tondi; Michele Serricchio; Paolo Pola; Gianfederico Possati

2010-01-01

346

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

347

Does a skeletonized or pedicled right gastro-epiploic artery improve patency when used as a conduit in coronary artery bypass graft surgery?  

PubMed

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether skeletonization of the right gastro-epiploic artery (RGEA) improves graft patency in coronary artery bypass grafting (CABG). Altogether >25 papers were found using the reported search, of which 11 papers represented the best evidence to answer this clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. Four out of the 11 papers were comparative studies (skeletonized conduits vs. pedicled conduits) and four studies produced one-year follow-up data. No studies revealed long-term patency rates as there was no follow-up data beyond five years. It is important to note that the evidence in the literature is based in a Japanese population. The vast majority of the target vessel which had been grafted by the RGEA was the right coronary artery and more specifically the posterior descending artery (PDA). The association between off-pump technique, sequential grafting, skeletonization of the RGEA with the harmonic scalpel and angiographic patency has not been adequately assessed. The studies reveal excellent patency rates for both early and mid-term skeletonized RGEA conduits. Overall patency rates were 97.7% within three months, 92.4% at a mean of approximately 1 year, 91.5% at a mean of approximately 2 years, and 86.4% at 4 years. In the four comparative studies, skeletonization patency was at least comparable and in one study superior to pedicled conduits. One study revealed a higher four-year cumulative patency rate for skeletonized conduits in comparison to a previous study by the same author where pedicled grafts were used. In conclusion, patency rates exceeded 95% in 10 studies for a follow-up of up to three months postoperatively. The evidence which supports the use of a 'skeletonized' RGEA is growing and this paper demonstrates clearly that in terms of patency, a skeletonized RGEA to the PDA should be considered as a conduit for CABG surgery especially when total arterial revascularization strategy with in situ conduits and no manipulation of the ascending aorta is the treatment of choice. PMID:19903686

Ali, Erden; Saso, Srdjan; Ashrafian, Hutan; Athanasiou, Thanos

2009-11-10

348

Hydrogen ion concentration and coronary artery bypass graft surgery with and without cardiopulmonary bypass  

PubMed Central

Background Acidosis during cardiopulmonary bypass (CPB) has been related to the strong ion difference (SID) and the composition of intravascular fluids that are administered. Less intravascular fluids tend to be administered during off- than on-pump CABG and should influence the degree of acidosis that develops. This study aimed to explore the role of CPB in the development of acidosis by comparing changes in hydrogen ion concentration ([H+]) and electrolytes in patients undergoing on- and off-pump coronary artery bypass graft (CABG) surgery. Methods Eighty two patients had arterial blood gas measurements pre-operatively, following CABG and at approximately 0600 h the morning after surgery. Carbon dioxide tension (PaCO2) and concentrations of sodium, potassium, chloride, [H+], bicarbonate and haemoglobin were measured and strong ion difference calculated. Data was analysed using mixed repeated-measures analysis of variance. Results Intra-operatively, mean SID decreased more in the on- compared to the off-pump group (4.0 mmol/L, 95% confidence interval 2.8-5.3 mmol/L, p?

2013-01-01

349

Antiarrhythmic effect of ischemic preconditioning in recent unstable angina patients undergoing coronary artery bypass grafting.  

PubMed

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 CABG. Forty-one patients with recent unstable angina and three-vessel coronary artery disease admitted for CABG were randomized into an IP group and a control group. The IP protocol involved twice occluding the ascending aorta with a cross-clamp for 2 minutes, followed by 3 minutes of reperfusion. Twenty-four-hour continuous electrocardiography (24-h ECG) was recorded from the preoperative day to the 2nd postoperative day. The incidences of supraventricular extrasystole (SVES), ventricular extrasystole (VES), supraventricular tachycardia (SVT), and ventricular tachycardia (VT) were 95.2%, 85.7%, 26.2%, and 26.2%, respectively, before surgery and 100.0%, 100.0%, 88.1%, and 76.2%, respectively, after surgery. IP significantly reduced the incidence of VT and the severity of SVES, VES, SVT, and VT after surgery. The period of mechanical ventilation and the length of stay in the intensive care unit were significantly shorter in the IP group. In summary, rhythm disturbances are common in CABG patients with recent unstable angina. IP significantly reduces rhythm disturbances, including SVES, VES, SVT, and VT after CABG. The findings indicate that IP could constitute an additional myocardial protective strategy in recently unstable angina patients undergoing CABG. PMID:14612991

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

2003-11-14

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

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

2012-07-13

353

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

Microsoft Academic Search

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

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

2007-01-01

354

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

SciTech Connect

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

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

1990-11-15

355

Bloodless off pump coronary artery bypass grafting treatment of choice for Jehova's witness patients.  

PubMed

Jehovah's witnesses (JW) belong to a religious group refusing to accept blood transfusion Surgical treatment remains a challenge in this subset of patients. From 1945, JW introduced a ban on accepting blood transfusions, even in life-threatening situations while autologous blood must also be refused if it is predeposited-thus excluding preoperative autodonation. However, autologous blood is acceptable if it is not separated from the patients' circulation at any time. The invasive nature of coronary artery bypass grafting (CABG), the associated decrease of body temperature and the use of cardiopulmonary bypass (CPB) are major reasons for increased blood loss and high incidence for blood transfusions during and after this procedures. Allogenic blood transfusions are often given and considered necessary in such operations, in spite of increased mortality, morbidity and major adverse outcomes resulting from transfusion. Reduction in the use of blood products should therefore be a general desire for every patient due to the associated risk factors. The evolution of less invasive cardiac surgical approaches, such as CABG without CPB (OPCAB) may contribute to a further reduction of blood transfusion and although these minimally invasive techniques may benefit every patient, they might be particularly valuable for JW. In this report, we present our initial experience in JW patient undergoing OPCAB and the way to use patient blood management for improved surgical outcome in such patient. PMID:22486150

Mujanovic, Emir; Bergsland, Jacob; Jahic, Mirza; Djedovic, Samed; Behrem, Adnan; Stanimirovic-Mujanovic, Sanja; Kabil, Emir

2012-01-01

356

Predictors of hospital readmission two years after coronary artery bypass grafting.  

PubMed Central

OBJECTIVE: To determine the clinical factors before, and in association with, coronary artery bypass grafting (CABG) that increase the risk of readmission to hospital in the first two years after surgery. PATIENTS: All patients in western Sweden who had CABG without simultaneous valve surgery between 1 June 1988 and 1 June 1991. METHODS: All patients who were readmitted to hospital were evaluated by postal inquiry and hospital records. RESULTS: A total of 2121 patients were operated on, of whom 2037 were discharged from hospital. Information regarding readmission was missing in four patients, leaving 2033 patients; 44% were readmitted to hospital. The most common reasons for readmission were angina pectoris and congestive heart failure. There were 12 independent significant predictors for readmission: clinical history (a previous history of either congestive heart failure or myocardial infarction, or CABG); acute operation; postoperative complications (time in intensive care unit greater than two days, neurological complications); clinical findings four to seven days after the operation (arrhythmia, systolic murmur equivalent to mitral regurgitation); medication four to seven days after the operation (antidiabetics, diuretics for heart failure, other antiarrhythmics (other than beta blockers, calcium antagonists, and digitalis), and lack of treatment with aspirin). CONCLUSION: 44% of patients were readmitted to hospital two years after CABG. The most common reasons for readmission were angina pectoris and congestive heart failure. Four clinical markers predicted readmission: clinical history; acute operation status; postoperative complications; and clinical findings and medication four to seven days after operation.

Herlitz, J.; Albertsson, P.; Brandrup-Wognsen, G.; Emanuelsson, H.; Haglid, M.; Hartford, M.; Hjalmarson, A.; Karlson, B. W.; Karlsson, T.; Sanden, W.

1997-01-01

357

Effect of cardiorespiratory fitness on short-term morbidity and mortality after coronary artery bypass grafting.  

PubMed

Although preoperative risk assessment for coronary artery bypass grafting (CABG) has been evaluated with multiple predictive models, none have incorporated a low level of cardiorespiratory fitness, which represents one of the strongest predictors of all-cause and cardiovascular mortality in subjects with and without heart disease. The aim of the present study was to evaluate preoperative cardiorespiratory fitness, expressed as METs (1 MET = 3.5 ml O2/kg/min), and short-term morbidity and mortality after CABG. The Society of Thoracic Surgeons database was queried for patients who underwent CABG from January 2002 to December 2010 at Beaumont Health Systems. Electronic medical records were reviewed for peak or symptom-limited exercise testing <90 days before CABG. Peak METs were estimated from the achieved treadmill speed, grade, and duration or the cycle ergometer workload, corrected for body weight. Patients who met eligibility criteria (n = 596) were categorized into 2 groups: those with reduced aerobic capacity (<5 METs [n = 78]) and those achieving ?5 METs (n = 518). Fisher's exact tests were used to compare preoperative aerobic capacity and short-term postoperative morbidity and mortality between the 2 groups. After adjusting for potential confounding variables, an inverse relation was found between cardiorespiratory fitness and complications after CABG. Specifically, low preoperative cardiorespiratory fitness (<5 METs) was associated with higher operative and 30-day mortality after CABG (p <0.05). In conclusion, these data suggest that preoperative cardiorespiratory fitness provides an independent and additive marker for mortality after CABG. PMID:23849973

Smith, James L; Verrill, Thomas A; Boura, Judy A; Sakwa, Marc P; Shannon, Francis L; Franklin, Barry A

2013-07-10

358

Speckle-tracking imaging to monitor myocardial function after coronary artery bypass graft surgery.  

PubMed

Objectives- The purpose of this study was to investigate the changes in myocardial function in patients after coronary artery bypass graft (CABG) surgery using longitudinal and circumferential strain on speckle-tracking imaging. Methods- A total of 145 patients who successfully underwent CABG surgery with a left ventricular ejection fraction (LVEF) of 50% or greater were enrolled in this study. Patients were classified into 4 groups based on age: group 1 (33-59 years), group 2 (60-64 years), group 3 (65-69 years), and group 4 (70-79 years). Routine echocardiography and longitudinal and circumferential strain measurements on speckle-tracking imaging were performed 1 week before and 1, 3, and 6 months after the CABG. Results- In all groups, longitudinal strain increased significantly at 3 and 6 months after CABG therapy compared to baseline (P < .05). A significant increase in circumferential strain was found 1 month after the CABG in groups 1, 2, and 3, and a continuous increase in the parameter was observed in all groups 3 months after therapy (P < .05). However, the LVEF, left ventricular end-diastolic dimension, and stroke volume measured by routine echocardiography were not significantly changed after successful CABG treatment in all groups during 6 months of follow-up. Conclusions- Based on the results of our study in all age groups, speckle-tracking imaging parameters are more effective than the LVEF, left ventricular end-diastolic dimension, and stroke volume for monitoring improvement in myocardial function after CABG surgery. PMID:24154899

Yin, Zhe-Yu; Li, Xiao-Feng; Tu, Ying-Feng; Dong, Dan-Dan; Zhao, Dong-Liang; Shen, Baozhong

2013-11-01

359

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

360

Improved late survival with arterial revascularization  

PubMed Central

New coronary artery revascularization strategies are developing: improved quantification of coronary artery disease by the SYNTAX score, new-generation drug-eluting stents and increased use of stents for multivessel disease, ongoing evaluation of stents for left main disease, new strategies for minimally invasive coronary artery bypass grafting (CABG) including the use of robotic-assisted CABG, hybrid procedures, and off pump CABG. In comparisons of all these strategies, the impact on survival is arguably the most important parameter. It has long been accepted that using the left internal mammary artery (LIMA) to bypass the left anterior descending coronary artery (LAD) is the gold standard and may confer the survival advantage reported for CABG compared with percutaneous coronary intervention in the literature. The survival advantage of using additional arterial conduits as compared to the conventional use of LIMA with saphenous veins only has long been debated. Our study, which involved a large cohort of 8,622 patients with multivessel disease, followed over a long period of time, has shown that in primary isolated CABG surgery performed more than 15 years ago with the use of LIMA to the LAD, bypassing the non-LAD targets with at least 1 additional arterial graft, either the right internal mammary artery and/or the radial artery, was an independent predictor of increased survival during the following 15 years. The results were confirmed with both a propensity-matched analysis that included 1,153 patients in each group and a multivariate analysis that was able to control for all differences between the groups because of the power of the large cohort in this series. The significant survival advantage of coronary artery bypass surgery with the use of multiple arterial grafting cannot be ignored in patients with multivessel coronary artery disease as various revascularization strategies are considered.

Schaff, Hartzell V.; Dearani, Joseph A.; Daly, Richard C.

2013-01-01

361

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

362

Prolonged antispasmodic effect in isolated radial artery graft and pronounced platelet inhibition induced by the inodilator drug, levosimendan.  

PubMed

Radial artery frequently develops spasm and requires vasodilator therapy during coronary artery bypass graft surgery (CABG). Levosimendan was recently shown to oppose 5-hydroxytryptamine-induced contraction of radial artery (RA) grafts. The aim of the present study was to explore whether levosimendan retains its vasodilatory capacity following in vitro pre-incubation of RA segments with the inodilator. A possible cumulative effect of the drug in human platelets was also studied. Human isolated RA segments were pre-incubated in 0.16??mol/L levosimendan containing solution or in 0.9% NaCl, Bretschneider, 5% albumin and a 5% human serum protein solution (Biseko) as controls for 45?min. Contractions were induced by three consecutive administrations of 5-hydroxytryptamine (0.31??M) 45, 90 and 120?min. after exchanging the pre-incubation solutions with Krebs-Henseleit solution, uniformly. Receptor-independent contractions (KCl, 80?mmol/L), endothelium-dependent (acetylcholine, 1??mol/L) and independent relaxations (papaverine, 100??mol/L) were also investigated. Washed human platelets were pre-incubated with levosimendan (0.06??mol/L) for 2 or 15?min. and aggregated with thrombin (0.1?IU/mL). Contractions of RA grafts induced by 5-hydroxytryptamine were significantly smaller 45?min. and 90?min. after the replacement of levosimendan with Krebs-Henseleit solution. Biseko solution also decreased the contraction of the graft at 45?min. Contractions did not change in time following the pre-incubations of radial arteries with 0.9% NaCl, Bretschneider and 5% albumin solutions. The grafts remained intact as assessed by their maximum contractions and endothelium-dependent and endothelium-independent relaxations at the end of the investigations. Platelets revealed larger anti-aggregatory effect to levosimendan following the enhancement of the incubation time. Results indicate that the antispasmodic and anti-aggregatory effects of levosimendan cumulate in the vascular tissue and in platelets. The storage of RA with the inodilator before implantation may help to prevent the intraoperative spasm of the graft and also thrombotic occlusion during CABG surgery. PMID:21952040

Ambrus, Nóra; Szolnoky, Jen?; Pollesello, Piero; Kun, Attila; Varró, Andrįs; Papp, J Gyula; Pataricza, Jįnos

2011-10-21

363

[Aortic valve replacement and ventricular septal defect closure after previous bilateral internal thoracic artery bypass grafting; report of a case].  

PubMed

The patient was a 74-year-old man with a history of ventricular-septal defect (VSD). He underwent coronary artery bypass grafting (CABG), which was performed using the bilateral internal thoracic artery (ITA) 9 years ago. Since 2009, he experienced heart failure, and in 2011, he started administration of tolvaptan, vasopressin V2 receptor antagonist. In 2011, he developed fever, and follow-up echocardiography revealed moderate aortic regurgitation and vegetation around the VSD and the aortic valve. Therefore, we performed redo-aortic valve replacement (AVR) and VSD closure. Both ITAs were carefully dissected and were clamped during cardiac arrest. The patient was discharged on the 36th postoperative day, without tolvaptan. AVR and VSD closure after bilateral ITA bypass grafting is a challenging procedure if the patent ITA crosses the midline. Patent ITA should be occluded to avoid cardioplegia washout during aortic cross-clamping. Multi-detector-row computed tomography (MDCT) enables excellent imaging for dissecting ITA grafts. PMID:23917138

Tarui, Tatsuya; Ikeda, Masahiro; Miyazu, Katsuyuki

2013-07-01

364

Intra-arterial steroid-injection therapy for steroid-refractory acute graft-versus-host disease with the evaluation of angiography  

Microsoft Academic Search

We treated three patients with steroid-refractory acute graft-versus-host disease (aGVHD) with intra-arterial steroid-injection therapy (IAST). Two patients with gut aGVHD received IAST into both superior and inferior mesenteric arteries, while one patient with liver aGVHD received IAST into the proper hepatic artery. The volume of stools and the bilirubin level improved soon after IAST. Angiography of the superior and inferior

K Nakai; K Tajima; N Tanigawa; N Matsumoto; K Zen; S Nomura; M Fujimoto; Y Kishimoto; R Amakawa; S Sawada; S Fukuhara

2004-01-01

365

Complete arterial coronary bypass revascularization with single aorto-ostial anastomosis and long-term outcome.  

PubMed

Coronary reoperations continue to play an important role in the practice of coronary artery bypass grafting (CABG). Apart from having a sicker patient subgroup, reoperation poses an increasingly more complex and technically demanding surgery to perform. The superior patency of the left internal mammary artery (LIMA) has prompted increased interest in using arterial conduits for coronary bypass. However in situations where LIMA to left anterior descending (LAD) graft can not be done successfully, it remains a problem. We present a case of repeat three vessel coronary bypass surgery where three free arterial grafts were used with single anastomosis to ascending aorta as an alternative because of compromised length of LIMA and radial grafts. PMID:20337168

Prayaga, Sastry; Marashdeh, Mohammad M; Sachdeva, Rajesh

2010-03-01

366

Survival enhancing indications for coronary artery bypass graft surgery in California  

PubMed Central

Background Coronary artery bypass graft (CABG) surgery is performed because of anticipated survival benefit, improvement in quality of life, or both. We performed this study to explore variations in clinical indications for CABG surgery among California hospitals and surgeons. Methods Using California CABG Outcomes Reporting Program data, we classified all isolated CABG cases in 2003–2004 as having "probable survival enhancing indications (SEIs)", "possible SEIs" or "non-SEIs." Patient and hospital characteristics associated with SEIs were examined. Results While 82.9% of CABG were performed for probable SEIs, the range extended from 68% to 96% among hospitals and 51% to 100% among surgeons. SEI rates were higher among patients aged ? 65 compared with those aged 18–64 (Adjusted Odds Ratio [AOR] > 1.29 for age groups 65–69, 70–74 and ? 75; all p < 0.001), among Asians and Native Americans compared with Caucasians (AOR 1.22 and 1.15, p < 0.001); and among patients with hypertension, peripheral vascular disease, diabetes, cerebrovascular disease and congestive heart failure compared to patients without these conditions (AOR > 1.09, all p < 0.001). Variations in indications for surgery were more strongly related to patient mix than to surgeon or hospital effects (intraclass correlation [ICC] = 0.04 for hospital; ICC = 0.01 for surgeon). Conclusion California hospitals and surgeons vary in their distribution of indications for CABG surgery. Further research is required to identify the roles of market factors, referral patterns, patient preferences, and local clinical culture in producing the observed variations.

Li, Zhongmin; Kravitz, Richard L; Marcin, James P; Romano, Patrick S; Rocke, David M; Denton, Timothy A; Brindis, Ralph G; Dai, Jian; Amsterdam, Ezra A

2008-01-01

367

Soluble adhesion molecules and myocardial injury during coronary artery bypass grafting.  

PubMed

Cardiopulmonary bypass is acknowledged to be one of the major causes of a complex systemic inflammatory response after cardiac surgery. Leukocyte-endothelial binding followed by neutrophil migration appears to play a central role. These interactions are mediated by adhesion molecules on the surface of activated cells. The present study compared the perioperative levels of soluble adhesion molecules after coronary artery bypass grafting (CABG) in patients with or without cardiopulmonary bypass (CPB). Altogether, 9 patients underwent off-pump revascularization and 11 did so with CPB. Plasma levels of soluble adhesion molecules sE-selectin and sP-selectin and soluble intercellular adhesion molecule-1 (sICAM-1) were measured before anesthesia induction and 1, 4, and 20 hours after reperfusion to the myocardium. The baseline plasma levels of the adhesion molecules were similar in the two groups. Perioperative levels of sE-selectin remained the same and did not differ between groups. Plasma sP-selectin increased in both groups, the change being significantly greater in the CPB group than that in the off-pump group (p = 0.001). Plasma sICAM-1 decreased during an early stage after CABG with CPB, recovering at 4 hours after reperfusion; and a significant increase in ICAM-1 was observed 20 hours later. In the off-pump group, sICAM-1 levels did not change at 1 and 4 hours after reperfusion but increased 20 hours later. Postoperative creatine kinase-muscle bound (CK-MB) levels were significantly higher in the CPB group than in the off-pump group (p = 0.001). The change in sP-selectin levels also showed a correlation with CK-MB values (r = 0.676, p = 0.001). The results indicated that off-pump revascularization is associated with reduced endothelial activation and myocardial injury. PMID:12616425

Wei, Minxin; Kuukasjärvi, Pekka; Laurikka, Jari; Kaukinen, Seppo; Iisalo, Pekka; Laine, Seppo; Tarkka, Matti

2003-02-01

368

Does posterior pericardiotomy reduce the incidence of atrial fibrillation after coronary artery bypass grafting surgery?  

PubMed Central

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether posterior pericardiotomy (PP) reduces the incidence of atrial fibrillation (AF) after coronary artery bypass grafting surgery. Twelve papers were found using the reported search, of which seven 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 were tabulated. One non-randomized prospective cohort controlled study generated early evidence that PP reduced the rate of postoperative AF and pericardial effusion. The operative details of PP were clearly explained in this paper. The efficacy of this procedure was subsequently examined in five prospective randomized controlled trials performed with some limitations, listed in the table. Meta-analysis of the randomized control trials examined a group of 763 patients (PP = 389, control = 374). It revealed a highly significant reduction in total arrhythmias and AF in the PP group (odds ratio 0.31 and 0.33, respectively). There was a 10.8% AF rate in the PP group (41/379) and a 28.1% AF rate in the control group (108/384). Furthermore, the PP group had a significant reduction in the rate of early and late pericardial effusion (P < 0.001). Moreover, the reduction in the incidence of arrhythmias was significantly associated with the reduction in the incidence of pericardial effusion. Referring to these studies, two guidelines recommend PP to reduce postoperative AF with grade B strength of recommendation. We conclude that PP significantly reduces the incidence of postoperative AF. The number needed to treat to prevent one case of AF is six.

Kaleda, Vasily I.; McCormack, David J.; Shipolini, Alex R.

2012-01-01

369

Impaired Executive Function Is Associated with Delirium After Coronary Artery Bypass Graft Surgery  

PubMed Central

OBJECTIVES To determine the extent to which preoperative performance on tests of executive function and memory was associated with delirium after coronary artery bypass graft (CABG) surgery. DESIGN Prospective observational cohort study. SETTING Two academic medical centers and one Department of Veterans Affairs medical center in Massachusetts. PARTICIPANTS Eighty subjects without preoperative delirium undergoing CABG or CABG-valve surgery completed baseline neuropsychological assessments with validated measures of memory and executive function. MEASUREMENTS Beginning on postoperative Day 2, a battery to diagnose delirium was administered daily. Confirmatory factor analysis (CFA) was used to define two cognitive domain composites (memory and executive function). The loading pattern of neuropsychological measures onto the latent cognitive domains was determined a priori. Poisson regression was used to model the association between neuropsychological performance and cognitive domain composite scores and risk of postoperative delirium. The association was expressed as the difference between impaired (0.5 standard deviations (SDs) below mean) and nonimpaired (0.5 SDs above mean) performers. RESULTS Forty subjects (50%) developed delirium. Measures of memory function were not significantly related to delirium. Of the executive function measures, verbal fluency, category fluency, Hopkins Verbal Learning Test learning, and backward recounting of days and months were significantly related to delirium. Preoperative mental status was a strong predictor of postoperative delirium. After controlling for age, sex, education, medical comorbidity, mental status, and the other cognitive domain, CFA cognitive domain composites suggest that risk for delirium is specific for executive functioning impairment (relative risk (RR) = 2.77, 95% confidence interval (CI) = 1.12–6.87) but not for memory impairment (RR = 0.49, 95% CI = 0.19–1.25). CONCLUSION Worse preoperative performance in executive function was independently associated with greater risk of developing delirium after CABG.

Rudolph, James L.; Jones, Richard N.; Grande, Laura J.; Milberg, William P.; King, Emily G.; Lipsitz, Lewis A.; Levkoff, Sue E.; Marcantonio, Edward R.

2008-01-01

370

Insurance type and choice of hospital for coronary artery bypass graft surgery.  

PubMed Central

OBJECTIVE: To examine the effect of insurance type on the relationship between hospital attributes and patient flows, with particular attention to whether HMO enrollees are more or less likely than other patients to receive care at high-quality hospitals and whether HMO enrollees travel farther to receive care. DATA SOURCES/STUDY SETTING: Data on patient flows, taken from discharge abstracts compiled by the California Office of Statewide Health Planning and Development. Our sample consists of patients undergoing coronary artery bypass graft surgery (CABG) in 1991 who resided in three California markets. Only patients under the age of 65 and insured by HMOs, Blue Cross/Blue Shield, or other commercial insurance were included. Hospital quality is based on hospital-specific measures of excess mortality from CABG. Other hospital attributes were taken from American Hospital Association survey data. STUDY DESIGN: Conditional-choice models were used to estimate the probability that patients would receive care at any given hospital as a function of their insurance type and the hospital's attributes. PRINCIPAL FINDINGS: Patients were more likely to receive care from hospitals closer to their residence. However, HMO patient flows were less sensitive to proximity. In general, the likelihood that an HMO enrollee received care at a given hospital was positively related to hospital quality. Moreover, quality had a greater effect on patient flows for HMO enrollees than for non-HMO enrollees. However, the evidence suggests that the effect of quality on patient flows is neither uniform across markets nor across HMOs. CONCLUSIONS: HMOs do not appear to direct patients to low-quality hospitals. However, heterogeneity among HMOs and across markets suggests that buyers must recognize that choosing an HMO involves greater scrutiny than simply picking a plan labeled "HMO."

Chernew, M; Scanlon, D; Hayward, R

1998-01-01

371

Effect of statin use on acute kidney injury risk following coronary artery bypass grafting.  

PubMed

Acute kidney injury (AKI) is a serious complication of cardiovascular surgery. Although some nonexperimental studies suggest that statin use may reduce postsurgical AKI, methodologic differences in study designs leave uncertainty regarding the reality or magnitude of the effect. The aim of this study was to estimate the effect of preoperative statin initiation on AKI after coronary artery bypass grafting (CABG) using an epidemiologic approach more closely simulating a randomized controlled trial in a large CABG patient population. Health care claims from large, employer-based and Medicare insurance databases for 2000 to 2010 were used. To minimize healthy user bias, patients were identified who underwent nonemergent CABG who either newly initiated a statin <20 days before surgery or were unexposed for ?200 days before CABG. AKI was identified <15 days after CABG. Multivariate-adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using Poisson regression. Analyses were repeated using propensity score methods adjusted for clinical and health care utilization variables. A total of 17,077 CABG patients were identified. Post-CABG AKI developed in 3.4% of statin initiators and 6.2% of noninitiators. After adjustment, a protective effect of statin initiation on AKI was observed (RR 0.78, 95% CI 0.63 to 0.96). This effect differed by age, with an RR of 0.91 (95% CI 0.68 to 1.20) for patients aged ?65 years and an RR of 0.62 (95% CI 0.45 to 0.86) for those aged <65 years, although AKI was more common in the older group (7.7% vs 4.0%). In conclusion, statin initiation immediately before CABG may modestly reduce the risk for postoperative AKI, particularly in younger CABG patients. PMID:23273532

Layton, J Bradley; Kshirsagar, Abhijit V; Simpson, Ross J; Pate, Virginia; Jonsson Funk, Michele; Stürmer, Til; Brookhart, M Alan

2012-12-28

372

Coronary artery bypass grafting in Canada: national and provincial mortality trends, 1992-1995  

PubMed Central

BACKGROUND: Despite a body of research on outcomes of coronary artery bypass grafting (CABG) in Canada, little is known about Canada-wide outcome trends and interregional differences in outcome. The objectives of this study were to examine Canadian trends in rates of in-hospital death after CABG and to compare provincial risk-adjusted death rates. METHODS: Hospital discharge data were obtained from the Canadian Institute for Health Information and were used to identify complete cohorts of patients who underwent CABG in 8 provinces in fiscal years 1992/93 through 1995/96. Data from Quebec hospitals were not available. A logistic regression model was used to calculate risk-adjusted death rates by year, province, and province and year. RESULTS: A total of 50,357 CABG cases were studied, with an overall death rate of 3.6%. A national trend of decreasing mortality was found, with a risk-adjusted death rate of 3.8% in 1992/93 versus 3.2% in 1995/96 (relative decrease of 17%) (p < 0.001 for difference across years). Some provinces (e.g., Alberta, Manitoba and Ontario) achieved overall declines in death rates over the study period, whereas others (e.g., British Columbia and Saskatchewan) did not. The average severity of illness of patients who underwent CABG differed considerably across provinces. Despite risk adjustment for these differences, provincial death rates varied significantly (p < 0.001). INTERPRETATION: Rates of death after CABG in Canada decreased significantly in a relatively short period. Despite this encouraging finding, there were interprovincial differences in severity of illness and risk-adjusted death rates. This finding raises the possibility of unequal access to CABG and variable quality of care for patients undergoing the surgery across Canadian provinces.

Ghali, W A; Quan, H; Brant, R

1998-01-01

373

The effect of retrograde autologous priming on intraoperative blood product transfusion in coronary artery bypass grafting.  

PubMed

INTRODUCTION: Retrograde autologous priming (RAP) of the cardiopulmonary bypass (CPB) circuit could reduce the degree of haemodilution associated with priming with acellular solutions. However, there is no strong evidence to prove that the practice of RAP reduced intraoperative packed red cell (PRC) or blood product transfusion. OBJECTIVE: To evaluate the effect of RAP on intraoperative PRC usage in coronary artery bypass grafting (CABG). METHODS: This study is a prospective, observational study on patients who underwent first-time, isolated CABG using CPB between April 2012 and July 2012. Two groups of patients were identified: 1. Non-RAP group (n=128) and 2. RAP group (n=73). The primary outcome for the study was the amount of PRC and blood product usage between the induction of anaesthesia and the cessation of CPB. RESULTS: Use of PRC and blood products in the operating room was comparable in both groups. Univariate logistic regression showed that RAP was not an independent predictor of PRC or blood product transfusion (p=0.43). Multivariate logistic regression showed that CPB time, preoperative haemoglobin (Hb) levels and creatinine clearance were independent predictors of blood product transfusion. CONCLUSION: Practising RAP with mean volumes of 300 ml does not necessarily reduce PRC and other blood product transfusion requirements during CABG. In our practice, RAP was performed, aiming at displacing CPB circuit prime volume with which the perfusionist felt comfortable and dictated by haemodynamic parameters prior to commencing CPB. We presume this is the case in many units around the world. This practice, in our opinion, is not enough to achieve the benefits of RAP, if any, in the form of a reduction of packed red cell transfusion requirements. The true advantages of RAP in cardiac surgery need to be studied in a prospective, randomized, controlled trial. PMID:23744846

Nanjappa, A; Gill, J; Sadat, U; Colah, S; Abu-Omar, Y; Nair, S

2013-06-01

374

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

PubMed Central

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

2010-01-01

375

Prevalence and correlates of complicated grief in adults who have undergone a coronary artery bypass graft  

PubMed Central

Background Complicated Grief (CG) is a recently described mental health condition that follows bereavement. CG is often comorbid with depression and may also be associated with poor health outcomes. However, CG has not been studied in depressed medically ill populations. This study examined the prevalence, correlates, and impact of CG in depressed post-coronary artery bypass graft surgery (CABG) patients. Methods A 5-item CG screen was administered to 302 depressed post-CABG patients participating in a comparative effectiveness intervention trial at 7 Pittsburgh-area hospitals from March 2004 to September 2007. Eligible patients were randomly assigned to either a telephone-delivered collaborative care intervention for depression or their primary care physicians’ usual care. Measures examined depression, physical and mental health-related quality of life, and physical functioning over 8 months. Results Compared to CG screen-negative patients, CG screen-positive patients were younger, more likely to: be female, non-White, have lost a partner or child, and to have used tobacco or antidepressants. At baseline, they had significantly higher depression and lower mental health scores. At 8 months, screen-positives had poorer physical functioning and marginally higher depression scores. Limitations The study lacked a definitive measure of CG. Moreover, the CG-positive group was relatively small, reducing the power to detect differences between groups or control for the possible influence of other variables on identified results. Conclusions CG in depressed post-CABG patients is associated with negative health and mental health outcomes. These results underscore the importance of identifying and treating CG in depressed medically ill populations.

Ghesquiere, Angela; Shear, M. Katherine; Gesi, Camilla; Kahler, Julie; Belnap, Bea Herbeck; Mazumdar, Sati; He, Fanyin; Rollman, Bruce L.

2012-01-01

376

Beneficial effects of using a minimal extracorporeal circulation system during coronary artery bypass grafting.  

PubMed

Background: In this study, we assessed clinical results by using a minimal extracorporeal circuit (MECC) and compared it to a conventional cardiopulmonary bypass (CPB) system in patients undergoing coronary artery bypass grafting (CABG) procedures. Methods and Materials: From August to October 2006, forty consecutive patients undergoing isolated CABG procedures were randomly assigned to either a miniaturized closed circuit CPB with the Maquet-Cardiopulmonary MECC system (Group M, n=20) or to a conventional CPB system (Group C, n=20). Clinical outcomes were observed before, during and after the operation. Besides evaluating the perioperative clinical data, serial blood venous samples were obtained after induction, 30 minutes after CPB initiation, 2h, 6h, 12h, and 24h post-CPB. The focus of our study was on myocardial damage (cTnI), neutrophil and platelet counts, activated partial thromboplastin time (aPTT) and free hemoglobin. Results: Both the transfusion of packed red blood cells and fresh frozen plasma were significantly lower in Group M compared to Group C (p<0.05). The levels of cTnI were lower in Group M at 2h, 6h and 12h post-CPB than in Group C (p<0.01). The values of aPTT in Group M recovered to normal levels after surgery, but were prolonged in Group C at early post-CPB and were statistically longer than Group M at 2h, 6h, and 12h post-CPB (p<0.05). The concentrations of free hemoglobin in Group C were higher than in Group M during and post-CPB, and there was a statistical difference at 2h post-CPB (p<0.05). Conclusion: In conclusion, the MECC system is a safe alternative for patients who undertake extracorporeal circulation (ECC) for CABG surgery. Lower transfusion requirements and less damage to red cells may further promote the use of MECC systems, especially in higher risk patients. PMID:21987667

Liu, Y; Tao, L; Wang, X; Cui, H; Chen, X; Ji, B

2011-10-10

377

Maxillary Reconstruction using Chimeric Flaps of the Subscapular Artery System without Vein Grafts and the Novel Usage of Chimeric Flaps.  

PubMed

The purpose of this study was to overcome the disadvantages associated with the shortness of the vascular pedicle of subscapular system combined flaps when performing the maxillary reconstruction procedure. Combined flaps of the subscapular artery system were used for maxillary reconstruction. A latissimus dorsi myocutaneous flap, a scapular fasciocutaneous flap, and two kinds of scapular bone flaps were elevated as combined flaps. Next, the circumflex scapular artery (CS) and vein were cut off from the combined flaps and anastomosed to the serratus anterior branch, thereby establishing chimeric flaps. Then, maxillary reconstruction was performed using these flaps. We encountered two patients who underwent maxillectomy for maxillary cancer. Satisfactory improvements in facial shape were obtained in both cases. In cases in which combined flaps of the subscapular artery system are used for maxillary reconstruction, the biggest problem is that the vascular pedicle does not reach the recipient vessel in the neck due to the shortness of the CS. Therefore, vein grafts are generally performed to extend the flaps to the maxilla. Our novel procedure has the great advantages of long vascular pedicles and high flexibility in setting the flaps without the use of vein grafts. PMID:24022603

Watanabe, Koichi; Takahashi, Nagahiro; Morihisa, Yoichiro; Ikejiri, Mitsuhiro; Koga, Noriyuki; Rikimaru, Hideaki; Kiyokawa, Kensuke

2013-09-10

378

Histological assessment of the palatal mucosa and greater palatine artery with reference to subepithelial connective tissue grafting  

PubMed Central

This study aimed to measure the thickness of the epithelium and lamina propria of the palatal mucosa and to elucidate the location of the greater palatine artery to provide the anatomical basis for subepithelial connective tissue grafting. Thirty-two maxillary specimens, taken from the canine distal area to the first molar distal area, were embedded in paraffin and stained with hematoxylin-eosin. The thickness of the epithelium and lamina propria of the palatal mucosa was measured at three positions on these specimens, starting from 3 mm below the alveolar crest and in 3-mm intervals. The location of the greater palatine artery was evaluated by using image-processing software. The mean epithelial thickness decreased significantly in the posterior teeth; it was 0.41, 0.36, 0.32, and 0.30 mm in the canine, first premolar, second premolar, and first molar distal areas, respectively. The lamina propria was significantly thicker in the canine distal; it was 1.36, 1.08, 1.09, and 1.05 mm, respectively. The mean length from the alveolar crest to the greater palatine artery increased toward the posterior molar; it was 7.76, 9.21, 10.93, and 11.28 mm, respectively. The mean depth from the surface of the palatal mucosa to the greater palatine artery decreased from the canine distal to the first premolar distal but increased again toward the posterior molar; it was 3.97, 3.09, 3.58, and 5.50 mm, respectively. Detailed histological assessments of the lamina propria of the palatal mucosa and the greater palatine artery are expected to provide useful anatomical guidelines for subepithelial connective tissue grafting.

Cho, Kwang-Hee; Yu, Sun-Kyoung; Lee, Myoung-Hwa; Lee, Dong-Seol

2013-01-01

379

Is it worth placing ventricular pacing wires in all patients post-coronary artery bypass grafting?  

PubMed Central

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether ventricular pacing wires should be placed routinely in all patients undergoing coronary artery bypass grafting (CABG) regardless of immediate post-cardiopulmonary bypass (CPB) rhythm status. Using the reported search, 142 papers were found, from which 10 papers represented the best evidence on the subject. The author, date and country of 10 publications, study type, patient group studied, relevant outcomes and results are tabulated. Complete atrio-ventricular (AV) block is the main reason for inserting ventricular pacing wires upon conclusion of CABG. Eight studies found complete AV block to be a rare entity post-CABG. The rate of complete AV block in CABG in our review ranged from 0.3 to 24%. The calculated average rate of AV block in all studies was 2.4%. The number needed to treat with ventricular wires to support a patient who develops AV block is 42. One randomized controlled trial found 3% risk of complete AV block post-CABG. Another cohort of 222 patients revealed a rate of 1.8% for complete AV block. For one cohort of 770 patients, post-CABG the rate of complete AV block was found to be 0.3%. In one cohort of 25 patients, there was a rate of 4% for complete AV block post-CABG. Another study of 564 patients revealed a rate of 0.7% for complete AV block. A study of 4999 patients post-CABG reported a rate of 1.2% for complete AV block. In one cohort of 93 patients, there was a 4% risk of complete AV block. Another cohort of 62 patients showed a rate of 1.6% for complete AV block. Only two papers found the rate of complete AV block post-CABG to be as high as 24 and 16%. Both studies were limited by sample size. In conclusion, routine ventricular pacing wire insertion post-CABG is unnecessary given that routine use of ventricular wires can occasionally cause complications such as bleeding and cardiac tamponade and thus is not risk free. We also found that the incidence of complete AV block is probably higher in on-CPB CABG than off-CPB CABG and that AV pacing may be haemodynamically beneficial for some patients postoperatively.

Khorsandi, Maziar; Muhammad, Ishaq; Shaikhrezai, Kasra; Pessotto, Renzo

2012-01-01

380

[Significance of hot shot in patients with unstable angina undergoing emergency coronary artery bypass graft surgery].  

PubMed

We investigated the efficacy of terminal warm blood cardioplegia (hot shot) in patients with cardioplegic techniques. From January 1991 through April 1993, 68 patients recieved hypothermic cardioplegia induced by cold modified St. Thomas' Hospital solution containing 10mg/L of diltiazem hydrochloride followed by intermittent infusion of the cold crystalloid solution or cold blood cardioplegia without hot shot. From May 1993 through December 1994, 65 patients recieved hot shot before removal of aortic cross-clamp following the hypothermic cardioplegia. The earlier group consisted of 51 patients with stable angina undergoing elective CABG and 17 patients with unstable angina undergoing emergency of urgent CABG. The later group consisted of 44 patients with stable angina and 21 patients with unstable angina. The unstable angina undergoing coronary artery bypass graft surgery (CABG) using antegrade incidence of perioperative myocardial infarction was significantly higher in patients with unstable angina without hot shot (35%) compared to those with stable angina with and without hot shot (2% and 4%, respectively) and those with unstable angina with hot shot (5%). The level of maximum creatine kinase-MB (IU/L) was significantly greater in patients with unstable angina without hot shot (134 +/- 26) compared to those with stable angina with and without hot shot (57 +/- 7 and 65 +/- 4, respectively) and those with unstable angina with hot shot (57 +/- 8). The doses of dopamine and dobutamine (mg/kg) administered during 48 hours after CABG was not different between patients with stable angina with and without hot shot (13.9 +/- 0.9 vs 13.9 +/- 0.9), but tended to be lower in patients with unstable angina with hot shot (13.7 +/- 1.3) compared to those without hot shot (18.6 +/- 2.1). Left ventricular stroke work index (g.m/m2/b) immediately after CABG was comparable between patients with stable angina with and without hot shot (40 +/- 2.0 vs 36 +/- 1.5), but significantly greater in patients with unstable angina with hot shot (39 +/- 2.3) compared to those without hot shot (29 +/- 2.2). These results suggest that hot shot may provide a significant benefit in myocardial preservation during CABG especially in patients with unstable angina. PMID:8717258

Otani, H; Kawasaki, H; Ninomiya, H; Kido, M; Kawaguchi, H

1996-02-01

381

Effects of Cardiac Rehabilitation Program on Right Ventricular Function after Coronary Artery Bypass Graft Surgery  

PubMed Central

Background Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery (CABG). However, the effect of this program on right ventricular function following CABG is unclear. The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular (RV) function in a cohort of patients who underwent CABG. Methods: A total of 28 patients who underwent CABG and participated consecutively in an 8-week cardiac rehabilitation program at Tehran Heart Center were studied. The control group consisted of 39 patients who refused to attend cardiac rehabilitation and only received postoperative medical treatment after registration in the Cardiac Rehabilitation Clinic. Two-dimensional and Doppler echocardiography was performed to assess the RV function in both groups at the three time points of before surgery, at the end of surgery, and at the end of the rehabilitation program. Results: Significant increase of RV function parameters were observed in both rehabilitation group (RG) and control group (CG) at the end of the rehabilitation program compared with post-CABG evaluation in terms of tricuspid annular plane systolic execution (RG: 12.50 mm to 14.18 mm; CG: 13.41 mm to 14.56 mm), tricuspid annular peak systolic velocity (RG: 8.55 cm/s to 9.14 cm/s; CG: 9.03 cm/s to 9.26 cm/s), and tricuspid annular late diastolic velocity (RG: 8.93 cm/s to 9.39 cm/s; CG: 9.26 cm/s to 9.60 cm/s).The parameters of the RV function did improve in both groups, but this improvement was not associated with participation in the complete cardiac rehabilitation program. Conclusion: The RV function parameters gradually improved after CABG; this progress, however, was independent of the exercise-based cardiac rehabilitation program.

Zoroufian, Arezoo; Taherian, Ali; Hosseini, Seyed Kianoosh; Sardari, Akram; Sheikhvatan, Mehrdad

2012-01-01

382

Tools and procedures for ex vivo vein arterialization, preconditioning and tissue engineering: a step forward to translation to combat the consequences of vascular graft remodeling.  

PubMed

The present contribution reviews recent progress in bioengineering approaches used to mimic arterial hemodynamic conditions in vascular grafts and vessel substitutes used in vascular surgery. While implantation of vascular bypasses is still the primary option for cardiac and vascular surgeons to recover blood perfusion in cardiac and peripheral ischemic tissues, effective techniques to reduce the impact of post-grafting vascular remodeling are insufficient. In our view, the design of specific bioreactors to perform vascular conditioning with complex stimulation patterns will provide valuable tools for comprehensive molecular analysis of vessel arterialization process. In addition, this approach will allow the future design of refined protocols to perform pre-conditioning of natural vessels, reseeding of human or animalderived decellularized vascular grafts or, finally, derivation of fully engineered arterial-compliant substitutes, with a reduced remodeling impact. PMID:22873197

Piola, Marco; Soncini, Monica; Prandi, Francesca; Polvani, Gianluca; Beniamino Fiore, Gianfranco; Pesce, Maurizio

2012-12-01

383

Videometric analysis of regional left ventricular function before and after aortocoronary artery bypass surgery: correlation of peak rate of myocardial wall thickening with late postoperative graft flows.  

PubMed Central

The peak rate of systolic wall thickening (pdTw/dt) in regions of the left ventricle was determined by biplane roentgen videometry in 60 patients before and a median of 14 mo after aorto-coronary bypass graft surgery. The left ventricular ejection fraction, stroke volume, and end-diastolic volume and pressure did not change significantly after surgery in the presence of patent or occluded grafts (P greater than 0.05). Statistically significant increases occurred in the peak rate of systolic wall thickening regions supplied by patent bypass grafts, and significant decreases occurred in regions with occluded grafts (P less than 0.01). Of 42 preoperatively hypokinetic regions (pdTw/dt greater than 0 less than 5.0 cm/s) supplied by a patent graft, 30 improved by an average of 2.6 cm/s after operation; 18 returned to normal. Failure of 24 hypokinetic regions to improve to normal was associated with myocardial infarction in 11 or with late postoperative graft blood flows of less than 60 ml/min measured by videodensitometry, in 10. All seven preoperatively akinetic (pdTw/dt=0) or dyskinetic (pdTw/dt less than 0) regions did not improve after the operation despite the fact that, in five of the seven, coronary bypass flows were over 60 ml/min. All eight preoperatively hypokinetic regions supplied by coronary artery graft flows of less than or equal 40 ml/min failed to improve to normal after operation. All nine preoperatively hypokinetic regions supplied by coronary artery graft flows of over 60 ml/min improved to normal after surgery. Late postoperative coronary artery bypass graft flows, the functional status of the myocardium, the status and distribution of the native coronary circulation, and decreased regional function elsewhere in the ventricle must all be considered when regional left ventricular function is interpreted.

Chesebro, J H; Ritman, E L; Frye, R L; Smith, H C; Connolly, D C; Rutherford, B D; Davis, G D; Danielson, G K; Pluth, J R; Barnhorst, D A; Wallace, R B

1976-01-01

384

Treatment of recurrent head and neck carcinoma involving the carotid artery: carotid reconstruction with ePTFE graft.  

PubMed

The aim of our study is to investigate the feasibility of reconstructing the carotid artery using expanded polytetraflouroethylene (ePTFE) in patients with recurrent head and neck carcinoma involving the carotid artery. Ten patients, who had recurrent head and neck carcinoma involving the carotid artery, received carotid artery resection and reconstruction with ePTFE, tissue defects were repaired by pectoralis major myocutaneous flap. Results show that eight patients did not present any vascular and neurologic complications. One patient presented slight hemiparesis, another patient developed wound infection and pharyngocutaneous fistula. The mean follow-up period was 33.1 ± 16.0 months. The 2-year survival rate was 50% (5/10), and there was one patient who survived for 60 months without locoreginal recurrence or distant metastasis. En bloc resection of tumor and involved carotid-associated ePTFE reconstruction provide effective improvement in the locoregional control of the recurrent head and neck carcinoma. The pedicle pectoralis major myocutaneous flap can provide not only wound bed with affluent blood supply for the vascular grafts, but also reparation of skin or the tissue defects of oropharynx and hypopharynx. PMID:21400255

He, Xiang-bo; Li, Jing-jia; Chen, Yue-hong; Shu, Chang; Tang, Qing-lai; Yang, Xin-ming

2011-03-15

385

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

386

[A case of coronary artery bypass grafting after unsuccessful PTCA in a patient with systemic lupus erythematosis].  

PubMed

For angina of effort in a 69-year-old male patient who had been on steroid for SLE for 7 years we performed PTCA. However, with no dilation obtained we were compelled to perform CABG. The left internal thoracic artery was anastomosed with seg. 12 and the left great saphenous vein was anastomosed sequentially with seg. 14 and seg. 4PL. Through coronary angiography performed at postoperative 2 months, the vein graft was found well patent but in the left internal thoracic artery 90%-stenosis was observed at the anastomosed part, for which PTCA was performed to have it dilated up to 25%. In patho-histological examinations, intimal hypertrophy was observed in both grafts, which seemed to suggest a possible risk factor to determine long-term prognosis. In cases of SLE, the frequency of occurrences of ischemic heart diseases is high, indicating probabilities to be taken up as serious complication from now on. Until now, however, there are few instances reported on performing CABG for patients with SLE. We are reporting here our studies of this particular case of SLE, discussing the involvement of steroids, angitis and lupus anticoagulants as causative factors of ischemic heart diseases and related issues of surgical treatments. PMID:8336031

Terai, H; Sakata, R; Higuchi, K; Funazu, H

1993-06-01

387

Comparison of frequency of atrial fibrillation after coronary artery bypass grafting in African Americans versus European Americans.  

PubMed

In the general population, African Americans experience atrial fibrillation (AF) less frequently than European Americans. This difference could also exist in the incidence of this arrhythmia after cardiac surgery, but this possibility has been insufficiently examined. To test the association of such an ethnic difference, we compared the incidence of postoperative AF in a consecutive series of 2,312 African Americans and 6,054 European Americans who underwent isolated coronary artery bypass grafting from July 2000 to June 2007. Raw differences between the cohorts in the incidence of new AF were adjusted to take into account the baseline differences. Postoperatively, new-onset AF developed in 504 (22%) of 2,312 African-American patients and in 1,838 (30%) of 6,054 European-American patients (p <0.01). After adjustment with logistic regression analysis for numerous baseline differences, African Americans remained less likely to develop AF (odds ratio 0.63, 95% confidence interval 0.55 to 0.72; p <0.001). Risk was also adjusted using propensity matching. In that analysis, 457 (22%) of 2,059 African-American patients had postoperative AF, as did 597 (29%) of 2,059 matched European-American patients (p <0.01). In conclusion, AF was significantly less common among African-American patients than among European-American patients after coronary artery bypass grafting. PMID:21676370

Sun, Xiumei; Hill, Peter C; Lowery, Robert; Lindsay, Joseph; Boyce, Steven W; Bafi, Ammar S; Garcia, Jorge M; Haile, Elizabeth; Corso, Paul J

2011-06-14

388

The efficacies of modified mechanical post conditioning on myocardial protection for patients undergoing coronary artery bypass grafting  

PubMed Central

Background Coronary artery bypass grafting (CABG) with cardioplegic cardiac arrest and cardiopulmonary bypass (CPB) is associated with myocardial injury. The aim of this study was to investigate whether a modified mechanical post-conditioning (MMPOC) technique has a myocardial protective effect by enhancing early metabolic recovery of the heart following revascularization. Methods A prospective, randomized trial was conducted at a single-center university hospital performing adult cardiac surgery. Seventy-nine adult patients undergoing first-time elective isolated multivessel coronary artery bypass grafting were prospectively randomized to MMPOC or control group. Anesthetic, cardiopulmonary bypass, myocardial protection, and surgical techniques were standardized. The post reperfusion cardiac indices, inotrope use and biochemical-electrocardiographic evidence of myocardial injury were recorded. The incidence of postoperative complications was recorded prospectively. Results Operative characteristics, including CPB and aortic cross-clamp time, were similar between the two groups (p>0.05). The MMPOC group had lower troponin I and other cardiac biomarkers level post CPB and postoperatively, with greater improvement in cardiac indices (p<0.001). MMPOC shortened post surgery hospitalization from 9.1?±?2.1 to 7.5?±?1.6?days (p<0.001). Conclusions MMPOC technique promotes early metabolic recovery of the heart during elective CABG, leading to better myocardial protection and functional recovery.

2012-01-01

389

Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries  

SciTech Connect

The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters <18 mm and 30 (26%) patients had one or more CIA diameters >18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs {>=}18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs {>=}18 mm (p = 0.232). One-year freedom from IRSI was 92% {+-} 3% and 84% {+-} 9% for the <18-mm and {>=}18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

England, Andrew, E-mail: a.england@liv.ac.u [University of Liverpool, Department of Medical Imaging and Radiotherapy (United Kingdom); Butterfield, John S. [University Hospitals of South Manchester NHS Foundation Trust, Department of Radiology (United Kingdom); McCollum, Charles N. [University Hospitals of South Manchester NHS Foundation Trust, Department of Vascular Surgery (United Kingdom); Ashleigh, Raymond J. [University Hospitals of South Manchester NHS Foundation Trust, Department of Radiology (United Kingdom)

2008-07-15

390

Magnetic Resonance Angiography of Nonferromagnetic Iliac Artery Stents and Stent-Grafts: A Comparative Study in Sheep  

SciTech Connect

Purpose: To compare nonferromagnetic iliac artery prostheses in their suitability for patency monitoring with magnetic resonance angiography (MRA) using conventional angiography as a reference. Methods: In experiment 1, three Memotherm stents were inserted into the iliac arteries of each of six sheep: two 'tandem' stents on one side and a single stent on the other side. In experiment 2, four prostheses (normal and low-porosity Corvita stent-grafts, Memotherm, ZA-stent) were inserted in each of 11 sheep. Patency was monitored before and 1, 3, and 6 months after insertion with 3D phase-contrast and two 2D time-of-flight sequences (TOF-1: TR/TE = 18/6.9, TOF-2: 13/2.5) with and without contrast at 1.5 T. On 206 coronal MIP images (72 pre-, 134 post-stenting), three readers analyzed 824 iliac segments (206 x 4) for patency and artifacts. Results: There was no difference in the number of artifacts between tandem and single iliac Memotherm stents. The ZA-stent induced significantly fewer artifacts than the other prostheses (p < 0.00001). With MRA, patency of the ZA-stent was correctly diagnosed in 88% of cases, which was almost comparable to nonstented iliac segments (95%), patency of the Memotherm stent in 59%, and of the Corvita stent-grafts in 57% and 55%. The TOF-2 sequence with contrast yielded the best images. Conclusion: MRA compatibility of nonferromagnetic prostheses depends strongly on the design of the device. MRA may be used to monitor the patency of iliac ZA-stents, whereas iliac Memotherm stents and Corvita stent-grafts appear to be less suited for follow-up with MRA.

Schuermann, Karl; Vorwerk, Dierk; Buecker, Arno; Neuerburg, Joerg; Grosskortenhaus, Stefanie; Haage, Patrick; Piroth, Werner [Department of Diagnostic Radiology, University of Technology, Pauwelsstrasse 30, D-52057 Aachen (Germany); Hunter, David W. [Department of Radiology, Box 292, Fairview University of Minnesota Hospital and Clinic, 420 Delaware St. SE, Minneapolis, MN 55455 (United States); Guenther, Rolf W. [Department of Diagnostic Radiology, University of Technology, Pauwelsstrasse 30, D-52057 Aachen (Germany)

1999-09-15

391

Adrenocorticotrophic hormone stimulation of mammary secretion in lactating goats independent of increased mammary uptake of glucose.  

PubMed

The treatment of lactating goats with ACTH (single intramuscular injection) or cortisol (systemic infusion) resulted in an increase in milk yield and in the secretion of lactose, citrate and glucose into milk. The concentration of glucose in arterial plasma was also increased, resulting in a greater supply of glucose to the mammary gland. After ACTH treatment mammary uptake of glucose from the circulation did not increase and the balance between mammary uptake of glucose from blood and mammary output of glucose 'equivalents' into milk was significantly reduced. The results show that ACTH and cortisol can increase milk yield and lactose secretion by altering mammary metabolism of glucose. PMID:6325572

Stewart, H J; Thompson, G E

1984-05-01

392

Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?  

PubMed

Thoracic endovascular aortic repair (TEVAR) has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal and distal landing zones for stent-graft anchoring. Many aortic pathologies affect in the immediate proximity of the left subclavian artery (LSA) limiting the proximal landing zone site without proximal vessel coverage. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA's origin with the endovascular stent graft (ESG). This manoeuvre has the potential for immediate and delayed neurological and vascular symptoms. Some authors, therefore, propose prophylactic revascularisation of the LSA by transposition or bypass, while others suggest prophylactic revascularisation only under certain conditions, and still others see no requirement for prophylactic revascularisation in anticipation of LSA ostium coverage. In this review about LSA revascularisation in TEVAR patients with coverage of the LSA, we searched the electronic databases MEDLINE and EMBASE historically until the end date of May 2010 with the search terms left subclavian artery, covering, endovascular, revascularisation and thoracic aorta. We have gathered the most complete scientific evidence available used to support the various concepts to deal with this issue. After a review of the current available literature, 23 relevant articles were found, where we have identified and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals abnormal supra-aortic vascular anatomy or pathology. We further conclude that elective patients undergoing planned coverage of the LSA during TEVAR should receive prophylactic LSA transposition or LSA-to-left-common-carotid-artery (LCCA) bypass surgery to prevent severe neurological complications, such as paraplegia or brain stem infarction. PMID:21376612

Weigang, Ernst; Parker, Jack A T C; Czerny, Martin; Lonn, Lars; Bonser, Robert S; Carrel, Thierry P; Mestres, Carlos A; Di Bartolomeo, Roberto; Schepens, Marc A A M; Bachet, Jean E; Vahl, Christian-Friedrich; Grabenwoger, Martin

2011-03-03

393

Can preoperative myocardial perfusion scintigraphy predict changes in left ventricular perfusion and function after coronary artery bypass graft surgery?  

PubMed Central

OBJECTIVES We wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG). METHODS Ninety-two patients with stable angina pectoris (and at least one occluded coronary artery) underwent MPS before, and 6 months after, undergoing CABG. The result of the MPS was kept secret from the surgeons. RESULTS Before CABG, 90% of the patients had angina. After CABG, 97% of the patients were without symptoms. Overall graft patency was 84%. Before CABG, one patient had normal perfusion; in the rest of them the defects were classified as follows: reversible (60%), partly reversible (27%) and irreversible (12%). Following CABG, 33% had normal perfusion; in the rest the defects were reversible in 29%, partly reversible in 12% and irreversible in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects and one patient had partly reversible defects. Of 83 perfusion defects, which were normalized after CABG, 67 were reversible (81%) or partly reversible (12%). Seventy-five percent of all reversible coronary artery territories before CABG were normalized after operation. CONCLUSIONS Our results indicate that reversible or partly reversible perfusion defects at a preoperative MPS have a high chance of normalized myocardial perfusion assessed by MPS 6 months after operation. Normal perfusion is obtained almost exclusively in territories with reversible ischaemia. Symptoms improved in nearly all patients and LVEF in a significant fraction of the patients, not related to preoperative MPS.

Eckardt, Rozy; Kjeldsen, Bo Juel; Johansen, Allan; Grupe, Peter; Haghfelt, Torben; Thayssen, Per; Andersen, Lars Ib; Hesse, Birger

2012-01-01

394

The elusive link between high sensitivity C-reactive protein and carotid subclinical atherosclerosis in coronary artery bypass grafting candidates: A cross-sectional study  

Microsoft Academic Search

BACKGROUND: Previous studies demonstrated a modest association between C-Reactive Protein (CRP), stenosis of carotid artery, and carotid Intima-Media Thickness (IMT) in general population. During present study, we aimed to evaluate the relationship between High Sensitivity C-Reactive Protein (hsCRP) and Common Carotid Intima-Media Thickness (CCIMT) in patients who candidate for Coronary Artery Bypass Grafting (CABG). METHODS: The study subjects were enrolled

Parvin Shakouri; Nariman Nezami; Mohammad Kazem Tarzamni; Reza Javad Rashid

2008-01-01

395

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

Microsoft Academic Search

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

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

1996-01-01

396

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

Microsoft Academic Search

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

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

2000-01-01

397

Association between intraoperative cerebral microembolic signals and postoperative neuropsychological deficit: comparison between patients with cardiac valve replacement and patients with coronary artery bypass grafting  

Microsoft Academic Search

OBJECTIVESTo examine the association between intraoperative cerebral microembolic signals (MES) and postoperative neuropsychological deficit in patients with valve replacement (VR) and patients with coronary artery bypass grafting (CABG).METHODSNeuropsychological examination (10 tests) was performed 1–2 days before and 2 months after surgery (VR (n=26) and CABG (n=14)). The intraoperative number of cerebral MES were monitored from the right middle cerebral artery

Sigrun Kierulf Brękken; Ivar Reinvang; David Russell; Rainer Brucher; Jan L Svennevig

1998-01-01

398

Perioperative monitoring of primary and secondary hemostasis in coronary artery bypass grafting.  

PubMed

On-pump cardiac surgery is accompanied by complex alterations of hemostasis. The excessive postoperative bleeding has been attributed to acquired platelet dysfunction, impaired plasmatic coagulation, and increased fibrinolysis. The characterization of the hemostatic defects responsible for bleeding is crucial for specific treatment and optimal clinical management of the patient. For rapid determination of platelet-dependent primary hemostatic capacity (PHC), the Platelet Function Analyzer PFA-100 system is available. To evaluate the PFA performance in perioperative monitoring, a study was performed in 49 patients selected for low bleeding risk undergoing selective primary coronary artery bypass grafting (CABG). We compared PHC with Simplate bleeding time (BT) and platelet aggregometry. Furthermore, we analyzed global hemostasis by thromboelastography (TEG) and plasmatic coagulation by standard clotting tests prothrombin time (PT, Quick), activated partial thromboplastin time (aPTT), thrombin time (TT) and clotting factors and fibrinolysis by batroxobin (reptilase) time (RT). In all patients BT was postoperatively increased by 1.5- to 2-fold irrespective of perioperative complications and decreased to mildly prolonged values on the first postoperative day (1st day). In patients without complications, PHC in both collagen-adenosine diphosphate closure time (CADP-CT: 83 seconds preop, 78 seconds postop, and 74 seconds 1st day) and collagen-epinephrine closure time (CEPI-CT: 98 seconds preop, 95 seconds postop, 85 seconds 1st day) remained nearly stable. Apart from a patient with postoperative moderate thrombocytopenia, in bleeding patients no other significant defect of postoperative platelet hemostatic capacity was observed. However, on 1st day, the PHC of those patients was significantly reduced compared with non-bleeding patients. In patients with postoperative myocardial ischemia, increased PHC was identified by significantly shorter postoperative CADP-CT (66 seconds vs. 83 seconds) than in uncomplicated patients. By aggregometry, partial platelet dysfunction was observed in some patients without correlation to bleeding complications. In seven of 9 patients the postoperative bleeding complication was attributed to prolonged heparin anticoagulation and/or mildly enhanced fibrinogenolysis/fibrinolysis by TEG and standard plasmatic coagulation tests (TEG: k time 18 minutes vs. 8 minutes; aPTT: 47 seconds vs. 32 seconds; TT: 18.0 seconds vs. 12.3 seconds) and (RT: 19.5 seconds vs. 17.7 seconds). The impairment of PHC, platelet aggregation, and clotting factors observed on the 1st day in bleeding and in intra-aortic balloon pump (IABP) patients are most likely secondary effects, for example, loss of active platelets and clotting factors, to the primary postoperative bleeding or implantation of the IABP. In conclusion, our data indicate that in standard CABG procedures highly variable alterations of the hemostatic system occur after cardiopulmonary bypass (CPB) even in patients with assumed low operative risks. For identification of post-CPB bleeding complications, thromboelastography, aPTT, and TT and heparin and batroxobin (reptilase) time as fibrinolysis-sensitive assays are useful. Platelet function appears to be rapidly restored in uncomplicated CABG. PHC determination by PFA-100 demonstrates a high specificity for adequate platelet function and, therefore, could be beneficial in improved transfusion of platelet concentrates. PHC testing by PFA-100 may help identify postoperative platelet hyper-reactivity associated with myocardial lesion. PMID:16149021

Hertfelder, Hans-Jörg; Bös, Monika; Weber, Dagmar; Winkler, Kai; Hanfland, Peter; Preusse, Claus J

2005-01-01

399

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

Microsoft Academic Search

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

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

1996-01-01

400

Perioperative Blood Pressure Control in Hypertensive and Normotensive Patients Undergoing Off-pump Coronary Artery Bypass Grafting: Prospective Study of Current Anesthesia Practice  

PubMed Central

Aim To analyze blood pressure changes during intra- and immediate postoperative period in patients undergoing off-pump coronary artery bypass grafting. Methods The study included 355 consecutive patients undergoing off-pump coronary artery bypass grafting between January 5, 2004 and December 30, 2005. Out of these patients, 325 were allocated into groups with preoperative history of hypertension (n?=?115) and without preoperative history of hypertension (n?=?210). Systolic, diastolic, and mean arterial blood pressure was measured at the following four time points: on the day before surgery, before anesthesia induction, after the last graft, and on entry to intensive care unit. Results Mean arterial pressure was significantly higher in patients with a history of hypertension on the day before surgery (97 vs 92 mm Hg, P?=?0.003, Mann-Whitney test) and before anesthesia induction (107 vs 98 mm Hg; P?=?0.003). It was higher at all measuring points (after the last graft, 79 vs 78 mm Hg; and on entry to intensive care unit, 88 vs 86 mm Hg), but this difference was neither statistically nor clinically significant. The study showed that mean arterial pressure followed similar dynamics over time in both patient groups (P<0.001 both), with no significant time-dependent between-group differences. Conclusion Current anesthesia techniques that include deep opioid analgesia in combination with vasodilators provide a satisfactory control of intraoperative hypertension. Management of blood pressure changes during intra- and immediate postoperative period in off-pump coronary artery bypass grafting patients with preoperative hypertension was no more difficult than in patients without preoperative hypertension.

Barisin, Stjepan; Sakic, Kata; Goranovic, Tatjana; Barisin, Ana; Sonicki, Zdenko

2007-01-01

401

Pelvic Arterial Embolisation in a Trauma Patient with a Pre-Existing Aortobifemoral Graft  

SciTech Connect

Pelvic fractures secondary to blunt trauma are associated with a significant mortality rate due to uncontrolled bleeding. Interventional radiology (IR) can play an important and central role in the management of such patients, offering definitive minimally invasive therapy and avoiding the need for high-risk surgery. Rapid access to whole-body computed tomography has been shown to improve survival in polytrauma patients and allows rapid diagnosis of vascular injury and assessment of suitability for endovascular therapy. IR can then target and treat the specific area of bleeding. Embolisation of bleeding pelvic arteries has been shown to be highly effective and should be the treatment of choice in this situation. The branches of the internal iliac artery (IIA) are usually involved, and these arteries are accessed by way of IIA catheterisation after abdominal aortography. Occasionally these arteries cannot be accessed by way of this conventional route because of recent IIA ligation carried out surgically in an attempt to stop the bleeding or because (in the rare situation we describe here) these vessels are excluded secondary to previous aortoiliac repair. In this situation, knowledge of pelvic arterial collateral artery pathways is important because these will continue to supply pelvic structures whilst making access to deep pelvic branches challenging. We describe a rare case, which has not been previously reported in the literature, in which successful embolisation of a bleeding pelvic artery was carried out by way of the collateral artery pathways.

Abulaban, Osama; Hopkins, Jonathan; Willis, Andrew P.; Jones, Robert G., E-mail: robert.jones@uhb.nhs.uk [Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust (United Kingdom)

2011-02-15

402

Coronary artery bypass grafting in a patient with situs inversus totalis and dextrocardia  

Microsoft Academic Search

Situs inversus totalis is a rar e congenital anomaly . We report a case of a 78-year-old woman with this condition and ischemic coronary artery disease who underwent myocardial revascularizatio n. The cardiac catheterism showed severe proximal stenosis with aneurysms in the anterior interventricular branch, diagonal ar tery, and right cor onar y artery . The pr ocedur e was

Eduardo Keller SAADI; Luis Henrique DUSSIN; Alvaro NICOLAO; Alcides José ZAGO

2007-01-01

403

Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study  

Microsoft Academic Search

BACKGROUND: In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation. METHODS: The study cohort included

Boris G Sobolev; Lisa Kuramoto; Adrian R Levy; Robert Hayden

2006-01-01

404

Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump  

Microsoft Academic Search

Background—There is increasing evidence that cardiopulmonary bypass (CPB) may be responsible for the morbidity associated with coronary artery bypass grafting (CABG) surgery. Recent developments in cardiac stabilization devices have made CABG without CPB feasible. However, there is conflicting evidence to date from published trials comparing outcomes between CABG performed with and without CPB, with some trials indicating an advantage to

Jean-Francois Légaré; Karen J. Buth; Sharon King; Jeremy Wood; John A. Sullivan; Camille Hancock Friesen; John Lee; Kier Stewart; Gregory M. Hirsch

405

Does Patient Gender Affect Outcomes after Concomitant Coronary Artery Bypass Graft and Aortic Valve Replacement? An Australian Society of Cardiac and Thoracic Surgeons Database Study  

Microsoft Academic Search

Objectives: Women undergoing isolated coronary artery bypass graft (CABG) surgery have been previously shown to be at an independently increased risk for post-operative morbidity and mortality. However, there are considerably less data on whether this trend remains true in patients undergoing concomitant aortic valve replacement (AVR) and CABG surgery. The aim of our study was to investigate this pertinent issue.

Akshat Saxena; Chin-Leng Poh; Diem T. Dinh; Christopher M. Reid; Julian A. Smith; Gilbert C. Shardey; Andrew E. Newcomb

2011-01-01