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Sample records for mammary artery graft

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

    PubMed

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

    2004-09-01

    A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. Cardiac catheterization then performed and revealed patent left internal mammary artery and saphenous vein grafts. Besides, selective injection of the left internal mammary artery graft also showed a fistula formation between left internal mammary artery graft and pulmonary vasculature of the left upper lobe. He was managed conservatively because of the severely diseased left anterior descending artery distal to internal mammary artery anastomosis and low pulmonary artery pressure. The development of fistulous connection between internal mammary artery and pulmonary vasculature is an extremely rare complication following CABG. Patients with such fistulae usually present with chest pain due to coronary steal syndrome. A new heart sound, especially a continuous murmur, may be detected during physical examination. Surgical correction is indicated in the event of refractory angina, growing fistula causing heart failure or endarteritis. Otherwise, a conservative approach with instruction of the patient for prophylactic precautions of subacute bacterial endocarditis may be recommended for asymptomatic patients. PMID:15301909

  2. CT coronary angiography evaluation of involvement of the left internal mammary artery graft in advanced left upper lobe lung tumour

    PubMed Central

    Bisleri, Ullas; Beliaev, Andrei M

    2014-01-01

    Evaluation of internal mammary artery graft involvement in upper lobe lung tumour is important to determine an optimal surgical treatment. We report the case of a 52-year-old male patient with an advanced left upper lobe lung tumour located in the proximity of the left internal mammary artery graft. CT coronary angiography showed that the tumour did not invade the graft. The patient underwent a successful palliative left upper lobe lung resection. PMID:24596411

  3. Does the use of bilateral mammary artery grafts compared with the use of a single mammary artery graft offer a long-term survival benefit in patients undergoing coronary artery bypass surgery?

    PubMed

    Smith, Tim; Kloppenburg, Geoffrey T L; Morshuis, Wim J

    2014-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Does the use of bilateral mammary artery grafts compared with the use of a single mammary artery graft offer a long-term survival benefit in patients undergoing coronary artery bypass surgery?' Altogether 214 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All the included studies were follow-up studies; eight studies used prospective data collection, and five studies collected the study data retrospectively. No randomized controlled trials were found. Nine of the 13 included papers used a propensity-score-matched comparison of the survival of bilateral mammary artery graft [or, bilateral internal thoracic artery (BITA) graft] patients vs single mammary artery graft [or, single internal thoracic artery (SITA) graft] patients. These studies consistently showed an enhanced survival of BITA patients compared with propensity-score-matched SITA patients. Three of the 13 included papers used Cox proportional hazards regression analysis to compare survival of BITA vs SITA patients; one larger study showed better crude survival of BITA patients, but did not identify BITA grafts as independent predictor of enhanced survival. The remaining two studies also did not identify BITA grafts as independent predictor of enhanced survival. One study only presented crude survival estimates of BITA vs SITA patients and therefore was of limited informative value. We conclude that the use of BITA grafts seems to offer a long-term survival benefit compared with a SITA graft for patients undergoing coronary artery bypass grafting surgery. Although randomized evidence is lacking, observational evidence supporting this hypothesis is mounting. PMID:24087830

  4. Hemodynamics of left internal mammary artery bypass graft: Effect of anastomotic geometry, coronary artery stenosis, and postoperative time.

    PubMed

    Fan, Tingting; Lu, Yuan; Gao, Yan; Meng, Jie; Tan, Wenchang; Huo, Yunlong; Kassab, Ghassan S

    2016-03-21

    Although the left internal mammary artery (LIMA) bypass graft is the best choice for surgical revascularization, its hemodynamics are still complex and can result in long-term graft failure. Here, we performed a hemodynamic analysis of the LIMA-coronary artery with end-to-side/side-to-side anastomoses based on 15 patient-specific CTA images at various postoperative periods. We hypothesize that hemodynamic patterns are determined by the interplay of LIMA geometry, anastomotic configuration, and severity of native coronary artery stenosis, which are strongly affected by the postoperative time. A 3D finite volume method with the inlet pressure wave and outlet resistance boundary conditions was used to compute the distribution of pressure and flow, from which the time-averaged wall shear stress (TAWSS), oscillation shear index (OSI), time-averaged WSS gradient (TAWSSG), and transverse WSS (transWSS) were determined. To characterize the hemodynamic environment, we defined surface area ratios of low TAWSS (≤4dynes/cm(2)), high OSI (≥0.15), TAWSSG (≥500dynes/cm(3)), and transWSS (≥6dynes/cm(2)) in the LIMA graft and at the anastomosis between LIMA graft and coronary artery. These ratios were determined by the interplay of multiple morphometric parameters in the LIMA-coronary artery, but increased with postoperative time. These findings have significant implications for understanding LIMA graft patency. PMID:26900034

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

    PubMed

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

    2013-12-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

    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.

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

    PubMed

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

    2014-05-01

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

  8. Effects of exercise and nitrates on blood flow in internal mammary artery to coronary artery grafts: a non-invasive study.

    PubMed

    Mauric, A; Samani, N J; de Bono, D P

    1995-06-01

    1. The aim of the present study was to investigate the effects of exercise and of sublingual glyceryl trinitrate on the pattern of blood flow, as studied by Doppler ultrasound, in internal mammary artery grafts performed to relieve severe stenosis of the left anterior descending coronary artery. The accessibility of the graft to transcutaneous ultrasound examination allows the effects of exercise and nitrate administration on coronary blood flow to be studied non-invasively. 2. Angina-free patients with left internal mammary to left anterior descending coronary artery grafts were studied using transcutaneous duplex ultrasound at rest, after leg exercise and after sublingual administration of 0.5 mg or 1 mg of glyceryl trinitrate. 3. Resting graft blood flow showed a biphasic pattern, with forward flow in both systole and diastole. Exercise caused an increase in time-averaged velocity of graft blood flow from 17.3 (3.3) to 24.0 (7.2) cm/s (P = 0.001), and of calculated volume flow from 44.7 (3.08) to 59.8 (5.89) ml/min (P = 0.002). Diastolic peak velocity increased from 36.1 (9.9) cm/s to 46.8 (16.2) cm/s (P = 0.04), while peak systolic velocity was unchanged. Nitrate administration caused a fall in systolic and diastolic blood pressure and an increase in heart rate; graft flow was maintained [time-averaged velocity 18.3 (6.2) cm/s before and 16.7 (5.7) cm/s after 500 micrograms of glyceryl trinitrate], but systole was shortened and the proportion of blood flow in diastole increased [systolic/diastolic flow ratio 0.558 (0.139) before and 0.374 (0.156) after 500 micrograms of glyceryl trinitrate, P = 0.01].(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7634746

  9. Mitral Valve Replacement via Anterolateral Right Thoracotomy without Cross-Clamping in a Patient with Fungal Infective Endocarditis and Functioning Internal Mammary Artery after Previous Coronary Artery Bypass Grafting and Mitral Valve Repair.

    PubMed

    Taguchi, Takahiro; Dillon, Jeswant; Yakub, Mohd Azhari

    2016-01-01

    A 55-year-old man developed severe mitral regurgitation with persistent fungal infective endocarditis 8 months after coronary artery bypass grafting with a left internal mammary artery and 2 saphenous veins, as well as mitral valve repair with a prosthetic ring. Echocardiography demonstrated severe mitral regurgitation and a valvular vegetation. Computed tomography coronary arteriography indicated that all grafts were patent and located intimately close to the sternum. Median resternotomy was not attempted due to the risk of injury to the bypass grafts, and therefore, a right anterolateral thoracotomy approach was utilized. Mitral valve replacement was performed with the patient under deep hypothermia and ventricular fibrillation without aortic cross-clamping. The patient`s postoperative course was uneventful. Thus, right anterolateral thoracotomy may be a superior approach to mitral valve surgery in patients who have undergone prior coronary artery bypass grafting. PMID:26913683

  10. Radial artery graft vasospasm.

    PubMed

    Gabe, E D; Figal, J C; Wisner, J N; Laguens, R

    2001-01-01

    We report an unusual case of vasospasm of a grafted radial artery complicated with ventricular fibrillation during the postoperative course of coronary artery bypass graft surgery. To our knowledge this is the first documented case of a radial artery graft spasm leading to a severe arrhythmia. The arrhythmia resolved spontaneously. Radial artery graft spasm was demonstrated by angiography and was successfully resolved by intravenous nitroglycerin administration. PMID:11163573

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

    PubMed

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

    2015-01-01

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

  12. Atherosclerosis and the internal mammary arteries

    SciTech Connect

    Singh, R.N.

    1983-06-01

    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.

  13. Bilateral internal thoracic artery grafting

    PubMed Central

    2013-01-01

    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. PMID:23977627

  14. Physiologic Functional Evaluation of Left Internal Mammary Artery Graft to Left Anterior Descending Coronary Artery Steal due to Unligated First Thoracic Branch in a Case of Refractory Angina

    PubMed Central

    Sawaya, Fadi J.; Liberman, Henry; Devireddy, Chandan

    2016-01-01

    Unligated side branches of the left internal mammary artery (LIMA) have been described in the literature as a cause of coronary steal resulting in angina. Despite a number of studies reporting successful side branch embolization to relieve symptoms, this phenomenon remains controversial. Hemodynamic evidence of coronary steal using angiographic and intravascular Doppler techniques has been supported by some and rejected by others. In this case study using an intracoronary Doppler wire with adenosine, we demonstrate that a trial occlusion of the LIMA thoracic side branch with selective balloon inflation can confirm physiologic significant steal and whether coil embolization of the side branch is indicated. PMID:26981289

  15. Off pump long-onlay-patch angioplasty to the LAD using the left internal mammary artery.

    PubMed

    Takanashi, Shuichiro; Fukui, Toshihiro; Yamamoto, Shin; Hosoda, Yasuyuki

    2003-01-01

    Surgical treatment for diffusely diseased coronary arteries has been considered to be a relative contraindication for off pump coronary artery bypass (OPCAB) grafting. We report a case of off pump long-onlay-bypass grafting using the left internal mammary artery. To our knowledge, the long-onlay-patch grafting with OPCAB technique has not been previously described. Two sets of Octopus-3 tissue stabilizers were placed longitudinally along the target coronary artery (Double-Octopus technique). This technique allowed us to performed surgical angioplasty and bypass grafting without cardiopulmonary bypass support. Patients with severe diffuse coronary lesions who are at high risk for cardiopulmonary bypass will benefit from this technique. PMID:14721814

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

    SciTech Connect

    Abbott, J. Dawn; Brennan, Joseph J.; Remetz, Michael S.

    2004-01-15

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

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

    PubMed

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

    2014-07-01

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

  18. Who Needs Coronary Artery Bypass Grafting?

    MedlinePlus

    ... the NHLBI on Twitter. Who Needs Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is used ... is a test that uses dye and special x rays to show the insides of your coronary arteries. ...

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

    PubMed

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

    2013-06-01

    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

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

    SciTech Connect

    Nielson, Jeffery L. Kang, Preet S.

    2006-04-15

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

  1. Reusing the patent internal mammary artery as a conduit in redo coronary artery bypass surgery.

    PubMed

    Nwaejike, Nnamdi; Tennyson, Charlene; Mosca, Roberto; Venkateswaran, Rajamiyer

    2016-03-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with previous internal mammary artery/internal thoracic artery (ITA) grafts, can the internal mammary artery/ITA be reused/recycled in redo coronary artery bypass surgery? Fourteen papers were found using the reported search of which 10 represented the best evidence to answer the clinical question. There was variation in patient selection, the number of patients reported, outcome measures recorded, and methods and duration of follow-up. The results were mostly in favour of using a recycled ITA when it could be safely harvested. Most studies were retrospective. One large series of 60 patients who underwent redo coronary artery bypass grafting (CABG) using previously implanted ITAs had a mean time to reoperation of 117 68 months. They reported no operative deaths; no patients required further or subsequent target vessel revascularization; 30-day mortality was 8.3% and myocardial infarction rate was 3%. Another two series of 16 and 12 patients underwent recycling of arterial grafts during coronary artery revascularization with no perioperative deaths in either. Postoperative angiography was performed in 10 patients in one of these studies, which showed excellent flow in all redone left internal thoracic artery (LITA) grafts. One study reported results from a prospective cohort of 9 patients who underwent redo coronary artery bypass grafting. Interval between operations was between 1 and 132 months. There was no perioperative mortality, but 1 patient required reintervention (to an interposition vein graft). A further study of 4 patients who underwent redo CABG using ITAs that were patent but with severe stenosis at the distal anastomosis had no mortality. Postoperative angiography showed patency of all grafts. There have also been 4 case reports on reusing the ITA/ITA in redo CABG with no damage to the reused LITA, no perioperative mortality and satisfactory follow-up at up to 29 months. Evidently, the recycled ITA can be used in redo coronary artery bypass grafting. Papers found were retrospective series or case reports. As such, there is no direct comparison in outcomes between the recycled ITA and first-time ITA harvest or any other conduit for CABG. In conclusion, we find that when it is possible to harvest a previously used ITA, studies have shown it to be a safe and viable conduit in redo CABG with good long-term outcomes. PMID:26669852

  2. Evolution of complete arterial grafting. For coronary artery disease.

    PubMed Central

    Buxton, B F; Fuller, J A; Tatoulis, J

    1998-01-01

    Arterial grafting for the correction of coronary artery disease preceded the use of saphenous vein grafts, but the overwhelming popularity of the saphenous vein from 1970 to 1985 left the development of arterial grafting dormant. Excellent graft patency results from pedicled internal thoracic artery grafting and continued saphenous vein graft failure prompted our unit to explore complete arterial grafting with internal thoracic artery and radial artery grafts. One thousand and fifty-three patients who received a combination of internal thoracic artery and radial artery grafts were compared with 1,156 patients who received internal thoracic artery and saphenous vein grafts. All patients underwent primary coronary artery bypass surgery between 1995 and 1998. The early mortality and morbidity and the probability of survival at 2 years were similar in both groups of patients. Early graft patency studies of 35 radial artery grafts showed 33 (94%) were patent at a mean of 12 months. Complete arterial grafting using internal thoracic and radial arteries is safe and may provide a long-term benefit. Images PMID:9566058

  3. Types of Coronary Artery Bypass Grafting

    MedlinePlus

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

  4. Infrainguinal anastomotic arterial graft infections treated by selective graft preservation.

    PubMed Central

    Calligaro, K D; Westcott, C J; Buckley, R M; Savarese, R P; DeLaurentis, D A

    1992-01-01

    The purpose of this study was to determine whether the type of graft material and bacteria involved in an infrainguinal arterial anastomotic infection can be used as guidelines for graft preservation. Between 1972 and 1990, the authors treated 35 anastomotic infections involving a common femoral or distal artery. The graft material was Dacron in 14 patients, polytetrafluoroethylene (PTFE) in 14, and vein in 7. Of the 14 Dacron grafts, immediate graft excision was required for overwhelming infection in eight patients (bleeding in five, sepsis in three) and for an occluded graft in one patient. Three of five patients failed attempted graft preservation because of nonhealing wounds. Thus, 12 of the 14 Dacron grafts ultimately required graft excision. Of the 21 "smooth-walled" vein and PTFE grafts, 10 required immediate graft excision for occluded grafts (five PTFE, one vein) or bleeding (three PTFE, one vein). Ten of the remaining 11 (91%) patients with patent "smooth-walled" grafts, intact anastomoses, and absence of sepsis managed by graft preservation healed their wounds and maintained distal arterial perfusion. Wound cultures grew pure gram-positive cocci in 17 of 21 "smooth-walled" graft infections versus 8 of 14 Dacron graft infections. In the absence of systemic sepsis, graft preservation is the treatment of choice for gram-positive infections involving an intact anastomosis of patent PTFE and vein grafts. Regardless of the bacterial cause, the authors recommend that any infrainguinal anastomotic infection of a Dacron graft be treated by immediate excision of all infected graft material. PMID:1632705

  5. Correlation between Doppler, Manual Morphometry, and Histopathology Based Morphometry of Radial Artery as a Conduit in Coronary Artery Bypass Grafting.

    PubMed

    Yadava, Om Prakash; Sharma, Vinod; Prakash, Arvind; Ahlawat, Vikas; Kundu, Anirban; Mohanty, Bikram K; Mishra, Rekha; Dinda, Amit K

    2016-01-01

    Background. Long-term graft patency is the major factor impacting survival after coronary artery bypass grafting. Arteries are superior in this regard. Radial artery is considered the second best conduit after internal mammary artery. Several studies have shown excellent radial artery patency. We evaluated the morphologic characteristics of radial artery by three modalities, (i) preoperative Doppler ultrasound, (ii) intraoperative manual morphometry, and (iii) postoperative histology-based morphometry, and compared these with the aim of validating Doppler as a noninvasive test of choice for preoperative assessment of radial artery. Methods. This was a prospective study involving 100 patients undergoing coronary artery bypass grafting in which radial artery was used. The radial artery was assessed using preoperative Doppler ultrasound studies, intraoperative morphometry, and postoperative histopathology and morphometry. The morphometric measurements included (i) luminal diameter, (ii) intimal and medial thickness, and (iii) intima-media thickness ratio. Results. Using Bland-Altman plots, there was a 95% limit of agreement between the preoperative Doppler measurements and the postoperative histopathology and morphometry. Conclusion. Doppler ultrasound is an accurate screening test for evaluation of radial artery, in terms of intimal/medial thickness and luminal diameter as a conduit in coronary artery bypass grafting and has been validated by both morphometric and histopathology based studies. PMID:27047699

  6. Correlation between Doppler, Manual Morphometry, and Histopathology Based Morphometry of Radial Artery as a Conduit in Coronary Artery Bypass Grafting

    PubMed Central

    Yadava, Om Prakash; Sharma, Vinod; Prakash, Arvind; Ahlawat, Vikas; Mohanty, Bikram K.; Mishra, Rekha; Dinda, Amit K.

    2016-01-01

    Background. Long-term graft patency is the major factor impacting survival after coronary artery bypass grafting. Arteries are superior in this regard. Radial artery is considered the second best conduit after internal mammary artery. Several studies have shown excellent radial artery patency. We evaluated the morphologic characteristics of radial artery by three modalities, (i) preoperative Doppler ultrasound, (ii) intraoperative manual morphometry, and (iii) postoperative histology-based morphometry, and compared these with the aim of validating Doppler as a noninvasive test of choice for preoperative assessment of radial artery. Methods. This was a prospective study involving 100 patients undergoing coronary artery bypass grafting in which radial artery was used. The radial artery was assessed using preoperative Doppler ultrasound studies, intraoperative morphometry, and postoperative histopathology and morphometry. The morphometric measurements included (i) luminal diameter, (ii) intimal and medial thickness, and (iii) intima-media thickness ratio. Results. Using Bland-Altman plots, there was a 95% limit of agreement between the preoperative Doppler measurements and the postoperative histopathology and morphometry. Conclusion. Doppler ultrasound is an accurate screening test for evaluation of radial artery, in terms of intimal/medial thickness and luminal diameter as a conduit in coronary artery bypass grafting and has been validated by both morphometric and histopathology based studies. PMID:27047699

  7. Quadruple Vessel Coronary Artery Bypass Grafting in a 14-Year-Old Child With Plasminogen Activator Inhibitor-1 4G/4G Gene Polymorphism.

    PubMed

    Cvetkovic, Draginja; Lafaro, Rocco; Giamelli, Joseph; Suvro, Sett; Erb, Markus; Yaghoubian, Saman

    2016-06-01

    Myocardial ischemia due to coronary artery disease is an extremely rare condition in childhood and adolescence. Absence of obvious serious risk factors remains a challenge to modern cardiology. We present the case of a 14-year-old boy who underwent quadruple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery and bilateral radial artery grafting. We try to highlight a rare but important 4G variant PAI-1 (SERPINE 1) gene mutation as the etiology of severe coronary artery disease in our patient. To the best of our knowledge, he is one of the youngest patients who underwent coronary artery bypass surgery with 4 arterial grafts. PMID:26848133

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

    PubMed Central

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

    2015-01-01

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

  9. Endovascular stenting for treatment of a left internal mammary artery pseudoaneurysm following redo-sternotomy: a case report.

    PubMed

    Cheung, Paul K M; Philipp, Roger K; Freed, Darren H

    2013-11-01

    An 85-year-old gentlemen with a history of previous triple vessel coronary bypass grafting presented with severe aortic stenosis and occlusion of the previous saphenous vein grafts but with patent left internal mammary artery (LIMA)-left anterior descending. The patient underwent uncomplicated repeat sternotomy and aortic valve replacement with repeated coronary bypass. On post-operative day 21 the patient was successfully resuscitated from a pulseless electrical activity (PEA) arrest, and was found to have a 1-cm pseudoaneurysm of the left internal mammary artery at the level of sternomanubrial junction with associated hemothorax. The LIMA remained patent and a pinhole source of extravasation was discovered by angiography at the aneurysmal site. The defect was successfully repaired by endovascular implant of a 3.5 mm × 12 mm Graft Master covered stent (Abbott Vascular). The patient recovered well from the procedure without further complications and was discharged after a total of 48 days of hospital stay. Our experience confirms the feasibility of repairing post-operative pseudoaneurysm in the internal mammary artery by endovascular stent grafting, thereby avoiding the risks and complications of a repeat open chest procedure. PMID:23378258

  10. Preventing Deep Wound Infection after Coronary Artery Bypass Grafting

    PubMed Central

    Bryan, Charles S.; Yarbrough, William M.

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  12. Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting

    PubMed Central

    Gong, Wenhui; Cai, Junfeng; Wang, Zhe; Chen, Anqing; Ye, Xiaofeng; Li, Haiqing

    2016-01-01

    Background Robot-assisted coronary artery bypass grafts (RACAB) utilizing the da Vinci surgical system are increasingly used and allow the surgeon to conveniently harvest internal mammary arteries (IMAs). The aim of this study was to compare the outcomes of off-pump RACAB and minimally invasive direct coronary artery bypass grafting (MIDCAB) in the short and medium term. Methods We performed a retrospective review of 132 patients with single- or multiple-vessel coronary artery disease who underwent minimally invasive off-pump CABG (OPCAB) between May 2009 and May 2014. The patients were divided into two groups based on the surgical approach, MIDCAB and RACAB group. The anastomosis of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) was performed as regular OPCAB through the incision on the beating heart using regular stabilization devices (Genzyme Corporation). The preoperative, intraoperative, postoperative, and follow-up data, including major adverse cardiac and cerebrovascular events (MACCE), were compared. Results The preoperative data were similar. RACAB significantly shorten the intensive care unit (ICU) stay and postoperative compared with the MIDCAB group (P<0.05). There were 12 (19.7%) patients treated with a two-stage hybrid procedure in the MIDCAB group and 34 (47.9%) patients in the RACAB group (P=0.001). Thirty-day mortality was 1.6% in the MIDCAB group. There were 9 (14.7%) MIDCAB patients and 2 (2.8%) RACAB patients (P=0.013) that developed new arrhythmia. The two groups showed comparable mid-term survival (P=0.246), but the MACCEs were significantly different (P=0.038). Conclusions RACAB may be a valuable alternative for patients requiring single or simple multi-vessel coronary artery bypass grafting (CABG). Although the mid-term mortality outcomes are similar, RACAB improves short-term outcomes and mid-term MACCE-free survival compared with MIDCAB. PMID:27076941

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

    PubMed Central

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

    2014-01-01

    Introduction Minimally invasive coronary artery bypass grafting (MICABG) is a less invasive method of performing surgical revascularization. This technique coupled with use of off pump technique of surgical revascularization makes it truly less invasive. This method is highly effective even in high-risk patients. Results of this procedure are comparable to standard off pump technique and are better than percutaneous coronary intervention utilizing drug-eluting stent. We present an early and mid-term result of the use of this technique. Method We enrolled 33 patients for analysis operated between 2008 and 2012. Operation was performed utilizing off-pump technique of coronary artery bypass grafting through a minimal invasive incision. Left internal mammary artery graft was done for single vessel disease and radial artery was utilized for other grafts if required. Median follow up of 2.5 years (6 months–4 years) is available. Results Median age was 58.5 years (41–77) and all were male. Single vessel disease was present in 7, double vessel in 14 and triple vessel disease in 12 patients. All the patients had normal left ventricular size and function. There was no operative and 30-day mortality. Conversion to median sternotomy to complete the operation was done in 6.6% (2 out of 33 patients). One patient had acute myocardial infarction and there were no deaths during follow up. Conclusion MICABG is a safe and effective method of revascularization in low risk candidates for coronary artery bypass grafting. PMID:24814114

  14. Late fiber deterioration in Dacron arterial grafts.

    PubMed Central

    Berger, K; Sauvage, L R

    1981-01-01

    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. PMID:6452101

  15. [Policy of using the right internal thoracic artery "in situ" for coronary artery bypass grafting].

    PubMed

    Vecherskiĭ, Iu Iu; Andreev, S L; Zatolokin, V V

    2015-01-01

    The authors analysed the outcomes in a total of 73 patients subjected to coronary artery bypass grafting with the use of the "in situ" the right internal thoracic artery. Of these, 14 patients endured bypass grafting with assessment of the conformity of the length of the "in situ" right ITA as a conduit for the distal third of the right coronary artery (RCA). 16 patients underwent grafting of the RITA "in situ" with the RCA by passing through the pleural cavity. The remaining 43 patients were subjected to bilateral mammary composite bypass grafting using the radial artery (RA). A total of 22 segments of the RA were subjected to a comparative morphometric examination depending on the method of exposure. We additionally analysed 56 cases of utilizing the RA with the use of the pharmacological protocol of preventing spasm. The results were regarded statistically significant if p<0.05. We used the non-parametric criterion of Mann-Whitney. The obtained results showed that the right ITA "in situ" may be used for bypass grafting of the RCA system, excluding the risk of graft tension, if the perpendicular from the 6th intercostal space crosses the sharp edge of the heart 1.5-2 cm distal to the medial point, with the minimum number of complications after 1.5±0.3 years (7.1%). When the above-mentioned perpendicular is located proximal to the middle point of the sharp edge of the heart it is possible to use the right ITA "in situ" for the RCA system thanks to passing the conduit through the right pleural cavity under the anterior segment of the upper lobe and the medial segment of the middle lobe of the right lung with no complications after 1 year. The method of composite bypass grafting by means of the proximal segment of the right ITA "in situ" and the RA makes it possible to effectively revascularize any portions of the coronary bed (latency 94.7% after 3.0±0.8 years), to avoid manipulations on the aorta, and to save the bed of the right ITA in the middle and distal third of the sternum with no postoperative complications. It was revealed that in the conditions of decreased osmotic pressure the increase in the thickness of the vascular wall is more pronounced in the skeletonized segments of the RA (1.38±0.05 mm) as compared with the segments surrounded by connective and fatty tissue (1.09±0.04 mm). The pharmacological protocol for prevention of radial artery spasm used in 56 patients resulted in a small number of complications observed after 3.0±0.8 years (myocardial infarctions - 1.75%, angina pectoris relapse - 7%). Hence, the developed methods of using the right ITA "in situ" widen possibilities of bilateral mammary bypass grafting, excluding the existing problems of routine use of the both ITAs "in situ". PMID:25757178

  16. Biochemical (functional) adaptation of "arterialized" vein grafts.

    PubMed Central

    Henderson, V J; Cohen, R G; Mitchell, R S; Kosek, J C; Miller, D C

    1986-01-01

    Canine venous autografts and allografts were interposed in the femoral and carotid arterial positions in 29 dogs; grafts were harvested at three postoperative intervals (1-2 weeks, 4-6 weeks, and 8-10 weeks) for light and scanning electron (SEM) microscopy and lumenal surface prostacyclin (PGI2) production. Normal veins and arteries were used as controls. Radioimmunoassay for tritiated 6-k-PGF1 alpha, the stable metabolite of PGI2, was performed using a flow surface template incubation chamber during basal and arachidonic acid stimulated conditions. Using SEM, the autografts revealed normal endothelial cell (EC) surfaces at all time intervals; conversely, allografts exhibited extensive EC loss at 1-2 weeks with gradual reparation by 10-12 weeks (such that the EC surface was virtually indistinguishable from that of control veins or autografts). PGI2 production was significantly greater in control arteries than veins (p = 0.0001). At 1-2 weeks and 4-6 weeks, lumenal production of PGI2 in both the autografts and allografts was not significantly different from control vein; however, PGI2 production after 10-12 weeks was identical to normal arterial levels (and significantly [p less than 0.0044] higher than venous levels) in both basal and stimulated conditions. Although the mechanisms responsible for this functional (biochemical) "arterialization" process remain conjectural, increased biosynthesis and/or release of PGI2 by endothelial cells, acute phase inflammatory cells (allografts) mediated by interleukin-1 or myointimal cells seems most likely. Further elucidation of these sources of PGI2 is necessary, but these data demonstrate for the first time that venous grafts placed in the arterial circulation undergo complete functional adaptation (in addition to the well known morphological changes). Images FIGS. 2A and B. FIGS. 3A-D. PMID:3516084

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

    SciTech Connect

    Heper, Gulumser Barcin, Cem; Iyisoy, Atila; Tore, Hasan F.

    2006-10-15

    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.

  18. What to Expect during Coronary Artery Bypass Grafting

    MedlinePlus

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

  19. Motexafin lutetium in graft coronary artery disease

    NASA Astrophysics Data System (ADS)

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

    2000-03-01

    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.

  20. Platelet--arterial synthetic graft interaction and its modification

    SciTech Connect

    Callow, A.D.; Connolly, R.; O'Donnell, T.F. Jr.; Gembarowicz, R.; Keough, E.; Ramberg-Laskaris, K.; Valeri, C.R.

    1982-11-01

    We compared the in vivo platelet reactivity of two commonly used clinical grafts, Dacron and expanded polytetrafluoroethylene (PTFE), with that of a control autogenous artery graft and assessed whether platelet reactivity was modified by the platelet-antiaggregating agent prostacyclin (PGI2) (epoprostenol). Grafts were randomly placed into the carotid arteries of 21 baboons. Platelets labeled with /sup 111/In were infused within one hour after implantation graft for gamma camera scanning of platelet uptake. The accumulation of platelets on Dacron grafts began almost immediately after injection and reached a peak after one to two hours. The PTFE and control autogenous artery grafts accumulated comparable small amounts of platelets. Prostacyclin was then infused in a second series of baboons with Dacron grafts, at a rate of 150 to 200 ng/kg/min. It prevented the usual platelet uptake when administered concomitant with graft implantation and reduced previously established platelet activity.

  1. A Novel Technique of Preserving Internal Mammary Artery Perforators in Nipple Sparing Breast Reconstruction

    PubMed Central

    Swistel, Alexander; Small, Kevin; Dent, Briar; Cohen, Oriana; Devgan, Lara

    2014-01-01

    Summary: As nipple-sparing mastectomy with implant-based reconstruction has increased, attention must be paid to the viability of the nipple-areolar complex. This article describes the use of preoperative Doppler ultrasound to identify the internal mammary artery perforators. Preserving the internal mammary artery improves vascular supply to the nipple-areolar complex. PMID:25426381

  2. The Same Angiographic Factors Predict Venous and Arterial Graft Patency

    PubMed Central

    Gaudino, Mario; Niccoli, Giampaolo; Roberto, Marco; Cammertoni, Federico; Cosentino, Nicola; Falcioni, Elena; Panebianco, Mario; DAmario, Domenico; Crea, Filippo; Massetti, Massimo

    2016-01-01

    Abstract To evaluate the value of angiographic factors in predicting failure of both venous and arterial coronary artery bypass graft. We retrieved from our angiographic database 148 patients who underwent venous and/or arterial CABG and for whom a control coronary angiography at more than 1 month after surgery was available. Pre-CABG and follow-up angiographies were analyzed in order to evaluate diameter stenosis (DS,%), stenosis length (mm), Bogaty score (extent index), Sullivan score, and Gensini score for the extent of coronary artery disease, and Jeopardy Duke score for the extent of myocardial area supplied by an artery. Thirty-nine patients (26%) experienced graft failure at follow-up (mean follow-up 11.3??4.6 months). Patients with venous graft failure [26 (20%)] had significantly smaller DS (P?=?0.013), shorter stenosis length (P?=?0.01), and lower extent index (P?=?0.015), Sullivan score (P?=?0.013), Gensini score (P?=?0.04) as compared with those without venous graft failure. Patients with arterial graft failure [13 (11%)] had significantly lower DS (P?=?0.008), shorter stenosis length (P?=?0.001), and lower extent index (P?=?0.03) and Sullivan score (P?=?0.023) as compared with those without arterial graft failure. Venous and arterial graft failure are associated with less severe stenosis and less extensive atherosclerosis of the grafted vessel. PMID:26735525

  3. [Vaso-reactive properties of radial and internal mammary arteries: application to coronary bypass surgery].

    PubMed

    Chardigny, C; Jebara, V; Descombes, J J; Acar, C; Verbeuren, T; Fabiani, J N

    1994-09-01

    Satisfactory results were obtained with the radial artery used as a conduit for coronary artery bypass. However, spasm of this conduit was observed. Human radial and internal mammary artery ring segments were studied in organ chambers. Potassium chloride, norepinephrine, serotonin and thromboxane A2 mimetic were used to obtain dose-response curves, permitting assessment of force of contraction and sensitivity. The radial artery presents stronger contractions than the internal mammary artery. The two vessels have equal sensitivity to the vasoconstrictors used. These data emphasize the hyperreactivity of the radial artery and the need for prevention of vasospasm when this vessel is used as a conduit for coronary artery bypass. PMID:7646232

  4. Detection of Helicobacter pylori DNA in aortic and left internal mammary artery biopsies.

    PubMed

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

    2008-01-01

    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. PMID:18612444

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

    PubMed Central

    Wilson, J M; Ferguson, J J

    1995-01-01

    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). PMID:7647598

  6. Use of cryopreserved cadaveric arterial allograft as a vascular conduit for peripheral arterial graft infection

    PubMed Central

    Kwon, Hyojeong; Kwon, Hyunwook; Hong, Joon Pio; Han, Youngjin; Park, Hojong; Song, Gi-Won; Kwon, Tae-Won

    2015-01-01

    Major peripheral arterial graft infection is a potentially devastating complication of vascular surgery, associated with significant mortality and high amputation rates. Autologous saphenous veins are considered optimal arterial conduits for lower extremity revascularization in infected fields, but they are often unavailable or unsuitable in these patients. This study describes two patients with major peripheral graft infection, but without available autologous veins, who underwent graft excision and cryopreserved cadaveric arterial allograft reconstruction. Although long-term graft durability is unclear because of gradual deterioration and degeneration, these findings suggest that cadaveric allografts may be good options for patients with major peripheral graft infection. PMID:26131446

  7. One-Year Patency of Valvulotomized Vein Grafts Is Similar to That of Arterial Grafts.

    PubMed

    Monsefi, Nadejda; Zierer, Andreas; Honarpisheh, Gazal; Bauer, Ralf; Kerl, Matthias; Beiras-Fernandez, Andres; Moritz, Anton

    2016-04-01

    Background Inferior vein graft patency after coronary artery bypass grafting (CABG) is attributed to various factors. Venous valves may limit flow, cause thrombus formation, and diminish diastolic backflow. The aim of our study was to compare clinical outcome and midterm patency rate of valvulotomized vein grafts and arterial grafts in patients undergoing CABG. Methods Between 2007 and 2010, valvulotomized saphenous vein segments were used to graft the right coronary artery (RCA) in 147 patients undergoing CABG with mean 2.8 ± 1 arterial and 1.5 ± 0.6 venous anastomoses. Outcome, reintervention, and reoperation were assessed after 4 ± 1.6 years. Intraoperative bypass flow rate was measured before and after valvulotomy of venous bypass grafts in 12 patients. Patency of the grafts was assessed by means of multislice computed tomography (MSCT) in 45 patients. Results A total of 102 patients underwent isolated CABG and 45 had combined procedures. In-hospital mortality was 2%. At 4 years' clinical follow-up, 95% of the patients were asymptomatic. Five patients underwent recoronary angiography because of angina pectoris. The MSCT and reangiography patency rate of all valvulotomized saphenous vein grafts was 97.1 versus 95.8% of arterial grafts 18 ± 6 months postoperatively. Intraoperative measurements showed a significant increase (+20.2 mL/min; p = 0.01) of flow in the venous bypass grafts to the RCA after valvulotomy. There were no reoperations at the latest follow-up. Conclusion Patients with valvulotomized venous grafts had good clinical outcome. The one-year patency rate of those grafts is comparable to that of arterial grafts. However, long-term results and angiography studies will be needed to strengthen these findings. PMID:25866977

  8. Surgical management for large chest keloids with internal mammary artery perforator flap*

    PubMed Central

    Xue, Dan; Qian, Huan

    2016-01-01

    Therapy for large symptomatic keloids is often plagued with complicated reconstruction manner and recurrence. This article reports a rare treatment combination for a chest keloid with internal mammary artery perforator flap reconstruction and radiation therapy. We excised the keloid and covered the defect with an internal mammary artery perforator flap. Immediate electron-beam irradiation therapy was applied on the second postoperative day. There was no sign of recurrence over the follow-up period of 18 months. The combination of internal mammary artery perforator flap and immediate radiation therapy is useful when faced with chest keloids of similar magnitude and intractability. PMID:26982790

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

    PubMed

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

    2014-05-01

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

  10. Staged Management of a Ruptured Internal Mammary Artery Aneurysm

    PubMed Central

    Kwon, O Young; Kim, Gun Jik; Oh, Tak Hyuk; Lee, Young Ok; Lee, Sang Cjeol; Cho, Jun Yong

    2016-01-01

    The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture. PMID:27066438

  11. Remote ischaemic preconditioning for coronary artery bypass grafting

    PubMed Central

    Benstoem, Carina; Stoppe, Christian; Liakopoulos, Oliver J; Meybohm, Patrick; Clayton, Tim C; Yellon, Derek M; Hausenloy, Derek J; Goetzenich, Andreas

    2015-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the benefits and harms of remote ischaemic preconditioning in patients undergoing coronary artery bypass grafting, with or without valve surgery.

  12. POST CORONARY ARTERY BYPASS GRAFT STUDY (CABG)

    EPA Science Inventory

    Relative effectiveness of moderate versus more aggressive lipid lowering, and of low dose anticoagulation versus placebo, in delaying saphenous vein coronary bypass graft atherosclerosis and preventing occlusion of saphenous grafts of patients with saphenous vein coronary bypass ...

  13. Explant pathology study of decellularized carotid artery vascular grafts.

    PubMed

    Hilbert, Stephen L; Boerboom, Lawrence E; Livesey, Stephen A; Ferrans, Victor J

    2004-05-01

    The purpose of this study was to evaluate the morphologic findings in small-diameter freeze-dried decellularized carotid artery grafts implanted in goats as carotid artery interposition grafts for 6-7 months. Unimplanted decellularized carotid artery grafts did not contain intact cells; however, remnants of smooth muscle cells were present in the media. The extracellular matrix was well preserved. All decellularized grafts were patent at explant, without significant dimensional changes or aneurysm formation. Their luminal surfaces were lined by a thin neointima, consisting of myofibroblasts, collagen, and a discontinuous layer of endothelial cells. Histologic evidence of calcification within the explants was not observed; however, electron microscopy showed calcification of minute remnants of cell membranes. Inflammatory cells were not present in the graft wall. Host cell migration was greatest in the adventitia along the length of the graft. Migration of host cells into the media was more apparent close to the anastomoses, forming cellular nests rich in extracellular proteoglycans, whereas cell migration into areas subjacent to the lumen was minimal. Ingrowth of host blood vessels was not observed. These results demonstrate satisfactory structural and morphologic features of a decellularized carotid artery small-diameter graft implanted for up to 7 months. PMID:15057992

  14. Superior epigastric artery pseudoaneurysm- a rare complication of chest drain insertion in coronary artery bypass grafting

    PubMed Central

    Sadat, Umar; Jah, Asif; Ward, Nick; Gaunt, Michael

    2007-01-01

    Background Although chest drain insertion during coronary artery bypass grafting is a fairly standard procedure, however it may result in extremely rare complications. Case presentation This is the first case being reported that demonstrates a pseudoaneurysm of superior epigastric artery resulting from chest drain insertion following coronary artery bypass grafting. Conclusion Adequate caution should be used along with good understanding of the anatomical landmarks during apparently simple and standard operative procedures. PMID:17459158

  15. 99mTc-MDP bone SPECT for the evaluation of sternal ischaemia following internal mammary artery dissection.

    PubMed

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

    2002-01-01

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

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

    SciTech Connect

    Clevert, D.-A. Stickel, M.; Steitz, H.-O.; Kopp, R.; Strautz, T.; Flach, P.; Johnson, T.; Jung, E.M.; Jauch, K.W.; Reiser, M.

    2007-02-15

    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.

  17. Factors influencing acute thrombus formation on carotid artery vascular grafts

    SciTech Connect

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

    1988-10-01

    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.

  18. Off-pump coronary artery bypass grafting in patients with mirror-imaging dextrocardia.

    PubMed

    Yuan, Xin; Sun, Hansong; Wang, Xianqiang

    2015-08-01

    Dextrocardia requires alterations in techniques during coronary artery bypass graft (CABG) surgery. We report two cases undergoing off-pump coronary artery bypass graft (OPCAB) surgery and discuss techniques for the operative management of these patients. PMID:26059016

  19. Off-pump minimally invasive coronary artery bypass grafting using the bilateral internal thoracic arteries and the right gastroepiproic artery.

    PubMed

    Kikuchi, Keita; Une, Dai; Kurata, Atsushi; Ruel, Marc

    2016-04-01

    We report our initial experience of an off-pump total arterial minimally invasive coronary arterial bypass grafting (MICS CABG) with the use of bilateral internal thoracic arteries (BITA) and the right gastroepiproic artery. A 47-year old male with renal dysfunction secondary to diabetes mellitus was admitted for heart failure due to severe triple-vessel disease. Off-pump MICS CABG with total arterial grafts was elected because the patient refused to undergo median sternotomy due to the strong desire to regain the baseline function promptly. Total arterial grafts were selected to maximize the potential long-term outcome. There were no postoperative complications except temporary dialysis. Postoperative coronary computed tomography revealed the patency of all grafts. Our experience suggests that BITA can be safely harvested under direct vision in MICS CABG. Total arterial graft revascularization with BITA via minimally invasive approach may offer the benefits of MICS CABG while providing the undetermined but potentially superior conduit longevity of arterial grafts. PMID:26369344

  20. Off-pump coronary artery bypass grafting as re-do surgery in two cases in which the right gastroepiploic artery was grafted to the right coronary artery.

    PubMed

    Mizoguchi, Hiroki; Sakaki, Masayuki; Inoue, Kazushige; Kobayashi, Yasuhiko; Iwata, Takashi; Suehiro, Yasuo; Nishibayashi, Akimitsu

    2011-01-01

    Transdiaphragmatic off-pump coronary artery bypass grafting (OPCAB) to the right coronary artery, is an effective way to reduce the risks of second bypass surgery as well as the risk of graft injury after coronary artery bypass grafting (CABG). We report two cases of successful OPCAB as re-do surgery in which the right gastroepiploic artery (RGEA) was grafted to the right coronary artery. The first case was a 58-year-old woman, who underwent CABG 10 years ago. OPCAB (RGEA to right coronary artery) was performed since myocardial perfusion scintigraphy revealed ischemia in the inferior wall. The second case was a 67-year-old man who had hypertension, hyperlipidemia, peripheral arterial disease, and was undergoing dialysis (for 6 years). Six years previously, he developed a mycotic aneurysm of the right coronary artery and underwent open-heart surgery. He often had episodes of angina at night or during dialysis, and then developed congestive heart failure and was hospitalized. Since ischemia was considered to be in the inferior wall, the RGEA was grafted to the right coronary artery. PMID:21881364

  1. Improving coronary artery bypass graft durability: use of the external saphenous vein graft support.

    PubMed

    Ferrari, Enrico; von Segesser, Ludwig; Berdajs, Denis

    2015-01-01

    Coronary bypass grafting remains the best option for patients suffering from multivessel coronary artery disease, and the saphenous vein is used as an additional conduit for multiple complete revascularizations. However, the long-term vein graft durability is poor, with almost 75% of occluded grafts after 10 years. To improve the durability, the concept of an external supportive structure was successfully developed during the last years: the eSVS Mesh device (Kips Bay Medical) is an external support for vein graft made of weft-knitted nitinol wire into a tubular form with an approximate length of 24 cm and available in three diameters (3.5, 4.0 and 4.5 mm). The device is placed over the outer wall of the vein and carefully deployed to cover the full length of the graft. The mesh is flexible for full adaptability to the heart anatomy and is intended to prevent kinking and dilatation of the vein in addition to suppressing the intima hyperplasia induced by the systemic blood pressure. The device is designed to reduce the vein diameter of about 15-20% at most to prevent the vein radial expansion induced by the arterial blood pressure, and the intima hyperplasia leading to the graft failure. We describe the surgical technique for preparing the vein graft with the external saphenous vein graft support (eSVS Mesh) and we share our preliminary clinical results. PMID:25976117

  2. Hydrogel-electrospun mesh composites for coronary artery bypass grafts.

    PubMed

    McMahon, Rebecca E; Qu, Xin; Jimenez-Vergara, Andrea Carolina; Bashur, Chris A; Guelcher, Scott A; Goldstein, Aaron S; Hahn, Mariah S

    2011-04-01

    The aim of the present study was to investigate the potential of hydrogel-electrospun mesh hybrid scaffolds as coronary artery bypass grafts. The circumferential mechanical properties of blood vessels modulate a broad range of phenomena, including vessel stress and mass transport, which, in turn, have a critical impact on cardiovascular function. Thus, coronary artery bypass grafts should mimic key features of the nonlinear stress-strain behavior characteristic of coronary arteries. In native arteries, this J-shaped circumferential stress-strain curve arises primarily from initial load transfer to low stiffness elastic fibers followed by progressive recruitment and tensing of higher stiffness arterial collagen fibers. This nonlinear mechanical response is difficult to achieve with a single-component scaffold while simultaneously meeting the suture retention strength and tensile strength requirements of an implantable graft. For instance, although electrospun scaffolds have a number of advantages for arterial tissue engineering, including relatively high tensile strengths, tubular mesh constructs formed by conventional electrospinning methods do not generally display biphasic stress-strain curves. In the present work, we demonstrate that a multicomponent scaffold comprised of polyurethane electrospun mesh layers (intended to mimic the role of arterial collagen fibers) bonded together by a fibrin hydrogel matrix (designed to mimic the role of arterial elastic fibers) results in a composite construct which retains the high tensile strength and suture retention strength of electrospun mesh but which displays a J-shaped mechanical response similar to that of native coronary artery. Moreover, we show that these hybrid constructs support cell infiltration and extracellular matrix accumulation following 12-day exposure to continuous cyclic distension. PMID:21083438

  3. Endovascular Stent-Grafting for Infected Iliac Artery Pseudoaneurysms

    SciTech Connect

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

    2005-01-15

    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.

  4. Left Lobe Recurrent Hepatocellular Carcinoma Treated with Lipiodol-TAE via the Left Internal Mammary Artery

    SciTech Connect

    Kanetsuki, Ichiro; Hori, Akira; Ohshiro, Kiyoshi; Nishi, Hirokazu; Yasutani, Tadashi; Sueyoshi, Takeshi; Tanaka, Hitoshi

    1997-09-15

    A multinodular hepatocellular carcinoma (HCC) was treated with seven transarterial interventions via the hepatic artery over a 2-year, 5-month period before the eighth angiography showed a recurrent HCC in the anterior portion of the left hepatic lobe. The left internal mammary artery (IMA) was feeding the tumor. This was successfully treated with Lipiodol-transcatheter arterial embolization using a coaxial system via a branch of the left IMA. No complications resulted from the procedure. The left IMA should be considered as a possible feeding artery to an HCC occurring in the anterior portion of the left hepatic lobe.

  5. In vitro effects of sodium nitroprusside and leptin on norepinephrine-induced vasoconstriction in human internal mammary artery

    PubMed Central

    Burma, Oktay; Uysal, Ayhan; Ozcan, Mete; Kacar, Emine; Şahna, Engin; Ayar, Ahmet

    2015-01-01

    Summary Aim The biological and pharmacological properties of vessels used in coronary artery bypass graft (CABG) surgery are as important as their mechanical properties. The aim of this study was to investigate the possible role of protein kinase C (PKC)-dependent mechanisms in leptin-induced relaxation in the human internal mammary artery (IMA). Methods IMA rings, obtained from patients undergoing CABG surgery, were suspended in isolated tissue baths containing Krebs-Henseleit solution, which were continuously gassed with 95% O2 and 5% CO2 at 37°C. Results The IMA rings were pre-contracted with increasing concentrations of norepinephrine (NE 10-9–10-4 mol/l) and the relaxation responses to sodium nitroprusside (SNP), a nitrosovasodilator, and leptin were studied in the presence and absence of a PKC inhibitor. Leptin (1 μM) caused a dose-dependent relaxation in NE pre-contracted IMA rings. Pre-treatment with a PKC inhibitor significantly attenuated this vasorelaxatory response to leptin in human isolated IMA. Conclusion It was found that SNP and leptin caused significant relaxation of the NE pre-contracted human IMA rings, and PKC was probably the sub-cellular mediator for this effect. Our findings may have clinical or pharmacological importance as it could be hypothesised that obese subjects who have a left IMA bypass graft would have better myocardial perfusion. PMID:25787668

  6. Upright bicycle exercise echocardiography after coronary artery bypass grafting.

    PubMed

    Sawada, S G; Judson, W E; Ryan, T; Armstrong, W F; Feigenbaum, H

    1989-11-15

    Upright bicycle exercise echocardiography and coronary angiography were performed in 42 patients from 1 month to 15 years (mean 6.3 years) after coronary artery bypass grafting (CABG) to determine if exercise-induced wall motion abnormalities could be correlated with the presence and location of nonrevascularized vessels. Nonrevascularized vessels were defined as obstructed vessels without grafts, obstructed grafts or native vessels obstructed distal to bypass graft insertion. Adequate quality echocardiograms were recorded at rest, peak exercise and after exercise in 38 patients (90%). Rest and postexercise echocardiograms were adequate in 3 others. Only 1 patient was excluded from analysis for inadequate peak and postexercise echocardiograms. Exercise-induced wall motion abnormalities were present in 33 of 35 patients (94%) who had 1 or more nonrevascularized vessels and these abnormalities were absent in 5 of 6 (83%) who had all vessels revascularized. Wall motion abnormalities were localized to the territory of the left anterior descending (LAD) artery or to a combined right (R) coronary-left circumflex (LC) region of circulation. Exercise-induced wall motion abnormalities were present in 24 of 27 LAD artery regions (89%) and 23 of 26 R-LC regions (88%) that had nonrevascularized vessels. These abnormalities were absent in 13 of 14 LAD regions (93%) and in 12 of 15 R-LC regions (80%) that had only revascularized vessels. Upright bicycle exercise echocardiography was successfully performed after CABG. The technique detected and accurately localized nonrevascularized and revascularized vessels. PMID:2683711

  7. Development of small diameter nanofiber tissue engineered arterial grafts.

    PubMed

    Kurobe, Hirotsugu; Maxfield, Mark W; Tara, Shuhei; Rocco, Kevin A; Bagi, Paul S; Yi, Tai; Udelsman, Brooks; Zhuang, Zhen W; Cleary, Muriel; Iwakiri, Yasuko; Breuer, Christopher K; Shinoka, Toshiharu

    2015-01-01

    The surgical repair of heart and vascular disease often requires implanting synthetic grafts. While synthetic grafts have been successfully used for medium-to-large sized arteries, applications for small diameter arteries (<6 mm) is limited due to high rates of occlusion by thrombosis. Our objective was to develop a tissue engineered vascular graft (TEVG) for small diameter arteries. TEVGs composed of polylactic acid nanofibers with inner luminal diameter between 0.5 and 0.6 mm were surgically implanted as infra-renal aortic interposition conduits in 25 female C17SCID/bg mice. Twelve mice were given sham operations. Survival of mice with TEVG grafts was 91.6% at 12 months post-implantation (sham group: 83.3%). No instances of graft stenosis or aneurysmal dilatation were observed over 12 months post-implantation, assessed by Doppler ultrasound and microCT. Histologic analysis of explanted TEVG grafts showed presence of CD31-positive endothelial monolayer and F4/80-positive macrophages after 4, 8, and 12 months in vivo. Cells positive for α-smooth muscle actin were observed within TEVG, demonstrating presence of smooth muscle cells (SMCs). Neo-extracellular matrix consisting mostly of collagen types I and III were observed at 12 months post-implantation. PCR analysis supports histological observations. TEVG group showed significant increases in expressions of SMC marker, collagen-I and III, matrix metalloproteinases-2 and 9, and itgam (a macrophage marker), when compared to sham group. Overall, patency rates were excellent at 12 months after implantation, as structural integrity of these TEVG. Tissue analysis also demonstrated vessel remodeling by autologous cell. PMID:25830942

  8. Development of Small Diameter Nanofiber Tissue Engineered Arterial Grafts

    PubMed Central

    Tara, Shuhei; Rocco, Kevin A.; Bagi, Paul S.; Yi, Tai; Udelsman, Brooks; Zhuang, Zhen W.; Cleary, Muriel; Iwakiri, Yasuko; Breuer, Christopher K.; Shinoka, Toshiharu

    2015-01-01

    The surgical repair of heart and vascular disease often requires implanting synthetic grafts. While synthetic grafts have been successfully used for medium-to-large sized arteries, applications for small diameter arteries (<6 mm) is limited due to high rates of occlusion by thrombosis. Our objective was to develop a tissue engineered vascular graft (TEVG) for small diameter arteries. TEVGs composed of polylactic acid nanofibers with inner luminal diameter between 0.5 and 0.6 mm were surgically implanted as infra-renal aortic interposition conduits in 25 female C17SCID/bg mice. Twelve mice were given sham operations. Survival of mice with TEVG grafts was 91.6% at 12 months post-implantation (sham group: 83.3%). No instances of graft stenosis or aneurysmal dilatation were observed over 12 months post-implantation, assessed by Doppler ultrasound and microCT. Histologic analysis of explanted TEVG grafts showed presence of CD31-positive endothelial monolayer and F4/80-positive macrophages after 4, 8, and 12 months in vivo. Cells positive for α-smooth muscle actin were observed within TEVG, demonstrating presence of smooth muscle cells (SMCs). Neo-extracellular matrix consisting mostly of collagen types I and III were observed at 12 months post-implantation. PCR analysis supports histological observations. TEVG group showed significant increases in expressions of SMC marker, collagen-I and III, matrix metalloproteinases-2 and 9, and itgam (a macrophage marker), when compared to sham group. Overall, patency rates were excellent at 12 months after implantation, as structural integrity of these TEVG. Tissue analysis also demonstrated vessel remodeling by autologous cell. PMID:25830942

  9. Patients Perception About Coronary Artery Bypass Grafting

    PubMed Central

    Mendona, Kelminda Maria Bulhes; de Andrade, Tarcisio Matos

    2015-01-01

    OBJECTIVE The diagnosis of coronary artery disease referred for heart surgery has an important psychological component. The purpose of this study was to access the difficulties experienced by individuals awaiting coronary artery bypass grafting and to determine strategies that facilitate adaptation to a new lifestyle, modified by the disease. METHODS A qualitative, exploratory study involving patients admitted to a university teaching hospital in the city of Salvador, Bahia, Brazil, awaiting coronary artery bypass grafting. Semi-structured interviews were performed in accordance with a previously defined script based on the study objective. Each transcription was read in its entirety to verify the representativeness, homogeneity and pertinence of the data obtained (pre-analysis), followed by separation of categories of analysis. RESULTS The descriptions of this study show that patients admitted to the completion of coronary artery bypass grafting experience a wide range of psychological difficulties, considering that surgery acquires interpretations that vary according to individuals' subjectivity. The patients recognized the benefit of being able to discuss their feelings as a means of diminishing their fear and anxiety. CONCLUSION Helping patients find resources to confront more positively the daily hospitalization is an important aspect for the health care professionals who assist them. This goal can be achieved through modification of the biomedical model of care for a biopsychosocial view. The investment of time and attention is of fundamental importance and aims to overcome existing deficiencies that interfere with the outcome of patients after cardiac surgery. PMID:26735601

  10. Immunocytochemical features of obstructed saphenous vein coronary artery bypass grafts.

    PubMed Central

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

    1989-01-01

    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 PMID:2659629

  11. Coronary artery bypass grafting in a patient with gout arthritis

    PubMed Central

    Ugurlucan, Murat; Filizcan, Ugur; Caglar, Ilker Murat; Zencirci, Ertugrul; Kaya, Erhan; Es, Mehmet Ugur; Gurol, Tayfun; Yildiz, Yahya

    2012-01-01

    Ischemic heart disease is accepted as the most common cause of mortality and morbidity nearly all over the world. Gout disease is the most common condition of inflammatory arthritis among the adult population. Literature includes limited information about the treatment strategies when both the conditions coexist. In this report, we present the case report of a 63 year old male patient with the diagnosis of Gout arthritis who underwent a coronary artery bypass grafting procedure successfully. PMID:22346148

  12. External iliac artery polytetrafluoroethylene graft interposition: An effective rescuer for kidney transplant in progressive intimal dissection of external iliac artery

    PubMed Central

    Dar, Tanveer Iqbal; Tyagi, Vipin; Khawaja, Abdul Rouf; Chadha, Sudhir; Jauhari, Harsha

    2016-01-01

    Aims and Objective: The aim of this study is to highlight the use of polytetrafluoroethylene (PTFE) interposition graft as an important salvage procedure in case of irreparable intimal injury of external iliac artery during renal transplant recipient surgery. Materials and Methods: Since 1987, we encountered irreparable intimal dissection of external iliac artery in five cases just after opening the clamp. It was successfully managed by PTFE interposition graft with subsequent end to side anastomosis of donor renal artery to the vascular graft. Results: No patient had bleeding or infective complications related to the graft and three patients had immediate diuresis. Normal immediate graft function was present in three patients while the other two had delayed graft function. Conclusion: Polytetrafluoroethylene interposition graft is a successful procedure to salvage the kidney and lower limb in case of progressive intimal dissection of external iliac artery during renal transplant surgery.

  13. Management of a Left Internal Thoracic Artery Graft Injury during Left Thoracotomy for Thoracic Surgery.

    PubMed

    Oates, Matthew; Yadav, Sumit; Saxena, Pankaj

    2016-07-01

    There have been some recent reports on the surgical treatment of lung cancer in patients following previous coronary artery bypass graft surgery. Use of internal thoracic artery graft is a gold standard in cardiac surgery with superior long-term patency. Left internal thoracic artery graft is usually patent during left lung resection in patients who present to the surgeon with an operable lung cancer. We have presented our institutional experience with left-sided thoracic surgery in patients who have had previous coronary artery surgery with a patent internal thoracic artery graft. PMID:26907619

  14. Vein Graft Preservation Solutions, Patency, and Outcomes After Coronary Artery Bypass Graft Surgery

    PubMed Central

    Harskamp, Ralf E.; Alexander, John H.; Schulte, Phillip J.; Brophy, Colleen M.; Mack, Michael J.; Peterson, Eric D.; Williams, Judson B.; Gibson, C. Michael; Califf, Robert M.; Kouchoukos, Nicholas T.; Harrington, Robert A.; Ferguson, T. Bruce; Lopes, Renato D.

    2015-01-01

    IMPORTANCE In vitro and animal model data suggest that intraoperative preservation solutions may influence endothelial function and vein graft failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical studies to validate these findings are lacking. OBJECTIVE To evaluate the effect of vein graft preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery. DESIGN, SETTING, AND PARTICIPANTS Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003, were used. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts. INTERVENTIONS Preservation of vein grafts in saline, blood, or buffered saline solutions. MAIN OUTCOMES AND MEASURES One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization. RESULTS Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. One-year VGF rates were much lower in the buffered saline group than in the saline group (patient-level odds ratio [OR], 0.59 [95% CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95% CI, 0.49-0.79; P < .001]) or the blood group (patient-level OR, 0.62 [95% CI, 0.46-0.83; P = .001]; graft-level OR, 0.63 [95% CI, 0.48-0.81; P < .001]). Use of buffered saline solution also tended to be associated with a lower 5-year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64-1.02; P = .08]) and blood (0.81 [0.63-1.03; P = .09]) solutions. CONCLUSIONS AND RELEVANCE Patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and trends toward better long-term clinical outcomes compared with patients whose grafts were preserved in saline- or blood-based solutions. PMID:25073921

  15. Racial Disparities in Outcomes Following Coronary Artery Bypass Grafting

    PubMed Central

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

    2013-01-01

    More than 12 million people in the United States have coronary heart disease, the second leading cause of hospitalization in the United States. It is known that persons within racial minorities, specifically African Americans, have a higher prevalence of coronary heart disease, yet are much less likely to undergo invasive cardiac treatment interventions. An invasive intervention commonly used to treat coronary heart disease is coronary artery bypass grafting, with over 140,000 operations performed annually in the United States. However, blacks are known to experience higher post–coronary artery bypass graft morbidity and mortality. The causes for racial disparities in post–coronary artery bypass graft outcomes are not well known but may include factors related to the individual, provider, system, and society/environment, either alone or in combination. The purpose of this article is to provide an overview of the literature regarding disparities in the health and healthcare of black patients with coronary heart disease with respect to CABG, and examine potential hypotheses for variant outcomes after surgery. PMID:16966914

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

    SciTech Connect

    Lenton, James; Davies, John; Homer-Vanniasinkam, S.; McPherson, Simon

    2008-09-15

    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.

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

    PubMed Central

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

    2013-01-01

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

  18. Post-Coronary Artery Bypass Grafting Myocardial Ischemia Caused by an Overgrown Left Internal Thoracic Artery Side Branch

    PubMed Central

    Kim, Eung Re; Oh, Se Jin; Kang, Hyun-Jae; Kim, Ki-Bong

    2014-01-01

    We present a patient who developed recurrent angina after coronary artery bypass grafting (CABG). Myocardial single-photon emission computed tomography (SPECT) demonstrated deterioration in the myocardial perfusion, and coronary angiography revealed an overgrown side branch of the grafted left internal thoracic artery (ITA); otherwise, there were no significant changes compared with previous imaging studies obtained after the CABG. After percutaneous embolization of the grafted left ITA side branch, the angina was resolved and myocardial SPECT showed improved perfusion. PMID:25346902

  19. Intercostal thorascopic harvesting of the internal mammary artery for supercharging a pedicled rectus abdominis flap.

    PubMed

    Kaddoura, I L; Hashim, H; Kayle, D; Shabb, B

    1998-06-01

    Thorascopic harvesting of the internal mammary artery for supercharging the rectus abdominis pedicled flap for breast reconstruction is presented. The procedure was carried on a woman who had previously undergone a mastectomy and who was obese and a diabetic. The patient underwent a "high" flap delay 2 weeks earlier. At the time of operative transfer and setting, the flap's vascularity was found to be compromised. Instead of turbocharging the deep inferior epigastric pedicle to the irradiated axillary vessels, it was possible to harvest and utilize the internal mammary artery without rib resection for the supercharging, thus saving the flap and reconstruction. The technical aspects, and possible advantages and disadvantages of such a procedure are discussed. PMID:9641287

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

    SciTech Connect

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

    2005-01-15

    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.

  1. Improvement of Ejection Fraction After Coronary Artery Bypass Grafting Surgery in Patients with Impaired Left Ventricular Function

    PubMed Central

    Haxhibeqiri-Karabdic, Ilirijana; Hasanovic, Aida; Kabil, Emir; Straus, Slavenka

    2014-01-01

    ABSTRACT Objectives: The present study evaluates our experience with aorto-coronary bypass grafting in patients with severe dysfunction of left ventricle (LV) and low ejection fraction-EF(<35%). Revascularization of myocardium in this settings remains contraversial because of concerns over morbidity, mortality and quality of life. Material and Methodes: Forty patients with severe coronary artery disease and dysfunction of LV (low ejection fraction <35%) underwent coronary artery bypass grafting in period of 3 years. Preoperative diagnostic of 40 patients was consisted of anamnesis, clinical exam, non-invasive methods EHO, MR and invasive diagnostic methods-cateterization. The major indication for surgery was severe anginal pain, heart failure symptoms and low ejection fraction. Internal mammary artery was used in all operated patients. Results: Average age of patients who have been operated was 59,8. In the present study, 81,3% were male and 18,8% female. We found one-vessel disease present in 2,5% (1/40) of patients, two -vessel disease in 40% (16/40), three-vessel disease in 42,5% (17/40) and four -vessel disease in 15% (6/40) of patients. One bypass grafting we implanted in 2,5% patients, two bypasses in 42,5%, three bypasses in 45 5%, and four bypasses in 10% of patients. Left ventricular ejection fraction assessed preoperativly was 18%-27% and postoperatively was improved to 31, 08% in period of 30 days. Conclusion: In patients with left ventricular dysfunction, coronary artery bypass grafting can be performed safely with improvement in quality of life and in left ventricular ejection fraction. PMID:25568566

  2. Glycemic Control during Coronary Artery Bypass Graft Surgery

    PubMed Central

    Lazar, Harold L.

    2012-01-01

    Hyperglycemia, which occurs in the perioperative period during cardiac surgery, has been shown to be associated with increased morbidity and mortality. The management of perioperative hyperglycemia during coronary artery bypass graft surgery and all cardiac surgical procedures has been the focus of intensive study in recent years. This report will paper the pathophysiology responsible for the detrimental effects of perioperative hyperglycemia during cardiac surgery, show how continuous insulin infusions in the perioperative period have improved outcomes, and discuss the results of trials designed to determine what level of a glycemic control is necessary to achieve optimal clinical outcomes. PMID:23209941

  3. Laparoscopic gastrectomy after coronary artery bypass grafting using the right gastroepiploic artery: a report of two cases.

    PubMed

    Kawamura, Hideki; Takahashi, Norihiko; Tahara, Munenori; Takahashi, Masahiro; Taketomi, Akinobu

    2014-08-01

    We successfully executed laparoscopic distal gastrectomy in two patients who had previously undergone coronary artery bypass grafting using the right gastroepiploic artery (RGEA). A laparoscopic distal gastrectomy preserving the RGEA graft with Roux-en-Y reconstruction was performed on two men, one 69 years of age and one 73 years of age. In both cases, the RGEA was used during coronary artery bypass grafting for the posterior descending branch. The laparoscopic approach helped avoid injury to the RGEA associated with laparotomy and retractor placement. In addition, the locations of ports necessary for laparoscopy were situated away from the RGEA graft and from adhesions resulting from bypass. Using typical laparoscopic settings, we were able to easily identify the grafted RGEA. Thus, laparoscopic distal gastrectomy is not only less invasive than open gastrectomy procedures, but it is also associated with a lower risk of injury to the RGEA graft. PMID:25131322

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

    PubMed

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

    2013-03-01

    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

  5. Emergency Coronary Artery Bypass Graft Surgery for Iatrogenic Left Main Coronary Artery Dissection

    PubMed Central

    Tarbiat, Masoud; Safarpoor, Gholamreza

    2015-01-01

    Iatrogenic coronary artery dissection during coronary angiography with or without rupture is a rare but feared complication. We herein report a case of iatrogenic left main coronary artery dissection in a 49-year-old female. Admitted to our hospital with a recent history of severe hypotension, she develpled apnea during angiography. She was intubated and resuscitated with an Epinephrine infusion in the Cath-Lab. The diagnosis was iatrogenic left main coronary artery dissection based on angiography. Immediately, the patient was transferred to the operating room in a lethargic state with an Epinephrine infusion and prepared for emergency coronary artery bypass graft surgery. In the ICU, she was completely alert with no hemodynamic complications and finally was discharged in a good overall condition. At 18 months' follow-up, the patient was in a stable situation with good daily function. PMID:26985212

  6. Treatment of a Hepatic Artery Aneurysm by Endovascular Stent-Grafting

    SciTech Connect

    Jenssen, Guttorm L. Wirsching, Jan; Pedersen, Gustav; Amundsen, Svein Roar; Aune, Steinar; Dregelid, Einar; Jonung, Torbjorn; Daryapeyma, Alireza; Laxdal, Elin

    2007-06-15

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

  7. Spontaneous Rupture of the Superficial Femoral Artery Treated with Endovascular Stent-Grafting

    SciTech Connect

    Ramus, James R. Gibson, Matthew; Magee, Timothy; Torrie, Peter

    2007-09-15

    Spontaneous rupture of the superficial femoral artery (SFA) is rare. It may occur in the presence of an SFA aneurysm or in a nonaneurysmal, but usually atherosclerotic, artery. Previously these ruptures have been treated by surgical exclusion, often with bypass grafting. We report a case of spontaneous rupture of a nonaneurysmal SFA treated successfully with endovascular stent-grafting.

  8. Tracheo-innominate artery fistula successfully treated by endovascular stent-graft repair.

    PubMed

    Nakai, Motoki; Sato, Hirotatsu; Sato, Morio; Ikoma, Akira; Sanda, Hiroki; Nakata, Kohei; Minamiguchi, Hiroki; Kawai, Nobuyuki; Sonomura, Tetsuo; Nishimura, Yoshiharu; Okamura, Yoshitaka

    2013-01-01

    We report two patients who developed a tracheo-innominate artery fistula (TIF) after tracheostomy. Contrast-enhanced computed tomography revealed a pseudoaneurysm of the innominate artery protruding into the trachea. Stent grafts were deployed for the innominate artery via two different access routes: the transfemoral approach and the right carotid artery approach. Endovascular stent-graft repair resulted in complete exclusion of the TIF and control of the bleeding from the tracheal stoma. At 12- and 16-month follow-ups, neither patient had clinical signs of graft infection, recurrent fistulization, or ischemic complications. It is feasible and useful to employ the carotid artery approach for stent-graft implantation in patients who have vascular anatomical limitations for the transfemoral approach. Endovascular repair of TIF by stent grafting is a minimally invasive treatment that can be tolerated by patients in poor clinical condition, and is a feasible alternative to surgical treatment. PMID:23065488

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

    PubMed

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

    2013-01-01

    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

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

    PubMed Central

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

    2000-01-01

    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. PMID:10930967

  11. Robotically assisted multivessel minimally invasive direct coronary artery bypass grafting with the use of bilateral internal thoracic arteries.

    PubMed

    Nishida, Satoru; Yasuda, Tamotsu; Watanabe, Go; Kikuchi, Yujiro; Shintani, Yoshiko; Ito, Shigeki; Tabata, Shigeki; Kawachi, Kenji

    2007-09-01

    This case report presents the robotically assisted multivessel minimally invasive direct coronary artery bypass grafting (MIDCAB) technique using the bilateral internal thoracic arteries. A 54-year-old man with multivessel coronary artery disease was considered eligible for a robotically assisted myocardial revascularization. The bilateral internal thoracic arteries were harvested completely in a totally skeletonized fashion through three 1-2-cm-long incisions on the left thoracic wall. A small left anterior thoracotomy was then performed. The left internal thoracic artery was anastomosed to the left anterior descending coronary artery, and the composite radial artery graft from the right internal thoracic artery was sequentially anastomosed to the first diagonal branch, the obtuse marginal branch, and the distal right coronary artery on the beating heart without cardiopulmonary bypass. The harvesting time of the grafts was 66 min, and the total operative time was 5 h 58 min. Postoperative angiography revealed that all grafts were widely patent. The postoperative course was uneventful, and the patient was discharged 10 days after the operation. Robotically assisted MIDCAB using the bilateral thoracic arteries is a safe and effective means of myocardial revascularization for patients with multivesssel disease. PMID:17721036

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

    PubMed Central

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

    2015-01-01

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

  13. Conservative Management of Chylothorax after Coronary Artery Bypass Grafting

    PubMed Central

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

    2015-01-01

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

  14. Improving quality and outcomes of coronary artery bypass grafting procedures.

    PubMed

    Ferguson, T Bruce; Buch, Ashesh N

    2016-05-01

    The evolution in the approach, clinical care and outcomes of ischemic heart disease, has been dramatic over the past decade. Optimizing medical therapy initially and throughout the care delivery process has been transformative. The addition of new physiologic data to the traditional anatomic framework for diagnosis and therapy of more extensive stable ischemic heart disease (SIHD) enables quality and outcomes improvements in this patient population overall and in the patient subsets of acute coronary syndrome and SIHD. In patients undergoing coronary artery bypass grafting (CABG), these developments have changed the objective goal of surgical revascularization over this time interval. This review discusses the opportunities for quality and outcomes improvement in CABG, in the context of SIHD overall. PMID:26818448

  15. Successful management of tracheo-innominate artery fistula with endovascular stent graft repair.

    PubMed

    Deguchi, J; Furuya, T; Tanaka, N; Nobori, M; Seki, Y; Nomura, Y; Umehara, I; Saito, H; Miyata, T

    2001-06-01

    Tracheo-innominate artery fistula is a highly lethal complication after tracheostomy. A 37-year-old man who had undergone a tracheostomy 14 years earlier because of dysphagia after brain surgery had a tracheo-innominate artery fistula with exsanguinating hemorrhage from his tracheostomy site. After temporary control of the bleeding, a stent graft was implanted in the innominate artery through the brachial artery. The patient recovered uneventfully and remained well 14 months after the procedure, with no sign of infection. Endovascular stent grafting may be the treatment of choice for patients with tracheo-innominate artery fistula. PMID:11389430

  16. A Computational Model of Optimal Vein Graft Adaptation in an Arterial Environment

    NASA Astrophysics Data System (ADS)

    Ramachandra, Abhay B.; Sankaran, Sethuraman; Humphrey, Jay; Marsden, Alison

    2012-11-01

    In coronary artery disease, surgical revascularization using venous bypass grafts is performed to relieve symptoms and prolong life. Coronary bypass graft surgery is performed on approximately 500,000 people every year in the United States, with graft failure rates as high as 50% within 5 years. When a vein graft is implanted in the arterial system it adapts to the high flow rate and high pressure of the arterial environment by changing composition and geometry, and thus stiffness. Hemodynamic loads, resulting in altered wall shear and intramural stresses, are major factors impacting vein graft remodeling. Here, a constrained mixture theory of growth and remodeling for arteries is extended to model the evolution of a vein graft subjected to arterial flow and pressure conditions. A derivative-free optimization method is used to estimate the optimal set of constitutive parameters that best match passive biaxial mouse inferior vena cava data from experiments. Optimization is performed using surrogate management framework, a pattern search method with established convergence theory. The resulting parameter set is used to predict optimal vein adaptation in an arterial environment for two illustrative cases: a) Step change b) Gradual change in loading. Results are compared against vein graft data from the literature and a possible set of mechanisms for sub-optimal vein graft remodeling is suggested.

  17. Post-traumatic internal mammary artery pseudoaneurysm: A rare complication of pericardiocentesis

    PubMed Central

    Mehra, Sanjay; Buch, Ashesh; Truong, Crystal N; Moshiri, Mariam; Shriki, Jabi E.; Bhargava, Puneet

    2015-01-01

    Before the advent of ultrasound, percutaneous pericardiocentesis was associated with relatively high mortality and complication rates (6% and 20–50%, respectively) [1–3]. Ultrasound (US)-guided pericardiocentesis has dramatically decreased the incidence of complications by direct visualization of the heart and other adjacent vital structures. US helps localize the size and location of the pericardial effusion, measure the distance from the chest wall, localize adjacent, vital organs, and determine the optimal access site to the effusion. We report a case of posttraumatic internal mammary artery pseudoaneurysm, a rare complication of pericardiocentesis.

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

    SciTech Connect

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

    1987-02-01

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

  19. On Pump Coronary Artery Bypass Graft Surgery Versus Off Pump Coronary Artery Bypass Graft Surgery: A Review

    PubMed Central

    Islam, Mohammad Yousuf-ul; Ahmed, Muhammad Umer; Khan, Muhammad Shahzeb; Bawany, Faizan Imran; Khan, Asadullah; Arshad, Mohammad Hussham

    2014-01-01

    There are two basic ways of performing coronary artery bypass graft surgery (CABG): on pump CABG and off pump CABG. Off pump CABG is relatively a newer procedure to on-pump CABG and does not require the use of the cardiopulmonary bypass machine. On pump CABG is the more traditional method of performing bypass surgery. However its resultant inflammatory effects cause renal dysfunction, gastrointestinal distress and cardiac abnormalities which have forced the surgeons to look for alternatives to the procedure. An extensive literature search revealed that on pump CABG causes better revascularization as compared to off pump CABG while off pump CABG has a much lower post operative morbidity and mortality especially in high risk patients. We suggest that the technique used should depend on the ease of the surgeon doing the operation as both the methods seem almost equally efficient according to the review. PMID:24762361

  20. [Clinical experience in thoracoscopic left internal mammary artery harvesting with voice activated robotic assistance].

    PubMed

    Kodera, K; Boyd, W D; Kiaii, B; Novik, R J; Rayman, R; Ganapathy, S; Dobkowski, W B; McKenzie, N F; Menkis, A H; Otsuka, T; Yozu, R

    2001-11-01

    Between September 1998 to February 2000, 45 consecutive patients underwent robotic-assisted, video-enhanced coronary artery bypass grafting. All IMA's were harvested using the voice-activated robotic assistant (AESOP 3000, Computer Motion Inc, Santa Barbara, CA) and the Harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH). Left IMA's were successfully harvested in all patients. Harvested IMA's were anastomosed to LAD's under direct vision through limited left anterior thoracotomy. The IMA harvest time was 57.8 +/- 23.2 min, intraoperative graft flow was 34.3 +/- 20.5 ml/min, postoperative hospital stay was 3.9 +/- 1.5 days. The early postoperative angiogram showed that all grafts were patent. There was no mortality, no significant morbidity. The robotic assisted, video enhanced CABG provides safe and complete LIMA dissection with minimal manipulation and assures sufficient LITA length for tension free anastomosis. PMID:11712382

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

    PubMed Central

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

    2014-01-01

    Background Radial artery (RA) was the second arterial graft introduced in clinical practice for myocardial revascularization. The skeletonization technique of the left internal thoracic artery (LITA) may actually change the graft's flow capacity with potential advantages. This leads to the assumption that the behavior of the RA, as a coronary graft, is similar to that of the LITA, when skeletonized. Objective This study evaluated 'free' aortic-coronary radial artery (RA) grafts, whether skeletonized or with adjacent tissues. Methods A prospective randomized study comparing 40 patients distributed into two groups was conducted. In group I, we used skeletonized radial arteries (20 patients), and in group II, we used radial arteries with adjacent tissues (20 patients). After the surgical procedure, patients underwent flow velocity measurements. Results The main surgical variables were: RA internal diameter, RA length, and free blood flow in the radial artery. The mean RA graft diameters as calculated using quantitative angiography in the immediate postoperative period were similar, as well as the flow velocity measurement variables. On the other hand, coronary cineangiography showed the presence of occlusion in one RA graft and stenosis in five RA grafts in GII, while GI presented stenosis in only one RA graft (p = 0.045). Conclusion These results show that the morphological and pathological features, as well as the hemodynamic performance of the free radial artery grafts, whether prepared in a skeletonized manner or with adjacent tissues, are similar. However, a larger number of non-obstructive lesions may be observed when RA is prepared with adjacent tissues. PMID:24918911

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

    SciTech Connect

    Pavcnik, Dusan; Obermiller, Josef; Uchida, Barry T.; Van Alstine, William; Edwards, James M.; Landry, Gregory J.; Kaufman, John A.; Keller, Frederick S.; Roesch, Josef

    2009-01-15

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

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

    SciTech Connect

    Medda, Massimo; Lioupis, Christos Mollichelli, Nadia; Fantoni, Cecilia; Inglese, Luigi

    2008-03-15

    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.

  4. Establishment of an Animal Model of Vascular Restenosis with Bilateral Carotid Artery Grafting

    PubMed Central

    Li, Ruixiong; Lan, Bin; Zhu, Tianxiang; Yang, Yanlong; Wang, Muting; Ma, Chensheng; Chen, Shu

    2014-01-01

    Background Vascular restenosis occurring after CABG is a major clinical problem that needs to be addressed. Vein grafts are associated with a higher degree of stenosis than artery grafts. However, the mechanism responsible for this effect has not been elucidated. We aimed to establish a rabbit model of vascular restenosis after bilateral carotid artery grafting, and to investigate the associated spatiotemporal changes of intimal hyperplasia in carotid artery and jugular vein grafts after surgery. Material/Methods Twenty adult New Zealand white rabbits (10 males; 10 females), weighing 2.0–2.5 kg, were obtained from the Experimental Animal Center of Southern Medical University, Guangzhou, China (License No.: scxk-Guangdong-2006-0015). We quantitatively analyzed intimal thickness, area, and degree of stenosis in carotid artery and jugular vein bridges. Results After 8 weeks of a high-fat diet, rabbit carotid arteries showed early atherosclerotic lesions. With increasing time after surgery, carotid artery and jugular vein grafts showed histopathological and morphological changes, including smooth muscle cell migration, lipid deposition, intimal hyperplasia, and vascular stenosis. The degree of vascular stenosis was significantly higher in vein grafts than in artery grafts at all time points – 35.1±6.7% vs. 16.1±2.6% at Week 12, 56.2±8.5% vs. 23.4±3.4% at Week 16, and 71.2±1.3% vs. 25.2±5.3% at Week 20. Conclusions Rabbit bilateral carotid arteries were grafted with carotid artery and jugular vein bridges to simulate pathophysiological processes that occur in people after CABG surgery. PMID:25549796

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

    SciTech Connect

    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

    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.

  6. [Follow-up study of coronary artery bypass grafting after Kawasaki disease--early and late postoperative evaluation].

    PubMed

    Ohara, K; Yagihara, T; Kishimoto, H; Isobe, F; Yamamoto, F; Nabuchi, A; Kito, Y; Fujita, T; Suzuki, A; Kamiya, T

    1989-01-01

    In our hospital, 22 patients with severe coronary arterial lesion after Kawasaki disease underwent coronary artery bypass grafting (CABG) since 1982. The age of the cases at surgery ranged from 1 year to 19 years. Mean age was 8.3 years. Fifteen cases were bypassed using internal mammary artery (IMA) and 5 cases using IMA and autologous saphenous vein (SVG). Two cases were bypassed using only SVG. They have been examined until now by catheterization, by Treadmill test, and by Tl-201 myocardial imaging, around 1 month (Study 1) and around 1 year (Study 2) after surgery for the evaluation of results of CABG. One patient died from acute myocardial infarction 3 months after surgery and one patient shows return of anginal attack due to graft stenosis. Other patients are almost uneventful. In the study 1,20 (100%) IMA were patent, and 7 (88%) SVG were patent. In the study 2, 11 (92%) IMA and 6 (67%) SVG remained patent. Development of left anterior descending artery distal to IMA anastomosis was shown in 8 cases in the study 2. On the follow-up study with TI-201 myocardial imaging, disappearance or decrease of perfusion defect was seen in 7 cases (59%) in the study 1 and 9 cases (75%) in the study 2. On the Treadmill test, disappearance or improvement of ischemic change was seen in 15 cases (88%) in the study 1 and 10 cases (84%) in the study 2. These results suggest that IMA is more preferable for than SVG for young children who has an indication of CABG after Kawasaki disease. PMID:2786537

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

    PubMed Central

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

    2008-01-01

    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. PMID:18269756

  8. Transluminal placement of a prosthetic graft-stent device for treatment of subclavian artery aneurysm.

    PubMed

    May, J; White, G; Waugh, R; Yu, W; Harris, J

    1993-12-01

    A 78-year-old man was seen with an expanding 5 cm false aneurysm of the right subclavian artery. This was treated by an intraluminal graft-stent device introduced through the brachial artery via a 16 F sheath. The graft was constructed from two polytetrafluoroethylene patches of 0.4 mm thickness and anchored in the subclavian artery by an 8 mm stainless steel stent. The procedure was monitored by an image intensifier. Completion arteriography and postoperative duplex scanning confirmed normal flow through the subclavian artery with no communication between the lumen and the aneurysmal sac. The patient recovered without complication. PMID:8264035

  9. Acute coronary artery bypass graft failure in a patient with polycythemia vera.

    PubMed

    Osada, Hiroaki; Nakajima, Hiroyuki; Meshii, Katsuaki; Ohnaka, Motoaki

    2016-02-01

    Polycythemia vera in patients undergoing cardiac surgery is clinically rare. A 65-year-old man with polycythemia vera was admitted with effort-related chest discomfort. We planned coronary artery bypass grafting for left anterior descending artery and obtuse marginal branch stenosis, using bilateral internal thoracic arteries, with perioperative prophylactic management to avoid thromboembolism. His internal thoracic arterial grafts occluded during and after surgery due to thrombus, and ST-elevation myocardial infarction developed, which needed a percutaneous coronary intervention. This case suggests that optimal management methods should be studied further to contribute to better patient outcomes in this condition. PMID:25193984

  10. Healing comparison of small intestine submucosa and ePTFE grafts in the canine carotid artery.

    PubMed

    Sandusky, G E; Lantz, G C; Badylak, S F

    1995-04-01

    Continuing investigation of small-diameter vascular graft materials suggests that unacceptable graft complications continue and that the ideal material has not yet been found. We compared healing of xenogeneic small diameter grafts (3.5 to 5.0 mm diameter) made from porcine small intestine submucosa (SIS) implanted in the carotid artery to expanded polytetrafluorethylene (ePTFE) in the contralateral carotid in 8 dogs. Two dogs were sacrificed for graft evaluation at 7, 28, 90, and 180 days after surgery. Only one SIS graft was occluded at 28 days and the other 7 were patent. Six of 8 ePTFE grafts were occluded with thrombi. One was patent at 7 and one at 90 days. At 7 days post-implant, the luminal surface of the SIS graft was covered by a thick (30 microns), compact fibrin meshwork. By 28 days endothelial cells were seen completely covering the fibrin meshwork which stained for FVIII-related antigen. Smooth muscle cells were observed in the neo-intima. Most ePTFE grafts had fibrin on the luminal surface which formed fibrin thrombi with platelets and numerous red blood cells. Complete endothelial coverage of the ePTFE grafts was not observed by 180 days. There was not a pronounced neointima seen on the luminal surface of the graft. The vasa vasorum was present in the fibrous capsule surrounding the ePTFE graft, but it did not penetrate into the graft as seen in the SIS graft. At 90 days the SIS vascular graft had the histological appearance similar to a normal artery. The SIS graft potency and healing characteristics were superior to the synthetic ePTFE graft and warrant further investigation. PMID:7723321

  11. A case of ruptured infectious anterior cerebral artery aneurysm treated by interposition graft bypass using the superficial temporal artery

    PubMed Central

    Abe, Takatsugu; Endo, Hidenori; Shimizu, Hiroaki; Fujimura, Miki; Endo, Toshiki; Sakata, Hiroyuki; Watanabe, Mika; Tominaga, Teiji

    2016-01-01

    Background: To describe the application of an interposition graft bypass using superficial temporal artery (STA) for the treatment of a ruptured anterior cerebral artery (ACA) infectious aneurysm. Case Description: A 30-year-old male suffered from severe headache with high fever. The patient's diagnosis was ruptured infectious ACA aneurysm at the A3 segment with a maximum diameter of 4.5 mm, caused by infectious endocarditis. The patient was initially treated with high-dose intravenous antibiotics. Follow-up digital subtraction angiography (DSA) revealed that the fusiform aneurysm had enlarged to a maximum diameter of 14.0 mm. A left paracentral artery, supplying the motor area of the left lower extremity, originated from the body of this aneurysm. Because the angiographic findings suggested a risk of recurrent bleeding, the patient underwent open surgery. Interposition graft bypass using the STA was performed to reconstruct the left A3 segment in an end-to-side manner (left proximal callosomarginal artery – STA graft – left distal pericallosal artery). Then, the origin of the left paracentral artery was cut and anastomosed to the STA graft in an end-to-side manner. The affected parent artery was trapped, and the aneurysm was resected. Postoperative magnetic resonance imaging showed no ischemic or hemorrhagic complications, and postoperative DSA revealed the patency of the interposition graft. Pathological diagnosis of the resected aneurysm revealed features corresponding to infectious cerebral aneurysm. The postoperative course was uneventful, and the patient was discharged without any neurological deficits. Conclusion: In the treatment of infectious cerebral aneurysms, revascularization should be considered when the affected artery supplies the eloquent area. Interposition graft bypass using the STA is one of the options for revascularization surgery for the treatment of infectious ACA aneurysms. PMID:26862444

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

    PubMed

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

    2007-02-01

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

  13. Decellularized ovine arteries as small-diameter vascular grafts.

    PubMed

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

    2014-08-01

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

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

    SciTech Connect

    Gupta, Vivek Niranjan, Khandelwal; Rawat, Lokesh; Gupta, A. K.

    2009-05-15

    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.

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

    SciTech Connect

    Trehan, Vijay; Nigam, Arima; Ramakrishnan, S.

    2007-02-15

    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.

  16. Unilateral femoral arterial thrombosis in a dog with malignant mammary gland tumor: clinical and thermographic findings, and successful treatment with local intra-arterial administration of streptokinase.

    PubMed

    Kim, Jung-Hyun; Park, Hee-Myung

    2012-05-01

    An 8-year-old intact female dog presented with a sudden onset of unilateral hindlimb paralysis of 3 days duration. Based on the history and results of physical, neurological, and histopathological examinations, and blood work, an arterial thrombosis was suspected as a complication of the hypercoagulability from a malignant mammary gland tumor. Thermography provided evidence of the unilateral femoral thrombus. Initially, thrombolysis with streptokinase administered by intravenous infusion was ineffective. Thereafter, the direct delivery of streptokinase to the site of thrombus was attempted. The approach was curative. These results suggest that thermography could describe the site of the arterial thrombus, and local intra-arterial administration of streptokinase may be an effective therapy for the canine arterial thrombosis complicated by malignant mammary gland tumor. PMID:22185771

  17. Anomalous left coronary artery originating from the pulmonary artery in an adult.

    PubMed Central

    Ortiz de Salazar, A; Gonzalez, J A; Zuazo, J; Rodriguez, E; Ruiz de Azua, E

    1996-01-01

    We report the case of a 63-year-old man who presented at our hospital with paroxysmal atrial fibrillation. He was found to have an anomalous left coronary artery originating from the pulmonary artery. The patient underwent successful revascularization with the use of a left internal mammary artery bypass graft. Images PMID:8969031

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

    PubMed

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

    2005-07-01

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

  19. Hyperhomocysteinemia and Mortality after Coronary Artery Bypass Grafting

    PubMed Central

    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

    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 mol/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. PMID:17183715

  20. Deployment of stent grafts in curved aneurysmal arteries: toward a predictive numerical tool.

    PubMed

    Perrin, David; Demanget, Nicolas; Badel, Pierre; Avril, Stéphane; Orgéas, Laurent; Geindreau, Christian; Albertini, Jean-Noël

    2015-01-01

    The mechanical behavior of aortic stent grafts plays an important role in the success of endovascular surgery for aneurysms. In this study, finite element analysis was carried out to simulate the expansion of five marketed stent graft iliac limbs and to evaluate quantitatively their mechanical performances. The deployment was modeled in a simplified manner according to the following steps: (i) stent graft crimping and insertion in the delivery sheath, (ii) removal of the sheath and stent graft deployment in the aneurysm, and (iii) application of arterial pressure. In the most curved aneurysm and for some devices, a decrease of stent graft cross-sectional area up to 57% was found at the location of some kinks. Apposition defects onto the arterial wall were also clearly evidenced and quantified. Aneurysm inner curve presented significantly more apposition defects than outer curve. The feasibility of finite element analysis to simulate deployment of marketed stent grafts in curved aneurysm models was demonstrated. The study of the influence of aneurysm tortuosity on stent graft mechanical behavior shows that increasing vessel curvature leads to stent graft kinks and inadequate apposition against the arterial wall. Such simulation approach opens a very promising way toward surgical planning tools able to predict intra and/or post-operative short-term stent graft complications. PMID:25399927

  1. Implications of Hemodialysis in Patients Undergoing Coronary Artery Bypass Grafting

    PubMed Central

    Efird, Jimmy T.; O’Neal, Wesley T.; Gouge, Catherine A.; Kindell, Linda C.; Kennedy, Whitney L.; Bolin, Paul; O’Neal, Jason B.; Anderson, Curtis A.; Rodriguez, Evelio; Ferguson, T. Bruce; Chitwood, W. Randolph; Kypson, Alan P.

    2013-01-01

    Background Cardiovascular disease is the leading cause of morbidity and mortality in patients on hemodialysis. To our knowledge, no studies have examined long-term outcomes of hemodialysis patients following coronary artery bypass grafting (CABG) in a predominately rural, low-income, and racially dichotomous population. Methods Long-term survival of hemodialysis patients undergoing non-emergent, isolated CABG was compared with non-hemodialysis patients. Survival probabilities were computed using the Kaplan-Meier product limit method and stratified by hemodialysis. Hazard ratios (HR) and 95% confidence intervals (95%CI) were computed using a Cox regression model. Results Hemodialysis patients (n=220) had shorter long-term survival than non-hemodialysis patients (median survival=3.3 versus 14 years, p<0.0001). The survival difference remained statistically significant after adjusting for clinically relevant variables (HR=5.2, 95%CI=4.4-6.2). Conclusion Hemodialysis patients had significantly shorter long-term survival compared with non-hemodialysis patients after CABG. Further research is needed to address the cost and policy implications of our findings, especially among priority populations. PMID:25309935

  2. Coronary Artery Bypass Graft (CABG) surgery depletes plasma thiamine levels

    PubMed Central

    Donnino, Michael W.; Cocchi, Michael N.; Smithline, Howard; Carney, Erin; Chou, Peter P.; Salciccoli, Justin

    2010-01-01

    Purpose Thiamine is an essential component of cellular metabolism, and lack of this vitamin results in a potentially life-threatening biochemical lesion. The stress of surgery and critical disease depletes electrolytes, minerals, and essential biochemical substrates. We hypothesized that critical illness (represented by major surgery) will result in decreased thiamine levels over time. Methods We performed a prospective, observational study of serial thiamine levels of 15 patients who underwent non-emergent coronary artery bypass graft (CABG) surgery. The primary endpoint was change in thiamine levels from pre- to immediately post-surgery. Secondary endpoints included change in thiamine levels between pre- surgery and 6 and 24 hour time-points. Results Of the 15 study patients, one did not have a plasma thiamine measurement at time zero because of lab error and could not be accounted for in paired comparisons over time. Plasma thiamine levels decreased significantly from the pre to post-CABG period (p = 0.0004). In addition, there was a statistically significant decrease in thiamine levels from pre-surgery to 24 hours (P = 0.003). Conclusion Our data suggest that major surgery (as a surrogate for the stress of critical illness) depletes thiamine levels; further study is needed to determine whether routine replacement of thiamine in the critically ill is warranted. PMID:20005469

  3. Three-Layered PCL Grafts Promoted Vascular Regeneration in a Rabbit Carotid Artery Model.

    PubMed

    Wang, Kai; Zheng, Wenting; Pan, Yiwa; Ma, Shaoyang; Guan, Yong; Liu, Ruming; Zhu, Meifeng; Zhou, Xin; Zhang, Jun; Zhao, Qiang; Zhu, Yan; Wang, Lianyong; Kong, Deling

    2016-04-01

    In this study, a three layered poly (ε-caprolactone) (PCL) graft (tPCL) was fabricated by electrospinning PCL and electrospraying poly (ethylene oxide) (PEO), which has a thin dense inner layer, a loose middle layer, and a dense outer layer. Regular PCL grafts (rPCL) with only a dense layer were used as control. In vivo evaluation was performed in rabbit carotid artery. Enhanced cell infiltration, rapid regeneration of endothelium and smooth muscle layers, and increased elastin deposition were observed within the tPCL graft wall. After 3 months, tPCL grafts showed faster PCL degradation than the rPCL grafts. Infiltrated macrophages in the tPCL grafts secreted higher level of monocyte chemoattractant protein-1 (MCP-1) and vascular endothelial growth factor (VEGF) which enhanced vascular regeneration. In conclusion, the tPCL graft may be a useful vascular prosthesis and worth for further investigation. PMID:26756321

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

    SciTech Connect

    Heye, Sam Vanbeckevoort, Dirk; Blockmans, Daniel; Nevelsteen, Andre; Maleux, Geert

    2005-01-15

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

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

    SciTech Connect

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

    2003-08-15

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

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

    PubMed

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

    2014-06-01

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

  7. Assessment of internal mammary artery injury after blunt chest trauma: a literature review

    PubMed Central

    Chen, Jin-ming; Lv, Jin; Ma, Kai; Yan, Jing

    2014-01-01

    The occurrence, bleeding, and treatment of internal mammary artery (IMA) injury after blunt chest trauma have not been well described in the literature. We reviewed articles published from July 1977 to February 2014 describing IMA injury after blunt chest trauma in 49 patients. There was a predominant incidence in males and on the left side. Blunt trauma to the IMA can cause anterior mediastinal hematoma, hemothorax, pseudoaneurysm, arteriovenous fistula, and extra-pleural hematoma. Of the 49 patients studied, 20 underwent embolization, 22 underwent surgical operation, 4 were managed by clinical observation, and 3 had undescribed treatment. Different parts and extents of IMA injury, adjacent vein injury, as well as the integrity of the pleura determined differences in bleeding modality. Prompt diagnosis, complete hemostasis, aggressive resuscitation, and multidisciplinary teams are recommended for patients with IMA injury. PMID:25294375

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

    PubMed

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

    2004-12-01

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

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

    PubMed Central

    2014-01-01

    Background Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique. Methods/Design The NEO Trial is a randomised clinical trial with a 2 × 2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group. The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively. We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the radial artery. The trial also aims to show if there is any patency difference between mammario-radial compared to aorto-radial revascularisation techniques but this objective is exploratory. Trial registration ClinicalTrials.gov identifier: NCT01848886. Danish Ethics committee number: H-3-2012-116. Danish Data Protection Agency: 2007-58-0015/jr.n:30–0838. PMID:24754891

  10. Outcome in Patients Having Salvage Coronary Artery Bypass Grafting.

    PubMed

    Santarpino, Giuseppe; Ruggieri, Vito G; Mariscalco, Giovanni; Bounader, Karl; Beghi, Cesare; Fischlein, Theodor; Onorati, Francesco; Faggian, Giuseppe; Gatti, Giuseppe; Pappalardo, Aniello; De Feo, Marisa; Bancone, Ciro; Perrotti, Andrea; Chocron, Sidney; Dalen, Magnus; Svenarud, Peter; Rubino, Antonino S; Mignosa, Carmelo; Gherli, Riccardo; Musumeci, Francesco; Dell'Aquila, Angelo M; Kinnunen, Eeva-Maija; Biancari, Fausto

    2015-10-15

    Salvage coronary artery bypass grafting (CABG) is often performed for cardiogenic shock on compassionate basis without clinical data justifying this aggressive approach. The aim of this study was to analyze early and intermediate outcomes after salvage CABG. We retrospectively reviewed the data of 85 patients who underwent salvage CABG at 11 European cardiac surgery centers. Salvage CABG was defined according to the EuroSCORE criteria, that is, a procedure performed in patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theater or before induction of anesthesia. A percutaneous coronary intervention procedure preceded salvage CABG in 55 patients (64.7%). Thirty patients (35.3%) died during the inhospital stay. The mean EuroSCORE II was 32.0% and the observed-to-expected ratio was 1.08. Salvage CABG was associated with high rates of postoperative stroke (9.4%), resternotomy for bleeding (23.5%), resternotomy for hemodynamic instability (15.3%), dialysis (18.8%), severe gastrointestinal complications (12.9%), and deep sternal wound infection (10.6%). Survival at 1, 3, and 5 years was 58.6%, 49.8%, and 40.9%, respectively. Twenty patients (23.5%) were postoperatively treated with extracorporeal membrane oxygenation (ECMO). The rates of adverse events after ECMO were particularly high (stroke 40%, resternotomy for bleeding 60%, dialysis 35%, gastrointestinal complications 30%, and deep sternal wound infection 30%). Of patients treated with ECMO, 8 (40%) survived to discharge, and 1-year survival was 29.2%. Salvage CABG is associated with high risk of immediate mortality and severe adverse events. However, the observed immediate and intermediate outcome justify coronary surgery in these critically ill patients. A number of these patients are currently treated by ECMO, and its results are encouraging. PMID:26303635

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

    PubMed Central

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

    2015-01-01

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

  12. Re-operation for recurrent coronary artery and graft disease. A review of 73 patients in a group of 2573 consecutive first operations.

    PubMed

    Nair, U R; Campbell, C C; Dark, J F; Deiraniya, A K; Lawson, R A; Moussalli, H; Rahman, A N

    1989-01-01

    Between January 1980 and December 1986, 2573 patients underwent simple first time coronary artery bypass grafting, of whom 73 (65 males and 8 females) aged 34-69 years (mean 51.3 yrs) had repeat bypass grafts at Wythenshawe Hospital, Manchester. Of these 73 patients, 15 had a previous myocardial infarction, 5 hyperlipidaemia, 4 systemic hypertension, and 12 had a strong family history of ischemic heart disease. There was an overall deterioration of left ventricular function at the time of reoperation. The interval between the two operations was 5-131 months (mean 34.2 mths); recurrence of angina occurred earlier (mean 18.4 mths). Vessels grafted at the first operation were LAD (59), RCA (46), circumflex (41) and diagonal (13). The corresponding data at reoperation were LAD (55), RCA (46), circumflex (28) and diagonal (10). Blocked grafts were seen in 67 patients and new lesions noticed in 29. Reoperation was done using saphenous vein (129), internal mammary artery (5), arm veins (2) and tubular Gortex grafts (2). One patient had concurrent excision of a left ventricular aneurysm. Coronary anastomoses were performed with elective ventricular fibrillation (47) or cardioplegic arrest (91). Aortic cross clamp time varied from 0-92 minutes. Seven patients required intra-aortic balloon support. These patients died in the first 30 days, an operative mortality rate of 4.1%, and two 18 months after surgery. Sixty-eight percent of patients seen at 1 year were totally symptom free. We conclude that reoperation for coronary artery disease can be done with a low mortality and good immediate relief of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2789223

  13. A mechanical argument for the differential performance of coronary artery grafts.

    PubMed

    Prim, David A; Zhou, Boran; Hartstone-Rose, Adam; Uline, Mark J; Shazly, Tarek; Eberth, John F

    2016-02-01

    Coronary artery bypass grafting (CABG) acutely disturbs the homeostatic state of the transplanted vessel making retention of graft patency dependent on chronic remodeling processes. The time course and extent to which remodeling restores vessel homeostasis will depend, in part, on the nature and magnitude of the mechanical disturbances induced upon transplantation. In this investigation, biaxial mechanical testing and histology were performed on the porcine left anterior descending artery (LAD) and analogs of common autografts, including the internal thoracic artery (ITA), radial artery (RA), great saphenous vein (GSV) and lateral saphenous vein (LSV). Experimental data were used to quantify the parameters of a structure-based constitutive model enabling prediction of the acute vessel mechanical response pre-transplantation and under coronary loading conditions. A novel metric Ξ was developed to quantify mechanical differences between each graft vessel in situ and the LAD in situ, while a second metric Ω compares the graft vessels in situ to their state under coronary loading. The relative values of these metrics among candidate autograft sources are consistent with vessel-specific variations in CABG clinical success rates with the ITA as the superior and GSV the inferior graft choices based on mechanical performance. This approach can be used to evaluate other candidate tissues for grafting or to aid in the development of synthetic and tissue engineered alternatives. PMID:26437296

  14. Successful Antibiotic Treatment of Severe Staphylococcal Infection of a Long Stent Graft in the Superficial Femoral Artery with Graft Preservation in the Long Term

    SciTech Connect

    Treitl, Marcus; Rademacher, Antje; Becker-Lienau, Johanna; Reiser, Maximilian F.; Hoffmann, Ulrich; Czihal, Michael

    2011-06-15

    Introduction: Bacterial infection of endovascular stent grafts is a serious condition, regularly leading to graft replacement by open bypass surgery.Case ReportWe describe the case of a staphylococcal infection of a 150-mm covered stent graft (Gore Viabahn), placed in the superficial femoral artery. Stent graft infection was successfully treated by oral administration of penicillinase-resistant flucloxacillin and the lipopeptide daptomycin with complete graft preservation, not requiring surgical treatment. During 1-year follow-up, the graft infection did not reappear. However, the patient developed restenosis at the proximal margin of the stent with recurrence of mild claudication, so far treated conservatively. Conclusion: With the increased use of covered stent grafts in the peripheral vasculature, the frequency of graft infection will increase. We demonstrate that with newly developed antibiotics, it is possible to treat this severe complication conservatively, with complete graft preservation and without the need for bypass surgery in selected cases.

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

    PubMed Central

    Owens, Christopher D.

    2009-01-01

    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. PMID:19837532

  16. Extra-anatomic autologous reconstruction with hepatic-iliac artery bypass graft for aortic endograft infection.

    PubMed

    Buora, Adelaide; Floriani, Marco; Gabrielli, Livio

    2015-01-01

    We present a new intra-abdominal extra-anatomic bypass graft for a 64-year-old man treated with an abdominal aortic endograft and with signs of endograft infection. We performed surgical removal of the endograft and intra-abdominal extra-anatomic reconstruction of a hepatic-to-right external iliac artery bypass with autologous superficial femoral vein and a crossover graft between the right and left external iliac artery with the great saphenous vein. The later occlusion of the saphenous vein graft led us to perform a femoral-femoral prosthetic crossover. At 42 months from the intervention, the patient was in good health, and duplex scanning confirmed the patency of all grafts. PMID:24176632

  17. Functional characterization of post-junctional adrenergic receptor subtypes in bovine intra-mammary arteries.

    PubMed

    Pereira, F J; Will, J A

    1997-12-01

    We examined the functional role of adrenergic receptor subtypes (ARs) in bovine intra-mammary arteries (IMAs), 1.5-2.5 mm internal diameter. Norepinephrine (NE) and phenylephrine (PE) produced concentration-dependent increases in tone in segments maintained at a previously determined optimal basal tension in vitro. The sensitivity of the tissue to NE and PE, based on -log molar ED50s was 6.87 +/- 0.17 and 7.05 +/- 0.35, respectively. In addition a Schild analysis yielded antagonist affinities for the receptor mediating contractile responses to NE (pA2 value) of 10.46 +/- 0.85 for prazosin and 6.29 +/- 0.18 for yohimbine. These data indicate a dominance of functional alpha 1 (alpha(1)) over alpha 2 (alpha(2))-ARS in this tissue. Based on the inhibitory effects of chloroethylclonidine (CEC) on PE responses and the further reduction in sensitivity when nifedipine was added to the CEC, also in the presence of PE, we conclude that there is more than one alpha(1)-AR subtype, with a predominant role for alpha(1B)-ARs in phenylephrine responses. Stimulation of beta (beta)-ARs, resulted in relatively small reductions in tone (the highest magnitude of response was 25.94 +/- 6.46% of the papaverine maximum at 3 x 10(-6) M isoproterenol); in addition, propranolol did not significantly alter tissue sensitivity to NE. Additional characterization of functional autonomic receptor populations in this circulatory bed will form a basis for future studies on circulatory dynamics in the mammary gland. PMID:9430766

  18. Risk factors for mortality of patients undergoing coronary artery bypass graft surgery

    PubMed Central

    dos Santos, Carlos Alberto; de Oliveira, Marcos Aurélio Barboza; Brandi, Antônio Carlos; Botelho, Paulo Henrique Husseini; Brandi, Josélia de Cássia Menin; dos Santos, Marcio Antônio; de Godoy, Moacir Fernandes; Braile, Domingo Marcolino

    2014-01-01

    Introduction Coronary artery bypass grafting is a safe procedure performed worldwide with low rates of mortality and morbidity in general population. Objective To investigate risk factors for mortality of patients undergoing coronary artery bypass grafting coronary artery bypass grafting surgery. Methods A total of 1,628 consecutive patients undergoing on-pump coronary artery bypass grafting were retrospectively studied from December 1999 to February 2012. Data analysis involved paired Student t test, Mann-Whitney test and Fisher’s exact test for the categorical data. Logistic regression, Odds Ratio and 95%CI were used for definition of risk factors for mortality. Results Of a total of 1,628 patients undergoing on-pump coronary artery bypass grafting, 141 (8.7%) died. The following risk factors for mortality were identified after logistic regression: dialysis (OR=7.61; 95%CI 3.58-16.20), neurologic dysfunction type I (OR=4.42; 95%CI 2.48-7.81), use of IABP (OR=3.38; 95%CI 1.98-5.79), cardiopulmonary bypass time (OR=3.09; 95%CI 2.04-4.68), serum creatinine on admission and peak values > 0.4mg/dL (OR=2.67; 95%CI 1.79-4.00), age > 65 years (OR=2.31; 95%CI 1.55-3.44), and time between hospital admission and and surgical procedure (OR=1.53; 95%CI 1.03-2.27). Conclusion Dialysis, type I neurologic dysfunction, use of IABP, cardiopulmonary bypass time (> 115 minutes), serum creatinine on admission and peak values>0.4mg/dL, age > 65 years and time between hospital admission and surgical procedure were considered as risk factors for mortality in patients undergoing on-pump coronary artery bypass grafting surgery. PMID:25714203

  19. Effects of an artery/vascular graft compliance mismatch on protein transport: a numerical study.

    PubMed

    Stewart, Sandy F C; Lyman, Donald J

    2004-07-01

    Small-diameter vascular graft failure by intimal hyperplasia and thrombosis may result from flow disturbances and disruption of chemical transport in the fluid at the distal anastomosis, because of compliance mismatch between the graft and host artery. In previous studies. lower-than-normal wall shear stress (WSS), particle trapping, and high particle residence times were observed at the distal anastomosis due to a pulsatile tubular expansion effect caused by nonuniform radial deformations. This study was undertaken to examine effects of compliance and radius mismatch on the distribution of a model protein released at the graft-fluid interface. Finite element simulations of end-to-end vascular grafting were performed under pulsatile flow, using fluid-structure coupling to give physiologic wall displacements. Results showed that protein is convected smoothly downstream in a uniform compliant tube. A compliance mismatch disturbed the transport, causing positive and negative gradients in the concentration profile at the distal anastomosis. This was seen when the graft and artery radii were matched at zero pressure and at mean arterial pressure; low WSSs were only observed in the former case. Thus the distal intimal hypertrophy seen in noncompliant grafts may be caused partly by decreased WSS, and partly by concentration gradients of dissolved chemicals affecting chemotaxis of cells. PMID:15298437

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

    SciTech Connect

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

    1987-08-01

    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.

  1. The management of impending myocardial infarction using coronary artery by-pass grafting and an intra-aortic balloon pump.

    PubMed

    Harris, P L; Woollard, K; Bartoli, A; Makey, A R

    1980-01-01

    Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed. PMID:6968314

  2. Impact of top end anastomosis design on patency and flow stability in coronary artery bypass grafting.

    PubMed

    Koyama, Sachi; Kitamura, Tadashi; Itatani, Keiichi; Yamamoto, Tadashi; Miyazaki, Shohei; Oka, Norihiko; Nakashima, Kouki; Horai, Tetsuya; Ono, Minoru; Miyaji, Kagami

    2016-05-01

    For coronary artery bypass grafting (CABG), free grafts such as a saphenous vein or radial artery are often used for grafts to the lateral and posterior walls. However, the relationship between top-end anastomosis design and long-term patency remains unknown. Because coronary artery blood flow is dominant during diastole, top-end anastomosis may work better if the graft is directed towards the apex, whereas the shortest graft pathway appears to be most efficient. Using computational fluid dynamic models, we evaluated the hemodynamic variables that were affected by the angle of the top-end anastomosis. We created three-dimensional geometries of the aortic root with coronary arteries that involved 75 % stenosis in the obtuse marginal and postero-lateral branches. Two bypass models under vasodilator administration were created: in a"Model A", the top-end anastomosis is parallel to the long axis of the ascending aorta and the graft passed over the conus directed towards the apex; in a "Model B", the top-end anastomosis is directed toward the shortest pathway, and form near the right angles to the long axis of the ascending aorta. Wall shear stress (WSS) and its fluctuation, an oscillatory shear index (OSI) were evaluated to predict fibrosis progression at the anastomosis site and graft flow. Graft flow was 197.3 ml/min and 207.3 ml/min in the "Model A" and "Model B", respectively. The minimal WSS value inside the graft with the "Model A" and "Model B" was 0.53 Pa and 4.09 Pa, respectively, and the OSI value was 0.46 and 0.04, respectively. The top-end anastomosis of a free graft should be directed vertically towards the aorta to achieve the shortest graft pathway to maintain a high graft flow rate and to avoid the risks of endothelial fibrosis and plaque progression over the long-term after CABG. PMID:25910614

  3. Trachea--innominate artery fistula following tracheostomy. Successful repair using an innominate vein graft.

    PubMed

    Nunn, D B; Sanchez-Salazar, A A; McCullagh, J M; Renard, A

    1975-12-01

    This report discusses the first recorded patient in whom a trachea--innominate artery fistula after tracheostomy was treated successfully by resection of the eroded segment of artery followed by graft replacement using the patient's left innominate vein. The mechanism of vessel erosion and its prevention are discussed. Also, suitable methods are presented for obtaining temporary control of the severe hemorrhage associated with a tracheoarterial fistula while simultaneously maintaining an adequate airway. PMID:1108817

  4. The present day potential role of fractional flow reserve-guided coronary artery bypass graft surgery.

    PubMed

    Casselman, Filip; Van der Merwe, Johan; Ferrara, Angela; Barbato, Emanuele

    2016-04-01

    The favorable impact of fractional flow reserve measurements on the decision-making and overall outcomes of percutaneous coronary artery intervention is well established. However, the clinical application of fractional flow reserve in surgical revascularizations is still debated. The purpose of this article is to provide a comprehensive review on the current potential role of fractional flow reserve guidance in coronary artery bypass grafting. PMID:26806476

  5. Elasticity assessment of electrospun nanofibrous vascular grafts: a comparison with femoral ovine arteries.

    PubMed

    Bagnasco, D Suarez; Ballarin, F Montini; Cymberknop, L J; Balay, G; Negreira, C; Abraham, G A; Armentano, R L

    2014-12-01

    Development of successful small-diameter vascular grafts constitutes a real challenge to biomaterial engineering. In most cases these grafts fail in-vivo due to the presence of a mechanical mismatch between the native vessel and the vascular graft. Biomechanical characterization of real native vessels provides significant information for synthetic graft development. Electrospun nanofibrous vascular grafts emerge as a potential tailor made solution to this problem. PLLA-electrospun nanofibrous tubular structures were prepared and selected as model bioresorbable grafts. An experimental setup, using gold standard and high resolution ultrasound techniques, was adapted to characterize in vitro the poly(L-lactic acid) (PLLA) electrospun structures. The grafts were subjected to near physiologic pulsated pressure conditions, following the pressure-diameter loop approach and the criteria stated in the international standard for cardiovascular implants-tubular vascular prostheses. Additionally, ovine femoral arteries were subjected to a similar evaluation. Measurements of pressure and diameter variations allowed the estimation of dynamical compliance (%C, 10(-2) mmHg) and the pressure-strain elastic modulus (E(Pε), 10(6) dyn cm(-2)) of the abovementioned vessels (grafts and arteries). Nanofibrous PLLA showed a decrease in %C (1.38±0.21, 0.93±0.13 and 0.76±0.15) concomitant to an increase in EPε (10.57±0.97, 14.31±1.47 and 17.63±2.61) corresponding to pressure ranges of 50 to 90 mmHg, 80 to 120 mmHg and 100 to 150 mmHg, respectively. Furthermore, femoral arteries exhibited a decrease in %C (8.52±1.15 and 0.79±0.20) and an increase in E(Pε) (1.66±0.30 and 15.76±4.78) corresponding to pressure ranges of 50-90 mmHg (elastin zone) and 100-130 mmHg (collagen zone). Arterial mechanics framework, extensively applied in our previous works, was successfully used to characterize PLLA vascular grafts in vitro, although its application can be directly extended to in vivo experiences, in conscious and chronically instrumented animals. The specific design and construction of the electrospun nanofibrous PLLA vascular grafts assessed in this work, showed similar mechanical properties as the ones observed in femoral arteries, at the collagen pressure range. PMID:25491850

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

    SciTech Connect

    Dorffner, Roland; Thurnher, Siegfried; Prokesch, Rupert; Youssefzadeh, Soraya; Hoelzenbein, Thomas; Lammer, Johannes

    1998-03-15

    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.

  7. Predicting extraction and uptake of arterial energy metabolites by the mammary glands of lactating cows when blood flow is perturbed.

    PubMed

    Cant, J P; Madsen, T G; Cieslar, S R L

    2016-01-01

    Previous work shows that mammary uptake of milk precursors from blood can be affected by the rate of blood flow (F) to the glands. The purpose of the current work was to test the ability of compartmental and cylindrical capillary models to account for the variation in mammary extraction and net uptake of plasma metabolites produced by perturbation of mammary F. The data for model fitting were obtained from a previous experiment in which mammary arteriovenous differences of acetate + ?-hydroxybutyrate (2C), glucose, triacylglycerol (TAG), and long-chain fatty acids (LCFA) were measured in 4 cows before, during, and after intraarterial infusion of inhibitors of endothelial nitric oxide synthase and cyclooxygenase, which are 2 major systems of F control in the mammary glands. The 4 models tested were (1) constant extraction within each cow, (2) clearance from an extracellular compartment is a linear function of F with an intercept, (3) total capillary volume in a cylindrical representation is a linear function of F with an intercept, and (4) uptake from an extracellular compartment obeys Henri-Michaelis-Menten kinetics, where maximum velocity (Vmax) is a linear function of F with an intercept. According to prediction errors, model 4 fitted 2C extraction data best, accounting for 82% of the observed variation. The estimated Km (Henri-Michaelis-Menten constant) for venous 2C was 0.4 mM. For glucose clearance, a variant of model 2 with a positive effect of 2C uptake on clearance was identified as best, producing a coefficient of determination (R(2)) of 0.31. For TAG, model 2 with a positive effect of arterial TAG concentration on TAG clearance was best, with an R(2) of 0.22. For LCFA, model 2 with a positive effect of arterial LCFA on LCFA clearance was best, with an R(2) of 0.29. Models 2 and 3 fitted the extraction data with the same R(2)-values and prediction errors, so both compartmental and cylindrical approaches to describing the vascular bed were equally capable of describing the effect of F on mammary uptakes. A combined fit of all best-fit models to extraction data for all 4 metabolites at once explained 52, 42, 73, and 77% of variation in net uptakes of 2C, glucose, TAG, and LCFA, respectively. According to the fitted model, each 1 L/min increase in F increased the mammary volumes of distribution of 2C, glucose, TAG, and LCFA by 13, 14, 18, and 7%, respectively. PMID:26585481

  8. Fingertip Replantation Using Y-Shaped Vein Graft to Pulp Artery.

    PubMed

    Kim, Jun Hyuk; Lee, Young Man

    2015-10-01

    Re-establishing adequate venous outflow is the most important factor for success of fingertip replantation. However, in zone I level, replantation is very difficult, especially in repairing venous circulation. The authors have made an attempt to replantation using Y-shaped vein (YSV) graft to identify and repair veins easily in fingertip replantation. From January 2007 to December 2012, a total of 46 fingertip replantations in 44 consecutive patients with amputations in the Tamai zone I level were performed by using YSV graft. In all patients, arterial anastomosis was performed using YSV graft, and interpositional vein grafts were used for venous repair. The overall success rate of the YSV-grafted replantations was 91.3% (42/46). Postoperative vascular complications occurred in 6 YSV-grafted replantations (13%), and pulp atrophy in the YSV-grafted digits was 9.5% (4/42). Fingertip replantation in zone I level is a difficult territory to a microsurgeon, especially anastomosing veins. However, our YSV grafting technique has shown value in this setting, enabling better esthetic and functional results. PMID:25180958

  9. Mechanisms of arterial graft failure. 1. Role of cellular proliferation in early healing of PTFE prostheses.

    PubMed Central

    Clowes, A. W.; Gown, A. M.; Hanson, S. R.; Reidy, M. A.

    1985-01-01

    Failure of long-term synthetic arterial bypass grafts has been attributed in part to anastomotic stenosis, but the pathologic basis for this has not been determined. Which cells participate in the formation of the stenosis and the relationship between normal healing and the pathologic development of anastomotic narrowing have not been delineated. In this study we have examined early wound healing in 4-mm polytetrafluorethylene arterial bypass grafts placed in baboons. In this primate model, endothelium and smooth muscle cells (SMCs) derived from the cut ends of adjacent artery form the new intima and migrate together along the luminal surface of the graft at approximately 0.2 mm/day. Both cell types proliferate in association with the growing edge. In addition, both endothelium and SMCs located discretely over anastomoses continue to proliferate despite complete endothelial coverage. Intimal cross-sectional area in this region is always greater than over adjacent graft. Fibroblasts are invariably found in graft matrix and adventitia and do not contribute to formation of intima. It is hypothesized that anastomotic narrowing might be due to chronic endothelial injury and turnover associated with continued SMC proliferation and intimal thickening. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 PMID:3966536

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

    SciTech Connect

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

    2005-05-15

    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.

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

    SciTech Connect

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

    1989-06-15

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

  12. Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

    PubMed Central

    Chi, Li-Qun; Zhang, Jian-Qun; Kong, Qing-Yu; Xiao, Wei; Liang, Lin; Chen, Xin-Liang

    2015-01-01

    Background: It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD). Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD. Methods: From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE + CABG were performed, which was about 17.2% (38/221) of the cohort. All these patients were divided into two groups: CE + CABG group (Group A) and CABG alone group (Group B). All clinical data were compared between the two groups, and postoperative complications and in-hospital mortality were analyzed. The categorical and continuous variables were analyzed by Chi-square test and Student's t-test respectively. Results: Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was performed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A (3/38), which was more often than that in Group B (3/183). At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent (50/50). There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions: Coronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation. PMID:26021501

  13. Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians?

    PubMed Central

    LaPar, Damien J.; Bhamidipati, Castigliano M.; Reece, T. Brett; Cleveland, Joseph C.; Kron, Irving L.; Ailawadi, Gorav

    2011-01-01

    Objective Selected patients appear to benefit from off-pump coronary artery bypass compared with conventional coronary artery bypass with cardiopulmonary bypass. It is unknown whether elderly patients undergoing isolated coronary artery bypass grafting operations derive any benefit when performed off-pump. We hypothesized that off-pump coronary bypass offers a greater operative benefit to elderly patients when compared with conventional coronary artery bypass. Methods A total of 1993 elderly patients (age ≥80 years) underwent isolated, primary coronary artery bypass graft operations at 16 different statewide centers from 2003 to 2008. Patients were stratified into 2 groups: conventional coronary artery bypass (n = 1589, age = 82.5 ± 2.4 years) and off-pump bypass (n = 404, age = 83.0 ± 2.4 years). Preoperative risk, intraoperative findings, postoperative complications, and costs were evaluated. Results Patients undergoing off-pump bypass grafting were marginally older (P = .001) and had higher rates of preoperative atrial fibrillation (14.6%vs 10.0%; P = .01) and New York Heart Association class IV heart failure (29.7% vs 21.1%; P <.001) than did those having conventional coronary bypass grafting. Other patient risk factors and operative variables, including Society of Thoracic Surgeons predicted risk of mortality, were similar in both groups (P = .15). Compared with off-pump bypass, conventional coronary bypass incurred higher blood transfusion rates (2.0 ± 1.7 units vs 1.6 ± 1.9 units; P = .05) as well as more postoperative atrial fibrillation (28.4% vs 21.5%; P = .003), prolonged ventilation (14.7% vs 11.4%; P = .05), and major complications (20.1% vs 15.6%; P = .04). Importantly, postoperative stroke (2.6% vs 1.7%; P = .21), renal failure (8.1% vs 6.2%; P = .12), and postoperative length of stay (P = .41) were no different between groups. Despite more complications in patients having conventional bypass, operative mortality (P = .53) and hospital costs (P = .43) were similar to those of patients having off-pump procedures. Conclusions Performance of coronary artery bypass grafting among octogenarian patients is safe and effective. Off-pump coronary artery bypass confers shorter postoperative ventilation but equivalent mortality to conventional coronary artery bypass. Off-pump coronary artery bypass was associated with a reduction in the composite incidence of major complications in unadjusted and adjusted analyses and should be considered an acceptable alternative to conventional bypass for myocardial revascularization in elderly patients. PMID:21051050

  14. Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

    SciTech Connect

    Pecoraro, Felice Sabatino, Ermanno R.; Dinoto, Ettore; Rosa, Giuliana La; Corte, Giuseppe; Bajardi, Guido

    2015-10-15

    A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    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

    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. PMID:22287575

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

    Lekas, Raimundas; Jakuska, Povilas; Krisciukaitis, Algimantas; Veikutis, Vincentas; Dzemyda, Gintautas; Mickevicius, Tomas; Morkūnaite, Kristina; Vilke, Alina; Treigys, Povilas; Civinskiene, Genuvaite; Andriuskevicius, Jonas; Vanagas, Tomas; Skauminas, Kestutis; Bernatoniene, Jurga

    2009-01-01

    Thermography is a relatively new contact-free method used in experimental and clinical studies and in cardiovascular surgery to investigate the myocardium and coronary artery function. Objects of complex study included mongrel dogs and patients with coronary artery disease who underwent cardiac surgery. For active dynamic thermography, we used a thermovision camera "A20V" (FLIR Systems, USA). Our data indicate that both experimental and clinical study performed on beating hearts could be an important approach to interoperation inspection of autovenous graft function. An infrared camera also can be successfully used to determine the extent of ischemic damage to the myocardium, heart, and blood vessels during surgery as a significant prognostic tool for evaluating outcome after cardiac operation. PMID:19357452

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

    SciTech Connect

    Suzuki, Kojiro Mori, Yoshine; Komada, Tomohiro; Matsushima, Masaya; Ota, Toyohiro; Naganawa, Shinji

    2009-07-15

    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.

  20. Pseudoaneurysm of a branch of left internal mammary artery: a late and potentially fatal complication after redo-sternotomy.

    PubMed

    Falconieri, Fabio; Raevsky, Evgeny; Davies, Simon; Moat, Neil

    2015-06-01

    Post-sternotomy pseudoaneurysms of the internal mammary arteries (IMAs) and their branches are rare and often present with rupture-associated haemothorax and haemodynamic instability. In those cases, urgent surgical correction or embolization can be the treatment of choice. Traumatic chest injuries might lead to IMA branch injury as well; after cardiac surgery, injuries to these branches during sternal closure can be an extremely rare cause of pseudoaneurysm. We describe the case of a 78-year old lady with a left IMA branch pseudoaneurysm, arising from left sternal edge a few weeks after redo-sternotomy for mitral valve surgery. We also describe its non-surgical successful repair. PMID:25788578

  1. [Scintigraphic comparison of graft patency between the left internal thoracic artery and saphenous vein graft after coronary bypass surgery].

    PubMed

    Nakano, H; Shimakura, T; Katsumata, T; Shimamura, Y; Hoshino, K; Harada, T; Maejima, F; Kohno, H; Asakawa, K; Shichikawa, H

    1993-07-01

    Graft patency after coronary bypass surgery (CABG) was evaluated with stress 201-thallium scintigraphy (stress 201Tl) in 26 cases, including 13 cases using the left internal thoracic artery (LITA group) in situ and 13 cases with saphenous vein graft (SVG group). All of them had effort or unstable angina caused by LAD lesion without apparent infarction. Stress 201Tl using a symptom-limited, graded bicycle exercise test was performed before CABG and 1 month, 6 months to 1 year, 1 year to 1.5 years after surgery. Five tomographic images including the apical side of the area fed by the bypass anastomosed to LAD in short axial sections were picked out and piled up. Fan-shaped ROI was made on this area and % Tl uptake was calculated using the following formula. 201Tl counts in ROI--Background counts/Maximum counts--Background counts x 100 (%) The normal % Tl uptake calculated in the control group (n = 11) in this ROI was 68.2 +/- 4.8%. Preoperative % Tl uptake showed 49.3 +/- 0.2% in the LITA group and 54.3 +/- 13.2% in the SVG group. % Tl uptake of the SVG group 1 month after CABG was slightly higher than that of the LITA group, (62.0 +/- 7.0% vs. 56.3 +/- 7.6%). However 6 months to 1 year after, % Tl uptake of the LITA group increased to 60.8 +/- 6.4%, inspite of a tendency on the decrease of that in the SVG group, (59.0 +/- 8.5%), and further more, 1 year to 1.5 years after CABG, increased to 62.3 +/- 5.1% near the normal % Tl uptake of the control group and the SVG group decreased to 58.8 +/- 6.8%. This result suggested that arterial in situ bypass graft might have an auto-regulation and "growing property" corresponding to flow demand, and this helps the excellent long-term patency of arterial bypass grafts. PMID:8336431

  2. Endovascular Repair of Acute Symptomatic Pararenal Aortic Aneurysm With Three Chimney and One Periscope Graft for Complete Visceral Artery Revascularization

    SciTech Connect

    Brechtel, Klaus Ketelsen, Dominik; Endisch, Andrea; Heller, Stephan; Heuschmid, Martin; Stock, Ulrich A.; Kalender, Guenay

    2012-04-15

    PurposeTo describe a modified endovascular technique for complete revascularization of visceral and renal arteries in symptomatic pararenal aortic aneurysm (PRAA).TechniqueArterial access was surgically established in both common femoral arteries (CFAs) and the left subclavian artery (LSA). Revascularization of the left renal artery, the celiac trunk, and the superior mesenteric artery was performed through one single sheath via the LSA. Suitable covered stents were put in the aortic branches but not deployed. The right renal artery was accessed over the left CFA. Due to the longitudinal extension of the presented aneurysm two stent-grafts were introduced via the right CFA. After deploying the aortic stent-grafts, all covered stents in the side branches were deployed consecutively with a minimum overlap of 5 mm over the cranial and caudal stent-graft edges. Simultaneous ballooning was performed to fully expand all stent-grafts and warranty patency. Conclusion: This is the first report in the literature of chimney grafting in PRAA for complete revascularization of visceral and renal branches by using more than two covered stents introduced from one side through one single sheath. However this technique is modified, it should be used only in bailout situations when branched stent-grafts are not available and/or surgery is not suitable.

  3. Emergency placement of stent-graft for symptomatic acute carotid artery occlusion after endarterectomy.

    PubMed

    Ko, Jun Kyeung; Choi, Chang Hwa; Lee, Sang Weon; Lee, Tae Hong

    2016-03-01

    A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions. Complete recanalization of the left internal CA was achieved and the patient showed a dramatic improvement of his preoperative deficits. To our knowledge, this is the first case of stent-graft implantation for a symptomatic acute CA occlusion following CEA. Stent-graft placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA. PMID:25653229

  4. Simultaneous off-pump coronary artery bypass graft and nephrectomy.

    PubMed

    Dedeilias, Panagiotis; Roussakis, Antonios; Koletsis, Efstratios N; Kouerinis, Ilias; Balaka, Christina; Apostolakis, Efstratios; Malovrouvas, Dimitrios

    2008-01-01

    We report the one-stage surgical management of a 68-year-old patient with renal cell carcinoma and serious hematuria combined with coronary artery disease and unstable angina. After the accomplishment of coronary revascularization without cardiopulmonary bypass, we proceeded to nephrectomy and resection of the renal tumor at the same time. The patient's postoperative course was uneventful, and at 17 months of follow-up, the patient showed no signs of recurrence. To the best of our knowledge, such a case has never been reported before in the literature. PMID:19017005

  5. Atrial fibrillation and flutter following coronary artery bypass graft surgery: A retrospective study and review

    PubMed Central

    Premaratne, Ishani D; Fernando, Naomi D; Williams, Lashira; Hasaniya, Nahidh W

    2016-01-01

    Introduction and objectives Atrial fibrillation is a common arrhythmia following coronary artery bypass graft surgery. Its incidence can range from 10 to 60% of patients undergoing coronary artery bypass graft. This rhythm can result in shorter or longer intervals between beats. Methods Medical records of 143 patients from the Queen’s Medical Center, Kuakini Medical Center, Saint Francis Medical Center, and Straub Hospital and Clinic, all of which are located in Honolulu, Hawaii were reviewed. An additional 39 records of patients who did not develop these complications were also reviewed as a control group. Patients were selected according to the ICD codes for atrial fibrillation/flutter and coronary artery bypass graft. Both anomalies can lead to increased health care costs, morbidity, and mortality. In this study, possible predisposing factors to these complications were investigated. The time of onset, weight gain, elapsed time, fluid status (in/out), hematocrit, and drug regimens were compared between the two groups. Results The differences in weight gain, fluid status, and hematocrit between the groups were not significant. There were a total of 17 different drugs prescribed to the group as a whole but not every patient received the same regimen. Conclusions Atrial fibrillation and flutter were found to be more common in males, particularly between the ages of 60 and 69 years. There were no other significant findings. PMID:27123238

  6. Clinical characteristics of functional recovery after coronary artery bypass graft surgery in Japanese octogenarians

    PubMed Central

    Tobita, Ryo; Iwata, Kentaro; Kamisaka, Kenta; Yuguchi, Satoshi; Tahara, Masayuki; Oura, Keisuke; Morisawa, Tomoyuki; Ohhashi, Satoko; Kumamaru, Megumi; Hanafusa, Yusuke; Kato, Michitaka; Saitoh, Masakazu; Sakurada, Koji; Takahashi, Tetsuya

    2016-01-01

    [Purpose] This study aimed to elucidate characteristics of postoperative physical functional recovery in octogenarians undergoing coronary artery bypass graft surgery. [Subjects and Methods] This was a multi-center, retrospective study. Nine hundred and twenty-seven elective isolated coronary artery bypass graft surgeries were evaluated (746 males and 181 females, mean age: 68.6 years, range: 31–86 years). Participants were stratified according to age < 80 years (n = 840; mean age, 67.1; range, 31–79) or > 80 years (n = 87; mean age, 82.2; range, 80–86). Patient characteristics and postoperative physical functional recovery outcomes were compared between groups. [Results] There was no significant difference between groups when considering the postoperative day at which patients could sit on the edge of the bed, stand at bedside, or walk around the bed. The postoperative day at which patients could walk 100 m independently was later in octogenarians, when compared with non-octogenarians (6.1 ± 3.2 days vs. 4.9 ± 3.9 days). In octogenarians, the percentage of patients who could walk 100 m independently within 8 days after surgery was 79.5%. [Conclusion] A postoperative target time in octogenarians for independent walking, following coronary artery bypass grafting, can be set at approximately 6 days. PMID:27065553

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

    PubMed Central

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

    2013-01-01

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

  8. Redo off-pump coronary artery bypass grafting via a left thoracotomy

    PubMed Central

    Duvan, Ibrahim; Ates, Sanser; Emre Onuk, Burak; Pinar Sungar, Umit; Kurtoglu, Murat; Halidun Karagoz, Yahya

    2015-01-01

    Summary Background In this study, we retrospectively reviewed our experience in a meticulously selected group of patients undergoing redo off-pump coronary artery bypass graft (CABG) surgery from the descending aorta to the circumflex artery (Cx) and its branches. Methods Between January 2001 and October 2013, 32 patients at our hospital underwent redo off-pump CABG from the descending aorta to the Cx and its branches via a left posterolateral thoracotomy. Of these patients, 27 were male (84.3%) and five were female (15.7%), with a mean age of 61.66 ± 8.63 years. All patients had a patent left internal thoracic artery-to-left anterior descending coronary artery (LITA–LAD) anastomosis. Thoracotomy was performed through the fifth intercostal space. The saphenous vein or radial artery was prepared as a graft at the same time as the left posterolateral thoracotomy from the contralateral extremity, without any positional problem. Results The main reasons for surgery in this group of patients were new lesion formation in 19, graft occlusion in six, and both in seven patients. The average operating time was 143.90 ± 36.93 minutes, respiratory assist time was 5.08 ± 1.88 hours, intensive care unit (ICU) stay was 21.3 ± 4.41 hours and hospital stay was 5.06 ± 2.74 days. Thirty-eight bypasses were performed. The follow-up period was 56.17 ± 39.2 months. Six patients were lost in the follow-up period and four patients died. Twenty-two were alive and free of cardiac problems. Conclusion Redo off-pump CABG via a left posterolateral thoracotomy provided a safe and effective surgical approach with lower rates of postoperative morbidity and mortality in patients who required revascularisation of the Cx and its branches. PMID:25475408

  9. Relationship between pre-extubation positive endexpiratory pressure and oxygenation after coronary artery bypass grafting

    PubMed Central

    Lima, Reijane Oliveira; Borges, Daniel Lago; Costa, Marina de Albuquerque Gonçalves; Baldez, Thiago Eduardo Pereira; Silva, Mayara Gabrielle Barbosa e; Sousa, Felipe André Silva; Soares, Milena de Oliveira; Pinto, Jivago Gentil Moreira

    2015-01-01

    Introduction After removal of endotracheal tube and artificial ventilation, ventilatory support should be continued, offering oxygen supply to ensure an arterial oxygen saturation close to physiological. Objective The aim of this study was to investigate the effects of positive-end expiratory pressure before extubation on the oxygenation indices of patients undergoing coronary artery bypass grafting. Methods A randomized clinical trial with seventy-eight patients undergoing coronary artery bypass grafting divided into three groups and ventilated with different positive-end expiratory pressure levels prior to extubation: Group A, 5 cmH2O (n=32); Group B, 8 cmH2O (n=26); and Group C, 10 cmH2O (n=20). Oxygenation index data were obtained from arterial blood gas samples collected at 1, 3, and 6 h after extubation. Patients with chronic pulmonary disease and those who underwent off-pump, emergency, or combined surgeries were excluded. For statistical analysis, we used Shapiro-Wilk, G, Kruskal-Wallis, and analysis of variance tests and set the level of significance at P<0.05. Results Groups were homogenous with regard to demographic, clinical, and surgical variables. There were no statistically significant differences between groups in the first 6 h after extubation with regard to oxygenation indices and oxygen therapy utilization. Conclusion In this sample of patients undergoing coronary artery bypass grafting, the use of different positive-end expiratory pressure levels before extubation did not affect gas exchange or oxygen therapy utilization in the first 6 h after endotracheal tube removal.

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

    PubMed Central

    2014-01-01

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

  11. Off-pump coronary artery bypass grafting versus optimal medical therapy alone: effectiveness of incomplete revascularization in high risk patients

    PubMed Central

    Prestipino, Filippo; Spadaccio, Cristiano; Nenna, Antonio; Sutherland, Fraser WH; Beattie, Gwyn W; Lusini, Mario; Nappi, Francesco; Chello, Massimo

    2016-01-01

    Background Geriatric patients with multivessel coronary artery disease (CAD) are a challenging group to treat; these cases elicit discussion within heart teams regarding the actual benefit of undertaking major surgery on these patients and often lead to abandon the surgical option. Percutaneous procedures represent an important option, but coronary anatomy may be unfavorable. Off-pump coronary artery bypass (OPCAB) provides good quality graft on left anterior descending (LAD) without exposing the patient to cardiopulmonary bypass, and might be the ideal choice in patients with multiple comorbidities, not eligible to percutaneous or on-pump procedures. The objective of this study was to compare survival during a mid-term follow-up in high-risk patients with no percutaneous alternative, either treated with OPCAB or discharged in medical therapy. Methods We retrospectively evaluated from June 2008 to June 2013, 83 high-risk patients with multivessel CAD were included: 42 were treated with incomplete off-pump revascularization using left internal mammary artery (LIMA) on LAD; 41 were discharged in optimal medical therapy (OMT), having refused surgery. Follow-up ended in March 2015, with a telephonic interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events (MACEs). Results During follow up, 11 deaths in OPCAB group and 27 deaths in OMT group occurred. Death was due to cardiac factors in 6 and 15 patients, respectively. MACEs were observed in 6 patients in OPCAB group and in 4 patients in OMT group. With regards to survival from all-cause mortality, patients who underwent OPCAB survived more than those discharged in OMT (Log Rank < 0.001), and OMT group carries a propensity score-adjusted hazard ratio of 3.862 (P < 0.001). With regards to survival from cardiac-related events, patients who underwent OPCAB survived more than those discharged in OMT (Log Rank = 0.002), and OMT group carries a propensity score-adjusted hazard ratio of 3.663 (P = 0.010). There is no statistically significant difference concerning freedom from MACEs (Log Rank = 0.273). Conclusions For high-risk patients with multivessel CAD, not eligible to on-pump complete revascularization surgery or percutaneous procedures, incomplete revascularization with OPCAB LIMA-on-LAD offers benefits in survival when compared to OMT alone. PMID:26918009

  12. Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement.

    PubMed

    Mehta, Vimal; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay

    2016-01-01

    We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory. PMID:26021596

  13. Depression and Anxiety following Coronary Artery Bypass Graft: Current Indian Scenario

    PubMed Central

    Saini, Rajiv; Bakhla, Ajay Kumar; Singh, Jaswinder

    2016-01-01

    Epidemiological studies have shown a high prevalence of coronary artery disease among the Indian Population. Due to increasing availability and affordability of tertiary care in many parts of India, carefully selected patients undergo coronary artery bypass surgery to improve cardiac function. However, the procedure is commonly associated with depression and anxiety which can adversely affect overall prognosis. The objective of this review is to highlight early identifiable symptoms of depression and anxiety following coronary artery bypass graft (CABG) in Indian context so as to facilitate prompt intervention for better outcome. The current review was able to establish firm evidence in support of screening for depression and anxiety following CABG. Management of depression and anxiety following CABG is briefly reviewed. PMID:27034884

  14. Successful Covering of a Hepatic Artery Aneurysm with a Coronary Stent Graft

    SciTech Connect

    Sakai, Hidetsugu; Urasawa, Kazushi; Oyama, Naotsugu; Kitabatake, Akira

    2004-09-15

    In a 54-year-old woman with liver cirrhosis who underwent orthotopic liver transplantation, the postoperative course was complicated by aneurysm formation in the hepatic artery. Abdominal ultrasonography showed a daily increase in the size of the aneurysm in spite of careful management including strict rest and continuous intravenous infusion of antihypertensive agents. Since the patient's poor systemic status was a major obstruction to operative resection, transcatheter therapy was thought more preferable. We evaluated the lesion with intravascular ultrasonography as an adjunct to angiography and a dissection with a flap was well visualized. The aneurysm was covered with a commercially available stent-graft, designed for treatment of the coronary artery. This is a rare case in which a Jostent was implanted into the hepatic artery after liver transplantation.

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

    SciTech Connect

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

    2008-01-15

    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.

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

    SciTech Connect

    Gandini, R.; Spinelli, A.; Pampana, E.; Fabiano, S.; Pendenza, G. Simonetti, G.

    2006-10-15

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

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

    PubMed Central

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

    2014-01-01

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

  18. An Infected Aneurysm of the Vertebral Artery Treated with a Stent-graft: A Case Report

    PubMed Central

    HASHIMOTO, Kenji; ISAKA, Fumiaki; YAMASHITA, Kohsuke

    2015-01-01

    In a 75-year-old man, a growing vertebral artery aneurysm at the C3/4 intervertebral level was found at postoperative evaluation of cervical abscess, which was diagnosed as a complication of sepsis subsequent to cholangitis. Even after a successful antibiotic treatment and a surgical drainage, the aneurysm grew enough to cause compression of esophagus and trachea. The aneurysm was judged to be infection-related, based on the clinical course and the anatomical vicinity to the abscess. Following a dual antiplatelet treatment (clopidogrel 75 mg and aspirin 100 mg per day) for a week, the patient underwent endovascular treatment of the aneurysm with a stent-graft. Postoperative angiography showed complete obliteration of the aneurysm with preserving patency of the vertebral artery. A dual antiplatelet treatment was continued for 6 months and was changed to a single antiplatelet treatment (clopidogrel 75 mg per day) thereafter. Neither recurrence of the aneurysm nor stent-graft infection was observed for 4 years of follow-up. This case illustrates the potential use of a stent-graft in the treatment of an infected aneurysm. PMID:26437795

  19. Characterization of Evolving Biomechanical Properties of Tissue Engineered Vascular Grafts in the Arterial Circulation

    PubMed Central

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

    2014-01-01

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

  20. Endovascular salvage of a right brachial artery-right atrium hemodialysis graft using a covered endoprosthesis.

    PubMed

    Anaya-Ayala, Javier E; Ismail, Nyla; Reardon, Michael J; Peden, Eric K

    2012-01-01

    Creation of a functional hemodialysis access in patients with exhausted peripheral access sites and concomitant central venous occlusive disease (CVOD) is a multifaceted challenge; often requiring complex, innovative solutions, not without their own complications. We present a 57-year-old hemodialysis patient with a history of hypercoagulable disorder and multiple failed arteriovenous accesses. Because of inadequate peripheral access sites and chronic occlusions in superior vena cava, brachiocephalic veins and inferior vena cava, in addition to multiple transhepatic catheter related issues; we decided to perform a right brachial artery to right atrium (RA) hemodialysis graft. The access was used without complications for 18 months at which point he had his first episode of thrombosis; open thrombectomy and percutaneous balloon angioplasty (PTA) at the atrial anastomosis were done with success. The following three months, he endured two more thrombectomies and PTAs. During the last intervention we performed an intravascular Ultrasound (IVUS) through the atrial anastomosis, which demonstrated stenosis; and the decision was made to extend the outflow anastomosis with a covered stent into the atrium. Therefore a 10 cm x 10 mm Viabahn stent-graft (W. L. Gore and Associates, Flagstaff, Ariz.) was deployed and post dilated with 8 mm balloon within the graft component. Repeat injection and Intravascular Ultrasound (IVUS) demonstrated significant improvement and free outflow. The brachial-RA hemodialysis graft could be use immediately and at 5 months has remained fully functional and no reinterventions have been necessary. PMID:22522413

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

    SciTech Connect

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

    1981-04-01

    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.

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

    NASA Astrophysics Data System (ADS)

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

    2011-11-01

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

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

    PubMed

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

    2013-03-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Is CABG an effective alternative for the treatment of myocardial bridging?' Altogether, only six papers were identified using the reported search that represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers are tabulated; these studies reported the outcome of myotomy and coronary artery bypass grafting (CABG) for myocardial bridging. All of these studies were retrospective reports of the results of surgical intervention in patients with myocardial bridging. They showed that the incidence of myocardial bridging was less than 1-1.5% in patients with angina requiring angiography, and 7-9% of these patients had refractory angina despite medical treatment and required surgery. The evidence on the treatment of this congenital condition that mainly affects the middle segment of left anterior descending artery is limited, and there are no treatment guidelines currently available. Stenting of the tunnelled segment has shown high failure rates in approximately half of the cases. Current evidence in the literature suggests that surgery is the mainstay treatment for myocardial bridging. Surgery is performed either as supra-arterial myotomy and de-roofing of the muscle bands on- or off-pump, or as coronary artery bypass grafting of the affected coronary artery beyond the tunnelled segment. Although no mortality was reported with either of these operations, surgical myotomy on deep and extensive myocardial bridges carries the risk of entering the right ventricle, bleeding and aneurysm formation. In addition, in a small percentage of the patients undergoing myotomy, angina recurred. Despite the possibility of competitive flow in the native coronary artery after CABG for myocardial bridging, we did not identify any evidence demonstrating graft occlusion after CABG for myocardial bridging. In conclusion, in extensive and deep myocardial bridgings, CABG may be the treatment of choice that carries low risk, limited complications and excellent symptomatic relief. PMID:23171516

  4. Coronary endarterectomy in left anterior descending artery combined with coronary artery bypass grafting – midterm mortality and morbidity

    PubMed Central

    Domaradzki, Wojciech; Krauze, Jolanta; Kinasz, Leszek; Jankowska-Sanetra, Justyna; Świątkiewicz, Małgorzata; Paradowski, Krzysztof; Cisowski, Marek

    2015-01-01

    Introduction Completeness of myocardial revascularization is essential in surgical treatment of coronary artery disease. The aim of this study is to determine the effectiveness of coronary endarterectomy as an adjunct to coronary artery bypass grafting (CABG) in the most difficult cases. Material and methods Among 1559 patients who had CABG in our department, the cases of 17 who underwent an adjunct left anterior descending endarterectomy were analyzed. All procedures were performed with median sternotomy, extracorporeal circulation and in mild hypothermia (34°C), by the same surgeon. No coronary artery endarterectomy was planned before surgery. Results There was no infarction or cardiac arrest during hospitalization. Only one patient required mechanical circulatory support (intra-aortic balloon counterpulsation). Each patient was contacted and investigation for major adverse cardiac and cerebrovascular events (MACCE) was performed. Eleven patients (65%) already underwent midterm clinical evaluation. There was no death, myocardial infarction or cerebrovascular incident during the entire period (mean follow-up at 15.3 months). One patient required urgent coronarography due to chest pain. No other patient had chest pain or significant deterioration of ventricular function in echocardiography. Conclusions Outcomes and potential indications for performing left anterior descending coronary endarterectomy as an adjunct to CABG are discussed. PMID:26855644

  5. Platelet Hyperreactivity in Response to On- and Off-pump Coronary Artery Bypass Grafting

    PubMed Central

    Bochsen, Louise; Rosengaard, Lisbeth Bredahl; Nielsen, Allan Bybeck; Steinbrüchel, Daniel A.; Johansson, Pär I.

    2009-01-01

    Abstract: Hypercoagulability has been reported after off-pump coronary artery bypass grafting (OPCAB) compared with patients undergoing standard coronary artery bypass grafting (CABG) with cardiopulmonary bypass. The aim of this study was to evaluate the changes in platelet reactivity in response to cardiac surgery, both OPCAB and CABG. Platelet reactivity was monitored pre- and postoperatively (days 1 and 4) in elective OPCAB (n = 29) and CABG (n = 24) patients using the maximal amplitude (MA) parameter obtained with thrombelastography. Platelet reactivity was also examined at 1 month in 30 of the 53 patients. Twenty-three percent of the patients (12/53) had a preoperative MA value above normal reference value (MA > 69 mm). By postoperative day 4, 88% of the patients presented with an MA > 69 mm, and significant increases in MA were shown in both groups (p < .0001). Of the 30 patients examined at 1 month after surgery, 75% of the patients with high preoperative MA (6/8) remained at this level. In contrast, only 4.5% of patients with normal preoperative MA (1/22) presented with high MA at day 30. MA has previously been shown to correlate with the incidence of thrombotic and ischemic complications and this study identified 23% of patients needing coronary bypass surgery to be at high risk for recurrent ischemic events at 1 month after surgery, based on the MA. These results suggest that a more aggressive antithrombotic treatment might be warranted for patients undergoing coronary artery bypass grafting, both OPCAB and CABG, presenting with a high MA pre- and post-surgery. PMID:19361027

  6. Transfusion-related acute lung injury following coronary artery bypass graft surgery.

    PubMed

    Bitargil, M; Arslan, C; Başbuğ, H S; Göçer, H; Günerhan, Y; Bekov, Y Y

    2015-11-01

    Blood transfusion is sometimes a necessary procedure during or following coronary artery bypass graft (CABG) surgery. However, transfusion-related acute lung injury (TRALI)/possible TRALI is a rare and fatal complication and characterized by acute hypoxemia and non-cardiogenic pulmonary edema that occurs within 6 hours following a transfusion. Anti-leukocyte antibodies or, possibly, other bioactive substances cause inflammation and capillary endothelial destruction in susceptible recipients' lungs. Prompt diagnosis and mechanical ventilatory support are important. A successful treatment of two male patients following CABG surgery, compatible with TRALI/possible TRALI, is presented here. PMID:25575703

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

    PubMed Central

    Chedrawy, Edgar G.

    2014-01-01

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

  8. Treatment of aneurysmal aberrant right subclavian artery with triple-barrel stent graft.

    PubMed

    Schwein, Adeline; Georg, Yannick; Ohana, Mickaël; Delay, Charline; Lejay, Anne; Thaveau, Fabien; Chakfe, Nabil

    2015-04-01

    Aneurysmal evolution of an aberrant right subclavian artery (ARSA) is an operative indication. Endovascular treatment is a minimally invasive procedure, which offers good short-term and midterm results. We describe a case of a 9-cm diameter ARSA aneurysm in a symptomatic man, treated with the triple-barrel technique using a thoracic aortic stent graft combined with surgical and endovascular revascularization of the supra-aortic trunks. Postoperatively, the patient developed a type III endoleak which was covered. The triple-barrel technique has been a proposed treatment approach for complex aortic arch pathologies and remains a less invasive option when compared with open surgery. PMID:25596407

  9. Comparison of Risk of Atrial Fibrillation in Black Versus White Patients After Coronary Artery Bypass Grafting.

    PubMed

    Efird, Jimmy T; Gudimella, Preeti; O'Neal, Wesley T; Griffin, William F; Landrine, Hope; Kindell, Linda C; Davies, Stephen W; Sarpong, Daniel F; O'Neal, Jason B; Crane, Patricia; Nelson, Margaret A; Ferguson, Thomas Bruce; Chitwood, Walter Randolph; Kypson, Alan P; Anderson, Ethan J

    2016-04-01

    Obesity has been identified as a risk factor for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). However, no studies have addressed the influence of race on this association. A total of 13,594 patients undergoing first-time, isolated CABG without preoperative AF between 1992 and 2011 were included in our study. The association between body mass index and POAF was compared by race. Relative risk and 95% CIs were computed using maximum likelihood log-binomial regression. Increasing levels of body mass index were associated with higher POAF risk after CABG in black but not white patients (pinteraction = 0.0009). PMID:26857161

  10. Modified T-Graft for Extracorporeal Membrane Oxygenation in a Patient with Small-Caliber Femoral Arteries.

    PubMed

    Calderon, Daniel; El-Banayosy, Aly; Koerner, Michael M; Reed, Amy B; Aziz, Faisal

    2015-12-01

    Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort to provide cardiopulmonary support in patients whose advanced cardiac or respiratory failure does not respond to less invasive treatments. Lower-limb ischemia secondary to the large diameter of the arterial cannula is one of ECMO's major limitations: in patients who have small-caliber arteries, the cannulas can reduce native blood flow. The creation of a T-graft-a well-described technique to avoid limb ischemia-enables flow into the ECMO cannula without jeopardizing blood flow to the limb. However, leaving the graft exposed through an open groin wound can result in dislodgment, and it increases the risk of infection. We describe our modification of a conventional T-graft in an 18-year-old woman who had systolic heart failure, acute respiratory distress syndrome, and small-caliber femoral vessels. We tunneled a polytetrafluoroethylene graft inside a Dacron graft, then ran the combined graft through a subcutaneous tunnel similar to that created for a peripheral bypass. Thus, the graft was protected from environmental exposure and the risk of infection. Our technique seems safer and more secure than the original T-graft technique, and we recommend its consideration during ECMO cannulation. PMID:26664305

  11. Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms

    SciTech Connect

    Okada, Takuya Yamaguchi, Masato; Kitagawa, Atsushi; Kawasaki, Ryota; Nomura, Yoshikatsu; Okita, Yutaka; Sugimura, Kazuro; Sugimoto, Koji

    2012-02-15

    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.

  12. Comparison of incentive spirometry and intermittent positive pressure breathing after coronary artery bypass graft.

    PubMed

    Oikkonen, M; Karjalainen, K; Kähärä, V; Kuosa, R; Schavikin, L

    1991-01-01

    Fifty-two patients were randomized to receive either incentive spirometry (IS) or intermittent positive pressure breathing (IPPB) in addition to conventional chest physical therapy following coronary artery bypass grafting. Slow vital capacity and peak expiratory flow readings decreased rapidly and to an equal extent in both groups after surgery, and partly recovered by the sixth postoperative day (POP). Arterial PO2 values were similar for the groups on the first three POPs. On the POPs 2, 3, and 6, the number of chest films showing atelectases as well as the number of individual patients having atelectases revealed no statistically significant differences between the two groups. Based on the three variables studied, we consider both devices equal in efficiency after coronary surgery. PMID:1984988

  13. Coronary artery bypass grafting on the beating heart using the octopus method--a case report.

    PubMed

    Tan, P H; Tsai, T C; Chen, C S; Liu, K; Yang, L C; Wang, J H; Lin, S H

    2000-12-01

    A 74-year-old male was admitted due to chest tightness for one month. He had received percutaneous transilluminal coronary angioplasty (PTCA) because of single-vessel disease one year ago. Cardiac catheterization examination carried out during this admission revealed 90% stenosis of the left anterior descending coronary artery (LAD) and circumflex branch (CX). Because another attempt of PTCA was considered not optimal, the patient was advised to undergo surgical grafting to which he consented. After expediently balancing the merits and demerits of every practicable surgical procedure--the essential determinant in selection of which was that the patient's condition and criteria of indication of that procedure were in perfect harmony--we decided to carry out minimally invasive direct coronary artery bypass (MIDCAB) with the application of Octopus tissue stabilizer. We report the surgical course and anesthetic management of the patient and discourse some detail in MIDCAB. PMID:11392070

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

    PubMed

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

    2014-01-01

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

  15. Epicardial Adipose Tissue is Associated with Extensive Coronary Artery Lesions in Patients Undergoing Coronary Artery Bypass Grafting: an Observational Study

    PubMed Central

    KAYA, Mehmet; YENITERZI, Mehmet; YAZICI, Pınar; DIKER, Mustafa; CELIK, Omer; ERTÜRK, Mehmet; BAKIR, Ihsan

    2014-01-01

    Objectives: To investigate the relationship between the epicardial adipose tissue (EAT) volume measured by 256-slice dual source computed tomography (DSCT) and the complexity with the presence of significant coronary artery disease (CAD) in patients undergoing coronary artery bypass graft surgery (CABG). Material and methods: Study subjects were enrolled as they were undergoing DSCT for coronary evaluation. Two subgroups were formed according to coronary artery bypass history: Group A (patients with significant CAD), Group B (patients with normal coronary arteries). In both groups, EAT volume was measured by DSCT with the same technique. The complexity of CAD was assessed by using Syntax score (SxS). Group A patients were subdivided into two groups according to these results (Group A1, A2). Outcomes: Ninety-three patients (53 male, 40 female) with a mean age of 55.1 years were enrolled in the study (48 in group A and 45 in Group B). The serum levels of fasting plasma glucose (FPG), total cholesterol (TC) and low-density lipoprotein (LDL) were found statistically higher in Group A. In Group A, mean EAT volume was 44.87±21.28 cm3 while it was in normal range (32.37±17.50 cm3) in control group (p=0.003). Higher EAT volume was found to be related to FPG (r=0.242, p=0.015) and body surface area (BSA) (r =0.268, p=0.009) and also correlated positively with CAD. On the other hand, there was no significant difference between subgroups when considering the complexity of CAD. Conclusions: Our data shows that increased EAT volume is associated with significant CAD. EAT volume contributes to the development of coronary lesions, but it does not affect the complexity of the lesions. PMID:25705268

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

    SciTech Connect

    Sharafuddin, Melhem J.; Titus, Jack L.

    1997-03-15

    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.

  17. Primary pulmonary artery sarcoma: a new surgical technique for pulmonary artery reconstruction using a self-made stapled bovine pericardial graft conduit.

    PubMed

    Obeso Carillo, Gerardo Andrés; Casais Pampín, Rocío; Legarra Calderón, Juan José; Pradas Montilla, Gonzalo

    2015-01-01

    Primary pulmonary artery sarcoma is an uncommon neoplasm with a grim prognosis. Complete resection is the only treatment that can improve the patient's survival. The role of multimodality treatment is still controversial, although adjuvant chemotherapy possibly could improve outcomes of these patients. Several pulmonary artery reconstructive techniques have been reported in the scientific literature, such as patch reconstruction, end-to-end anastomosis, synthetic prosthesis or biological grafts. In this article, we propose a new surgical option for pulmonary artery reconstruction after radical tumour resection using a self-made stapled bovine pericardial graft conduit in a patient with a mass in the pulmonary trunk and right pulmonary artery. We believe that the use of this technique adds safety and effectiveness, and reduces the surgical time. PMID:25000937

  18. [Multiple brain abscesses in the territory of the vertebral-basilar artery resulting from an infected aortic arch graft].

    PubMed

    Otani, Yoshihiro; Inoue, Satoshi; Kawauchi, Satoshi; Uneda, Atsuhito; Kajitani, Takumi; Watanabe, Kyoichi; Deguchi, Kentaro; Kiriyama, Hideki; Tokunaga, Koji; Matsumoto, Kengo

    2015-03-01

    A 62-year-old man with high fever and in a state of disorientation was transferred to our hospital. One year before this transfer, he had undergone total arch replacement surgery for thoracic aortic dissection. On admission to our hospital, head MRI revealed multiple brain abscesses in the territory of the vertebral-basilar artery, and chest CT showed gas around the aortic graft, in particular, at the origin of the left subclavian artery. We diagnosed him with brain abscesses in the left vertebral-basilar artery resulting from an infected aortic graft. We immediately began administration of intravenous antibiotics. Although his blood, urine, and cerebrospinal fluid cultures were negative, fortunately, the brain abscesses and ectopic gas disappeared. Since reports of only antibiotic use for treating brain abscesses due to aortic graft infection are rare, the appropriate duration of antibiotic administration has not been established yet. Therefore, careful observation is required in this case. PMID:25748809

  19. [Dose the administration of low-dose aprotinin contribute to an anti-inflammatory effect in coronary artery bypass grafting?].

    PubMed

    Shirasawa, B; Hamano, K; Gohra, H; Katoch, T; Fujimura, Y; Zempo, N; Esato, K

    1999-10-01

    A study was conducted to determine whether the administration of low-dose aprotinin contributed to an anti-inflammatory effect in coronary artery bypass grafting. Levels of the inflammatory cytokines; IL-6, IL-8, and GEL, were measured before and after cardiopulmonary bypass, then 1, 3 and 6 days after coronary artery bypass grafting, in a group of patients given aprotinin (n = 7) and a control group (n = 15). A comparison of the levels of all these inflammatory cytokines between the two groups revealed no significant difference at any time point. This indicates, that low-dose aprotinin did not contribute to an anti-inflammatory effect in coronary artery bypass grafting. PMID:10513162

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

    SciTech Connect

    Weintraub, Joshua L. Belanger, Adam R.; Sung, Chris C.; Stangl, P. Anondo; Nowakowski, F. Scott; Lookstein, Robert L.

    2010-06-15

    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.

  1. The effectiveness of lavender essence on strernotomy related pain intensity after coronary artery bypass grafting

    PubMed Central

    Heidari Gorji, Mohammad Ali; Ashrastaghi, Om Golsum; Habibi, Valiollah; Charati, Jamshid Yazdani; Ebrahimzadeh, Mohammad Ali; Ayasi, Mitra

    2015-01-01

    Background: Considering the side effects of pharmacological methods, there has been a suggestion to use nonpharmacological methods such Aromatherapy following coronary artery bypass grafting (CABG). This study aims to evaluate the effectiveness of lavender 2% aromatherapy on sternotomy pain intensity after coronary artery bypass graft surgery in patients who have undergone surgery. Materials and Methods: During this clinical trial, 50 patients who were candidates for CABG, were randomly divided into two equal groups, that is, the control group (n = 25) and the case group (n = 25). Following CABG, the case group received two drops of 2% lavender oil every 15 minutes with supplemental oxygen and the control group received only supplemental oxygen through a face mask. The data collection tools comprised of the demographic check list and visual analog scale (VAS) for evaluating the pain intensity. The pain intensity were assessed pre- and five, 30, and 60 minutes post aromatherapy. The final data were analyzed by the t-test and chi-squared test. Results: The findings showed that the pain perception intensity in the case group was lower than that in the control group at the 30- and 60-minute phases after intervention (P < 0.0001). Conclusion: The result indicated that aromatherapy can be used as a complementary method in postoperative pain reduction, as it reduced pain. The patients require two sedative drugs, and moreover, it avoids expenses of treatment. PMID:26261829

  2. Staged stenting of a long aneurysm of a saphenous vein coronary artery bypass graft.

    PubMed

    Jamshidi, Peiman; Resink, Therese; Erne, Paul

    2008-01-01

    A 65-year-old male who underwent coronary artery bypass graft surgery (CABG) 21 years ago and received a mitral valve annuloplasty 5 years ago presented with recurrent angina. Computed tomography showed an aneurysm of the saphenous vein graft (SVG), measuring approximately 43 x 33 mm with mural thrombus. Diagnostic catheterization showed that the SVG to the marginal branch of the left circumflex artery had a large aneurysm with mural thrombus, which measured 32 x 45 mm. The lesion was pretreated with a 5.5 x 47 mm Magic Wallstent (Boston Scientific, Maple Grove, Minnesota) followed by 4.0 x 26, 4. x 26, 4.0 x 19 and 4.0 x 16 mm PTFE-covered stents. Postdilatation was performed using a 5.0 x 20 mm balloon. Because of significant flow from the distal end of the PTFE-covered stents seen at coronary angiography after 6 months, we implanted another 4.0 x 26 mm PTFE-covered stent at the distal edge of the previous stent. Final angiography and intravascular ultrasound showed no significant flow into the aneurysm. PMID:18174622

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

    PubMed Central

    2013-01-01

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

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

    SciTech Connect

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

    2006-12-15

    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.

  5. Intimal thickening and permeability of arterial autogenous vein graft in a canine poor-runoff model: transmission electron microscopic evidence.

    PubMed

    Mii, S; Okadome, K; Onohara, T; Yamamura, S; Sugimachi, K

    1990-07-01

    The relationship between development of intimal thickening and permeability of an arterial autogenous vein grafts in dogs' limbs was examined with horseradish peroxidase used as a tracer. The transendothelial transports increased under conditions of abnormal blood flow, compared with findings with a normal blood flow, and a large amount of horseradish peroxidase infiltrated the subendothelial spaces for 4 weeks after implantation, a time when intimal thickening progressed rapidly. It would thus appear that, under conditions of abnormal blood flow, intimal hyperpermeation would be a contributing factor to the intimal thickening of an autogenous vein graft before an autovein graft had completely adapted to the new environment. PMID:2360192

  6. The vascularized sural nerve graft based on a peroneal artery perforator for reconstruction of the inferior alveolar nerve defect.

    PubMed

    Hayashida, Kenji; Hiroto, Saijo; Morooka, Shin; Kuwabara, Kaoru; Fujioka, Masaki

    2015-03-01

    The sural nerve has been described for nerve reconstruction of the maxillofacial region since it provides many advantages. We report a case of a vascularized sural nerve graft based on a peroneal artery perforator for immediate reconstruction after the removal of intraosseous neuroma originating in the inferior alveolar nerve. The patient had a neuroma caused by iatrogenic injury to the inferior alveolar nerve. A 4-cm long neuroma existed in the inferior alveolar nerve and was resected. A peroneal perforator was chosen as the pedicle of the vascularized sural nerve graft for the nerve gap. The graft including the skin paddle for monitoring the perfusion supplied by this perforator was transferred to the lesion. The nerve gap between the two stumps of the inferior alveolar nerve was repaired using the 6-cm long vascularized sural nerve. The perforator of the peroneal artery was anastomosed to the branch of the facial artery in a perforator-to-perforator fashion. There was no need to sacrifice any main arteries. The skin paddle with 1 cm × 3 cm in size was inset into the incised medial neck. Perceptual function tests with a Semmes-Weinstein pressure esthesiometer and two-point discrimination in the lower lip and chin at 10 months after surgery showed recovery almost to the level of the normal side. This free vascularized sural nerve graft based on a peroneal artery perforator may be a good alternative for reconstruction of inferior alveolar nerve defects. PMID:25346479

  7. Modified T-Graft for Extracorporeal Membrane Oxygenation in a Patient with Small-Caliber Femoral Arteries

    PubMed Central

    Calderon, Daniel; El-Banayosy, Aly; Koerner, Michael M.; Reed, Amy B.

    2015-01-01

    Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort to provide cardiopulmonary support in patients whose advanced cardiac or respiratory failure does not respond to less invasive treatments. Lower-limb ischemia secondary to the large diameter of the arterial cannula is one of ECMO's major limitations: in patients who have small-caliber arteries, the cannulas can reduce native blood flow. The creation of a T-graft—a well-described technique to avoid limb ischemia—enables flow into the ECMO cannula without jeopardizing blood flow to the limb. However, leaving the graft exposed through an open groin wound can result in dislodgment, and it increases the risk of infection. We describe our modification of a conventional T-graft in an 18-year-old woman who had systolic heart failure, acute respiratory distress syndrome, and small-caliber femoral vessels. We tunneled a polytetrafluoroethylene graft inside a Dacron graft, then ran the combined graft through a subcutaneous tunnel similar to that created for a peripheral bypass. Thus, the graft was protected from environmental exposure and the risk of infection. Our technique seems safer and more secure than the original T-graft technique, and we recommend its consideration during ECMO cannulation. PMID:26664305

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

    PubMed

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

    2014-02-01

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

  9. Pseudoaneurysm of the Internal Mammary Artery as an Unusual Cause of Post-sternotomy Hemorrhage: The Role of Multislice Computed Tomography in the Diagnosis and Treatment Planning

    SciTech Connect

    Kamath, Sridhar Unsworth-White, Jonathan; Wells, Irving P.

    2005-04-15

    Pseudoaneurysm of the internal mammary artery (IMA) following median sternotomy is extremely rare. To date, the reported cases are only in single figures. The majority of these pseudoaneurysms were suspected from the clinical presentation, echocardiography or computed tomography (CT) but were only confirmed on contrast angiography. This case report demonstrates the current ability to carry out detailed vascular imaging on a 16-slice CT scanner. This accurate delineation of the pseudoaneurysm allowed targeted therapeutic embolization to be performed without unnecessary angiographic imaging.

  10. Effect of coronary artery bypass grafting on left ventricular diastolic function.

    PubMed

    Lawson, W E; Seifert, F; Anagnostopoulos, C; Hills, D J; Swinford, R D; Cohn, P F

    1988-02-01

    Because left ventricular (LV) diastolic function is abnormal in patients with coronary artery disease (CAD), pulsed Doppler echocardiography was used to evaluate LV filling before and after coronary artery bypass grafting (CABG). Filling was evaluated by Doppler in 2 studies: (1) in a group of 41 unpaired patients (11 with angiographically normal coronary arteries, 14 with CAD but without CABG and 16 at 1 week after CABG) and (2) in a group of 12 patients with CAD before and 1 week after CABG. Doppler sampling at the level of the mitral anulus was analyzed for the deceleration half-time and for the ratio of peak late (A) to peak early (E) filling velocity, measures reflecting early ventricular filling and the relative contribution of atrial contraction to ventricular filling. In the first study the deceleration half-time was significantly prolonged in both CAD and CABG groups. The late to early peak transmitral velocity ratio, however, was significantly prolonged only in the nonrevascularized CAD patients. In the second group of CAD patients studied before and 1 week after surgical revascularization, both the late to early peak transmitral velocity ratio and the deceleration half-time showed significant postoperative improvement. Thus, patients with CAD showed impairment in early LV filling and a compensatory increase in the proportion of filling with active atrial contraction. Successful CABG appears to result in normalization of early filling and decreased reliance on active atrial transport. PMID:3257633

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

    PubMed Central

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

    2011-01-01

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

  12. Bilateral internal thoracic artery grafting in octogenarians: where are the benefits?

    PubMed

    Gatti, Giuseppe; Dell'Angela, Luca; Benussi, Bernardo; Dreas, Lorella; Forti, Gabriella; Gabrielli, Marco; Rauber, Elisabetta; Luzzati, Roberto; Sinagra, Gianfranco; Pappalardo, Aniello

    2016-05-01

    The use of bilateral internal thoracic artery (BITA) grafting for myocardial revascularization is usually discouraged in the very elderly because of increased risk of perioperative complications. The aim of the study was to analyze early and late outcomes of BITA grafting in octogenarians. From January 1999 throughout February 2014, 236 consecutive octogenarians with multivessel coronary artery disease underwent primary isolated coronary bypass surgery at the authors' institution. Six of these patients underwent emergency surgery and were excluded from this retrospective study; consequently, 135 BITA patients were compared with 95 single internal thoracic artery (SITA) patients according to early and late outcomes. Between BITA and SITA patients, there was no significant difference in the operative risk (EuroSCORE II: 8 ± 7.7 vs. 7.6 ± 6.1 %, p = 0.65). There was a lower aortic manipulation in BITA patients. Hospital mortality (3 vs. 4.2 %, p = 0.44) and perioperative complications were similar except that only BITA patients experienced sternal wound infection (5.2 %, p = 0.022). The mean follow-up was 4.7 ± 3.3 years. There were no differences between the two groups in overall survival (p = 0.79), freedom from cardiac and cerebrovascular deaths (p = 0.73), major adverse cardiac and cerebrovascular events (p = 0.63) and heart failure hospital readmission (p = 0.64). Predictors of decreased late survival were diabetes (p = 0.0062) and congestive heart failure (p = 0.0004). BITA grafting can be routinely used in octogenarians with atherosclerotic ascending aorta without an increase in hospital mortality or major adverse cardiac and cerebrovascular complications. However, there is an increased risk of sternal wound infection without a demonstrable long-term benefit. PMID:25854622

  13. Combined Endovascular Repair of a Celiac Trunk Aneurysm Using Celiac-Splenic Stent Graft and Hepatic Artery Embolization

    SciTech Connect

    Carrafiello, Giampaolo; Rivolta, Nicola; Fontana, Federico; Piffaretti, Gabriele; Mariscalco, Giovanni; Bracchi, Elena; Ferrario, Massimo

    2010-04-15

    Celiac trunk aneurysms are rare and usually asymptomatic lesions. However, treatment is generally warranted to avoid catastrophic rupture. We report a case of a 70-year-old man who sought care for a celiac trunk aneurysm close to the hepatosplenic bifurcation managed endovascularly by using a combined treatment of celiac-splenic stent-graft implantation and hepatic artery embolization.

  14. Incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting

    PubMed Central

    Bohatch Júnior, Milton Sérgio; Matkovski, Paula Dayana; Giovanni, Frederico José Di; Fenili, Romero; Varella, Everton Luz; Dietrich, Anderson

    2015-01-01

    Objective To determine the incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting. Methods A retrospective study with analysis of 230 medical records between January 2011 and October 2013 was conducted. Results Fifty-six (24.3%) out of the 230 patients were female. The average age of patients undergoing on-pump coronary artery bypass grafting was 59.91±8.62 years old, and off-pump was 57.16±9.01 years old (P=0.0213). The average EuroSCORE for the on-pump group was 3.37%±3.08% and for the off-pump group was 3.13%±3% (P=0.5468). Eighteen (13.43%) patients who underwent off-pump coronary artery bypass grafting developed postoperative atrial fibrillation, whereas for the onpump group, 19 (19.79%) developed this arrhythmia, with no significant difference between the groups (P=0.1955). Conclusion Off-pump coronary artery bypass grafting did not reduce the incidence of atrial fibrillation in the postoperative period. Important predictors of risk for the development of this arrhythmia were identified as: patients older than 70 years old and presence of atrial fibrillation in perioperative period in both groups, and non-use of beta-blockers drugs postoperatively in the on-pump group. PMID:26313722

  15. Stent-Graft for the Management of Hepatic Artery Rupture Subsequent to Transcatheter Thrombolysis and Angioplasty in a Liver Transplant Recipient

    SciTech Connect

    Yamakado, Koichiro Nakatsuka, Atsuhiro; Takaki, Haruyuki; Usui, Masanobu; Sakurai, Hiroyuki; Isaji, Shuji; Uemoto, Shinji; Takeda, Kan

    2008-07-15

    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.

  16. Ruptured mycotic common femoral artery pseudoaneurysm: fatal pulmonary embolism after emergency stent-grafting in a drug abuser.

    PubMed

    Karkos, Christos D; Kalogirou, Thomas E; Giagtzidis, Ioakeim T; Papazoglou, Konstantinos O

    2014-12-01

    The rupture of a mycotic femoral artery pseudoaneurysm in an intravenous drug abuser is a limb- and life-threatening condition that necessitates emergency intervention. Emergency stent-grafting appears to be a viable, minimally invasive alternative, or a bridge, to subsequent open surgery. Caution is required in cases of suspected concomitant deep vein thrombosis in order to minimize the possibility of massive pulmonary embolism during stent-grafting, perhaps by omitting stent-graft postdilation or by inserting an inferior vena cava filter first. We describe the emergency endovascular management, in a 60-year-old male intravenous drug abuser, of a ruptured mycotic femoral artery pseudoaneurysm, which was complicated by a fatal pulmonary embolism. PMID:25593530

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

    NASA Astrophysics Data System (ADS)

    Sankaran, Sethuraman; Marsden, Alison

    2010-11-01

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

  18. Use of the Gore Hybrid Vascular Graft in a challenging high-lying extracranial carotid artery aneurysm.

    PubMed

    Nigro, Gianluigi; Gatta, Emanuele; Pagliariccio, Gabriele; Grilli, Carlo; Carbonari, Luciano

    2014-03-01

    Extracranial carotid artery aneurysm is a rare condition with relatively significant morbidity and mortality. When surgery is not indicated, endovascular techniques are emerging as the preferred treatment. However, even this approach may be contraindicated due to anatomic factors. We present a case of a high-lying extracranial carotid artery aneurysm with challenging anatomy unsuitable for conventional or endovascular repair. After resecting the aneurysm, the carotid artery was revascularized using the new Gore Hybrid Vascular Graft (W. L. Gore & Associates, Flagstaff, Ariz). This straightforward procedure turned out to be safe and further reduced the cerebral ischemic time. PMID:23777810

  19. Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft.

    PubMed

    Duvnjak, Stevo

    2016-03-28

    Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the "bell-bottom" technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the "snorkel and sandwich" technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bell-bottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the "snorkel and sandwich" technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications. PMID:27027393

  20. Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft

    PubMed Central

    Duvnjak, Stevo

    2016-01-01

    Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the “bell-bottom” technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the “snorkel and sandwich” technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bell-bottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the “snorkel and sandwich” technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications. PMID:27027393

  1. Coronary artery bypass graft patients' pain perception during epicardial pacing wire removal.

    PubMed

    Roschkov, Sylvia; Jensen, Louise

    2004-01-01

    Surgical placement of temporary epicardial pacing wires (EPWs) onto the epicardial surface of the heart is standard practice during cardiac surgery. The purpose of this study was to determine the intensity and quality of pain and sensations experienced during the procedure of EPWs removal for coronary artery bypass graft (CABG) patients. A descriptive study, incorporating the McGill Pain Questionnaire-short form and visual analogue scales, was used with 100 CABG patients requiring EPW removal. The pain intensity was reported as mild (47%), while the main sensation experienced was pulling (70%). Age, gender, previous cardiac surgery and EPW removal experience, and use of analgesics did not influence the pain and sensations experienced. However, subjects who had EPWs removed on post-operative day five or earlier did present with higher MPQ-SF affective and combined scores. CABG patients can be prepared for EPW removal by providing information that the procedure is a mildly painful, pulling sensation. PMID:15460837

  2. Guillain-Barré Syndrome after Coronary Artery Bypass Graft Surgery:a Case Report.

    PubMed

    Hekmat, Manouchehr; Ghaderi, Hamid; Foroughi, Mahnoosh; Mirjafari, S Adeleh

    2016-01-01

    Guillain-Barre syndrome is a neurologic disorder that may appear after infection or major surgery.  Guillian-Barre syndrome following cardiac surgery is rare and only based on case reports, and we review all of the published cases. A 52-year-old man after 5 months suffering from chest pain was referred to our hospital and underwent coronary artery bypass graft for 3 vessel disease. The patient was discharged without complication on the 5th postoperative day. He presented Guillain- Barre syndrome after 12 months. He has not completely recovered weakness of upper extremities grade 4/5 with atrophy of both upper extremities remains after 18 months. This disorder is similar to classic GBS. It is important to be alert to de novo autoimmune neurological disorders after cardiac surgery. These disorders are similar to classic autoimmune disease and treated with standard therapies. PMID:26853295

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    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

    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. PMID:22965973

  5. Giant Saphenous Venous Graft Aneurysm with Compression of the Pulmonary Artery: A Rare Cause of Heart Failure

    PubMed Central

    Kalavakunta, Jagadeesh K.; Agrawal, Yashwant; Williams, Alicia; Pratt, Jerry W.; Saltiel, Frank

    2015-01-01

    We report a case of a 74-year-old man who presented with dyspnea on exertion and pedal edema. He had five-vessel coronary artery bypass graft (CABG) surgery twenty-six years ago and redo three-vessel CABG done thirteen years later. Computed tomographic angiography (CTA) of the heart and coronary vessels demonstrated a giant aneurysm arising from the saphenous venous graft (SVG) to the first obtuse marginal of the left circumflex artery compressing the pulmonary artery (PA). He underwent coronary angiography, confirming the CTA findings. Surgical and percutaneous interventions were offered, but the patient opted for conservative management due to the high risk of morbidity and mortality. PMID:26649205

  6. Changes in angiographic features and the ankle/brachial pressure index of femorodistal arterial bypass grafts during knee flexion.

    PubMed

    Akiyama, N; Furutani, A; Kuga, T; Fujioka, K; Zempo, N; Esato, K

    1996-01-01

    Systolic ankle pressure was measured in limbs in the extended and 90 degrees-flexed positions in three groups of patients who had undergone below-knee femorodistal arterial bypass. Group 1 consisted of eight limbs in seven patients who had received an autologous saphenous vein (ASV) graft; group 2 consisted of seven limbs in seven patients who had received a ringed expanded polytetrafluorethylene (ePTFE) graft; and group 3 consisted of five limbs in five patients who had received a reinforced biosynthetic borine collagen vascular (Omniflow) graft. Intravenous digital subtraction angiography was performed within 3 months of implantation. The ankle/brachial index (ABI) was significantly lower when the knee was flexed than when it was extended in group 1 and 3, but not in group 2. The ABI flexion in group 1 was similar to that in group 2. Morphologic changes such as kinking were demonstrated angiographically in groups 1 and 3. Given that the ABIs in groups 1 and 2 were similar with the knee flexed, despite the morphologic changes in group 1, we concluded that saphenous vein and ringed ePTFE grafts are more durable when subjected to acute knee flexion than Omniflow grafts. Thus, as graft failure is unlikely to result from kinking as a result of knee flexion alone, further clinical studies are required to elucidate the precise causes of graft failure. PMID:8919281

  7. Meta-Analysis of Radial Versus Femoral Artery Approach for Coronary Procedures in Patients With Previous Coronary Artery Bypass Grafting.

    PubMed

    Rigattieri, Stefano; Sciahbasi, Alessandro; Brilakis, Emmanouil S; Burzotta, Francesco; Rathore, Sudhir; Pugliese, Francesco R; Fedele, Silvio; Ziakas, Antonios G; Zhou, Yu J; Guzman, Luis A; Anderson, Richard A

    2016-04-15

    Cardiac catheterization through the radial artery approach (RA) has been shown to significantly reduce access-site complications compared with the femoral artery approach (FA) in many clinical settings. However, in the subset of patients with previous coronary artery bypass grafting (CABG), optimal vascular access site for coronary angiography and intervention is still a matter of debate. We aimed to perform a systematic review and meta-analysis of available studies comparing RA with FA in patients with previous CABG. Data were extracted by two independent reviewers; weighted mean differences and 95% confidence interval (CI) were calculated for continuous outcomes, whereas odds ratio (OR) and 95% CI were calculated for dichotomous outcomes. Summary statistics were calculated by random-effects model using Review Manager 5.3 software. The meta-analysis included 1 randomized and 8 nonrandomized studies, with a total of 2,763 patients. Compared with FA, RA required similar procedural time (mean difference 3.24 minutes, 95% CI -1.76 to 8.25, p = 0.20), fluoroscopy time (mean difference 0.62 minutes, 95% CI -0.83 to 2.07, p = 0.40), and contrast volume (mean difference -2.58 ml, 95% CI -18.36 to 13.20, p = 0.75) and was associated with similar rate of procedural failure (OR 1.32, 95% CI 0.63 to 2.80, p = 0.46), higher rate of crossover to another vascular access (OR 7.0, 95% CI 2.74 to 17.87, p <0.0001), and lower risk of access-site complications (OR 0.46, 95%CI 0.26 to 0.80, p = 0.006). In conclusion, the present meta-analysis suggests that in patients with previous CABG undergoing coronary procedures, RA, compared with FA, is associated with increased crossover rate but may reduce access-site complications. PMID:26892452

  8. Coronary artery bypass grafting in a patient with active idiopathic cryoglobulinemia: revisiting the issue

    PubMed Central

    Fakih, Hafiz Abdul Moiz; Elueze, Emmanuel; Vij, Rajiv

    2016-01-01

    Background Cryoglobulinemia is a cold-reactive autoimmune disease. It is of distinctive importance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass (CPB). Cryoglobulins, which activate at variable levels of hypothermia, can cause precipitation during surgery leading to possibly severe leukocytoclastic or necrotizing vasculitis, clinically manifested as ischemic events, such as cutaneous ulcerations, glomerulonephritis, arthritis, or peripheral neuropathies among the most reported associated comorbidities. Management of CPB and systemic protection in this rare but unique scenario requires individualized planning. We report the case of a patient with active cryoglobulinemia who was preoperatively managed with plasmapheresis. He underwent hypothermic coronary bypass with no precipitation and flare during and after surgery. Case presentation We describe the case of a 59-year-old Caucasian male with clinically significant idiopathic cryoglobulinemia and history of recurrent skin lesions and toe amputations secondary to cold exposure. He presented with 2-h duration of chest pain and new onset atrial fibrillation. After cardiac catheterization, a diagnosis of three-vessel coronary artery disease was established and coronary artery bypass grafting (CABG) was scheduled. Because of a high risk of flare-up during surgery, the patient was preemptively treated with two sessions of plasmapheresis before bypass. He then underwent hypothermic CABG. The pre- and perioperative course was unremarkable without any clinical evidence of precipitation. The patient was discharged on day 6 postoperatively without any complications. Conclusion Preoperative plasmapheresis before hypothermic coronary bypass can prevent fatal cryoglobulinemia-related complications in patients with active disease. PMID:26908383

  9. Changes in occipital capillary perfusion pressures during coronary artery bypass graft surgery.

    PubMed

    Steinmetz, J A; Langemo, D K

    1996-01-01

    This study compared tissue interface pressures (TIPs) on the occiput of 25 volunteer patients undergoing coronary artery bypass graft (CABG) surgery. Pressures were measured using the Gaymar pressure gauge and electropneumatic sensor before and after induction of anesthesia, after the patient was placed on the cardiopulmonary bypass pump, every 30 minutes throughout the procedure, immediately after the patient came off the pump, and before the incision was closed. Significant differences were found over time on mean TIPs and mean arterial pressures (MAPs). Pre-induction mean TIP was significantly higher than TIPs recorded on-pump, post-pump, and prior to closure. The highest average MAPs were at pre-induction; these were significantly higher than MAPs recorded at all other times. The TIPs recorded during surgery were high enough to put the patient at risk for circulation impairment and pressure ulcer development. Therefore, we recommend repositioning patients' heads regularly during surgery and assessing skin postoperatively for alopecia and pressure ulcers. PMID:8716271

  10. First reported revascularization of complex occlusion of the right coronary artery using the IVUS-guided reverse CART technique via a gastroepiploic artery graft.

    PubMed

    Dai, Jian; Katoh, Osamu; Zhou, Hua; Kyo, Eisho

    2016-02-01

    When patients who have previously undergone coronary artery bypass graft surgery develop ischemia symptoms that cannot be controlled by optimal medical therapy, repeat revascularization is indicated. The revascularization strategy should be based on individual clinical and anatomical characteristics. We report here a challenging patient who presented with recurrent stable angina due to worsening of a proximal right coronary artery (RCA) stenosis to chronic total occlusion (CTO) after anastomosis of the right gastroepiploic artery (GEA) to the posterior descending artery. A soft guidewire was advanced through the right GEA collateral channel to the distal end of the CTO, but the dedicated CTO guidewires could not be advanced across the severely calcified CTO using the retrograde wire crossing or kissing wire techniques. The RCA was eventually revascularized by implantation of drug-eluting stents using the intravascular ultrasound-guided reverse controlled antegrade and retrograde subintimal tracking technique. PMID:25148795

  11. Appropriate density of PCL nano-fiber sheath promoted muscular remodeling of PGS/PCL grafts in arterial circulation.

    PubMed

    Yang, Xin; Wei, Jianhua; Lei, Delin; Liu, Yanpu; Wu, Wei

    2016-05-01

    Cell-free approach represents a philosophical shift from the prevailing focus on cells in vascular tissue engineering. Porous elastomeric grafts made of poly(glycerol sebacate) (PGS) enforced with polycaprolactone (PCL) nano-fibers degrade rapidly and yield neoarteries nearly free of foreign materials in rat abdominal aorta. However, considering the larger variation of blood pressure and slower host remodeling in human body than in rat, it is important to investigate the in vivo performance of PGS-PCL graft with enhanced mechanical properties, so that optimized arterial grafts could be developed for clinical translation. We acquired increasingly compacted sheath by prolonging the electrospinning period of PCL appropriately, which significantly enforced whole grafts. The rational design of sheath density significantly decreased the risk of dilation, rupture as well as enabling the long-term muscular remodeling. Since 3-12 months after implantation, the PGS grafts with rationally strengthened sheath were remodeled into neoarteries resembled native arteries in the following aspects: high patency rate and even vessel wall thickness; a confluent endothelium and contractile smooth muscle layers; expression of elastin, collagen and glycosaminoglycan; tough and compliant mechanical properties. Although loose sheath may result in rupture of vessel wall, adequate porosity was proved to be essential for sheath structure and directly determined muscular remodeling through M2 macrophage involved constructive remodeling. Therefore, this study confirmed that adequate density of PCL sheath in PGS grafts could initiate stable and high-quality muscular remodeling, which contributes to long-term success in arterial circulation before clinical translation. PMID:26943048

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

    SciTech Connect

    Peregrin, J. H.; Buergelova, M.

    2009-05-15

    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.

  13. Long-term patency (9 1/2 years) and atherosclerosis of a polytetrafluoroethylene (Gortex) coronary artery bypass graft.

    PubMed

    Vlay, S C; Malik, A Z

    1998-01-01

    The patency of a polytetrafluoroethylene (Gortex) graft 9 1/2 years after coronary artery bypass graft surgery (CABG) is demonstrated. While this material is not commonly used as a conduit because of limited success in the past, this case demonstrates that, given the right circumstances, long-term patency is possible. Since available conduits for CABG are quite often limited, viable alternatives may be lifesaving and require further evaluation. In addition to mechanical considerations such as size, length, and material, anticoagulation and strict management of hyperlipidemia may be critical. PMID:9474468

  14. Nerve regeneration and elastin formation within poly(glycerol sebacate)-based synthetic arterial grafts one-year post-implantation in a rat model

    PubMed Central

    Allen, Robert A.; Wu, Wei; Yao, Mingyi; Dutta, Debaditya; Duan, Xinjie; Bachman, Timothy N.; Champion, Hunter C.; Stolz, Donna B.; Robertson, Anne M.; Kim, Kang; Isenberg, Jeffrey S.; Wang, Yadong

    2013-01-01

    The objective of this study was to evaluate the long term performance of cell-free vascular grafts made from a fast-degrading elastic polymer. We fabricated small arterial grafts from microporous tubes of poly(glycerol sebacate) (PGS) reinforced with polycaprolactone (PCL) nanofibers on the outer surface. Grafts were interpositioned in rat abdominal aortas and characterized at 1 year post-implant. Grafts remodeled into “neoarteries” (regenerated arteries) with similar gross appearance to native rat aortas. Neoarteries mimic arterial tissue architecture with a confluent endothelium and media and adventita-like layers. Patent vessels (80%) showed no significant stenosis, dilation, or calcification. Neoarteries contain nerves and have the same amount of mature elastin as native arteries. Despite some differences in matrix organization, regenerated arteries had similar dynamic mechanical compliance to native arteries in vivo. Neoarteries responded to vasomotor agents, albeit with different magnitude than native aortas. These data suggest that an elastic vascular graft that resorbs quickly has potential to improve the performance of vascular grafts used in small arteries. This design may also promote constructive remodeling in other soft tissues. PMID:24119457

  15. Application of Low-Level Laser Therapy Following Coronary Artery Bypass Grafting (CABG) Surgery

    PubMed Central

    Babazadeh, Kamran; Lajevardi, Marjan; Dabaghian, Fataneh Hashem; Mostafavi, Ehsan

    2014-01-01

    Introduction: An attack of acute myocardial infarction (MI) poses the threat of great damage to cardiac tissue. Operative therapeutic modalities such as coronary artery bypass grafting (CABG) may enhance myocardial perfusion in high-grade coronary vasculature occlusions. It has been shown previously that Low-Level Laser Therapy (LLLT) significantly reduces infarct size following induction of myocardial infarction in rats and dogs. The aim of this study was to investigate the effects of LLLT on cardiac tissue healing markers following grafting operations for coronary vessel occlusion. Methods: Thirty-two cases having each two or three coronary vessel occlusions (2VD/3VD) underwent low-level laser therapy post-CABG, and 28 patients who did not undergo laser therapy were studied as a control group. Diode laser (810 nm, 500 mW) was used as LLLT protocol for 3 successive days post-CABG. Repeated measurements of blood cell count (CBC) and cardiac damage markers (CPK, CPK-MB, LDH) attained before CABG and during the 5 days of LLLT post-operatively, taken at one and 12 hours after daily laser irradiation. Results: In a comparison of the mean levels of the control and laser group, the variables were statistically different on 5th day after intervention for WBC, Neutrophil and Lymphocyte counts and WBC and lymphocyte changes. A statistically significant difference was seen in changes of CPK, CPK-mb and LDH over time P<0.001. Conclusion: It is concluded that low-level laser irradiation after CABG surgery could decrease cardiac cellular damage and help accelerate the repair of cardiac tissue post-operatively. This may lower post-operative disability as well as bed rest period in these patients. PMID:25653805

  16. Treatment of renal graft artery stenosis. Comparison between surgical bypass and percutaneous transluminal angioplasty.

    PubMed

    De Meyer, M; Pirson, Y; Dautrebande, J; Squifflet, J P; Alexandre, G P; van Ypersele de Strihou, C

    1989-05-01

    In order to compare saphenous bypass (SB) and percutaneous transluminal angioplasty (PTA) as treatment of renal graft artery stenosis (GAS), we have reviewed the results of both procedures in 33 patients treated consecutively by either SB (n = 16) or PTA (n = 17). All patients had become hypertensive within the first year after transplantation despite triple hypotensive drug therapy. SB was performed 17 (range 3-55) and PTA 19 (range 2-96) months after transplantation. SB failed in only 1 patient as a result of vascular thrombosis with graft loss. PTA was technically unsuccessful in 3 patients and was complicated by vascular branch thrombosis in 1 patient. Blood pressure decrease was similar in both groups: from 179/114 before SB to 147/90 (n = 15, P less than .001) at 6 months and 150/93 (n = 14, P less than .005) at 12 months after SB and from 177/110 before PTA to 149/93 (n = 13, P less than .01) at 6 months and 150/95 (n = 10, P less than .02) at 12 months. At 1 year, control of BP was improved in 85% of SB group patients and 74% of PTA group patients. Recurrent stenosis was documented in 3 PTA group patients: subsequently 1 had a successful SB and the 2 others a repeated PTA--successful in 1, unsuccessful in the other. We conclude that both methods are equally effective for BP control but that PTA entails a higher rate of initial failure and a significant rate of restenosis. However, because of technical ease and better tolerance, PTA emerges as the first-choice treatment of GAS, SB remaining indicated when PTA is not feasible or has failed. PMID:2524121

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

    SciTech Connect

    Lupattelli, Tommaso; Garaci, Francesco Giuseppe; Basile, Antonio; Minnella, Daniela Paola; Casini, Andrea; Clerissi, Jacques

    2009-03-15

    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.

  18. Influence of endothelial cell seeding on platelet deposition and patency in small-diameter Dacron arterial grafts

    SciTech Connect

    Allen, B.T.; Long, J.A.; Clark, R.E.; Sicard, G.A.; Hopkins, K.T.; Welch, M.J.

    1984-01-01

    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.

  19. Aorto-right atrial fistula secondary to rupture of an occluded old saphenous venous graft to right coronary artery.

    PubMed

    Balestrini, Carlos Sebastian; Saaibi, José Federico; Ortiz, Santiago Navas

    2014-09-01

    We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded. PMID:23404794

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

    SciTech Connect

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

    1985-05-01

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

  1. Postoperative Complications After Coronary Artery Bypass Grafting in Patients With Chronic Obstructive Pulmonary Disease

    PubMed Central

    Ho, Chung-Han; Chen, Yi-Chen; Chu, Chin-Chen; Wang, Jhi-Joung; Liao, Kuang-Ming

    2016-01-01

    Abstract Coronary artery disease is common in patients with chronic obstructive pulmonary disease (COPD). Previous studies have shown that patients with COPD have a higher risk of mortality than those without COPD after coronary artery bypass grafting (CABG). However, most of the previous studies were small, single-center studies with limited case numbers (or their only focus was mortality). The aim of our study was to focus on readmission, acute myocardial infarction (AMI), acute respiratory failure (ARF), cerebrovascular accident, and venous thromboembolism rates after CABG in an Asian COPD population. We conducted a nationwide case–control study in Taiwan using the claims database of hospitalization between January 1, 2009 and December 31, 2013. Patients with COPD before CABG were defined as the case groups. Each case was propensity score-matched by age, sex, hypertension, diabetes, dyslipidemia, cardiovascular disease, cerebrovascular disease, and chronic kidney disease, with 2 controls selected from CABG patients without COPD. The outcomes of interest were mortality, wound infection, and the readmission rate over 30 days for the following diseases: AMI, pneumonia, ARF, cerebrovascular accident, and venous thromboembolism. There were 14,858 patients without COPD and 758 patients with COPD who underwent CABG. After propensity score matching, the 30-day mortality and 30-day readmission rates and AMI were higher in the non-COPD group. The incidences of pneumonia and ARF after CABG were higher in the COPD group. Chronic obstructive pulmonary disease does not necessarily lead to mortality, readmission, or AMI after CABG, and the major respiratory complications associated with CABG in patients with COPD were pneumonia and ARF. PMID:26937939

  2. The Performance of Cross-linked Acellular Arterial Scaffolds as Vascular Grafts; Pre-clinical Testing in Direct and Isolation Loop Circulatory Models

    PubMed Central

    Pennel, Timothy; Fercana, George; Bezuidenhout, Deon; Simionescu, Agneta; Chuang, Ting-Hsien; Zilla, Peter; Simionescu, Dan

    2014-01-01

    There is a significant need for small diameter vascular grafts to be used in peripheral vascular surgery; however autologous grafts are not always available, synthetic grafts perform poorly and allografts and xenografts degenerate, dilate and calcify after implantation. We hypothesized that chemical stabilization of acellular xenogenic arteries would generate off-the-shelf grafts resistant to thrombosis, dilatation and calcification. To test this hypothesis, we decellularized porcine renal arteries, stabilized elastin with penta-galloyl glucose and collagen with carbodiimide / activated heparin and implanted them as transposition grafts in the abdominal aorta of rats as direct implants and separately as indirect, isolation-loop implants. All implants resulted in high patency and animal survival rates, ubiquitous encapsulation within a vascularized collagenous capsule, and exhibited lack of lumen thrombogenicity and no graft wall calcification. Peri-anastomotic neo-intimal tissue overgrowth was a normal occurrence in direct implants; however this reaction was circumvented in indirect implants. Notably, implantation of non-treated control scaffolds exhibited marked graft dilatation and elastin degeneration; however PGG significantly reduced elastin degradation and prevented aneurismal dilatation of vascular grafts. Overall these results point to the outstanding potential of crosslinked arterial scaffolds as small diameter vascular grafts. PMID:24816365

  3. Alternative Physical Therapy Protocol Using a Cycle Ergometer During Hospital Rehabilitation of Coronary Artery Bypass Grafting: a Clinical Trial

    PubMed Central

    Trevisan, Margarete Diprat; Lopes, Diene Gomes Colvara; de Mello, Renato Gorga Bandeira; Macagnan, Fabrício Edler; Kessler, Adriana

    2015-01-01

    OBJECTIVE To compare the efficacy of a cycle ergometer-based exercise program to a standard protocol on the increment of the maximum distance walked during the six-minute walk test in the postoperative rehabilitation of patients submitted to coronary artery bypass grafting. METHODS A controlled clinical trial pilot, blinded to the outcome, enrolled subjects who underwent coronary artery bypass grafting in a hospital from Southern Brazil. Subjects were designated for the standard physical rehabilitation protocol or to an alternative cycle ergometer-based protocol through simple random sampling. The primary outcome was the difference in the maximum distance walked in the six-minute walk test before and after the allocated intervention. RESULTS Twenty-four patients were included in the analysis, 10 in the standard protocol and 14 in the alternative protocol group. There was an increment in the maximum distance walked in both groups, and borderline superiority in the intervention group comparing to the control group (312.2 vs. 249.7; P=0.06). CONCLUSION There was an increase in the maximum distance walked in the alternative protocol compared to the standard protocol. Thus, it is postulated that the use of a cycle ergometer can be included in physical rehabilitation in the hospital phase of postoperative coronary artery bypass grafting. However, randomized studies with larger sample size should be conducted to assess the significance of these findings. PMID:26934400

  4. Impact of body mass index on outcome in patients undergoing coronary artery bypass grafting and/or valve replacement surgery

    PubMed Central

    Costa, Vinícius Eduardo Araújo; Ferolla, Silvia Marinho; dos Reis, Tâmara Oliveira; Rabello, Renato Rocha; Rocha, Eduardo Augusto Victor; Couto, Célia Maria Ferreira; Couto, José Carlos Ferreira; Bento, Alduir

    2015-01-01

    Objective This study aimed to analyze the impact of body mass index on outcomes of 101 patients undergoing coronary artery bypass grafting, valve replacement, or combined valve/ coronary artery bypass grafting surgery in a private hospital in Belo Horizonte, Brazil. Methods This was a prospective cross-sectional study of patients undergoing cardiac surgery from May 2009 to December 2012. All patients were followed up from the first day of admission until discharge or death. Patients were divided into three groups according to BMI: normal weight, overweight, and obese. The main outcome measure was the association between BMI and postoperative morbidities and mortality. Results Multivariate analysis identified obesity as an independent predictor of increased risk of surgical reintervention (odds ratio [OR] 13.6; 95%CI 1.1 - 162.9; P=0.046) and reduced risk of bleeding (OR 0.05; 95% CI 0.09 - 0.69; P=0.025). Univariate analysis showed that obesity was associated with increased frequency of wound dehiscence (P=0.021). There was no association between BMI and other complications or mortality in univariate analysis. There was also no association between body mass index and duration of cardiopulmonary bypass, aortic clamping, mechanical ventilation, and intensive care unit or hospital stay. Conclusion Obese individuals undergoing coronary artery bypass grafting, valve replacement, or combined surgery have a higher postoperative risk of surgical reintervention and lower chances of bleeding. PMID:26313724

  5. Use of Reversed Iliac Leg Stent-Graft for the Treatment of Isolated Aneurysm of Internal Iliac Artery

    PubMed Central

    Song, Kyung Sup; Lee, Hyunsil; Nam, Deok Ho; Park, Ki Hyuk; Yun, Sang-Seob; Lee, Bae Young; Lee, Kang Hoon

    2014-01-01

    This is to report the technique of reversed iliac leg stent-graft in endovascular treatment for isolated internal iliac artery (IIA) aneurysm, which had significant size discrepancy between the common iliac artery (CIA) and external iliac artery (EIA) in 3 patients from different hospitals. Three patients were a 85- and two 82-year-old men. Treated were right IIA aneurysms, sized 6.5×6.2 cm, 5.0×4.0 cm, and 4.1 cm in longest diameter, respectively. The diameters of the right CIA and right EIA measured 21 mm/11 mm, 15 mm/11 mm, and 20 mm/10 mm, respectively. In all cases, reversed iliac leg stent-grafts were prepared on-site; unsheathed and mounted upside-down manually, and deployed in each right CIA. Post-stent-graft angiograms showed complete exclusion of the aneurysms, except for minimal type 1 endoleak in one case. This technique is a useful treatment option in patients with isolated IIA aneurysm. PMID:26217614

  6. Increased Expression of Phosphorylated Polo-Like Kinase 1 and Histone in Bypass Vein Graft and Coronary Arteries following Angioplasty

    PubMed Central

    Sur, Swastika; Swier, Vicki J.; Radwan, Mohamed M.; Agrawal, Devendra K.

    2016-01-01

    Interventional procedures, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) to re-vascularize occluded coronary arteries, injure the vascular wall and cause endothelial denudation and medial vascular smooth muscle cell (VSMCs) metaplasia. Proliferation of the phenotypically altered SMCs is the key event in the pathogenesis of intimal hyperplasia (IH). Several kinases and phosphatases regulate cell cycle in SMC proliferation. It is our hypothesis that increased expression and activity of polo-like kinase-1 (PLK1) in SMCs, following PTCA and CABG, contributes to greater SMC proliferation in the injured than uninjured blood vessels. Using immunofluorescence (IF), we assessed the expression of PLK1 and phosphorylated-PLK1 (pPLK1) in post-PTCA coronary arteries, and superficial epigastric vein grafts (SEV) and compared it with those in the corresponding uninjured vessels. We also compared the expressions of mitotic marker phospho-histone, synthetic-SMC marker, contractile SMC marker, IFN-γ and phosphorylated STAT-3 in the post-PTCA arteries, SEV-grafts, and the uninjured vessels. Immunostaining demonstrated an increase in the number of cells expressing PLK1 and pPLK1 in the neointima of post PTCA-coronary arteries and SEV-grafts compared to their uninjured counterparts. VSMCs in the neointima showed an increased expression of phospho-histone, synthetic and contractile SMC markers, IFN-γ and phosphorylated STAT-3. However, VSMCs of uninjured coronaries and SEV had no significant expression of the aforementioned proteins. These data suggest that PLK1 might play a critical role in VSMC mitosis in hyperplastic intima of the injured vessels. Thus, novel therapies to inhibit PLK1 could be developed to inhibit the mitogenesis of VSMCs and control neointimal hyperplasia. PMID:26820885

  7. Passion for Life: Lived Experiences of Patients after Coronary Artery Bypass Graft

    PubMed Central

    Mohammadi, Nooredin; Abbasi, Mohammad; Nikbakht Nasrabadi, Alireza; Salehiomran, Abbas; Davaran, Saeid; Norouzadeh, Reza

    2015-01-01

    Background: Coronary artery bypass graft surgery (CABG) improves the quality of life, increases survival, and influences the patient's mental and emotional aspects. Little information is available on the lived experience of Iranian patients after this surgery. Understanding the lived experiences of patients will help health professionals with better provision of high quality care. Methods: This hermeneutic phenomenological study aimed to understand the lived experience of patients after CABG. Van Manen's method was used to conduct the study. A semi-structured, face-to-face interview technique was employed to explore the experiences of the patients following surgery. Seven men and 4 women between 49 and 80 years old were interviewed. Results: Passion for life was the main theme extracted from the participants’ interviews. This theme comprised the three sub-themes of receiving attention from family, being hopeful, and being spiritually oriented. Conclusion: The results showed that the participants experienced passion for life after their surgery. This finding reveals that patients tend to find a new perspective on life and their health after surgery. PMID:26697085

  8. Albumin Is A Better Predictor of Outcomes Than Body Mass Index Following Coronary Artery Bypass Grafting

    PubMed Central

    Bhamidipati, Castigliano M; LaPar, Damien J; Mehta, Gaurav S; Kern, John A; Upchurch, Gilbert R; Kron, Irving L; Ailawadi, Gorav

    2011-01-01

    Objective Body Mass Index (BMI) influences risk in coronary artery bypass grafting (CABG) patients, while albumin, is not collected by the Society of Thoracic Surgeons database. We postulate that preoperative albumin is a better predictor of mortality than BMI following CABG. Methods BMI from patients with serum albumin level within 6 months of isolated CABG between 1995–2010 from our institutional databases were identified. Patients were stratified by National Heart, Lung and Blood Institute (NHLBI) BMI class, and by preoperative albumin. Regression models were used to assess predictors of morbidity and mortality. Results We analyzed 2,794 isolated CABG patients at our institution. Unadjusted mortality was highest with lowest BMI (P≤.05), and in patients with 2–3g/dL albumin (P=.02). Ejection fraction (EF) and intra-aortic balloon pump (IABP) use were similar despite BMI; however, EF was lowest and IABP use highest in the 2–3g/dL albumin group (P<.001, respectively). Unlike BMI groups, increasing albumin was associated with lower major complication rates (P=.001). Similarly, adjusted mortality was not influenced by BMI (AOR 0.97, 95%CI 0.93–1.02), but increasing albumin levels reduced the adjusted odds of death (AOR 0.61, 95%CI 0.42–0.90). Conclusions Albumin, more than body mass index, is associated with mortality and morbidity in isolated CABG recipients and may be a better indicator for outcomes. PMID:22000173

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

    PubMed Central

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

    2014-01-01

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

  10. Coronary artery bypass grafting in young patients under 36 years of age.

    PubMed

    Cohen, D J; Basamania, C; Graeber, G M; Deshong, J L; Burge, J R

    1986-06-01

    Results of coronary artery bypass graft (CABG) surgery in patients under age 36 who were operated upon between 1970 and 1980 at two large medical centers were compared to matched control patients, age 45 to 59 years, and 60 years and over. Patient follow-up ranged from one to 13 years (average five years). Event-free survival was significantly worse in the young group (37 percent) vs the middle aged group (61 percent, p less than 0.01) and vs the elderly group (59 percent, p less than 0.02). Failure of the operation was due to failure to improve or worsening of Canadian Cardiovascular Society anginal class, need for reoperation, subsequent myocardial infarction, or death due to cardiac causes. Risk of failure of CABG surgery in young patients was increased with the presence of cardiac risk factors. Because of the high rate of long-term failure of CABG surgery in young patients, its use in this group needs to be reevaluated relative to current aggressive medical therapy for angina. PMID:3486752

  11. GRK5 polymorphisms and Postoperative Atrial Fibrillation following Coronary Artery Bypass Graft Surgery

    PubMed Central

    Liu, Lu; Zhang, Lijun; Liu, Minjie; Zhang, Yanqun; Han, Xia; Zhang, Zhiqiang

    2015-01-01

    Postoperative atrial fibrillation (POAF) is a serious yet common complication after coronary artery bypass grafting (CABG) surgery. Previous study have identified multiple genetic susceptibility loci for POAF susceptibility after CABG, although some studies are under-powered. However, none of these studies have been conducted among Asians. In current study, we aim to systematically evaluated the previous positive findings for POAF susceptibility after CABG among Chinese population, using a large population-based, two-stage, case-cohort study. From a discovery cohort of 1,348 patients, a total of nine independent loci were evaluated. Six significant SNPs were then assessed in a separately collected validation cohort of 2,000 patients. After adjustment for clinical predictors of POAF, two variants in GRK5 gene (rs4752292, and rs11198893) were replicated with significance were replicated in the validation cohort. The ORs for each additional copy of minor allele were 1.32 (95% CI: 1.151.50, P?=?5.82??10?5) and 1.47 (95% CI: 1.281.69, P?=?1.16??10?7), respectively. In this two-stage independently collected cardiac surgery cohorts, genetic variations in the GRK5 gene are independently associated with POAF risk in patients who undergo CABG surgery in Asians. PMID:26235218

  12. The application of walking training in the rehabilitation of patients after coronary artery bypass grafting

    PubMed Central

    Dylewicz, Piotr

    2015-01-01

    Walking is regarded as one of the most common and utilitarian activities of everyday life. Rehabilitation programs developed on the basis of this form of activity often constitute the primary method of rehabilitating patients after coronary artery bypass grafting. This paper provides a review of literature concerning various forms of walking training, discussing their impact on the parameters of exercise capacity and verifying the training methods with regard to the current guidelines. Attention is drawn to the diversity of the exercise protocols applied during the early and late stages of rehabilitation and pre-rehabilitation programs including: treadmill walking, walking down the corridor, treadmill walking enriched with virtual reality, and walking as an element of training sessions consisting of many different forms of activities. Exercise protocols were also analyzed in terms of their safety, especially in the case of high-intensity interval training. Despite the variety of the available rehabilitation programs, the training methodology requires constant improvement, particularly in terms of load dosage and the supervision of training sessions. PMID:26702291

  13. Previous percutaneous coronary intervention increases morbidity after coronary artery bypass grafting

    PubMed Central

    Mehta, Gaurav S.; LaPar, Damien J.; Bhamidipati, Castigliano M.; Kern, John A.; Kron, Irving L.; Upchurch, Gilbert R.; Ailawadi, Gorav

    2014-01-01

    Background We hypothesized that the incidence of previous percutaneous coronary intervention (PCI) is increasing and that prior PCI influences patient morbidity and mortality after coronary artery bypass grafting (CABG). Methods A total of 34,316 patients underwent isolated CABG operations at 16 different statewide, institutions from 2001 to 2008. Patients were stratified into prior PCI (n = 4346; 12.7%) and no prior PCI (n = 29,970). Patient risk factors, intraoperative variables, and outcomes were compared by univariate and multivariate analyses. Results The incidence of prior PCI in CABG has risen from <1% to 22.0% from 2001 to 2008 (P < .001). Prior PCI patients were younger (P < .001) and more commonly had previous myocardial infarction (P < .001), but less commonly had heart failure (P < .001). The operative mortality was similar between groups (2.3% vs 1.9%; P = .13). Prior PCI patients had more major complications (15.0% vs 12.0%; P < .001), longer hospitalization (P = .01), and higher readmission rates (P = .01). Importantly, by multivariate analyses, prior PCI was not associated with mortality, but was an independent predictor of major complications after CABG (odds ratio, 1.15; P = .01). Conclusion The incidence of prior PCI in patients undergoing CABG is increasing. Previous PCI is associated with a higher risk of major complications, greater hospital length of stay, and higher readmission rates after CABG. PMID:22503323

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  16. Effect of gender and race on operative mortality after isolated coronary artery bypass grafting.

    PubMed

    Pollock, Benjamin; Hamman, Baron L; Sass, Danielle M; da Graca, Briget; Grayburn, Paul A; Filardo, Giovanni

    2015-03-01

    Studies examining outcomes after coronary artery bypass grafting (CABG) by gender and/or race have shown conflicting results. It remains to be determined if, or how, gender and race are independent risk factors for CABG operative mortality. Using all consecutive patients who underwent isolated CABG at Baylor University Medical Center in Dallas, Texas, from January 2004 to October 2011, the risk-adjusted associations between gender and race, respectively, and operative mortality were estimated using a generalized propensity approach, accounting for recognized Society of Thoracic Surgeons risk factors for mortality. Women were nearly 2 times more likely to die during or within 30 days of the operation than men (odds ratio 1.96, 95% confidence interval 1.44 to 2.66, p <0.0001), while no significant mortality differences were observed among races. In conclusion, these findings suggest that women face a significantly greater risk for operative death that should be taken into account during the treatment decision-making process but that race is not associated with CABG mortality and so should not be among the factors considered. PMID:25596952

  17. Pyruvate dehydrogenase activity and quantity decreases after coronary artery bypass grafting: a prospective observational study

    PubMed Central

    Andersen, Lars W.; Liu, Xiaowen; Peng, Teng J.; Giberson, Tyler A.; Khabbaz, Kamal R.; Donnino, Michael W.

    2014-01-01

    Introduction Pyruvate dehydrogenase (PDH) is a key gatekeeper enzyme in aerobic metabolism. The main purpose of this study was to determine if PDH activity is affected by major stress in the form of coronary artery bypass grafting (CABG) which has previously been used as a model of critical illness. Methods We conducted a prospective, observational study of patients undergoing CABG at an urban, tertiary care hospital. We included adult patients undergoing CABG with or without concomitant valve surgery. Measurements of PDH activity and quantity and thiamine were obtained prior to surgery, at the completion of surgery, and 6 hours post-surgery. Results Fourteen patients were enrolled (age: 67 ± 10 years, 21 % female). Study subjects had a mean 41.7 % (SD: 27.7) reduction in PDH activity after surgery and a mean 32.0% (SD: 31.4) reduction 6 hours after surgery (p < 0.001). Eight patients were thiamine deficient (≤ 7 nmol/L) after surgery compared to none prior to surgery (p = 0.002). Thiamine level was a significantly associated with PDH quantity at all time points (p = 0.01). Post-surgery lactate levels were inversely correlated with post-surgery thiamine levels (r = −0.58 and p = 0.04). Conclusion The stress of major surgery causes decreased PDH activity and quantity, and depletion of thiamine levels. PMID:25526377

  18. Spinal anesthesia reduces postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting.

    PubMed

    Tabatabaie, O; Matin, N; Heidari, A; Tabatabaie, A; Hadaegh, A; Yazdanynejad, S; Tabatabaie, K

    2015-01-01

    We investigated the effect of high spinal anesthesia on postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting (CABG). The study was conducted in a tertiary referral university hospital on a population of 60 opium dependent patients undergoing CABG surgery. Patients were divided into two groups based on anesthesia protocol. One group were given general anesthesia (GA Group), the other group additionally received intrathecal morphine and bupivacaine (SGA Group). Postoperative delirium (POD) was defined as the main outcome of interest. Incidence of POD was significantly higher in patients of GA Group as compared with those in SGA Group (47% and 17% for GA and SGA respectively; P-value = 0.01). Time to extubation was on average 2.2 h shorter in SGA than in GA (7.1 h and 9.3 h respectively, P-value < 0.001). Intrathecal morphine and bupivacaine reduced the risk of POD after CABG in a population of opium dependent patients. PMID:26455008

  19. Changes in the cardiac muscle electric activity as a result of Coronary Artery Bypass Graft operation

    NASA Astrophysics Data System (ADS)

    Grajek, Magdalena; Krzyminiewski, Ryszard; Kalawski, Ryszard; Kulczak, Mariusz

    2008-01-01

    Many bioelectric signals have a complex internal structure that can be a rich source of information on the tissue or cell processes. The structure of such signals can be analysed in detail by applying digital methods of signal processing. Therefore, of substantial use in diagnosis of the coronary arterial disease is the method of digital enhancement of increasing signal resolution ECG (NURSE-ECG), permitting detection of temporary changes in the electric potentials in the cardiac muscle in the process of depolarisation. Thanks to the application of NURSE-ECG it has become possible to detect relatively small changes in the electric activity of particular fragments of the cardiac muscle undetectable by the standard ECG method, caused by ischemia, the effect of a drug or infarct. The aim of this study was to identify and analyse changes in the electric activity of the cardiac muscle as a result of the Coronary Artery Bypass Graft (CABG) operation. In this study the method of NURSE-ECG has been applied in order to identify and analyse changes in the electric activity of the cardiac muscle as a result of the CABG operation. In the study performed in cooperation of the Institute of Physics Adam Mickiewicz University and the Strus Hospital, Cardiac Surgery Ward, 37 patients with advanced coronary arterial disease were asked to participate. The patients were examined prior to the operation, on the day after the operation and two months after the operation and a year after the operation. The ECG recordings were subjected to a numerical procedure of resolution enhancement by a NURSE-ECG program to reveal the tentative changes in the electric potential of the cardiac muscle on its depolarisation. Results of the study have shown that the NURSE ECG method can be applied to monitor changes in the electric activity of the cardiac muscle occurring as a result of CABG operation. One the second day after the operation in the majority of patients (70%) a rapid decrease of the total cardiac muscle activity was observed. The NURSE ECG seems to be a promising supplementary method in medical diagnosis. In particular it can be applied for qualification of patients for CABG operation and for verification of the operation effects.

  20. A Longitudinal Study of Remodeling in a Revised Peripheral Artery Bypass Graft Using 3D Ultrasound Imaging and Computational Hemodynamics

    PubMed Central

    Leotta, Daniel F.; Beach, Kirk W.; Riley, James J.; Aliseda, Alberto

    2011-01-01

    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. PMID:21428682

  1. Reconstruction of full-thickness lower eyelid defect using superficial temporal artery island flap combined with auricular cartilage graft.

    PubMed

    Yang, Mei; Zhao, Yanyong

    2015-03-01

    Full-thickness lower eyelid defect is one of common surgical diseases, which may lead to exposure keratopathy, corneal ulceration, and blindness. The aim of this study was to investigate the effect of superficial temporal artery island flap combined with auricular cartilage graft on the repair of full-thickness lower eyelid defect.In this study, the reconstructions in 6 patients who had unilateral full-thickness lower eyelid defects due to ocular traumas or surgical resections of malignant tumors were carried out. The island flap of the frontal branch of superficial temporal artery reconstructed the outer layer and the total lower lid was supported with the plane of an auricular cartilage strip, offering a proper contour and physical strength to maintain a normal eyelid height. The follow-up time ranged from 6 to 24 months. No major complications including partial or total flap necrosis, signs of infection, venous congestion, and hematoma were seen in any of the patients, and all cases have been reconstructed well both aesthetically and functionally, showing esthetic eyelid contour, good color, and texture match.Superficial temporal artery island flap combined with auricular cartilage graft is a useful method functionally and cosmetically for the reconstructions of full-thickness lower eyelid defects because of its advantages including rich vascularity based on superficial temporal artery, wide pedicle rotational arc, which could be transferred throughout the face region, good eyelid contour with color and texture match, limited donor-site scar, and minimal postoperative morbidity. PMID:25692897

  2. Successful endothelialization and remodeling of a cell-free small-diameter arterial graft in a large animal model.

    PubMed

    Koobatian, Maxwell T; Row, Sindhu; Smith, Randall J; Koenigsknecht, Carmon; Andreadis, Stelios T; Swartz, Daniel D

    2016-01-01

    The large number of coronary artery bypass procedures necessitates development of off-the-shelf vascular grafts that do not require cell or tissue harvest from patients. However, immediate thrombus formation after implantation due to the absence of a healthy endothelium is very likely. Here we present the successful development of an acellular tissue engineered vessel (A-TEV) based on small intestinal submucosa that was functionalized sequentially with heparin and VEGF. A-TEVs were implanted into the carotid artery of an ovine model demonstrating high patency rates and significant host cell infiltration as early as one week post-implantation. At one month, a confluent and functional endothelium was present and the vascular wall showed significant infiltration of host smooth muscle cells exhibiting vascular contractility in response to vaso-agonists. After three months, the endothelium aligned in the direction of flow and the medial layer comprised of circumferentially aligned smooth muscle cells. A-TEVs demonstrated high elastin and collagen content as well as impressive mechanical properties and vascular contractility comparable to native arteries. This is the first demonstration of successful endothelialization, remodeling, and development of vascular function of a cell-free vascular graft that was implanted in the arterial circulation of a pre-clinical animal model. PMID:26561932

  3. Left Radial Versus Femoral Access for Coronary Angiography in Post-Coronary Artery Bypass Graft Surgery Patients.

    PubMed

    Pasley, Thomas F; Khan, Ali; Yen, Lu-Yin; Newcombe, Ruth; Humphreys, Hayley; El-Jack, Seif

    2016-03-01

    It has been recently demonstrated that coronary angiography of native coronary arteries via the radial artery results in reduced morbidity and mortality, when compared with a femoral approach. However, the efficacy and safety of the transradial approach in patients with coronary grafts is relatively unknown. We performed a retrospective audit of all patients with a history of previous coronary artery bypass graft (CABG) surgery who underwent diagnostic angiography at our institution from 2008-2012. The primary efficacy endpoint was procedure time (minutes), while the secondary efficacy measure was patient radiation exposure (μGy/m²). There were 326 post-CABG patients studied during the defined period, with 254 via femoral approach and 72 via left radial artery. There was no significant difference between the two approaches in procedure time (37 minutes in radial group vs 35 minutes in femoral group; t-test, P=.43). There was also no difference in radiation exposure (7855 μGy/m² in femoral group vs 6825 μGy/m² in radial group; Satterthwaite t-test, P=.08). This study shows the validity of a left radial approach in patients who have undergone angiography post CABG. It suggests that transradial angiography can be safely performed in these patients, without significant increase in procedural time or radiation exposure. PMID:26887028

  4. Thoracic Stent Graft Implantation for Aortic Coarctation with Patent Ductus Arteriosus via Retroperitoneal Iliac Approach in the Presence of Small Sized Femoral Artery

    PubMed Central

    Korkmaz, Ozge; Beton, Osman; Goksel, Sabahattin; Kaya, Hakkı; Berkan, Ocal

    2016-01-01

    Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach.

  5. Long great saphenous vein grafting as temporary coronary bypass for extended left hepatectomy: report of a case.

    PubMed

    Aosasa, Suefumi; Kimura, Akifumi; Nishikawa, Makoto; Noro, Takuji; Tsujimoto, Hironori; Hase, Kazuo; Yamamoto, Junji

    2015-12-01

    The right gastroepiploic artery (RGEA) has been used in coronary artery bypass grafting (CABG) as an alternative graft. In particular abdominal surgeries, surgery is required to rescue the graft flow into the coronary artery. A 77-year-old male with a history of CABG using RGEA was admitted with a diagnosis of a large hepatocellular carcinoma (HCC) occupying the whole caudate lobe. Preoperative coronary angiography indicated that the graft from the right internal mammary artery to the proximal left circumflex artery was obliterated among three branch bypasses. Following laparotomy, a great saphenous vein was harvested and delivered from the right axial artery to the RGEA graft over the thoracic wall, and the RGEA graft was ligated and divided. Subsequently, extended left hepatectomy was safely performed. Following hepatectomy, the RGEA graft was restored to the former condition, and the temporary graft was removed. After overcoming hyperbilirubinemia, the patient was discharged on postoperative day 28. This experience indicates that temporary bypass using the long great saphenous vein is effective and safe during long and invasive surgeries. PMID:26943376

  6. Endovascular Repair of Arterial Iliac Vessel Wall Lesions with a Self-Expandable Nitinol Stent Graft System

    PubMed Central

    Mensel, Birger; Kühn, Jens-Peter; Hoene, Andreas; Hosten, Norbert; Puls, Ralf

    2014-01-01

    Objective To assess the therapeutic outcome after endovascular repair of iliac arterial lesions (IALs) using a self-expandable Nitinol stent graft system. Methods Between July 2006 and March 2013, 16 patients (13 males, mean age: 68 years) with a self-expandable Nitinol stent graft. A total of 19 lesions were treated: nine true aneurysms, two anastomotic aneurysms, two dissections, one arteriovenous fistula, two type 1B endoleaks after endovascular aneurysm repair, one pseudoaneurysm, and two perforations after angioplasty. Pre-, intra-, and postinterventional imaging studies and the medical records were analyzed for technical and clinical success and postinterventional complications. Results The primary technical and clinical success rate was 81.3% (13/16 patients) and 75.0% (12/16), respectively. Two patients had technical failure due to persistent type 1A endoleak and another patient due to acute stent graft thrombosis. One patient showed severe stent graft kinking on the first postinterventional day. In two patients, a second intervention was performed. The secondary technical and clinical success rate was 87.5% (14/16) and 93.8% (15/16). The minor complication rate was 6.3% (patient with painful hematoma at the access site). The major complication rate was 6.3% (patient with ipsilateral deep vein thrombosis). During median follow-up of 22.4 months, an infection of the aneurysm sac in one patient and a stent graft thrombosis in another patient were observed. Conclusion Endovascular repair of various IALs with a self-expandable Nitinol stent graft is safe and effective. PMID:25119346

  7. Trends in postcoronary artery bypass graft sternal wound dehiscence in a provincial population

    PubMed Central

    Doherty, Christopher; Nickerson, Duncan; Southern, Danielle A; Kieser, Teresa; Appoo, Jehangir; Dawes, Jeffery; De Souza, Michael A; Harrop, Alan R; Rabi, Doreen

    2014-01-01

    BACKGROUND: It appears that the medical profile of patients undergoing coronary artery bypass graft (CABG) surgery has changed. The impact of this demographic shift on CABG outcomes, such as sternal wound dehiscence, is unclear. OBJECTIVES: To quantify the incidence and trends of sternal wound dehiscence, quantify the demographic shift of those undergoing CABG and identify patient factors predictive of disease. METHODS: A prospective analysis was performed on a historical cohort of consecutive patients who underwent CABG (without valve replacement) in Alberta between April 1, 2002 and November 30, 2009. The incidence and trends of sternal wound dehiscence were determined. In addition, the trend of the mean Charlson index score and European System for Cardiac Operative Risk Evaluation (EuroSCORE) (capturing patient comorbidities) was analyzed. Univariable analysis and multivariable models were performed to determine factors predictive of wound dehiscence. RESULTS: A total of 5815 patients underwent CABG during the study period. The incidence proportion of sternal wound dehiscence in Alberta was 1.86% and the incidence rate was 1.98 cases per 100 person-years. Although both the EuroSCORE and Charlson scores significantly increased over the study period, the incidence of sternal wound dehiscence did not change significantly. Factors predictive of sternal wound dehiscence were diabetes (OR 2.97 [95% CI 1.73 to 5.10]), obesity (OR 1.55 [95% CI 1.05 to 2.27]) and female sex (OR 1.90 [95% CI 1.26 to 2.87]). CONCLUSIONS: The incidence proportion of sternal wound dehiscence in Alberta was comparable with the incidence previously published in the literature. While patients undergoing CABG had worsening medical profiles, the incidence of sternal wound dehiscence did not appear to be increasing significantly. PMID:25332650

  8. Charts versus Discharge ICD-10 Coding for Sternal Wound Infection Following Coronary Artery Bypass Grafting

    PubMed Central

    Southern, Danielle A.; Doherty, Christopher; De Souza, Michael A.; Quan, Hude; Harrop, A. Robertson; Nickerson, Duncan; Rabi, Doreen

    2015-01-01

    Background Sternal wound infection (SWI) in patients undergoing coronary artery bypass grafting (CABG) can carry a significant risk of morbidity and mortality. The objective of this work is to describe the methods used to identify cases of SWI in an administrative database and to demonstrate the effectiveness of using an International Classification of Diseases, Tenth Revision (ICD-10) coding algorithm for this purpose. Methods ICD-10 codes were used to identify cases of SWI within one year of CABG between April 2002 and November 2009. We randomly chose 200 charts for detailed chart review (100 from each of the groups coded as having SWI and not having SWI) to determine the utility of the ICD-10 coding algorithm. Results There were 2,820 patients undergoing CABG. Of these, 264 (9.4 percent) were coded as having SWI. Thirty-eight cases of SWI were identified by chart review. The ICD-10 coding algorithm of T81.3 or T81.4 was able to identify incident SWI with a positive predictive value of 35 percent and a negative predictive value of 97 percent. The agreement between the ICD-10 coding algorithm and presence of SWI remained fair, with an overall kappa coefficient of 0.32 (95 percent confidence interval, 0.22–0.43). The effectiveness of identifying deep SWI cases is also presented. Conclusions This article describes an effective algorithm for identifying a cohort of patients with SWI following open sternotomy in large databases using ICD-10 coding. In addition, alternative search strategies are presented to suit researchers' needs. PMID:26396556

  9. Excess short-term mortality in women after isolated coronary artery bypass graft surgery

    PubMed Central

    Filardo, Giovanni; Hamman, Baron L; Pollock, Benjamin D; da Graca, Briget; Sass, Danielle M; Phan, Teresa K; Edgerton, James; Prince, Syma L; Ring, W Steves

    2016-01-01

    Objective Female sex is considered a risk factor for adverse outcomes following isolated coronary artery bypass graft (CABG) surgery. We assessed the association between sex and short-term mortality following isolated CABG, and estimated the ‘excess’ deaths occurring in women. Methods Short-term mortality was investigated in 13 327 consecutive isolated CABG patients in North Texas between January 2008 and December 2012. The association between sex and CABG short-term mortality, and the excess deaths among women were assessed via a propensity-adjusted (by Society of Thoracic Surgeons-recognised risk factors) generalised estimating equations model approach. Results Short-term mortality was significantly higher in women than men (adjusted OR=1.39; 95% CI 1.04 to 1.86; p=0.027). This significantly greater risk translates into 35 ‘excess’ deaths among women included in this study (>10% of the total 343 deaths in the study cohort) and into 392 ‘excess’ deaths among the ∼40 000 women undergoing isolated CABG in the USA each year. Conclusions The higher risk associated with female sex lead to 35 ‘excess’ deaths in women in this study cohort (over 10% of the total deaths) and to 392 ‘excess’ deaths among women undergoing isolated CABG in the USA each year. Further research is needed to assess the causal mechanisms underlying this sex-related difference. Results of such work could inform the development and implementation of sex-specific treatment and management strategies to reduce women's mortality following CABG. Based on our results, if such work brought women's short-term mortality into line with men's, total short-term mortality could be reduced by up to 10%. PMID:27042323

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

    PubMed Central

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

    2012-01-01

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

  11. Coronary artery bypass grafting in Canada: What is its rate of use? Which rate is right?

    PubMed Central

    Naylor, C D; Ugnat, A M; Weinkauf, D; Anderson, G M; Wielgosz, A

    1992-01-01

    We reviewed recent reports from administrative databases and clinical registries addressing the utilization of coronary artery bypass grafting (CABG) in Canada. The Canadian CABG rate per 100,000 people increased from 31.1 to 43.2 between 1981-82 and 1986-87. Between 1981 and 1986 the rate in the United States increased from 69.9 to 95.3 per 100,000, consistently about two times the Canadian rate. Provincial data have shown particular growth in utilization among elderly people. However, in the United States the 1985 CABG rate was twice as high as the aggregated age-specific rates for Ontario and Manitoba among people 65 to 74 years of age and four times higher among those 75 years or more. Limited registry data suggest that the Canadian CABG case mix is similar to the case mix in major US centres and that, utilization growth notwithstanding, the procedure is largely applied to patients who should, in theory, benefit (i.e., those with severe angina, impaired left ventricular function and left main-stem or triple-vessel disease). However, chart audits and registry evaluations using explicit criteria are needed to compare the use of CABG in Canada and the United States. In addition, Canadian data show moderate regional and municipal variations, the 1986-87 rates per 100,000 population in major census metropolitan areas varying from 19.5 to 46.9. Areas with consistently low rates raise particular concerns about impaired access to CABG. Reasons for variations should therefore be a research priority. PMID:1544075

  12. Can Plasma Fibrinogen Levels Predict Bleeding After Coronary Artery Bypass Grafting?

    PubMed Central

    Jalali, Alireza; Ghiasi, Mohammadsaeid; Aghaei, Aghdas; Khaleghparast, Shiva; Ghanbari, Behrooz; Bakhshandeh, Hooman

    2014-01-01

    Background: Fibrinogen is the main biomarker for bleeding. To prevent excessive postoperative bleeding, it would be useful to identify high-risk patients before coronary artery bypass grafting (CABG). Objectives: In order to predicating bleeding after CABG, we sought to determine whether preoperative fibrinogen concentration was associated with the amount of bleeding following CABG. Patients and Methods: A total of 144 patients (mean age = 61.50 ± 9.42 years; 65.7% men), undergoing elective and isolated CABG, were included in this case-series study. The same anesthesia technique and medicines were selected for all the patients. In the ICU, the patients were assessed in terms of bleeding at 12 and 24 hours post-operation, amount of contingent blood products received, and relevant tests. Statistical tests were subsequently conducted to analyze the correlation between preoperative fibrinogen concentration and the amount of post-CABG bleeding. Results: The mean ± standard deviation of bleeding at 12 and 24 hours post-operation was 285.37 ± 280.27 and 499.31 ± 355.57 mL, respectively. The results showed that postoperative bleeding was associated with different factors whereas pre-anesthesia fibrinogen was not correlated with bleeding at 12 (P = 0.856) and 24 hours (P = 0.936) post-operation. There were correlations between the extra-corporal circulation time and bleeding at 12 hours post-operation (ρ = 0.231, P = 0.007) and bleeding at 24 hours post-operation (ρ = 0.218, P = 0.013). Conclusions: Preoperative assessment of plasma fibrinogen levels failed to predict post-CABG bleeding. PMID:25478546

  13. Coronary artery bypass grafting in Canada: national and provincial mortality trends, 1992-1995

    PubMed Central

    Ghali, W A; Quan, H; Brant, R

    1998-01-01

    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. PMID:9679483

  14. Green Tea Gargling Effect on Cough & Hoarseness After Coronary Artery Bypass Graft

    PubMed Central

    Aryaeefar, Mohammad Reza; Jafari, Hedayat; Yazdani-Charati, Jamshid; Soleimani, Aria

    2015-01-01

    Introduction: Endotracheal intubation is a method necessary for controlling and maintaining airway during general anesthesia. Cough and hoarseness are common complications after endotracheal intubation. Inflammation has an important role in postoperative cough and hoarseness outbreak. Also it has been stated that green tea has anti-inflammatory properties. Therefore, the current study has been conducted to investigate green tea gargling solution effect on cough and hoarseness after coronary artery bypass graft (CABG) surgery. Methods: In this single-blind, randomized, & controlled clinical trial, we enrolled 121 patients undergoing CABG admitted to the ICU. The intervention group participants were asked to gargle 30 cc of green tea solution. The control group patients gargled 30 cc of distilled water. An hour after extubation, the intervention group patients were asked to gargle 30 cc of green tea and the control group patients were required to gargle 30 cc of distilled water every 6 hour up to 24 hour (each patient for 4 times). Moreover, the cough and hoarseness questionnaire was also filled in 6, 12, and 24 hours after endotracheal extubation. Results: The results showed no significant differences among the patients in both groups regarding age, gender, body mass index, smoking history, and anesthesia duration. There was a significant difference between the two groups in terms of cough 12 hours after removing the endotracheal tube. At other times, there was no significant difference between the two groups considering cough and hoarseness. Conclusion: The present study results showed that green tea gargling does not decrease hoarseness. Though, cough occurrence was less in the intervention group than the other group. PMID:26156921

  15. Using Biomarkers to Improve the Preoperative Prediction of Death in Coronary Artery Bypass Graft Patients

    PubMed Central

    Brown, Jeremiah R.; MacKenzie, Todd A.; Dacey, Lawrence J.; Leavitt, Bruce J.; Braxton, John H.; Westbrook, Benjamin M.; Helm, Robert E.; Klemperer, John D.; Frumiento, Carmine; Sardella, Gerald L.; Ross, Cathy S.; O’Connor, Gerald T.

    2010-01-01

    Abstract: The current risk prediction models for mortality following coronary artery bypass graft (CABG) surgery have been developed on patient and disease characteristics alone. Improvements to these models potentially may be made through the analysis of biomarkers of unmeasured risk. We hypothesize that preoperative biomarkers reflecting myocardial damage, inflammation, and metabolic dysfunction are associated with an increased risk of mortality following CABG surgery and the use of biomarkers associated with these injuries will improve the Northern New England (NNE) CABG mortality risk prediction model. We prospectively followed 1731 isolated CABG patients with preoperative blood collection at eight medical centers in Northern New England for a nested case-control study from 2003–2007. Preoperative blood samples were drawn at the center and then stored at a central facility. Frozen serum was analyzed at a central laboratory on an Elecsys 2010, at the same time for Cardiac Troponin T, N-Terminal pro-Brain Natriuretic Peptide, high sensitivity C-Reactive Protein, and blood glucose. We compared the strength of the prediction model for mortality using multivariable logistic regression, goodness of fit and tested the equality of the receiving operating characteristic curve (ROC) area. There were 33 cases (dead at discharge) and 66 randomly matched controls (alive at discharge). The ROC for the preoperative mortality model was improved from .83 (95% confidence interval: .74–.92) to .87 (95% confidence interval: .80–.94) with biomarkers (p-value for equality of ROC areas .09). The addition of biomarkers to the NNE preoperative risk prediction model did not significantly improve the prediction of mortality over patient and disease characteristics alone. The added measurement of multiple biomarkers outside of preoperative risk factors may be an unnecessary use of health care resources with little added benefit for predicting in-hospital mortality. PMID:21313927

  16. Center-level Variation in Infection Rates after Coronary Artery Bypass Grafting

    PubMed Central

    Shih, Terry; Zhang, Min; Kommareddi, Mallika; Boeve, Theodore J.; Harrington, Steven D.; Holmes, Robert J.; Roth, Gary; Theurer, Patricia F.; Prager, Richard L.; Likosky, Donald S.

    2014-01-01

    Background Healthcare acquired infections (HAIs) are a leading cause of morbidity and mortality after cardiac surgery. Prior work has identified a number of patient-related risk factors associated with HAIs. We hypothesized that rates of HAIs would differ across institutions, in part attributed to differences in case mix. Methods and Results We analyzed 20,896 patients undergoing isolated coronary artery bypass grafting (CABG) surgery at 33 medical centers in Michigan between 1/1/2009–6/30/2012. Overall HAIs included pneumonia, sepsis/septicemia, and surgical site infections, including deep sternal wound, thoracotomy, and harvest/cannulation site infections. We excluded patients presenting with endocarditis. Predicted rates of HAIs were estimated using multivariable logistic regression. Overall rate of HAI was 5.1% (1,071 of 20,896) [isolated pneumonia: 3.1% (n=644), isolated sepsis/septicemia: 0.5% (n=99), isolated deep sternal wound infection: 0.5% (n=96), isolated harvest/cannulation site: 0.5% (n=97), isolated thoracotomy: 0.02% (n=5), multiple infections: 0.6% (n=130)]. HAI subtypes differed across strata of center-level HAI rates. While predicted risk of HAI differed in absolute terms by 2.8% across centers (3.9%–6.7%, min:max), observed rates varied 18.2% (0.9%–19.1%). Conclusions There was an 18.2% difference in observed HAI rates across medical centers among patients undergoing isolated CABG surgery. This variability could not be explained by patient case mix. Future work should focus on the impact of other factors (e.g. organizational and systems of clinical care) on risk of HAIs. PMID:24987052

  17. Insurance type and choice of hospital for coronary artery bypass graft surgery.

    PubMed Central

    Chernew, M; Scanlon, D; Hayward, R

    1998-01-01

    OBJECTIVE: To examine the effect of insurance type on the relationship between hospital attributes and patient flows, with particular attention to whether HMO enrollees are more or less likely than other patients to receive care at high-quality hospitals and whether HMO enrollees travel farther to receive care. DATA SOURCES/STUDY SETTING: Data on patient flows, taken from discharge abstracts compiled by the California Office of Statewide Health Planning and Development. Our sample consists of patients undergoing coronary artery bypass graft surgery (CABG) in 1991 who resided in three California markets. Only patients under the age of 65 and insured by HMOs, Blue Cross/Blue Shield, or other commercial insurance were included. Hospital quality is based on hospital-specific measures of excess mortality from CABG. Other hospital attributes were taken from American Hospital Association survey data. STUDY DESIGN: Conditional-choice models were used to estimate the probability that patients would receive care at any given hospital as a function of their insurance type and the hospital's attributes. PRINCIPAL FINDINGS: Patients were more likely to receive care from hospitals closer to their residence. However, HMO patient flows were less sensitive to proximity. In general, the likelihood that an HMO enrollee received care at a given hospital was positively related to hospital quality. Moreover, quality had a greater effect on patient flows for HMO enrollees than for non-HMO enrollees. However, the evidence suggests that the effect of quality on patient flows is neither uniform across markets nor across HMOs. CONCLUSIONS: HMOs do not appear to direct patients to low-quality hospitals. However, heterogeneity among HMOs and across markets suggests that buyers must recognize that choosing an HMO involves greater scrutiny than simply picking a plan labeled "HMO." PMID:9685117

  18. Long-term pulmonary functional status following coronary artery bypass grafting surgery

    PubMed Central

    Rouhi-Boroujeni, Hamid; Rouhi-Boroujeni, Hojjat; Rouhi-Boroujeni, Parnia; Sedehi, Morteza

    2015-01-01

    BACKGROUND The present study aimed to describe the long-term alterations of pulmonary function and also to describe its association with post-operative pain after coronary artery bypass grafting (CABG) surgery. METHODS In this prospective study, thirty non-smoker male patients undergoing isolated on-pump CABG were consecutively included in this study. Pulmonary function measurements were performed, in a sitting position, preoperatively, a week postoperatively, and 6 months after the surgery using a Medical Graphics PF/Dx pulmonary function system. Pain was determined by using visual analog scale (VAS) pain scores with a standardized questionnaire’s. RESULTS Regarding functional class, all patients had New York Heart Association (NYHA) Class II to III. A week after operation, a severe restrictive pulmonary impairment was revealed with a mean decrease in VC to 60.9 ± 9.2% and in forced expiratory volume in one second (FEV1) to 64.6 ± 12.2% of pre-operative values (P < 0.001). Regarding sternotomy related pain, the mean pain VAS score was preoperatively 3.3 ± 1.5 that reached to 6.2 ± 2.5 and 4.8 ± 2.2 1 week and 6 months after the operation (P < 0.001). The trend of the changes in pain score within 6 months of operation was significantly similar to the trend of the changes in some pulmonary function indices such as FEV% and residual volume (RV). CONCLUSION A significant reduction is expected in most pulmonary functional parameters following CABG despite normal pulmonary function state preoperatively. Severe pain originated from sternotomy may be an important factor related to pulmonary dysfunction following CABG. PMID:26405447

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

    PubMed Central

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

    2015-01-01

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

  20. Association of Hospital Prices for Coronary Artery Bypass Grafting With Hospital Quality and Reimbursement.

    PubMed

    Giacomino, Bria D; Cram, Peter; Vaughan-Sarrazin, Mary; Zhou, Yunshu; Girotra, Saket

    2016-04-01

    Although prices for medical services are known to vary markedly between hospitals, it remains unknown whether variation in hospital prices is explained by differences in hospital quality or reimbursement from major insurers. We obtained "out-of-pocket" price estimates for coronary artery bypass grafting (CABG) from a random sample of US hospitals for a hypothetical patient without medical insurance. We compared hospital CABG price to (1) "fair price" estimate from Healthcare Bluebook data using each hospital's zip code and (2) Society of Thoracic Surgeons composite CABG quality score and risk-adjusted mortality rate. Of 101 study hospitals, 53 (52.5%) were able to provide a complete price estimate for CABG. The mean price for CABG was $151,271 and ranged from $44,824 to $448,038. Except for geographic census region, which was weakly associated with price, hospital CABG price was not associated with other structural characteristics or CABG volume (p >0.10 for all). Likewise, there was no association between a hospital's price for CABG with average reimbursement from major insurers within the same zip code (ρ = 0.07, p value = 0.6), Society of Thoracic Surgeoncomposite quality score (ρ = 0.08, p value = 0.71), or risk-adjusted CABG mortality (ρ = -0.03 p value = 0.89). In conclusion, the price of CABG varied more than 10-fold across US hospitals. There was no correlation between price information obtained from hospitals and the average reimbursement from major insurers in the same market. We also found no evidence to suggest that hospitals that charge higher prices provide better quality of care. PMID:26993975

  1. The improving outcomes of coronary artery bypass graft surgery in Ontario, 1981 to 1995

    PubMed Central

    Tu, J V; Wu, K

    1998-01-01

    BACKGROUND: There is continuing uncertainty over the relative contribution of outcomes monitoring to changes in surgical outcomes over time. The authors studied temporal trends in the clinical characteristics and short-term outcomes of patients who underwent coronary artery bypass grafting (CABG) in Ontario before and after the implementation, in 1993, of a province-wide program to provide feedback on cardiac surgery outcomes. METHODS: The authors analysed data from hospital discharge abstracts on the clinical characteristics and in-hospital death rates of all 67,784 patients who underwent isolated CABG in Ontario between Apr. 1, 1981, and Mar. 31, 1996. RESULTS: Death rates were relatively stable during the first half of the 1980s, then declined gradually in the second half of the decade; this decline continued into the first half of the 1990s. In the 1990s patients were older than those in the 1980s, and a higher proportion had coexisting diseases. Between 1986/87 and 1995/96 the unadjusted death rate decreased by 52% (5.0% v. 2.4%) (p < 0.001). The annual relative rate of decline was approximately 6% (95% confidence interval 5% to 7%) in the period before the outcomes feedback program was implemented and about 9% (95% confidence interval 7% to 11%) in the period after implementation. INTERPRETATION: Rates of death after CABG have been declining steadily in Ontario since the mid-1980s. Outcomes-based quality improvement interventions may facilitate; but are not a prerequisite for, improvements in the quality of surgical care. PMID:9724975

  2. [Recurrent angina due to high grade re-stenosis of the left subclavian artery after coronary artery bypass grafting in a patient on hemodialysis for chronic renal failure: report of a case].

    PubMed

    Shirasawa, B; Furukawa, S; Tsushimi, T; Takahashi, T; Fukuda, S; Kawamura, A; Imai, T; Ono, S; Yorozu, T; Oda, T; Zempo, N; Esato, K

    2001-08-01

    A 49-year-old woman on hemodialysis for chronic renal failure was admitted to our hospital with chest pain. She had undergone quadruple coronary artery bypass grafting (CABG) including a left internal thoracic to left anterior descending coronary artery anastomosis 9 months earlier. The blood flow through the left internal thoracic artery had decreased due to high grade stenosis at the proximal portion of the left subclavian artery, and recurrent angina had developed. She was treated by the placement of Palmaz biliary stents in the left subclavian artery, but re-stenosis occurred after 9 months, causing recurrent angina again. There fore, an operation was proposed and bypass grafting from the descending aorta to the left subclavian artery was successfully performed, resulting in complete resolution of her recurrent angina. This case serves to reinforce that patients on dialysis must be carefully followed up after CABG. PMID:11517551

  3. Blood outgrowth endothelial cells alter remodeling of completely biological engineered grafts implanted into the sheep femoral artery.

    PubMed

    Meier, Lee A; Syedain, Zeeshan H; Lahti, Matthew T; Johnson, Sandra S; Chen, Minna H; Hebbel, Robert P; Tranquillo, Robert T

    2014-03-01

    Hemocompatibility of tissue-engineered vascular grafts remains a major hurdle to clinical utility for small-diameter grafts. Here we assessed the feasibility of using autologous blood outgrowth endothelial cells to create an endothelium via lumenal seeding on completely biological, decellularized engineered allografts prior to implantation in the sheep femoral artery. The 4-mm-diameter, 2- to 3-cm-long grafts were fabricated from fibrin gel remodeled into an aligned tissue tube in vitro by ovine dermal fibroblasts prior to decellularization. Decellularized grafts pre-seeded with blood outgrowth endothelial cells (n = 3) retained unprecedented (>95 %) monolayer coverage 1 h post-implantation and had greater endothelial coverage, smaller wall thickness, and more basement membrane after 9-week implantation, including a final week without anti-coagulation therapy, compared with contralateral non-seeded controls. These results support the use of autologous blood outgrowth endothelial cells as a viable source of endothelial cells for creating an endothelium with biological function on decellularized engineered allografts made from fibroblast-remodeled fibrin. PMID:24429838

  4. Protective Effects of Danhong Injection against Cerebral Damage during On-Pump Coronary Artery Bypass Graft Surgery

    PubMed Central

    Xuejuan, Zhang; Jietao, Zhang; Di, Han; Yu, Zheng; Xiaozi, Guo; Yunfa, Li; Lihua, Dong

    2015-01-01

    To explore the protective effects of Danhong injection against cerebral damage during on-pump coronary artery bypass graft surgery and its mechanism. Methods. Fifty patients scheduled for on-pump CABG surgery were randomly divided into Danhong injection group (group D) and control group (group C). Group D was given Danhong injection while group C was given the same volume of normal saline when the artery was cut open. Jugular bulb blood right before the operation began (T1), when body temperature rewarming to 36°C (T2), 30 min after the termination of cardiopulmonary bypass (T3), and 6 hrs after the termination of CPB (T4) was collected. The superoxide dismutase activity by using xanthine oxidase method and concentration determination of malondialdehyde were examined. Results. In group C, SOD activity was less at T2–T4 than at T1. It was also less active comparatively in group D at T2–T4. The MDA concentration increased in both groups but was more obvious in group C. Levels of TNF-α, IL-6, IL-8, and IL-10 increased in both groups C and D at T3 and T4, compared to T1. Conclusions. Danhong injection shows significant protective effects against cerebral damage during on-pump coronary artery bypass graft surgery. PMID:26798399

  5. Comparison of the Postprocedural Quality of Life between Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention: A Systematic Review

    PubMed Central

    Fatima, Kaneez; Yousuf-ul-Islam, Mohammad; Bawany, Faizan Imran; Khetpal, Akash; Khetpal, Neelam; Lashari, Muhammad Nawaz; Arshad, Mohammad Hussham; Amir, Raamish Bin; Kakalia, Hoshang Rustom; Zaidi, Qaiser Hasan; Mian, Sharmeen Kamran; Kazani, Bahram

    2016-01-01

    The treatment of choice between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) has remained unclear. Considering quality of life (QOL) increases life expectancy, we believe QOL should be important in determining the optimum treatment. Thus the objective of this review was to illustrate the comparative effects of CABG and PCI on postprocedural QOL. Methods. We searched PubMed (Medline) and Embase from inception of the databases to May 2014 using “PCI versus CABG quality of life”, “Percutaneous Coronary intervention versus Coronary artery bypass graft surgery Quality of life”, “PCI versus CABG health status”, “Angioplasty versus CABG”, “Percutaneous coronary intervention versus coronary artery bypass surgery health status”, and different combinations of the above terms. 447 articles were found. After applying strict exclusion criteria, we included 13 studies in this review. Results. From the 9 studies that compared QOL scores at 6 months after procedure, 5 studies reported CABG to be superior. From the 10 studies that compared QOL among patients at 1 year after procedure, 9 reported CABG to be superior. Conclusion. It can be established that CABG is superior to PCI in improving patient's QOL with respect to all scales used to determine quality of life. PMID:26989556

  6. Second intercostal internal mammary artery perforator (IMAP) fasciocutaneous flap as an alternative choice for the treatment of deep sternal wound infections (DSWI).

    PubMed

    Koulaxouzidis, Georgios; Orhun, Arzu; Stavrakis, Themistoklis; Witzel, Christian

    2015-09-01

    Sternal wound infections after sternotomy are associated with high morbidity, high mortality and escalating treatment costs. Repeated radical debridement - with the removal of any hardware - and wound conditioning are the prerequisites for reconstruction. Muscle and, less frequently, omentum flaps are usually used for reconstruction. However, these flaps are associated with considerable donor-site morbidity, long operation times and aesthetic impairment. Fasciocutaneous flaps seem to be an alternative. This study presents our experience of using the second intercostal mammary artery fasciocutaneous perforator flap for defect closure in nine patients (mean age: 70.2 years). Following a retrospective chart review, we assessed data on patient demographics, the type of cardiac surgery, the prevalence of deep sternal wound infection (DSWI) risk factors, identified pathogens, surgery duration, hospitalization tim patients had undergone coronary artery bypass surgery, and two had valve replacements. The mean duration of surgery (121.4 ± 39 min) was short. The patients had a mean body mass index (BMI) of 32.8 ± 4.9 kg/m(2). An average flap size of 124 ± 22 cm(2) sufficiently covered and obliterated each defect. One mediastinal haematoma required revision surgery. One wound dehiscence at the flap and two at the donor site were managed conservatively. Our experience reveals that a fasciocutaneous flap based on the second intercostal perforator of the internal mammary artery can be an alternative, quick-to-prepare flap for covering sternal defects. In adipose patients, it has sufficient bulk, and it is large enough to cover common sternal wounds. It also has low complication and morbidity rates, and it achieves an aesthetically pleasing result. PMID:26113276

  7. How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance

    PubMed Central

    Canale, Leonardo Secchin; Bonatti, Johannes

    2014-01-01

    Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy). PMID:25714222

  8. Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses.

    PubMed

    Roohafza, Hamidreza; Sadeghi, Masoumeh; Khani, Azam; Andalib, Elham; Alikhasi, Hasan; Rafiei, Mohammadali

    2015-04-01

    Percutaneous coronary intervention (PCI) and the coronary artery bypass grafting surgery (CABG) are well accepted treatments for coronary artery disease. Many patients and their spouses experience increased level of stress, anxiety and depression before and after going under the procedure. One hundred and ninety-six cardiac patients who were candidate for CABG or PCI procedures and their spouses were asked to complete Hospital Anxiety and Depression Scale and General Health Questionnaire-12 before and 1 month after procedures. Anxiety, depression and stress level in patients and their spouses going under the procedures significantly reduced over time. Scores of anxiety, depression and stress in patients and their spouses were correlated. There was no difference in the level of anxiety, depression and stress between CABG and PCI groups before to after procedures. We suggest providing information about the procedures to both patients and their spouses to deal better with their own psychological state. PMID:24750214

  9. Association of Pre-Operative Albuminuria with Post-Operative Outcomes after Coronary Artery Bypass Grafting

    PubMed Central

    George, Lekha K.; Molnar, Miklos Z.; Lu, Jun L.; Kalantar-Zadeh, Kamyar; Koshy, Santhosh K. G.; Kovesdy, Csaba P.

    2015-01-01

    The effect on post-operative outcomes after coronary artery bypass graft(CABG) surgery is not clear. Among 17,812 patients who underwent CABG during October 1,2006-September 28,2012 in any Department of US Veterans Affairs(VA) hospital, we identified 5,968 with available preoperative urine albumin-creatinine ratio(UACR) measurements. We examined the association of UACR<30, 30–299 and >=300 mg/g with 30/90/180/365-day and overall all-cause mortality, and hospitalization length >10 days, and with acute kidney injury(AKI). Mean ± SD baseline age and eGFR were 66 ± 8 years and 77 ± 19 ml/min/1.73 m2, respectively. 788 patients(13.2%) died during a median follow-up of 3.2 years, and 26.8% patients developed AKI(23.1%-Stage 1; 2.9%-Stage 2; 0.8%-Stage 3) within 30 days of CABG. The median lengths of stay were 8 days(IQR: 6–13 days), 10 days(IQR: 7–14 days) and 12 days(IQR: 8–19 days) for groups with UACR < 30 mg/g, 30–299 mg/g and ≥300 mg/g, respectively. Higher UACR conferred 72 to 85% higher 90-, 180-, and 365-day mortality compared to UACR<30 mg/g (odds ratio and 95% confidence interval for UACR≥300 vs. <30 mg/g: 1.72(1.01–2.95); 1.85(1.14–3.01); 1.74(1.15–2.61), respectively). Higher UACR was also associated with significantly longer hospitalizations and higher incidence of all stages of AKI. Higher UACR is associated with significantly higher odds of mortality, longer post-CABG hospitalization, and higher AKI incidence. PMID:26548590

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

    PubMed

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

    2015-01-01

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

  11. Preoperative usages of levosimendan in patients undergoing coronary artery bypass grafting

    PubMed Central

    Eris, Cuneyt; Yavuz, Senol; Toktas, Faruk; Turk, Tamer; Gucu, Arif; Erdolu, Burak; Goncu, M Tugrul

    2014-01-01

    Objectives: Levosimendan (LS) is a new inotropic drug which belongs to the group of drugs known as calcium sensitizers. It is different from other inotropic agents by its inotropic and vasodilatory actions without an increase in myocardial oxygen consumption and considered as a good choice in high-risk patients undergoing cardiac surgery. We aimed to investigate the proper time of the administration and the effect of prophylactic usage of LS in patients with low left ventricular ejection fraction (LVEF) undergoing coronary artery bypass grafting (CABG). Methods: Forty patients who underwent isolated CABG with LVEF) less than 30% were evaluated retrospectively. Patients were divided into 3 groups according to the induction time of LS during different phases of the operation and compared to a non-LS control group. LS infusion (0.2 μg/kg/min) was applied 12 hours before the operation in Group 1 (G1) (n=10), after the induction of anaesthesia in Group 2 (G2) (n=10) and during the pump removal period in Group 3 (G3) (n=10) and non-LS control group 4 (G4) (n=10). Demographic data, operative characteristics, hemodynamic parameters and serum lactate, troponin, creatinine levels were compared between groups before and after LS treatment during pre and postoperative period. Data were evaluated by Fisher exact, Kruskal-Wallis, Mann-Whitney U, Chi-square and Wilcoxon rank tests. Results: We found that the duration of tracheal intubation, the intensive care unit stay and the hospital stay were significantly decreased in G1 and G2 when compared to the patients in G3 and G4. During postoperative period, in G1 and G2 one (10%) patient from each required intraaortic balloon pump (IABP), while in G3 two (20%) patients and in G4 five (50%) patients required IABP. Cardiac index (CI) was significantly increased in all groups from baseline to intensive care unit (ICU)1h and ICU24h. When groups compared each other significant increase was found in G1-G4 (p=0.001) and G2-G4 (p=0.007) at ICU1h. There was a significant increase in % EF especially in G1-G4 (p=0.011) and G2-G4 (p=0.007) at ICU1h. Systemic vascular resistance index significantly decreased in G1 and G2 in comparison to G3 and G4. However there was no significant decrease in pulmonary capillary wedge pressure of all 4 groups before and after LS. There was a significant decrease in mean pulmonary arterial pressure in G1 and G2 according to G4. Compared with the other groups preoperatively LS-treated patients (G1 and G2) had lower postoperative troponin I, serum lactate and creatinine concentrations. Conclusions: Our study shows that the elective preoperative initiation of LS especially 12 hours before the operation onset is associated with better improvement on cardiac functions as well as with lower mortality and complication rates, lower use of additional inotropic and vasopressor drugs, less need for intra-aortic balloon pump support and shorter length of stay in the ICU in patients with high perioperative risk or compromised left ventricular function. As a result, patients who received an infusion of LS 12 hours before surgery showed an evidence of less myocardial damage which suggested the preconditioning effect of the drug. PMID:24482709

  12. Treatment of recurrent head and neck carcinoma involving the carotid artery: carotid reconstruction with ePTFE graft.

    PubMed

    He, Xiang-bo; Li, Jing-jia; Chen, Yue-hong; Shu, Chang; Tang, Qing-lai; Yang, Xin-ming

    2011-12-01

    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

  13. Perioperative rupture of the LIMA graft leading to cardiogenic shock, emergency angiography, and stenting with a polytetrafluoroethylene-covered stent.

    PubMed

    Yeow, Wen-Loong; Edwards, Mark; Yong, Gerald

    2012-03-01

    A 58-year-old man underwent an elective coronary bypass graft for severe four-vessel stenosis. Cardiogenic shock developed just after coronary bypass grafting with a left internal mammary artery (LIMA) to left anterior descending (LAD) artery and superficial venous graft to 1st and 2nd obtuse marginal (OM1/OM2) arteries the posterior descending artery (PDA) was too small to graft. Despite significant inotropes and an intra-aortic balloon pump, the patient deteriorated in intensive care unit with cardiogenic shock and ventricular arrhythmia. Urgent coronary angiography revealed a rupture or torn LIMA graft with extravasation of contrast into the left pleural cavity. There was no distal LIMA to LAD flow probably due to graft thrombosis. Revascularisation was performed on the severe ostial native LAD stenosis with a drug eluting stent. The rupture graft was then stented with a polytetrafluoroethylene-covered stent, which stopped the bleeding, and latter, led to total graft thrombosis. The patient improved significantly and supportive inotropes could be weaned down. At 11 month follow-up, the patient had mild left ventricular dysfunction, widely patent ostial LAD stent and thrombosed LIMA graft. PMID:21542101

  14. Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

    SciTech Connect

    Fanelli, Fabrizio Cannavale, Alessandro; Gazzetti, Marianna; Fantozzi, Cristiano; Taurino, Maurizio; Speziale, Francesco

    2013-02-15

    This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

  15. VIABILITY OF VASCULARIZED BONE GRAFT FROM THE ILIAC CREST USING THE ILIAC BRANCH OF THE ILIOLUMBAR ARTERY: EXPERIMENTAL STUDY ON RATS

    PubMed Central

    Peruchi, Fabian Maccarini; Sebben, Alessandra Deise; Lichtenfels, Martina; de Oliveira Jaeger, Marcos Ricardo; Silva, Jefferson Braga

    2015-01-01

    Objective: Through an experimental model, our aim was to create inferences about the viability of vascularized bone grafts from the iliac crest in rats and investigate their histological features. Methods: Twenty-one rats were used, divided into two groups: the first consisted of animals that were subjected to the technique of vascularized bone graft pedicled onto the iliac branch of the iliolumbar artery; the second (control group) underwent the same procedure as performed on the first group, with the addition of ligation of the vascular pedicle. The viability of the bone grafts was observed for three weeks, by means of direct observation of the graft, histology and immunohistochemistry. Results: All the vascularized grafts evaluated in the first week showed viability according to direct observation, histology and immunohistochemistry. However, in the second and third weeks, direct observation showed that 75% of the grafts were unviable, while histological analysis and immunohistochemistry showed that 50% were unviable. Conclusions: Some grafts that are designed to be vascularized became unviable and began to behave like non-vascularized grafts under direct observation and histology. Despite the possibility of failure, use of vascularized bone grafts should be encouraged, because descriptive histology shows greater cell density in the medullary bone portion, and osteocytes that function better regarding deposition of bone matrix, with preservation of the intraosseous vascular network.

  16. Magnetic Resonance Angiography of Nonferromagnetic Iliac Artery Stents and Stent-Grafts: A Comparative Study in Sheep

    SciTech Connect

    Schuermann, Karl; Vorwerk, Dierk; Buecker, Arno; Neuerburg, Joerg; Grosskortenhaus, Stefanie; Haage, Patrick; Piroth, Werner; Hunter, David W.; Guenther, Rolf W.

    1999-09-15

    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.

  17. Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

    SciTech Connect

    England, Andrew; Butterfield, John S.; McCollum, Charles N.; Ashleigh, Raymond J.

    2008-07-15

    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.

  18. Gortex graft-external carotid artery anastomotic stricture treated by percutaneous transluminal angioplasty.

    PubMed

    Dacie, J E; Lumley, J S

    1985-01-01

    We describe successful percutaneous transluminal angioplasty (PTA) of a gortex-right external carotid artery anastomotic stricture in a 49-year-old man with amaurosis fugax and occlusion of the right internal carotid artery. No neurological complications occurred during the procedure. The patient had had three previous carotid operations, and PTA enabled successful transcranial arterial bypass surgery to be carried out, with complete relief of symptoms. PMID:2934132

  19. Use of the GuideLiner catheter for the treatment of a bifurcational total occlusion of the native left anterior descending artery through a tortuous composite venous graft.

    PubMed

    Hanna, Elias B; Dasari, Tarun W; Hennebry, Thomas A

    2011-03-01

    Difficulty in stent delivery is frequently encountered in cases of tortuous or calcified coronary arteries. Chronic total occlusion interventions often require extra back-up that may not be adequately provided by guiding catheters, even the most supportive guiding catheters. We report the first successful stenting of a complex native coronary artery occlusion through an angulated bypass graft with the support of a GuideLiner catheter. PMID:21364246

  20. Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?

    PubMed

    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

    2011-10-01

    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

  1. VATS left upper lobectomy after CABG with LIMA-LAD bypass graft

    PubMed Central

    Piwkowski, Cezary; Zieliński, Paweł; Dyszkiewicz, Wojciech

    2016-01-01

    Video-assisted thoracic surgery (VATS) lobectomy has been proven to be a safe operation associated with a low complication rate and good long-term results comparable to those obtained by the thoracotomy approach. During the development of thoracoscopic anatomical lung cancer resections, eligibility criteria for the operation have been gradually extended. Currently, even as complicated cases as bronchial and vascular sleeve resections or pneumonectomies are being performed by VATS. However, minimally invasive surgery after previous coronary artery bypass graft surgery merits special consideration due to the consequences of potential injury to the bypass graft. This is particularly important in the case of VATS left upper lobectomy after left internal mammary artery grafting to the left anterior descending artery bypass.

  2. Bypass grafting between the supraceliac aorta and the common hepatic artery during pancreaticoduodenectomy

    PubMed Central

    Liang, Diana H.; Rosenberg, Wade R.; Martinez, Sylvia

    2015-01-01

    Patients with celiac artery stenosis often remain asymptomatic due to formation of extensive collateral pathways. Hepatic or anastomotic ischemia may occur when the gastroduodenal artery and these collaterals are ligated during pancreaticoduodenectomy. Here, we present a patient with severe atherosclerotic disease of the celiac axis who successfully underwent pancreaticoduodenectomy with aorto-hepatic bypass. PMID:26330233

  3. Pelvic Arterial Embolisation in a Trauma Patient with a Pre-Existing Aortobifemoral Graft

    SciTech Connect

    Abulaban, Osama; Hopkins, Jonathan; Willis, Andrew P.; Jones, Robert G.

    2011-02-15

    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.

  4. Gender as a Moderator between Having an Anxiety Disorder Diagnosis and Coronary Artery Bypass Grafting Surgery (CABG) Outcomes in Rural Patients

    ERIC Educational Resources Information Center

    Dao, Tam K.; Voelkel, Emily; Presley, Sherine; Doss, Brendel; Huddleston, Cashuna; Gopaldas, Raja

    2012-01-01

    Purpose: This paper examines gender as a moderating variable between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients. Methods: Using the 2008 Nationwide Inpatient Sample (NIS) database, 17,885 discharge records of patients who underwent a primary CABG surgery were identified.

  5. Aneurysm of an Aberrant Right Subclavian Artery Successfully Excluded by a Thoracic Aortic Stent Graft with Supra-aortic Bypass of Three Arch Vessels

    SciTech Connect

    Munneke, Graham J. Loosemore, Thomas M.; Belli, Anna-Maria; Thompson, Matt M.; Morgan, Robert A.

    2005-06-15

    An aberrant right subclavian artery (ARSA) arising from a left-sided aortic arch is the fourth most common aortic arch anomaly. Aneurysmal dilatation of the ARSA requires treatment because of the associated risk of rupture. We present a case where supra-aortic bypass of the arch vessels was performed to facilitate exclusion of the aneurysm by a thoracic aortic stent graft.

  6. Treatment of a Celiac Trunk Aneurysm Close to the Hepato-splenic Bifurcation by Using Hepatic Stent-graft Implantation and Splenic Artery Embolization

    SciTech Connect

    Basile, Antonio Lupattelli, Tommaso; Magnano, Marco; Giulietti, Giorgio; Privitera, Giambattista; Battaglia, Giuseppe; Monaca, Vincenzo; Ettorre, Giancarlo

    2007-02-15

    We present a case of a 73-year-old man in whom a celiac trunk aneurysm close to the hepato-splenic bifurcation was discovered and treated by using celiac-hepatic stent-grafts implantation and splenic artery embolization.

  7. Gender as a Moderator between Having an Anxiety Disorder Diagnosis and Coronary Artery Bypass Grafting Surgery (CABG) Outcomes in Rural Patients

    ERIC Educational Resources Information Center

    Dao, Tam K.; Voelkel, Emily; Presley, Sherine; Doss, Brendel; Huddleston, Cashuna; Gopaldas, Raja

    2012-01-01

    Purpose: This paper examines gender as a moderating variable between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients. Methods: Using the 2008 Nationwide Inpatient Sample (NIS) database, 17,885 discharge records of patients who underwent a primary CABG surgery were identified.…

  8. Inferior Epigastric Artery Pseudoaneurysm Following Paracentesis in a Liver Graft Recipient: A Case Report

    PubMed Central

    Ebrahimi, Amir Pasha; Nasiri Toosi, Mohsen; Davoudi, Setareh; Jafarian, Ali; Ghanaati, Hossein

    2015-01-01

    Pseudoaneurysm happens when the artery wall is injured and the blood is contained by the surrounding tissues with eventual formation of a fibrous sac communicating with the artery. We report a case of a 39-year-old man with inferior epigastric artery (IEA) pseudoaneurysm after paracentesis. The pseudoaneurysm was diagnosed by Doppler ultrasound and treated by surgical intervention regarding the patient’s underlying comorbidity. IEA false aneurysm must be included in the differential diagnosis during investigation of the cause of any swelling after paracentesis. Cirrhotic patients may be more prone to this complication because of thin rectus muscle that could not confine the hematoma. PMID:26557270

  9. Flow capacity of skeletonized versus pedicled internal thoracic artery in coronary artery bypass graft surgery: systematic review, meta-analysis and meta-regression.

    PubMed

    Sá, Michel Pompeu Barros Oliveira; Cavalcanti, Paulo Ernando Ferraz; Santos, Henrique José de Andrade Costa; Soares, Artur Freire; Miranda, Rodrigo Gusmão Albuquerque; Araújo, Mayara Lopes; Lima, Ricardo Carvalho

    2015-07-01

    Many surgeons are concerned about the flow capacity of a skeletonized internal thoracic artery (ITA) in comparison with a pedicled ITA used during coronary artery bypass graft (CABG). This work aims to summarize the evidence comparing the flow capacity of a skeletonized versus pedicled ITA during CABG. We performed systematic review and meta-analysis according to the PRISMA statement based on a search in MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and reference lists of relevant articles. Studies included were original studies whose populations comprised patients undergoing CABG; compared outcomes between skeletonized versus pedicled ITA; the outcomes included data regarding intraoperative flow capacity of the grafts; the studies were prospective or retrospective or non-randomized or randomized controlled trials. In total, eight studies were identified and reviewed for eligibility and data were extracted. Forest plots and the summarized difference in means including 95% confidence intervals (CIs) were estimated and meta-regressions were performed. There was a statistically significant difference in favour of the skeletonized ITA compared with the pedicled ITA in terms of flow capacity (random-effect model: additional 20.8 ml/min, 95% CI 6.6-35.0, P = 0.004), being the summary measures under the influence of heterogeneity of the effects, but free from publication bias. We observed a difference with regard to the type of study, since non-randomized studies together demonstrated the superiority of a skeletonized ITA (random-effect model: additional 32.3 ml/min, 95% CI 21.0-43.6, P < 0.001), but the randomized studies together did not show it (random-effect model: additional 13.2 ml/min, 95% CI -1.1 to 27.6, P = 0.071). Meta-regression demonstrated some modulation influence by female gender, age and diabetes on the flow capacity of grafts. In summary, in terms of flow capacity, a skeletonized ITA appears to be superior in comparison with a pedicled ITA during CABG. PMID:25228742

  10. Robotic totally endoscopic coronary artery bypass and catheter based coronary intervention in one operative session.

    PubMed

    Bonatti, Johannes; Schachner, Thomas; Bonaros, Nikolaos; Laufer, Günther; Kolbitsch, Christian; Margreiter, Josef; Jonetzko, Patrycja; Pachinger, Otmar; Friedrich, Guy

    2005-06-01

    A 56-year-old male patient underwent robotically assisted totally endoscopic left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafting. After protamine administration complete heart block developed in the patient. On intraoperative angiography the LIMA to LAD graft was perfectly patent but an acute occlusion of the right coronary artery (RCA) was noted. We performed an immediate on table percutaneous coronary angioplasty and stent placement to the RCA. The heart regained sinus rhythm and the wall motion abnormalities on the back wall of the heart resolved. No clinical symptoms indicating ongoing myocardial ischemia were noted postoperatively. This case demonstrates that a hybrid procedure of robotic totally endoscopic coronary artery bypass grafting and catheter based coronary intervention is feasible in one simultaneous session. PMID:15919329

  11. Clinical comparison of percutaneous coronary intervention with domestic drug-eluting stents versus off pump coronary artery bypass grafting in unprotected left main coronary artery disease

    PubMed Central

    Yin, Yong; Xin, Xingli; Geng, Tao; Xu, Zesheng

    2015-01-01

    Objective: The aim of our study was to compare the clinical outcomes of percutaneous coronary intervention (PCI) with domestic drug-eluting stents (DES) and off pump coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery (ULMCA) disease. Methods: A total of 227 patients with ULMCA disease and underwent revascularization was included. One hundred and six patients were treated with PCI with domestic DES implantation and 121 patients with off pump CABG. Clinical outcomes with respect to the major adverse cardiovascular and cerebrovascular events (MACCE) including death any cause, non-fatal myocardial infarction (MI), stroke, and target vessel revascularization (TVR) during hospitalization and at 12-month follow-up were recorded. Results: There was no significant difference between the domestic DES and off pump CABG groups in the risk of death, non-fatal MI, stroke, and TVR during hospitalization and at 12-month follow-up. Overall in-hospital MACCE in PCI versus CABG was 0.94% versus 5.78% (P<0.05). The overall MACCE at 12-month follow up in PCI versus CABG was in 3.77% versus 3.31% (P>0.05). Conclusions: Domestic DES is feasible and safety in the treatment of ULMCA lesions. When compared with off-pump CABG, domestic DES achieved similar completeness of revascularization, similar in-hospital and 12-month follow-up outcomes. A longer follow-up is needed. PMID:26550424

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

    PubMed

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

    1991-06-01

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

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

    NASA Astrophysics Data System (ADS)

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

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

  14. Sequential Vein Bypass Grafting is Not Associated with an Increase of Either In-hospital or Mid-term Adverse Events in Off-pump Coronary Artery Bypass Grafting

    PubMed Central

    Xiao, Fucheng; Wang, Jian; Wu, Hengchao; Sun, Hansong

    2015-01-01

    Background: The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG). We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump CABG. Methods: From October 2009 to September 2013 at the Fuwai Hospital, 127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction (MI), stroke, requirement for intra-aortic ballon pump (IABP) assistance and prolonged ventilation. Major adverse cardiac events (MACEs: Death, MI or repeat revascularization) and angina recurrence were considered as mid-term endpoints. Results: No significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups versus 59.5 ml in sequential venous grafts groups (P < 0.001). There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, MI, stroke, IABP assistance and prolonged ventilation (11.0% vs. 14.2%, P = 0.45). Individual in-hospital measurement also did not differ significantly between the two groups. At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36) and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48) were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both MACEs and angina recurrence. Conclusions: Compared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in-hospital or mid-term adverse events in patients undergoing off-pump CABG. PMID:25563315

  15. The effects of discharge training and counseling on post-discharge problems in patients undergoing coronary artery bypass graft surgery

    PubMed Central

    Akbari, Masoumeh; Celik, Sevilay Senol

    2015-01-01

    Background: Advances in coronary artery surgery have reduced morbidity, mortality, and rates of graft occlusion. Discharge programs are important services for the continuity of treatment and must encompass physical, psychological, and social aspects of individual patient care. This study aimed at investigating the effect of planned discharge training and counseling on the problems experienced by patients undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: A semi-experimental study was performed on 100 patients undergoing CABG surgery in the surgery department. During a period of 9 months from January to September 2013, the patients in the intervention group were provided with adequate discharge training and counseling with a booklet before surgery and counseling until 6 weeks after discharge, while the control group patients received only routine clinical procedures, i.e. prescribing medicine, controlling vital signs, and wound dressing. The data were analyzed using Statistical Package for the Social Sciences (SPSS) 23. Frequency and distribution were used to describe the data, and paired sample t-test, variance analysis, Fisher's exact test, and Chi-squared tests were also used. Results: The reported problems for both groups had a descending pattern during the three follow-ups. However, this pattern had a greater slope in the intervention group compared to the control one. As a result of these education programs, problems were fewer in the intervention group than in the control group (P < 0.05). Conclusions: Discharge training and counseling given to the intervention group had a positive impact on decreasing the problems that the patients had. Therefore, the institutions may be recommended to support multidisciplinary patient training and counseling activities using the methods described in this study. PMID:26257798

  16. Outcomes of Primary Percutaneous Coronary Intervention for Patients with Previous Coronary Artery Bypass Grafting Presenting with STsegment Elevation Myocardial Infarction

    PubMed Central

    Garg, Pankaj; Kamaruddin, Hazlyna; Iqbal, Javaid; Wheeldon, Nigel

    2015-01-01

    Background: There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting acutely as ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). Objectives: To compare outcomes in STEMI patients undergoing PPCI with or without previous CABG surgery. Methods: An all-comer single-centre observational registry from a cardiothoracic centre in UK. All consecutive patients presenting for PPCI between 2007 and 2012 were included. Electronic records were used to extract relevant information. Mortality data were obtained from the Office of National Statistics. Overall median follow-up period was 1.7 years (intraquartile range 0.9-2.5). Results: Complete data were available for 2133 (97%) patients. 47-patients had previous history of CABG. Out of these, the infarct related artery (IRA) was native vessel in 22 and graft in 25 patients. Post re-vascularization TIMI flow was inferior in CABG cohort (

  17. Comparison of Economic and Patient Outcomes With Minimally Invasive Versus Traditional Off-Pump Coronary Artery Bypass Grafting Techniques

    PubMed Central

    Poston, Robert S.; Tran, Richard; Collins, Michael; Reynolds, Marty; Connerney, Ingrid; Reicher, Barry; Zimrin, David; Griffith, Bartley P.; Bartlett, Stephen T.

    2009-01-01

    Background Minimally invasive coronary artery bypass grafting (miniCABG) decreases in-hospital morbidity versus traditional sternotomy CABG. We performed a prospective cohort study (NCT00481806) to assess the impact of miniCABG on costs and metrics that influence quality of life after hospital discharge. Methods One hundred consecutive miniCABG cases performed using IMA grafting ± coronary stenting were compared with a matched group of 100 sternotomy CABG patients using IMA and saphenous veins, both treating equivalent number of target coronaries (2.7 vs. 2.9), off-pump. We compared perioperative costs, time to return to work/normal activity, and risk of major adverse cardiac/cerebrovascular events (MACCE) at 1 year: myocardial infarction (elevated troponin or EKG changes), target vessel occlusion (CT angiography at 1 year), stroke, or death. Results For miniCABG, robotic instruments and stents increased intraoperative costs; postoperative costs were decreased from significantly less intubation time (4.80 ± 6.35 vs. 12.24 ± 6.24 hours), hospital stay (3.77 ± 1.51 vs. 6.38 ± 2.23 days), and transfusion (0.16 ± 0.37 vs. 1.37 ± 1.35 U) leading to no significant differences in total costs. Undergoing miniCABG independently predicted earlier return to work after adjusting for confounders (t = − 2.15; P = 0.04), whereas sternotomy CABG increased MACCE (HR, 3.9; 95% CI, 1.4 –7.6), largely from lower target-vessel patency. Conclusions MiniCABG shortens patient recovery time, minimizes MACCE risk at 1 year, and showed superior quality and outcome metrics versus standard-of-care CABG. These findings occurred without increasing costs and with superior target vessel graft patency. PMID:18936577

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

    PubMed

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

    2014-06-01

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

  19. Changes in the Distribution of Hepatic Arterial Blood Flow Following TIPS with Uncovered Stent and Stent-Graft: An Experimental Study

    SciTech Connect

    Keussen, Inger; Song, Ho-Young; Bajc, Marika; Cwikiel, Wojciech

    2002-08-15

    Purpose: To evaluate changes in distribution of hepatic arterial blood flow in the liver following insertion of an uncovered stent and subsequently a stent-graft in the transjugular intrahepatic portosystemic shunt (TIPS) channel.Methods: The experiments were performed in eight healthy pigs under general anesthesia. In a pilot study in one pig, scintigraphic evaluation of arterial perfusion to the liver was done before and after inflation of a balloon in the right hepatic vein. In the other pigs, outflow from the right liver vein was checked repeatedly by contrast injection through a percutaneously inserted catheter. The arterial perfusion through the liver was examined by scintigraphy, following selective injection of macro-aggregate of 99Tcm-labeled human serum albumin 99Tcm-HSA) into the hepatic artery. This examination was done before and after creation of a TIPS with an uncovered stent and subsequently after insertion of a covered stent-graft into the cranial portion of the shunt channel. Results: In the pilot study changes in the arterial perfusion to the liver were easily detectable by scintigraphy. One pig died during the procedure and another pig was excluded due to dislodgement of the hepatic artery catheter. The inserted covered stent obstructed venous outflow from part of the right liver lobe. The 99Tcm-HSA activity in this part remained unchanged after TIPS creation with an uncovered stent. A reduction in activity was seen after insertion of a stent-graft (p0.06).Conclusion: The distribution of the hepaticarterial blood flow is affected by creation of a TIPS with a stent-graft, in the experimental pig model.

  20. Transvenous Embolization of a Spontaneous Femoral AVF 5 Years After an Incomplete Treatment with Arterial Stent-Grafts

    SciTech Connect

    Peynircioglu, Bora Ozkan, Murat; Dogan, Omer Faruk; Cil, Barbaros E.; Dogan, Riza

    2008-03-15

    A 66-year-old man with complex left femoral arterio-venous fistula (AVF) was first diagnosed after a deep venous thrombosis incident approximately 5 years ago. Partial treatment was performed by means of endografts along the superficial femoral artery, which remained patent for 5 years. The patient had been doing well until a couple of months ago when he developed severe venous stasis and ulcers of the left cruris, due to a high-flow nonhealing complex AVF with additional iliac vein occlusion. Therefore; the definitive treatment was performed by a unique endovascular technique combined with surgical venous bypass (femoro-femoral crossover saphenous bypass, the Palma operation). A novel percutaneous transvenous technique for occlusion of a complex high-flow AVF is reported with a review of the literature. The case is unique with spontaneous AVF, transvenous embolization with detachable coils and ONYX, and the hybrid treatment technique as well as the long-term patency of superficial femoral artery stent-grafts.

  1. Sciatic nerve regeneration induced by transplantation of in vitro bone marrow stromal cells into an inside-out artery graft in rat.

    PubMed

    Mohammadi, Rahim; Vahabzadeh, Behnam; Amini, Keyvan

    2014-10-01

    Traumatic injury to peripheral nerves results in considerable motor and sensory disability. Several research groups have tried to improve the regeneration of traumatized nerves by invention of favorable microsurgery. Effect of undifferentiated bone marrow stromal cells (BMSCs) combined with artery graft on peripheral nerve regeneration was studied using a rat sciatic nerve regeneration model. A 10-mm sciatic nerve defect was bridged using an artery graft (IOAG) filled with undifferentiated BMSCs (2 × 10(7) cells/mL). In control group, the graft was filled with phosphated buffer saline alone. The regenerated fibers were studied 4, 8 and 12 weeks after surgery. Assessment of nerve regeneration was based on behavioral, functional (Walking Track Analysis), electrophysiological, histomorphometric and immuohistochemical (Schwann cell detection by S-100 expression) criteria. The behavioral, functional and electrophysiological studies confirmed significant recovery of regenerated axons in IOAG/BMSC group (P < 0.05). Quantitative morphometric analyses of regenerated fibers showed the number and diameter of myelinated fibers in IOAG/BMSC group were significantly higher than in the control group (P < 0.05). This demonstrates the potential of using undifferentiated BMSCs combined with artery graft in peripheral nerve regeneration without limitations of donor-site morbidity associated with isolation of Schwann cells. It is also cost saving due to reduction in interval from tissue collection until cell injection, simplicity of laboratory procedures compared to differentiated BMSCs and may have clinical implications for the surgical management of patients after facial nerve transection. PMID:24942097

  2. Effects of high thoracic epidural anesthesia on mixed venous oxygen saturation in coronary artery bypass grafting surgery

    PubMed Central

    Gurses, Ercan; Berk, Dervi?; Sungurtekin, Hlya; Mete, Asli; Serin, Simay

    2013-01-01

    Background To investigate possible effects of high thoracic epidural anesthesia (HTEA) on mixed venous oxygen saturation (SvO2) in coronary artery bypass grafting surgery (CABGS). Material/Methods Sixty-four patients scheduled for CABGS were randomly assigned to either test (HTEA) or control group. Standard balanced general anesthesia was applied in both groups. Mean arterial blood pressure (MAP), heart rate (HR), oxygen saturation (SpO2), central venous pressure (CVP), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), mean pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), pulmonary compliance (C), bispectral index (BIS), body temperature, SvO2, hematocrit values were recorded before induction. Postoperative hemodynamic changes, inotropic agent, need for vasodilatation, transfusion and additional analgesics, recovery score, extubation time, visual analogue scale (VAS) values, duration of stay in intensive care unit (ICU) and hospital were recorded. Results Study groups were similar in SpO2, CVP, PCWP, PAP, C, body temperature, BIS values, development of intraoperative bradycardia. In HTEA group, intraoperative MAP, SVR, PVR, need for transfusion were lower, whereas CO, CI, SvO2, hematocrit values were higher (p<0.05). Postoperative MAP, HR, hypertension development, need for vasodilatator, transfusion, analgesics, extubation time, recovery data, duration of stay in ICU, hospital were lower in HTEA group (p<0.05). VAS score decreased in 30 minutes and 12 hours following extubation in HTEA and control group, respectively. Conclusions HTEA may improve balance between oxygen presentation and usage by suppressing neuroendocrin stress response; provide efficient postoperative analgesia, more stabile hemodynamic, respiratory conditions, lower duration of stay in ICU, hospital. PMID:23531633

  3. The role of radionuclide angiocardiography in the preoperative prediction of pain relief and prolonged survival following coronary artery bypass grafting.

    PubMed Central

    Jones, R H; Floyd, R D; Austin, E H; Sabiston, D C

    1983-01-01

    Radionuclide angiocardiography (RNA) provides noninvasive measurements of left ventricular function during rest and exercise, which appear to reflect the magnitude of fibrosis and ischemia in patients with coronary artery disease. This investigation evaluated the usefulness of these measurements for providing prognostic information, useful in selecting therapy. The RNA study group included 278 patients with a low resting ejection fraction and coronary artery disease documented by angiography. Patients were followed for up to three years to define survival and incidence of complete pain relief. The 172 patients treated medically had less favorable survival and pain relief than the 106 surgically treated patients. In the medically treated patients, a positive RNA defined a subgroup of 113 patients, with a 20% lower 3-year survival than the 59 patients with a negative RNA. Moreover, comparison of patients receiving medical and surgical therapy following a positive RNA documented a clear improvement in both survival and pain relief for those who showed significant ischemia during exercise and subsequently underwent coronary bypass procedures. In patients with a negative RNA, medical and surgical therapy resulted in a similar survival rate and little difference in pain relief. Calculations comparing the maximal potential increase in survival and complete pain relief, using multiple criteria known to provide prognostic information, identified the exercise response on RNA as the single most important variable for selection of therapy. Therefore, the left ventricular response to exercise provides important prognostic information in patients with low resting ejection fractions, and the results of this procedure can be used to define subgroups of patients who will and will not benefit from coronary artery bypass grafting. PMID:6602596

  4. The technical aspect of the gastroepiploic artery graft skeletonization with the harmonic scalpel: the samurai technique.

    PubMed

    Kamiya, Hiroyuki; Watanabe, Go; Tomita, Shigeyuki; Takemura, Hirofumi; Nagamine, Hiroshi; Nishida, Satoru

    2005-01-01

    A novel skeletonization technique using the scissors-type harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA) is presented. This "samurai technique," which uses the harmonic scalpel by frequently turning over the scissors, facilitates the handling of the gastroepiploic artery, enlarges the caliber size, and allows easy skeletonization without any vessel injury. PMID:15799901

  5. Customized Tapered Stent-Grafts in the Endovascular Management of Internal Iliac Artery Aneurysms: A Useful Adjunct to Conventional Endovascular Options

    SciTech Connect

    Haslam, J. Elizabeth Hardman, John; Horrocks, Michael; Fay, Dominic

    2009-01-15

    The endovascular exclusion of an isolated iliac artery aneurysm is recognized as a safe and favorable alternative to open surgical repair, with low associated morbidity and mortality. It has particular advantages in the treatment of internal iliac artery aneurysm (IIAA) given the technical difficulties associated with open surgical repair deep within the pelvis. We describe the use of customized tapered stent-grafts in the exclusion of wide-necked IIAA in five male patients considered high-risk for conventional surgical repair, in whom the common and external iliac artery morphology precluded the use of standard endovascular devices. In each case, IIAA outflow was selectively embolized and the aneurysm neck excluded by placement of a customized tapered stent-graft across the internal iliac artery origin. This technique was extremely effective, with 100% technical success, no serious associated morbidity, and zero mortality. In all five patients sac size was stable or reduced on computed tomography follow-up of up to 3 years (mean, 24.4 months), with a primary patency rate of 100%. We therefore advocate the use of customized tapered stent-grafts as a further endovascular option in the management of IIAA unsuitable for conventional endovascular repair.

  6. Following-up changes in red blood cell deformability and membrane stability in the presence of PTFE graft implanted into the femoral artery in a canine model

    NASA Astrophysics Data System (ADS)

    Toth, Csaba; Kiss, Ferenc; Klarik, Zoltan; Gergely, Eszter; Toth, Eniko; Peto, Katalin; Vanyolos, Erzsebet; Miko, Iren; Nemeth, Norbert

    2014-05-01

    It is known that a moderate mechanical stress can even improve the red blood cells' (RBC) micro-rheological characteristics, however, a more significant stress causes deterioration in the deformability. In this study, we aimed to investigate the effect of the presence of artificial graft on the RBC deformability and membrane stability in beagles. In the Control group only anesthesia was induced and in the postoperative (p.o.) period blood samplings were carried out. In the Grafted group under general anesthesia, the left femoral artery was isolated, from which a 3.5 cm segment was resected and a PTFE graft (O.D.: 3 mm) of equal in length was implanted into the gap. On the 1st, 3rd, 5th, 7th and 14th p.o. days blood was collected the cephalic veins and RBC deformability was determined ektacytometry (LoRRca MaxSis Osmoscan). Membrane stability test consisted of two deformability measurements before and after the cells were being exposed to mechanical stress (60 or 100 Pa for 300 seconds). Compared to the Control group and the baseline values the red blood cell deformability showed significant deterioration on the 3rd, 5th and mainly on the 7th postoperative day after the graft implantation. The membrane stability of erythrocyte revealed marked inter-group difference on the 3rd, 5th and 7th day: in the Grafted group the deformability decreased and during the membrane stability test smaller difference was observed between the states before and after shearing. We concluded that the presence of a PTFE graft in the femoral artery may cause changes in RBC deformability in the first p.o. week. RBC membrane stability investigation shows a lower elongation index profile for the grafted group and a narrowed alteration in the deformability curves due to mechanical stress.

  7. Management of scaphoid nonunion with avascular necrosis using 1,2 intercompartmental supraretinacular arterial bone graft

    PubMed Central

    Dehghani, Mohamad; Soltanmohamadi, Mohamad; Tahririan, Mohammad Ali; Moezi, Mehdi; Daneshpajouhnejad, Parnaz; Zarezadeh, Abolghasem

    2014-01-01

    Background: 1,2 ICSRA, introduced by Aidembery et al., is a well-established technique, with up to 100% union rate among different studies. The purpose of our study was to evaluate the outcome of scaphoid nonunion undergoing 1,2 ICSRA bone graft in Iran. Materials and Methods: All participants who presented sequentially over a period of 24 months between 2010 and 2013 with nonunion scaphoid fracture with AVN in proximal pole were included in the study. Anteroposterior and lateral view plain radiographs of carpal bones were obtained for diagnosis of nonunion, and a diagnosis of avascular necrosis was made by MRI of the scaphoid. Subjects underwent 1,2 ICSRA bone graft surgery. Patients were assessed based on radiographs and the Mayo Wrist Score (MWS) questionnaire on before and after surgery. Data were analyzed using SPSS ver. 18 by paired t test. Results: Overall, 16 patients (100% male) were included in the study. Mean age of subjects was 27.50 ± 5.86 (18 to 38). Mean Mayo score was 36.63 ± 8.92 and 83.75 ± 9.22 before and 6 month after surgery, respectively, and the difference was statistically significant (P < 0.001). after 8 weeks, 10 (62.5%) had union, and after 12 weeks, all subjects had union. Nine (56.25%) of our patients had excellent functional outcome, 5 (31.25%) had good and 2 (12.5%) had satisfactory functional outcome. Conclusion: 1,2 ICSRA is a proper pedicle of vascularized bone graft due to the ease of visibility and dissection. The functional results and union rates were satisfactory in our study. PMID:25250299

  8. Ascending aorta to bifemoral artery bypass.

    PubMed

    Baird, R J; Oates, T K

    1981-07-01

    In certain patients the standard bypass procedure for aortoiliac occlusion is unsuitable. Included in this group are those who are obese, who have horseshoe kidneys, abnormal renal arteries, large incisional hernias, thoracoabdominal coarctation, failed previous aortoiliac repair or who have undergone multiple laparotomies. Since 1975 the authors have operated on 16 such patients to construct a bypass graft from the ascending aorta to the femoral arteries without entering the abdominal cavity. The new ventral aorta follows the natural anastomotic axis of the mammary and epigastric arteries, behind the rectus muscle and in front of the posterior rectus sheath. The operation is simple and effective and is especially applicable to the patient with obstruction of both the coronary and aortoiliac arteries. PMID:7272859

  9. Color Duplex Assessment of 4th and 5th Internal Mammary Artery Perforators: The Pedicles of the Medially Based Lower Pole Breast Flaps

    PubMed Central

    Abdel-Monem, Kareem; Elshahat, Ahmed; Abou-Gamrah, Sherif; Eldin Abol-Atta, Hossam; Abd Eltawab, Reda; Massoud, Karim

    2012-01-01

    Objective: Reconstruction of a breast after mastectomy using the contralateral lower pole breast flap is an appealing procedure because it uses the tissues that were going to be excised during reduction of the sound breast to achieve symmetry. Literature mentioned that these flaps are supplied by the lower internal mammary artery perforators (IMAPs) with no further details. The aim of this study was to determine the site, size, and number of the 4th and 5th IMAPs by using preoperative color Duplex ultrasound and intraoperative exploration. Method: Twenty breasts in 10 patients who presented for reduction mammoplasty were included in this study. Preoperative color duplex was used to determine IMAPs in the 4th and 5th intercostal spaces. These perforators were localized intraoperatively. Intravenous fluorescein injection was used to determine the perfusion of the lower pole breast flap on the basis of these perforators. Results: Statistically, the 4th IMAPs diameters were significantly larger than the 5th IMAPs diameters (P < .05). The lower pole breast flap was perfused through these perforators. Conclusion: Color Duplex ultrasound is an accurate tool to preoperatively determine the 4th and 5th IMAPs. PMID:22292100

  10. Endovascular Treatment of a Giant Superior Mesenteric Artery Pseudoaneurysm Using a Nitinol Stent-Graft

    SciTech Connect

    Gandini, Roberto; Pipitone, Vincenzo; Konda, Daniel Pendenza, Gianluca; Spinelli, Alessio; Stefanini, Matteo; Simonetti, Giovanni

    2005-01-15

    A 68-year-old woman presenting with gastrointestinal bleeding (hematocrit 19.3%) and in a critical clinical condition (American Society of Anesthesiologists grade 4) from a giant superior mesenteric artery pseudoaneurysm (196.0 x 131.4 mm) underwent emergency endovascular treatment. The arterial tear supplying the pseudoaneurysm was excluded using a 5.0 mm diameter and 31 mm long monorail expanded polytetrafluoroethylene (ePTFE)-covered self-expanding nitinol stent. Within 6 days of the procedure, a gradual increase in hemoglobin levels and a prompt improvement in the clinical condition were observed. Multislice CT angiograms performed immediately, 5 days, 30 days and 3 months after the procedure confirmed the complete exclusion of the pseudoaneurysm.

  11. Endovascular Treatment of a Mycotic Intracavernous Carotid Artery Aneurysm Using a Stent Graft

    PubMed Central

    Gupta, Vivek; Jain, Vikash; Mathuria, SN; Khandelwal, N

    2013-01-01

    Summary Intracavernous carotid artery mycotic aneurysms are rare and management is determined by clinical presentation. We describe the first documented proximal intracranial mycotic aneurysm treated by a balloon expandable Aneugraft PCS covered stent. An 11-year-old female child presented with acute onset fever, headache, chemosis followed by diplopia, right-sided ptosis with ophthalmoplegia. Magnetic resonance imaging revealed bilateral cavernous sinus thrombosis. Subsequent work-up included serial computed tomographic arteriography and digital subtraction angiography which revealed a progressively enlarging intracavernous carotid aneurysm. An Aneugraft PCS covered stent was successfully deployed endovascularly, and complete exclusion of the aneurysm was achieved while maintaining the patency of the parent artery. The use of covered stents in intracranial vasculature can be an effective and safe treatment modality for exclusion of the mycotic aneurysm in selected cases. PMID:24070080

  12. Endovascular treatment of a giant superior mesenteric artery pseudoaneurysm using a nitinol stent-graft.

    PubMed

    Gandini, Roberto; Pipitone, Vincenzo; Konda, Daniel; Pendenza, Gianluca; Spinelli, Alessio; Stefanini, Matteo; Simonetti, Giovanni

    2005-01-01

    A 68-year-old woman presenting with gastrointestinal bleeding (hematocrit 19.3%) and in a critical clinical condition (American Society of Anesthesiologists grade 4) from a giant superior mesenteric artery pseudoaneurysm (196.0 x 131.4 mm) underwent emergency endovascular treatment. The arterial tear supplying the pseudoaneurysm was excluded using a 5.0 mm diameter and 31 mm long monorail expanded polytetrafluoroethylene (ePTFE)-covered self-expanding nitinol stent. Within 6 days of the procedure, a gradual increase in hemoglobin levels and a prompt improvement in the clinical condition were observed. Multislice CT angiograms performed immediately, 5 days, 30 days and 3 months after the procedure confirmed the complete exclusion of the pseudoaneurysm. PMID:15772727

  13. Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting

    PubMed Central

    Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

    2014-01-01

    Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602

  14. Heparin-induced thrombocytopenia following coronary artery bypass grafting: a diagnostic dilemma

    PubMed Central

    Khanal, Raju; Karmacharya, Paras; Forman, Daniel A.

    2015-01-01

    The diagnosis of heparin-induced thrombocytopenia (HIT) is a challenge in post-cardiac surgery patients because of the high incidence of non-immune thrombocytopenia and heparin–platelet factor 4 antibodies in these groups. We present a case of HIT in a post coronary artery bypass surgery patient, which was successfully treated with prompt recognition and discontinuation of heparin products. PMID:26486110

  15. Adventitial Vessel Growth and Progenitor Cells Activation in an Ex Vivo Culture System Mimicking Human Saphenous Vein Wall Strain after Coronary Artery Bypass Grafting

    PubMed Central

    Prandi, Francesca; Piola, Marco; Soncini, Monica; Colussi, Claudia; D’Alessandra, Yuri; Penza, Eleonora; Agrifoglio, Marco; Vinci, Maria Cristina; Polvani, Gianluca; Gaetano, Carlo; Fiore, Gianfranco Beniamino; Pesce, Maurizio

    2015-01-01

    Saphenous vein graft disease is a timely problem in coronary artery bypass grafting. Indeed, after exposure of the vein to arterial blood flow, a progressive modification in the wall begins, due to proliferation of smooth muscle cells in the intima. As a consequence, the graft progressively occludes and this leads to recurrent ischemia. In the present study we employed a novel ex vivo culture system to assess the biological effects of arterial-like pressure on the human saphenous vein structure and physiology, and to compare the results to those achieved in the presence of a constant low pressure and flow mimicking the physiologic vein perfusion. While under both conditions we found an activation of Matrix Metallo-Proteases 2/9 and of microRNAs-21/146a/221, a specific effect of the arterial-like pressure was observed. This consisted in a marked geometrical remodeling, in the suppression of Tissue Inhibitor of Metallo-Protease-1, in the enhanced expression of TGF-β1 and BMP-2 mRNAs and, finally, in the upregulation of microRNAs-138/200b/200c. In addition, the veins exposed to arterial-like pressure showed an increase in the density of the adventitial vasa vasorum and of cells co-expressing NG2, CD44 and SM22α markers in the adventitia. Cells with nuclear expression of Sox-10, a transcription factor characterizing multipotent vascular stem cells, were finally found in adventitial vessels. Our findings suggest, for the first time, a role of arterial-like wall strain in the activation of pro-pathologic pathways resulting in adventitial vessels growth, activation of vasa vasorum cells, and upregulation of specific gene products associated to vascular remodeling and inflammation. PMID:25689822

  16. Pleiotropic effect of lovastatin, with and without cholestyramine, in the post coronary artery bypass graft (Post CABG) trial.

    PubMed

    Domanski, Michael; Tian, Xin; Fleg, Jerome; Coady, Sean; Gosen, Christine; Kirby, Ruth; Sachdev, Vandana; Knatterud, Genell; Braunwald, Eugene

    2008-10-15

    This study evaluated patients in the Post Coronary Artery Bypass Graft (Post CABG) trial for evidence of statin pleiotropic effects in preventing atherosclerotic progression in saphenous vein grafts (SVGs). We studied 1,116 of the 1,351 patients in the Post CABG trial who were randomized to aggressive (low-density lipoprotein [LDL] cholesterol target <85 mg/dl) or moderate (target LDL cholesterol <140 mg/dl) lovastatin treatment and who had sufficient data available. The generalized estimating equation models, adjusting for important covariates, were applied to estimate the odds ratios (ORs) and probability of substantial atherosclerotic SVG progression (decrease in lumen diameter >or=0.6 mm) and the difference in minimum lumen diameter change between treatment groups. Aggressive lovastatin treatment compared with moderate treatment was associated with a significant decrease in risk of significant SVG atherosclerotic progression after adjustment for baseline cholesterol level, LDL cholesterol on treatment, high-density lipoprotein cholesterol, and triglyceride changes on treatment and other independent predictors (OR 0.68, 95% confidence interval 0.49 to 0.94, p = 0.019). Results were similar when the change or percent change from baseline of LDL cholesterol level on treatment was adjusted for rather than on-treatment LDL cholesterol and in the subset achieving a year-1 LDL cholesterol level from 90 to 135 mg/dl (OR 0.64, 95% confidence interval 0.42 to 0.98, p = 0.042). Mean decrease in minimum lumen diameter was also significantly smaller in the aggressive than the moderate treatment arm (-0.256 vs -0.343 mm, p = 0.042). In conclusion, aggressive versus moderate lovastatin treatment appeared therapeutic in slowing the atherosclerotic process in SVGs from Post CABG patients, independent of its greater LDL cholesterol-lowering effect. PMID:18929703

  17. Cardiopulmonary bypass increases the risk of vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure

    PubMed Central

    Hossne Junior, Nelson Américo; Miranda, Matheus; Monteiro, Marcus Rodrigo; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; Pestana, José Osmar Medina de Abreu; Gomes, Walter José

    2015-01-01

    Objective Coronary artery bypass grafting is currently the best treatment for dialysis patients with multivessel coronary artery involvement. Vasoplegic syndrome of inflammatory etiology constitutes an important postoperative complication, with highly negative impact on prognosis. Considering that these patients have an intrinsic inflammatory response exacerbation, our goal was to evaluate the incidence and mortality of vasoplegic syndrome after myocardial revascularization in this group. Methods A retrospective, single-center study of 50 consecutive and non-selected dialysis patients who underwent myocardial revascularization in a tertiary university hospital, from 2007 to 2012. The patients were divided into 2 groups, according to the use of cardiopulmonary bypass or not (off-pump coronary artery bypass). The incidence and mortality of vasoplegic syndrome were analyzed. The subgroup of vasoplegic patients was studied separately. Results There were no preoperative demographic differences between the cardiopulmonary bypass (n=20) and off-pump coronary artery bypass (n=30) group. Intraoperative data showed a greater number of distal coronary arteries anastomosis (2.8 vs. 1.8, P<0.0001) and higher transfusion rates (65% vs. 23%, P=0.008) in the cardiopulmonary bypass group. Vasoplegia incidence was statistically higher (P=0.0124) in the cardiopulmonary bypass group (30%) compared to the off-pump coronary artery bypass group (3%). Vasoplegia mortality was 50% in the cardiopulmonary bypass group and 0% in the off-pump coronary artery bypass group. The vasoplegic subgroup analysis showed no statistically significant clinical differences. Conclusion Cardiopulmonary bypass increased the risk for developing postoperative vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure.

  18. Demographic and Socioeconomic Factors of Patients With Coronary Artery Diseases Undertreatment of Coronary Artery Bypass Grafting, Percutaneous Coronary Intervention and Drug Therapy in Mashhad, Iran

    PubMed Central

    Mirzaie, Maryam; Khajedaluee, Mohammad; Falsoleiman, Homa; Mirzaie, Asadollah; Emadzadeh, Mehdi Reza; Erfanian Taghvaei, Majid Reza

    2015-01-01

    Background: Considering the importance of preventing cardiovascular diseases, determining the contributing risk factors for ischemic heart disease which leads to atherosclerotic plaque, could be effective in selecting the required interventions. Objectives: This study aimed to evaluate socioeconomic factors in patients with Coronary Artery Diseases (CAD) in three treatment groups: Coronary Artery Bypass Grafting (CABG), Percutaneous Coronary Intervention (PCI) and drug therapy. By identifying and comparing the underlying factors in treatment groups, we can gather useful information for future planning and policy making in order to reduce and eliminate the contributing factors. Patients and Methods: This cross-sectional study was conducted on 760 patients with CAD referred to cardiovascular health centers in Mashhad, Iran, including Javad-Al-Aeme Heart Hospital, Qaem, Imam Reza and Dr. Shariati educational Hospital. Samples were collected through purposive sampling from January to March 2014. Based on the experts’ opinion, the subjects were categorized into three treatment groups: CABG, PCI, and drug therapy. Results: The mean age of total patients was 58.3 ± 11.5 years (P = 0.09). The proportion of rural patients in the PCI (26.7%) and drug therapy (27.5%) groups was twice as high as the CABG group (11.7%) (P < 0.001). The proportion of patients with higher educational level (higher than high school diploma) in the CABG group (35.9%) was higher than PCI and drug therapy groups (26.7%, 24.3%) (P = 0.006). Smoking, drinking and drug abuse were more common in the drug therapy group (P = 0.03, P = 0.02, and P < 0.001, respectively). One-vessel and three-vessel coronary artery diseases were more common in the drug and CABG groups, respectively (P < 0.001). Conclusions: In total, application of therapeutic approaches in patients with CAD depends on many factors. In our study not only risk factors such as gender, lifestyle, smoking, alcohol abuse, diabetes and hypertension were associated with the incidence of CAD, but also they were highly correlated with the severity of the disease. PMID:26290754

  19. Comparison of the Effects of Coronary Artery Bypass Grafting Versus Medical Therapy on Short and Long Term Outcomes in Octogenarian Patients With Multi-Vessel Coronary Artery Disease

    PubMed Central

    Alizadehasl, Azin; Sohrabi, Bahram; Panjavi, Laleh; Sadeghpour, Anita; Azarfarin, Rasoul; Ghadrdoost, Behshid; Zolfaghari, Reza; Habibzadeh, Afshin

    2016-01-01

    Background: Appropriate treatment methods lead to a reduced rate of mortality and morbidity, and an improved quality of life, in patients with multi-vessel coronary artery disease. Objectives: In this study, we compared short and long-term outcomes of coronary artery bypass grafting (CABG) versus medical therapy in patients 80 years of age and older with multi-vessel coronary artery disease (MVCAD). Patients and Methods: In this retrospective study, 50 octogenarian patients with MVCAD who underwent CABG were compared with 50 patients in the same condition who were treated with medical therapy during the same time. The primary objective was to compare mortality and morbidity rates, as well as other factors such as the occurrence of chest pain, deterioration of the NYHA functional class, and re-hospitalization, between the two groups. The comparison was made using medical records from the five years post-treatment. Results: After five years, the overall mortality rate included 11 patients (22%) in the CABG group versus 18 patients (36%) in the medical therapy group; this difference was not significant between the two groups (P = 0.186). Regarding short-term outcomes, in the CABG group, cardiogenic shock occurred in 9 patients (18%), renal failure in 13 patients (26%), pulmonary complications in 9 patients (18%) and neurologic complications in 3 patients (6%); in the medical therapy group, these same complications occurred, respectively, in 6 patients (12%), 7 patients (14%), 10 patients (20%) and 1 patient (2%). In addition to these factors, freedom from chest pain and improvement in the functional class among the CABG group was significantly higher than among the medical therapy group (P = <0.001). Conclusions: CABG may be the superior form of treatment for long-term outcomes in terms of the relief of chest pain, improvement of the functional class, reduced need for re-admission, and later death for octogenarians. However, short-term morbidity may be higher among the CABG group, but the mortality rate after 30 days is quite similar. PMID:26889460

  20. [A coronary artery bypass grafting using cardiopulmonary bypass with intraaortic balloon pumping in patient with low cardiac function combined with cerebral vascular disease].

    PubMed

    Nishida, M; Gohra, H; Hirata, K; Ikeda, N; Mikamo, A; Okada, H; Hamano, K; Zempo, N; Esato, K

    2001-08-01

    We reported a 55-year-old man, who had coronary and cerebral vascular disease. Cerebral angiography showed occlusion at left internal carotid artery (ICA) and 50% stenosis at right ICA C4 portion. But acetazolamide reactivity was kept symmetrically. Coronary angiography showed severe three vessel disease, and left ventriculography showed diffuse severe hypokinesis/akinesis, and EF was below 30%. The patient underwent coronary artery bypass grafting using cardiopulmonary bypass with intraaortic balloon pumping to keep intraoperative blood pressure high. After the operation he recovered uneventfully without neurological complication. PMID:11517550

  1. Control of tachycardia and hypertension following coronary artery bypass graft surgery: efficacy and haemodynamic effects of esmolol.

    PubMed

    Tempe, D K; Mulchandani, P; Tandon, M S; Mehta, N; Tomar, A S; Banerjee, A; Khanna, S K

    1999-01-01

    Hypertension following coronary artery bypass grafting is not uncommon, especially in patients having good left ventricular function. It is often accompanied by tachycardia. The purpose of this study is to determine the efficacy of esmolol in the treatment of tachycardia and hypertension immediately following cardiopulmonary bypass and to study other haemodynamic effects of esmolol. Thirty patients undergoing elective [corrected] coronary artery bypass grafting were included in this prospective study. Morphine-based anaesthetic technique along-with standard bypass techniques were used in all the patients. The study was performed in the operating room about 30-45 minutes after the termination of cardiopulmonary bypass. Patients having a heart rate of more than 90 bpm and systolic blood pressure of more than 130 mm Hg without any inotropic support were included and randomly assigned to esmolol or control group. Esmolol was administered in a bolus dose of 500 micrograms/kg followed by infusion of upto 100 micrograms/kg/min. The patients in the control group were administered comparable volumes of normal saline. Baseline haemodynamic measurements were obtained just before the administration of esmolol or normal saline and were repeated after 5, 10, 15, 30 and 45 min. The baseline measurement in both the groups showed that patients were maintaining a state of hyperdynamic circulation with high systolic blood pressure (esmolol group 148 +/- 15 mm Hg, control group 140 +/- 8 mm Hg; p = NS), heart rate (esmolol group 128 +/- 17 bpm, control group 127 +/- 17 bpm; p = NS) and cardiac index (esmolol group 3.1 +/- 1 L/min/m2, control group 3.3 +/- 0.5 L/min/m2; p = NS). Esmolol decreased systolic blood pressure (p < 0.001), heart rate (p < 0.01) and cardiac index (p < 0.05) at five minutes. These changes persisted throughout the study period. The left ventricular stroke work index decreased at five minutes (p < 0.05) and remained so till 30 minutes. The maximum fall in heart rate (15%) and systolic blood pressure (16%) was observed at 45 minutes. There were no haemodynamic changes in the control group except that cardiac index, stroke volume and left ventricular stroke work index increased at five minutes. We conclude that esmolol lowers the indices of cardiovascular work in patients who demonstrated hyperdynamic circulation. This was achieved by decreasing the heart rate and systolic blood pressure which was accompanied by decrease in cardiac index and left ventricular stroke work index. PMID:10624069

  2. Pediatric Coronary Artery Revascularization Surgery: Development and Effects on Survival, Cardiac Events and Graft Patency for Children With Kawasaki Disease Coronary Involvements

    PubMed Central

    Kitamura, Soichiro

    2016-01-01

    Pediatric coronary artery bypass surgery gained wide acceptance with the introduction of internal thoracic arteries (ITAs) for bypass operations for post Kawasaki disease (KD) lesions. The technique is now established as the standard surgical choice, and its safety even in infancy, graft patency, growth potential, graft longevity and clinical efficacy have been well documented. In this article the author reviews the development of pediatric coronary bypass as the main indication for the treatment of coronary lesions due to KD. I believe that coronary revascularization surgery in pediatric population utilizing uni- or bilateral ITAs is the current gold-standard as the most reliable treatment, although percutaneous coronary intervention with or without a stent has been tried with vague long-term results in children. PMID:26848378

  3. Management of carotid Dacron patch infection: a case report using median sternotomy for proximal common carotid artery control and in situ polytetrafluoroethylene grafting.

    PubMed

    Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Ceccanei, Gianluca; Pacilè, Maria Antonietta

    2009-01-01

    We report on a 58-year-old male who presented with an enlarging cervical hematoma 3 months following carotid endarterectomy with Dacron patch repair, due to septic disruption of the Dacron patch secondary to presumed infection. The essential features of this case are the control of the proximal common carotid artery gained through a median sternotomy, because the patient was markedly obese with minimal thyromental distance, and the treatment consisting of in situ polytetrafluoroethylene bypass grafting, due to the absence of a suitable autogenous saphenous vein. Median sternotomy is rarely required in case of reintervention for septic false aneurysms and hematomas following carotid endarterectomy but should be considered whenever difficult control of the common carotid artery, when entering the previous cervicotomy, is anticipated. In situ polytetrafluoroethylene grafting can be considered if autogenous vein material is lacking. PMID:19875014

  4. Female Gender and Differences in Outcome after Isolated Coronary Artery Bypass Graft Surgery: Does Age Play a Role?

    PubMed Central

    Arif, Rawa; Farag, Mina; Gertner, Victor; Szabó, Gabor; Weymann, Alexander; Veres, Gabor; Ruhparwar, Arjang; Bekeredjian, Raffi; Bruckner, Tom; Karck, Matthias; Kallenbach, Klaus; Beller, Carsten J.

    2016-01-01

    Introduction Female gender is a known risk factor for early and late mortality after coronary artery bypass graft surgery (CABG). Higher age of women at operation may influence outcome, since age per se is also an important risk factor. The purpose of our study was to analyze possible gender differences in outcome after isolated CABG in different age groups to delineate the impact of female gender and age. Methods All patients over 60 years of age undergoing isolated CABG at our department during 2001 and 2011 were included and categorized by age into sexagenarians (2266, 16.6% women), septuagenarians (2332, 25.4% women) and octogenarians (374, 32% women) and assessed by gender for 30-day and 180-day mortality. Results Thirty-day mortality was significantly higher in women only amongst septuagenarians (7.1 vs. 4.7%, p = 0.033). Same differences apply for 180-day mortality (12.3 vs. 8.2%, p = 0.033) and estimated one-year survival (81.6 ± 4.2 vs. 86.9 ± 2.2%, p = 0.001). Predictive factors for 30-day mortality of septuagenarian were logistic EuroSCORE (ES) (p = 0.003), perioperative myocardial infarction (MI) (p<0.001), pneumonia (p<0.001), abnormal LV-function (p<0.04) and use of LIMA graft (p<0.001), but not female gender. However, female gender was found to be an independent predictor for 180-day mortality (HR 1.632, p = 0.001) in addition to ES, use of LIMA graft, perioperative MI, pneumonia and abnormal LV function (HR 1.013, p = 0.004; HR 0.523, p<0.001; HR 2.710, p<0.001; HR 3.238, p<0.001; HR 2.013, p<0.001). Conclusion Women have a higher observed probability of early death after CABG in septuagenarians. However, female gender was not found to be an independent risk factor for 30-day, but for 180-day survival. Therefore, reduction of high impact risk factors such as perioperative MI and enhancement of LIMA use should be future goals. In view of our findings, decision for surgical revascularization should not be based on gender. PMID:26845158

  5. Increased Perioperative B-type Natriuretic Peptide Associates with Heart Failure Hospitalization or Heart Failure Death after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Fox, Amanda A.; Nascimben, Luigino; Body, Simon C.; Collard, Charles D.; Mitani, Aya A.; Liu, Kuang-Yu; Muehlschlegel, Jochen D.; Shernan, Stanton K.; Marcantonio, Edward R.

    2013-01-01

    Background Heart failure (HF) is a leading cause of hospitalization and mortality. Plasma B-type natriuretic peptide (BNP) is an established diagnostic and prognostic ambulatory HF biomarker. We hypothesized that increased perioperative BNP independently associates with HF hospitalization or HF death up to 5 yr after coronary artery bypass graft surgery. Methods The authors conducted a two-institution, prospective, observational study of 1,025 subjects (mean age = 64 ± 10 yr SD) undergoing isolated primary coronary artery bypass graft surgery with cardiopulmonary bypass. Plasma BNP was measured preoperatively and on postoperative days 1–5. The study outcome was hospitalization or death from HF, with HF events confirmed by reviewing hospital and death records. Cox proportional hazards analyses were performed with multivariable adjustments for clinical risk factors. Preoperative and peak postoperative BNP were added to the multivariable clinical model in order to assess additional predictive benefit. Results One hundred five subjects experienced an HF event (median time to first event = 1.1 yr). Median follow-up for subjects who did not have an HF event = 4.2 yr. When individually added to the multivariable clinical model, higher preoperative and peak postoperative BNP concentrations each, independently associated with the HF outcome (log10 preoperative BNP hazard ratio = 1.93; 95% CI, 1.30–2.88; P = 0.001; log10 peak postoperative BNP hazard ratio = 3.38; 95% CI, 1.45–7.65; P = 0.003). Conclusions Increased perioperative BNP concentrations independently associate with HF hospitalization or HF death during the 5 yr after primary coronary artery bypass graft surgery. Clinical trials may be warranted to assess whether medical management focused on reducing preoperative and longitudinal postoperative BNP concentrations associates with decreased HF after coronary artery bypass graft surgery. PMID:23695172

  6. Anatomical study of the greater palatine artery and related structures of the palatal vault: considerations for palate as the subepithelial connective tissue graft donor site.

    PubMed

    Klosek, Sebastian Krystian; Rungruang, Thanaporn

    2009-04-01

    Palate is considered as a tissue graft donor site for dental surgical procedures. Therefore, the aim of this study was to investigate the anatomy of palatal structures, such as greater palatine artery, greater palatine foramen, and incisive fossa, in order to consider their topography at planning the graft dimensions and reduce the potential risk of injury of greater palatine artery. Direct inspection of 41 Thai cadavers was performed. The results showed the statistically significant differences as for the length of female and male palates (p = 0.017); however, vertical measurements were equally distributed in examined population. Main location of greater palatine foramen was palatal to the second molar (35.7%), as well as, interproximal to the second and third molars (35.7%) in women, and palatal to the second molar in men (65%). GPA was branching most frequently at the level of first premolar (38%) and at first and second molars together (43%) in women. In men, the branching on the alveolar process side was commonly observed at the level of first and second premolars together (56%), and at the level of second and third molars together (32%). In the area between maxillary first premolar and second molar, it appeared possible to harvest a connective tissue graft measuring at least 5 mm in height. The results of this research will provide the useful data for other comparative studies and for assisting periodontologists in planning the dimensions and harvesting the subepithelial connective tissue grafts from palate. PMID:19015806

  7. Abdominal Aortic Aneurysm with a Dilated Common Iliac Artery: Treatment Using a Handmade Bifurcated Stent-Graft with a Wide Iliac Limb End

    SciTech Connect

    Miyayama, Shiro; Matsui, Osamu; Akakura, Yukari; Yamamoto, Toru; Nishida, Hiroto; Yoneda, Kenji; Kawai, Keiichi; Murakami, Shinya

    2003-11-15

    The purpose of this study was to evaluate the usefulness of a bifurcated stent-graft with a wide iliac limb end (WILE) in the treatment of abdominal aortic aneurysm (AAA) with a dilated common iliac artery (CIA) to avoid occlusion of the internaliliac artery (IIA). The WILE, covered with an expanded polytetrafluoroethylene graft which was constructed of large diameter stents according to the individual CIA diameter, was connected to a two-piece bifurcated stent-graft covering a polyester graft. The WILE was placed in eight dilated CIAs of six patients. All but one WILE fitted the dilated CIA well. One did not fit, and coil embolization of the leak was needed. All eight IIA derived from the dilated CIA avoided occlusion. Perigraft leak due to other causes was identified in another two patients. Limb kinking was observed in two patients. Our stent is useful in the treatment of AAA with dilated CIA to avoid occlusion of the IIA, and may extend the indication of endoluminal repair of AAA.

  8. Assessment of the Risk Factors and Outcomes for Postoperative Atrial Fibrillation Patients Undergoing Isolated Coronary Artery Bypass Grafting

    PubMed Central

    Tsai, Yi-Ting; Lai, Ching-Huang; Loh, Shih-Hurng; Lin, Chih-Yuan; Lin, Yi-Chang; Lee, Chung-Yi; Ke, Hung-Yen; Tsai, Chien-Sung

    2015-01-01

    Background Atrial fibrillation is the most common complication of cardiac surgery and is associated with significant morbidity and mortality. Recognizing patients at high risk for developing postoperative atrial fibrillation (POAF) may help identify those who could benefit from strategies to prevent POAF. This study was conducted to delineate outcomes and to assess risk factors for POAF among Taiwanese patients undergoing coronary artery bypass grafting (CABG). Methods From January 2009 until February 2012, this prospective study included 266 consecutive patients admitted to our hospital with coronary artery disease. All patients underwent isolated CABG. Patients with preoperative permanent atrial fibrillation and concomitant surgery were excluded. Multiple risk factors associated with the incidence of POAF were collected and evaluated. Results POAF occurred in 126 of 226 patients (47.37%). Univariate analysis revealed that significant risk factors for the condition were age, gender, diabetes, dyslipidemia, smoking, impaired renal function, impaired cardiac function, and increased serum electrolytes. Multivariate analysis showed dyslipidemia [hazard ratio (HR): 0.418; 95% confidence interval (Cl): 0.190-0.915, p = 0.029], impaired renal function as indicated by an estimated glomerular filtration rate < 60 mL/min/1.73 m2 (HR: 3.174; 95% CI: 1.432-7.037, p = 0.004), and serum sodium (HR: 1.112; 95% Cl: 1.047-1.182, p = 0.001) prior to cardiopulmonary bypass as significant. Moreover, POAF was associated with lower 30-day, 1- and 3-year cumulative survival rates and higher early postoperative complications. Conclusions Patients with isolated CABG who were administered β-blockers, angiotensin converting enzyme inhibitor/angiotensin receptor blockers treatment, and lipid therapy before CABG were associated with reduced POAF, while those with impaired renal function and higher serum sodium before CABG predisposed POAF in a Taiwanese population. PMID:27122903

  9. Effect of Preoperative Aspirin Replacement With Enoxaparin in Patients Undergoing Primary Isolated On-Pump Coronary Artery Bypass Grafting.

    PubMed

    Nenna, Antonio; Spadaccio, Cristiano; Prestipino, Filippo; Lusini, Mario; Sutherland, Fraser W; Beattie, Gwyn W; Petitti, Tommasangelo; Nappi, Francesco; Chello, Massimo

    2016-02-15

    Management of preoperative antiplatelet therapy in coronary artery bypass grafting (CABG) is variable among surgeons: guidelines collide with prejudices because replacement of aspirin with low-molecular-weight heparin is still performed because of a presumed minor bleeding risk. This study aims to analyze postoperative bleedings and complications in patients scheduled for elective primary isolated on-pump CABG, depending on preoperative aspirin treatment or its replacement with enoxaparin. In this cohort study, we propensity score matched 200 patients in whom aspirin was stopped at least 5days before CABG and replaced with enoxaparin and 200 patients who continued aspirin therapy until the day before surgery. Postoperative bleedings and complications were monitored during hospitalization. Among patients who continued aspirin treatment, mean overall bleeding was 701.0 334.6ml, whereas in the matched enoxaparin group, it was significantly greater (882.6 64.6ml, p value <0.001); this was associated with reduced postoperative complications, lower values of postoperative C-reactive protein in aspirin takers, and a presumed protective effect for statins. After propensity score adjustment, aspirin treatment carried a protective effect against major postoperative bleeding (odds ratio 0.312, p= 0.001). In conclusion, postoperative bleeding is reduced in patients who continued aspirin, likely due to a reduction in postoperative inflammation. The practice of empirically discontinuing aspirin and replacing it with enoxaparin before CABG should be abandoned. Patients with coronary artery disease referred to CABG should continue antiplatelet medications until the surgical procedure. Those results might be extended to patients under oral anticoagulant therapy requiring CABG. PMID:26721653

  10. IL-18 level in patients undergoing coronary artery bypass grafting surgery or valve replacement: which link with epicardial fat depot?

    PubMed

    Dozio, E; Dogliotti, G; Malavazos, A E; Bandera, F; Cassetti, G; Vianello, E; Zelaschi, R; Barassi, A; Pellissero, G; Solimene, U; Morricone, L; Sigruener, A; Tarabin, V; Schmitz, G; Menicanti, L; Corsi Romanelli, M M

    2012-01-01

    Interleukin-18 (IL-18) is a member of the interleukin-1 family of cytokines produced constitutively by different cell types and by adipose tissue. Due to the link between obesity, inflammation and cardiovascular diseases, we aimed to measure IL-18 circulating level in patients undergoing open-heart surgery both for elective coronary artery bypass grafting (CABG) or for valve replacement (VR), and we also evaluated whether epicardial adipose tissue (EAT) depot may be a potential source of IL-18. Circulating IL-18 protein was quantified by enzyme-linked immunosorbent assay. IL-18, IL-18 receptor 1 (IL-18 R1) and IL-18 receptor accessory protein (IL-18-RAP) gene expression in EAT depot were evaluated by one colour microarray platform. EAT thickness was measured by echocardiography. In this study we found that all cardiovascular patients (CABG and VR) have increased circulating IL-18 level compared to healthy control subjects (p < 0.0001), but no statistical significant difference was observed between CABG and VR groups (p = 0.35). A great increase in the gene expression of IL-18 (p < 0.05), IL-18 R1 (p < 0.01) and IL-18 RAP (p < 0.001) was observed in EAT samples obtained from CABG vs VR patients. In conclusion, CABG and VR patients had similar increased level of circulating IL-18 protein, but in EAT depots isolated from CABG gene expression of IL-18, IL-18 R1 and IL-18-RAP resulted higher than in VR patients. Future investigation on local IL-18 protein production, its autocrine-paracrine effect and its correlation with plasmatic IL-18 level could give more information on the relationship between IL-18 and coronary artery disease. PMID:23298491

  11. Scintigraphic evaluation of myocardial and cerebral blood flow in patients with a history of coronary artery bypass grafting.

    PubMed

    Vesnina, Zh V; Efimova, I Iu; Kozlov, B N; Efimova, N Iu; Lishmanov, Iu B

    2004-01-01

    This paper deals with a comparative scintigraphic evaluation of the changes that occur in coronary and cerebral circulation in patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG) under conditions of cardiopulmonary bypass (CPB) or beating heart. Twenty-nine CAD patients who underwent CPB were examined. Of these, 14 patients were operated on using CPB (the first group) and 15 patients on the beating heart using the myocardial "stabilizer" Octopus (the 2nd group). The patient groups matched in terms of the age, sex, the clinical and angiographic factors. Perfusion scintigraphy of the heart and brain by means of single-photon emission computed tomography (SPECT) and the neurologic evaluation were performed twice in all the patients: before and 2-4 weeks after CABG. The second group patients demonstrated a significant lowering of the mean magnitude of stable defects (SD) of myocardial perfusion. The lowering or disappearance of SD was observed in a greater percentage of cases versus the first group. All the patients were found to have areas of hypokinesis in the SD projection. Also, the second group showed a significant rise of the mean magnitude of left ventricle ejection fraction. Operations with CPB were associated with a 5% decrease of cerebral blood flow in the frontal and temporal lobes of the right hemisphere. No significant deterioration of brain perfusion was observed in patients (on the whole in the group) operated on without heart arrest. It is noteworthy that there was a significant improvement of the average group indicators of cerebral perfusion in the right occipital and posterior segments of the temporal lobes. The changes in cerebral perfusion were in agreement with the course of changes in the cognitive status. Thus, CABG on the resting heart in CAD patients favours a more remarkable restoration of perfusion and contractility of the hibernated myocardium versus revascularization performed under CPB and exerts, as a result, a beneficial effect on cerebral circulation and the neuropsychological status of the patients. PMID:15163987

  12. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.

    PubMed

    Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero

    2011-10-01

    A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease. PMID:23804483

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

    PubMed

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

    2010-01-01

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

  14. Comparing the effects of adaptive support ventilation and synchronized intermittent mandatory ventilation on intubation duration and hospital stay after coronary artery bypass graft surgery

    PubMed Central

    Yazdannik, Ahmadreza; Zarei, Hadi; Massoumi, Gholamreza

    2016-01-01

    Background: Different modes of mechanical ventilation are used for respiratory support after coronary artery bypass graft (CABG). This study aimed to compare the effect(s) of using adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) on the length of mechanical ventilation (intubation duration) and hospital stay after coronary artery bypass graft surgery. Materials and Methods: In a randomized control trial, 64 patients were ventilated with ASV as the experiment group or with SIMV as the control group after CABG surgery in Chamran Hospital of Isfahan University of Medical Sciences. The time of tracheal intubation and the length of hospital stay were compared between the two groups. Data were analyzed and described using statistical analysis (independent t-test). Results: The mean time of intubation duration was significantly lower in ASV group compared with SIMV group. (4.83 h vs 6.71 h, P < 0.001). The lengths of hospital stay in the ASV and the SIMV groups were 140.6 h and 145.1 h, respectively. This difference was significant between the two groups (P = 0.006). Conclusions: According to the results of this study, using ASV mode for mechanical ventilation after CABG led to a decrease in intubation duration and also hospital stay in comparison with the SIMV group. It is recommended to use ASV mode on ventilators for respiratory support of patients undergoing coronary artery bypass graft surgery. PMID:27095997

  15. Comparison between transesophageal Doppler echocardiography and nuclear cardioangiography for the evaluation of left ventricular filling during coronary artery bypass grafting.

    PubMed

    Samuelsson, S; Brodin, L A; Broman, M; Owall, A; Settergren, G

    1995-01-01

    This study examines the relative contribution of early (E) and atrial (A) filling of the left ventricle. Ten patients were studied under anesthesia before and after coronary artery bypass grafting (CABG) using measurements of the mitral velocity-time integral (VTI) with transesophageal pulsed Doppler echocardiography and nuclear angiocardiography simultaneously. Thermodilution cardiac output measurements were made simultaneously in order to express the E and A filling in quantitative terms. The mean difference between methods in estimating E filling was -1.0 mL and the figures for the mean +/- 2 SD were 5.7 and -7.8 mL, r = 0.98 using regression analysis. The mean difference during A filling was 0.9 mL and the corresponding figures for the mean +/- 2 SD were 7.9 and -6.1 mL, r = 0.88. There was a reduction in the volume entering the left ventricle during the E filling (42-26 mL) and in the A phase (27-22 mL) from before surgery in comparison to after CABG. There was good agreement between transesophageal Doppler echocardiographic and nuclear angiocardiographic methods concerning the volume contribution during E and A phases of left ventricular filling. PMID:7802298

  16. The Effect of Music on Anxiety and Cardiovascular Indices in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Controlled Trial

    PubMed Central

    Heidari, Saeide; Babaii, Atye; Abbasinia, Mohammad; Shamali, Mahdi; Abbasi, Mohammad; Rezaei, Mahboobe

    2015-01-01

    Background: The instability of cardiovascular indices and anxiety disorders are common among patients undergoing coronary artery bypass graft (CABG) and could interfere with their recovery. Therefore, improving the cardiovascular indices and anxiety is essential. Objectives: This study aimed to investigate the effect of music therapy on anxiety and cardiovascular indices in patients undergoing CABG. Patients and Methods: In this randomized controlled trial, 60 patients hospitalized in the cardiovascular surgical intensive care unit of Shahid Beheshti Hospital in Qom city, Iran, in 2013 were selected using a consecutive sampling method and randomly allocated into the experimental and control groups. In the experimental group, patients received 30 minutes of light music, whereas in the control group, patients had 30 minutes of rest in bed. The cardiovascular indices and anxiety were measured immediately before, immediately after and half an hour after the study. Data were analyzed using the chi-square test and repeated measures analysis of variance. Results: Compared to the immediately before intervention, the mean anxiety scores immediately after and 30 minutes after the intervention were significantly lower in the experimental group (P < 0.037) while it did not significantly change in the control group. However, there were no significant differences regarding the cardiovascular indices in the three consecutive measurements (P > 0.05). Conclusions: Music therapy is effective in decreasing anxiety among patients undergoing CABG. However, the intervention was not effective on cardiovascular indices. Music can effectively be used as a non-pharmacological method to manage anxiety after CABG. PMID:26835471

  17. Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting

    PubMed Central

    Tarzia, Vincenzo; Bortolussi, Giacomo; Buratto, Edward; Paolini, Carla; Dal Lin, Carlo; Rizzoli, Giulio; Bottio, Tomaso; Gerosa, Gino

    2015-01-01

    AIM: To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting (CABG). METHODS: Two groups of CABG patients were studied: Group A, treated with aspirin alone (n = 50), and Group B treated with aspirin and clopidogrel (n = 50). Both had similar preoperative, clinical, biologic characteristics and operative management. Classic coagulation parameters and rotational thromboelastometry (ROTEM) profiles were determined preoperatively for both groups and the same heparin treatment was administered. ROTEM profiles (INTEM and EXTEM assays) were analyzed, both for traditional parameters, and thrombin generation potential, expressed by area-under-curve (AUC). RESULTS: There was no significant difference between rates of major bleeding between patients treated with aspirin alone, compared with those treated with aspirin and clopidogrel (12% vs 16%, P = 0.77). In the 14 cases of major bleeding, pre-operative classic coagulation and traditional ROTEM parameters were comparable. Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders (5030 ± 1115 Ohm*min) than non-bleeders (6568 ± 548 Ohm*min) (P < 0.0001). CONCLUSION: We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC, regardless of antiplatelet treatment. This suggests that thrombin generation potential, irrespective of the degree of platelet inhibition, correlates with surgical bleeding. PMID:26413234

  18. Comparative Effects of Preoperative Angiotensin-converting Enzyme In-hibitor, Statin and Beta-blocker Treatment on Human Internal Mammary Artery Reactivity in Patients with Coronary Artery Disease: A Pilot Study

    PubMed Central

    Dalaklioglu, Selvinaz; Golbasi, Ilhan; Ogutman, Caglar

    2013-01-01

    Purpose: We investigated the effect of angiotensin-converting enzyme (ACE)- inhibitor, statin, and beta-blocker usage before coronary bypass surgery (CABG) on vascular reactivity of the internal mammary artery (IMA). Methods: Patients, who underwent elective CABG were evaluated. Samples of IMA obtained from 22 patients were divided into 4 groups in respect of drugs used by patients before bypass surgery (control group, ACE inhibitor + statin group, ACE inhibitor + statin + beta-blocker group, and ACE inhibitor + beta-blocker group). The discarded, distal end section of IMA was carefully removed, and the vasoreactivity of IMA rings was evaluated in vitro using an organ chamber. Smooth muscle contractile function was tested on artery segments exposed to 10-80 mM KCl and norepinephrine. The endothelial function of IMA rings was assessed with acetylcholine (ACh) and bradykinin, while endothelium-independent vasorelaxation was evaluated by sodium nitroprusside (SNP). Results: Both ACh and bradykinin caused concentration-dependent relaxation in endothelium-intact IMA rings. However, the maximal effect produced by endothelium-dependent agents in all treatment groups was more prominent when compared with the control group. There was no significant difference in the endothelium-dependent relaxation response of IMA between ACE inhibitor + statin, ACE inhibitor + beta-blocker and ACE inhibitor + statin + beta-blocker groups. The vasodilatory potency of SNP was similar in all groups. Similarly, contractile response to KCl or norepinephrine was not significantly different between groups. Conclusion: Use of ACE inhibitors and statins before bypass surgery may influence IMA vasoreactivity by improving endothelial control of vascular tone. PMID:24044029

  19. The predictive value of multiple electrode platelet aggregometry for postoperative bleeding complications in patients undergoing coronary artery bypass graft surgery

    PubMed Central

    Woźniak, Karolina; Hryniewiecki, Tomasz; Kruk, Mariusz; Różański, Jacek; Kuśmierczyk, Mariusz

    2016-01-01

    Introduction Postoperative bleeding is one of the most serious complications of cardiac surgery and requires transfusion of blood or blood products. Acetylsalicylic acid (ASA) and clopidogrel (CLO) are the two most commonly used antiplatelet agents; when used in combination (i.e., as dual antiplatelet therapy [DAPT]), they exert a synergistic effect. Dual antiplatelet therapy, however, significantly increases the risk of postoperative bleeding. The effect of antiplatelet therapy can be monitored by platelet aggregation testing. One of the most commonly methods used for assessing platelet reactivity is multiple electrode aggregometry (MEA) which can be performed with the use of Multiplate analyzer. Although the method has long been used in interventional cardiology to assess the effect of antiplatelet therapy, it is not available at cardiac surgery departments as a standard diagnostic procedure. The aim of the study was to establish the frequency of bleeding complications following coronary artery bypass graft (CABG) surgery in patients on single antiplatelet therapy (SAPT) and patients on DAPT and to determine the usefulness of routine measurement of platelet responsiveness before CABG surgery in patients receiving antiplatelet therapy. Material and methods A consecutive cohort of 200 patients referred for elective surgical treatment of stable coronary artery disease was enrolled (100 consecutive patients on SAPT [ASA 75 mg/day] and 100 consecutive patients on DAPT [ASA 75 mg/day + CLO 75 mg/day]). All subjects continued their antiplatelet therapy until the day before surgery. For each subject, platelet aggregation testing in the form of an ASPI test and an ADP test was performed on the Multiplate analyzer. Each subject underwent coronary artery bypass grafting surgery. For the primary and secondary endpoints in our study we adopted the definition provided in ‘Standardised Bleeding Definitions for Cardiovascular Clinical Trials: A Consensus Report from the Bleeding Academic Research Consortium’ (‘Circulation’, 2011) for BARC type 4 bleeding (i.e. CABG-related bleeding). Results An ROC curve was constructed for the ASPI test and ADP test for a total of 200 patients. No significant correlations were demonstrated between the ASPI test results and either the primary endpoint or the secondary endpoints. A correlation was found between the ADP test results and the composite primary endpoint and each of the secondary endpoints. The primary endpoint of major postoperative bleeding occurred in 16 subjects. From the ROC curve, we established the optimal cut-off value for the ADP test of 26 U at sensitivity of 72%, specificity of 69%, positive predictive value of 69.90%, and negative predictive value of 71.13%. Conclusions In patients on antiplatelet therapy, an ADP test result of < 26 U is strongly predictive of serious bleeding complications after CABG surgery. The MEA ADP test allows to identify the group of patients at an increased risk of postoperative bleeding. PMID:27212971

  20. Anesthetic management of a patient with polycythemia vera undergoing emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting: a case report

    PubMed Central

    Im, Hyeongwoo; Yang, Jaeyoung; Lee, Sangmin Maria; Lee, Jong Hwan

    2015-01-01

    Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopathy, and as a result, the occurrence of thrombotic complications should be avoided after coronary anastomosis. Thus, optimizing the hemostatic balance is an important concern for anesthesiologists. However, only a few cases of anesthetic management in polycythemia vera patients undergoing concomitant aorta and coronary arterial bypass surgery have ever been reported. Here, we experience a polycythemia vera patient who underwent an emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting, and report this case with a review of the relevant literature. PMID:26634086

  1. Anesthetic management of a patient with polycythemia vera undergoing emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting: a case report.

    PubMed

    Im, Hyeongwoo; Min, Jeong Jin; Yang, Jaeyoung; Lee, Sangmin Maria; Lee, Jong Hwan

    2015-12-01

    Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopathy, and as a result, the occurrence of thrombotic complications should be avoided after coronary anastomosis. Thus, optimizing the hemostatic balance is an important concern for anesthesiologists. However, only a few cases of anesthetic management in polycythemia vera patients undergoing concomitant aorta and coronary arterial bypass surgery have ever been reported. Here, we experience a polycythemia vera patient who underwent an emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting, and report this case with a review of the relevant literature. PMID:26634086

  2. The management of concomitant renal oncocytoma and giant coronary and bilateral common iliac artery aneurysms.

    PubMed

    Clarke, Jonathan; Choong, Andrew; Raja, Shahzad; Amrani, Mohamed; Hellawell, Giles; Hussain, Tahir

    2014-05-01

    We present the rare case of a 66-year-old Caucasian male patient presenting with intermittent left-side abdominal pain. He underwent a kidneys, ureters, and bladder computed tomography scan on which an incidental 45-mm giant aneurysm of the left anterior descending coronary artery was discovered along with 55-mm right-sided and 62-mm left-sided common iliac artery aneurysms and a 100-mm benign renal oncocytoma. He underwent on-pump coronary artery bypass grafting of the left anterior descending, left circumflex and right coronary arteries using internal mammary artery and saphenous vein grafts. He subsequently underwent simultaneous open left nephrectomy and bilateral common iliac aneurysm repair using a bifurcated tube graft. He made a full recovery postoperatively. Giant coronary artery aneurysms are rare. In the pediatric population, they are predominantly secondary to Kawasaki disease. In adults, atheromatous disease is the leading cause. The coexistence of giant coronary artery aneurysms with extracoronary artery aneurysms is extremely unusual. We propose that the identification of giant coronary artery aneurysms necessitates further imaging investigations to identify the presence of extracoronary aneurysms. To our knowledge, this is the first description of such a case in the literature. PMID:24200531

  3. Pre-transplant portal vein thrombosis is an independent risk factor for graft loss due to hepatic artery thrombosis in liver transplant recipients

    PubMed Central

    Stine, Jonathan G.; Pelletier, Shawn J.; Schmitt, Timothy M.; Porte, Robert J.; Northup, Patrick G.

    2015-01-01

    Background Hepatic artery thrombosis is an uncommon but catastrophic complication following liver transplantation. We hypothesize that recipients with portal vein thrombosis are at increased risk. Methods Data on all liver transplants in the U.S. during the MELD era through September 2014 were obtained from UNOS. Status one, multivisceral, living donor, re-transplants, pediatric recipients and donation after cardiac death were excluded. Logistic regression models were constructed for hepatic artery thrombosis with resultant graft loss within 90 days of transplantation. Results 63,182 recipients underwent transplantation; 662 (1.1%) recipients had early hepatic artery thrombosis; of those, 91 (13.8%) had pre-transplant portal vein thrombosis, versus 7.5% with portal vein thrombosis but no hepatic artery thrombosis (p < 0.0001). Portal vein thrombosis was associated with an increased independent risk of hepatic artery thrombosis (OR 2.17, 95% CI 1.71–2.76, p < 0.001) as was donor risk index (OR 2.02, 95% CI 1.65–2.48, p < 0.001). Heparin use at cross clamp, INR, and male donors were all significantly associated with lower risk. Discussion Pre-transplant portal vein thrombosis is associated with post-transplant hepatic artery thrombosis independent of other factors. Recipients with portal vein thrombosis might benefit from aggressive coagulation management and careful donor selection. More research is needed to determine causal mechanism. PMID:27017168

  4. Clinicopathological comparisons of open vein harvesting and endoscopic vein harvesting in coronary artery bypass grafting patients in Mashhad

    PubMed Central

    Amouzeshi, Ahmad; Teshnisi, Mohamad Abbassi; Zirak, Nahid; Shamloo, Alireza Sepehri; Hoseinikhah, Hamid; Alizadeh, Behzad; Moeinipour, Aliasghar

    2016-01-01

    Introduction Harvesting of the greater saphenous vein is almost an inevitable part of coronary artery bypass grafting (CABG) operations, and it is done by two main techniques, i.e., conventional or open vein harvesting (OVH) and the minimally-invasive endoscopic vein harvesting (EVH). This study aimed to compare these two techniques in off-pump CABG procedures with respect to clinical and pathological outcomes. Methods This cohort study was conducted on CABG candidates during a one-year period from October 2013 through September 2014 in the Department of Cardiac Surgery at Mashhad University of Medical Sciences. Eighty-seven patients voluntarily underwent EVH, and another 86 patients matched for age, gender, and other cardiovascular risk factors were selected for OVH. They were followed up for six weeks, and the main outcome measures were infections of the wound, pain, duration of hospital stay, and the costs of hospitalization. Paired sample t-test, independent t-test, or their non-parametric equivalents and the chi-squared test were used by SPSS version 17.0 for data analysis. Results The mean duration of time for vein harvesting was shorter in the EVH group (p < 0.001), and the pain score was lower (p = 0.04). No infections occurred at the site of the wound. The length of hospital stay was not significantly different for the two groups (OVH versus EVH: 8.5 ± 3.3 versus 8.4 ± 3.2 days; p-value: 0.08). Hospitalization costs were significantly higher in the EVH group (OVH versus EVH: 5.8 ± 4.7 versus 7.3 ± 2.0 million Tomman; p-value: 0.008), yet no difference was diagnosed with respect to endothelial damage in the vein grafts harvested by the EVH and OVH techniques. Conclusion EVH is considered as a minimally invasive and safe vein harvesting technique in our Center, and it can reduce the harvesting time and post-operative pain. In addition, its efficiency was similar to that of OVH. PMID:26955438

  5. Hand Grip Strength and Myocardial Oxygen Consumption Index among Coronary Artery Bypass Grafting Patients

    PubMed Central

    Sokran, Siti Nur Baait Biniti Mohd; Mohan, Vikram; Kamaruddin, Kamaria; Sulaiman, Mohd Daud; Awang, Yahya; Othman, Ida Rosmini Binti; Victor, Smiley Jesu Priya

    2015-01-01

    Background Hand grip strength (HGS) is a reliable indicator of peripheral muscle strength. Although, numerous studies have investigated the strength of hand grip; little attention has been given to coronary artery disease (CAD) patients, exploring the relationship between HGS and myocardial oxygen consumption (MVO2) index. The current study aimed to evaluate the interaction between HGS and MVO2 index findings before and after cardiac surgery. Methods Twenty-seven patients with CAD had HGS were assessed using handheld dynamometer. HGS for each hand were documented. MVO2 index was assessed using rate pressure product (RPP), which is the product of the heart rate (HR) and systolic blood pressure (SBP). Repeated measures MANOVA were carried out to estimate the interaction between both hands HGS and MVO2 index before and after surgery. Results There was significant interactions (P<0.001) for both HGS dominant and non-dominant with large effect sizes (HGS dominant×MVO2 index: hp2=0.44; HGS dominant×RPP: hp2=0.49). This signifies that peripheral muscle strength of the upper limb (HGS dominant and non-dominant) had different effects on MVO2 index before and after surgery. The interaction graph shows that the increase in MVO2 index after surgery was significantly greater for peripheral muscle strength of the dominant hand when compared to non-dominant.  Conclusion Patients with CAD had interactions between HGS and oxygen consumption before and after surgery. Hence, HGS might be used as a predictor to assess oxygen consumption among cardiac patients. PMID:26170520

  6. Investigation of the Hemodynamic Effect of Stent Wires on Renal Arteries in Patients with Abdominal Aortic Aneurysms Treated with Suprarenal Stent-Grafts

    SciTech Connect

    Sun Zhonghua; Chaichana, Thanapong

    2009-07-15

    The purpose of the study was to investigate the hemodynamic effect of stent struts (wires) on renal arteries in patients with abdominal aortic aneurysms (AAAs) treated with suprarenal stent-grafts. Two sample patients with AAA undergoing multislice CT angiography pre- and postsuprarenal fixation of stent-grafts were selected for inclusion in the study. Eight juxtarenal models focusing on the renal arteries were generated from the multislice CT datasets. Four types of configurations of stent wires crossing the renal artery ostium were simulated in the segmented aorta models: a single wire crossing centrally, a single wire crossing peripherally, a V-shaped wire crossing centrally, and multiple wires crossing peripherally. The blood flow pattern, flow velocity, wall pressure, and wall shear stress at the renal arteries pre- and post-stent-grafting were analyzed and compared using a two-way fluid structure interaction analysis. The stent wire thickness was simulated with a diameter of 0.4, 1.0, and 2.0 mm, and hemodynamic analysis was performed at different cardiac cycles. The interference of stent wires with renal blood flow was mainly determined by the thickness of stent wires and the type of configuration of stent wires crossing the renal ostium. The flow velocity was reduced by 20-30% in most of the situations when the stent wire thickness increased to 1.0 and 2.0 mm. Of the four types of configuration, the single wire crossing centrally resulted in the highest reduction of flow velocity, ranging from 21% to 28.9% among three different wire thicknesses. Wall shear stress was also dependent on the wire thickness, which decreased significantly when the wire thickness reached 1.0 and 2.0 mm. In conclusion, our preliminary study showed that the hemodynamic effect of suprarenal stent wires in patients with AAA treated with suprarenal stent-grafts was determined by the thickness of suprarenal stent wires. Research findings in our study are useful for follow-up of patients treated with suprarenal stent-grafts to ensure long-term safety of the suprarenal fixation.

  7. Prognostic value of myocardial perfusion abnormalities for long-term prognosis in patients after coronary artery bypass grafting

    PubMed Central

    Milvidaite, Irena; Kulakiene, Ilona; Vencloviene, Jone; Kinduris, Sarunas; Jurkiene, Nemira; Grizas, Vytautas; Navickas, Ramunas; Slapikas, Rimvydas

    2014-01-01

    Aims: The objective was to evaluate the prognostic value of exercise myocardial perfusion scintigraphy (MPS) in patients who underwent coronary artery bypass grafting (CABG). Subjects and Methods: A retrospective, one-center study of 361 patients with multivessel coronary artery disease was carried out. All the patients underwent MPS after CABG due to worsened health status. MPS was performed at 4.5 years standard deviation (SD: 0.2), based on symptoms. MPS was carried out using Tc-99m methoxy isobutyl isonitrile and following a 1-day protocol (stress-rest). The end points were analyzed at 6.5 years (SD: 3.3) after MPS, on the average. Statistical Analysis Used: SPSS software for Windows, version 13.0. The t-test or the ?2-test was used. Survival times were calculated. A multivariate Cox proportional hazards model was developed. Results: During the follow-up, death occurred in 54 patients, and 37 patients experienced major adverse cardiovascular events (MACE). In the multivariate analysis, advanced age hazard ratio (HR: 1.45; 95% confidence interval [CI]: 1.42.02; P = 0.027), previous myocardial infarction (HR: 3.17; 95% CI: 1.228.2; P = 0.018), left ventricular ejection fraction of <40% (HR: 2.16; 95% CI: 1.23.89; P = 0.01), and the summed stress score (SSS) of ?4 (HR: 1.87; 95% CI: 1.023.41; P = 0.04) were independent predictors of all-cause death. The summed difference score (SDS) was the only independent predictor of MACE (HR: 1.26; 95% CI: 1.061.48; P = 0.034). Conclusions: The parameters of MPS were found to have prognostic value in the long-term period after CABG. Advanced age, previous myocardial infarction, decreased left ventricular ejection fraction, and the abnormal SSS were associated with an increased risk of all-cause death. The SDS was found to be the only significant risk factor for MACE. PMID:25400360

  8. Effectiveness of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease.

    PubMed

    Krishnaswami, Ashok; Goh, Anne C H; Go, Alan S; Lundstrom, Robert J; Zaroff, Jonathan; Jang, James J; Allen, Elaine

    2016-05-15

    The optimal coronary revascularization strategy (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]) in patients with end-stage renal disease (ESRD) remains uncertain. We performed an updated systematic review and meta-analysis of observational studies comparing CABG and PCI in patients with ESRD using a random-effects model for the primary outcome of long-term all-cause mortality. Our review registered through PROSPERO included observational studies published after 2011 to ensure overlap with previous studies and identified 7 new studies for a total of 23. We found that the median sample size in the selected studies was 125 patients (25 to 15,784) with a large variation in the covariate risk adjustment and only 3 studies reporting the indications for the revascularization strategy. CABG was associated with a small reduction in mortality (relative risk 0.92, 95% CI 0.89 to 0.96) with significant heterogeneity demonstrated (p = 0.005, I(2) = 48.6%). Subgroup analysis by categorized "year of study initiation" (<1990, 1991 to 2003, >2004) further confirmed the summary estimate trending toward survival benefit of CABG along with a substantial decrease in heterogeneity after 2004 (p = 0.64, I(2) = 0%). In conclusion, our updated systematic review and meta-analysis demonstrated that in patients with ESRD referred for coronary revascularization, CABG was associated with a small decrease in the relative risk of long-term mortality compared with PCI. The generalizability of the finding to all patients with ESRD referred for coronary revascularization is limited because of a lack of known indications for coronary revascularization, substantial variation in covariate risk adjustment, and lack of randomized clinical trial data. PMID:27013385

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

    PubMed Central

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

    2014-01-01

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

  10. Relationship between high on aspirin platelet reactivity and oxidative stress in coronary artery by-pass grafted patients.

    PubMed

    Kuliczkowski, Wiktor; Golanski, Ryszard; Bijak, Michal; Boryczka, Katarzyna; Kaczmarski, Jacek; Watala, Cezary; Golanski, Jacek

    2016-03-01

    The aim of the study was to assess the responsiveness of blood platelets to acetylsalicylic acid (ASA) in patients following coronary artery bypass grafting (CABG) surgery with relation to oxidative and antioxidative plasma status. The study included 37 patients treated with the CABG procedure. During the first 24 h after CABG patients were given 300 mg of ASA with the following dose of 150 mg daily. The blood was collected before the procedure and 10 days after. Whole blood platelet aggregation induced with arachidonic acid, collagen and adenosine diphosphate (ADP) was performed together with whole blood generation of thromboxane B2 (TxB2). Oxidative stress was measured before and 10 days after CABG with total oxidative plasma status (TOS) and total antioxidative status of the plasma (TAS). TOS/TAS index was calculated. We observed a significant increase in the TOS and TOS/TAS index and ADP-induced aggregation 10 days after CABG in comparison with its level before operation. There was a significant decrease in the arachidonic acid-induced aggregation and serum TxB2 level. Patients with ADP-induced and collagen-induced aggregation in the upper quartile had significantly higher TOS and TOS/TAS index before (ADP) and after the operation (ADP and collagen). There were 19 patients (51%) with high on aspirin platelet reactivity after CABG who had also higher TOS and TOS/TAS index and lower TAS value in comparison with aspirin responders. Despite ASA use, increased oxidative stress after CABG can overcome its antiplatelet effect and increase platelet activation through other pathways. PMID:26523914

  11. Shrunken Pore Syndrome is associated with a sharp rise in mortality in patients undergoing elective coronary artery bypass grafting

    PubMed Central

    Dardashti, Alain; Nozohoor, Shahab; Grubb, Anders; Bjursten, Henrik

    2016-01-01

    Abstract Shrunken Pore Syndrome was recently suggested for the pathophysiologic state in patients characterized by an estimation of their glomerular filtration rate (GFR) based upon cystatin  C, which is lower or equal to 60% of their estimated GFR based upon creatinine, i.e. when eGFRcystatin  C ≤ 60% of eGFRcreatinine. Not only the cystatin  C level, but also the levels of other low molecular mass proteins are increased in this condition. The preoperative plasma levels of cystatin  C and creatinine were measured in 1638 patients undergoing elective coronary artery bypass grafting. eGFRcystatin  C and eGFRcreatinine were calculated using two pairs of estimating equations, CAPA and LMrev, and CKD-EPIcystatin  C and CKD-EPIcreatinine, respectively. The Shrunken Pore Syndrome was present in 2.1% of the patients as defined by the CAPA and LMrev equations and in 5.7% of the patients as defined by the CKD-EPIcystatin  C and CKD-EPIcreatinine equations. The patients were studied over a median follow-up time of 3.5 years (2.0–5.0 years) and the mortality determined. Shrunken Pore Syndrome defined by both pairs of equations was a strong, independent, predictor of long-term mortality as evaluated by Cox analysis and as illustrated by Kaplan-Meier curves. Increased mortality was observed also for the subgroups of patients with GFR above or below 60 mL/min/1.73 m2. Changing the cut-off level from 60 to 70% for the CAPA and LMrev equations increased the number of patients with Shrunken Pore Syndrome to 6.5%, still displaying increased mortality. PMID:26647957

  12. Genome-Wide Association Study of New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Kertai, Miklos D.; Li, Yi-Ju; Ji, Yunqi; Qi, Wenjing; Lombard, Frederick W.; Shah, Svati H.; Kraus, William E.; Stafford-Smith, Mark; Newman, Mark F.; Milano, Carmelo A.; Waldron, Nathan; Podgoreanu, Mihai V.; Mathew, Joseph P.

    2016-01-01

    BACKGROUND Postoperative atrial fibrillation (AF) is a potentially life-threatening complication after coronary artery bypass graft (CABG) surgery. Genetic predisposition may predict risk for developing postoperative AF. METHODS Study subjects underwent CABG surgery with cardiopulmonary bypass at Duke University Medical Center. In a discovery cohort of 877 individuals from the Perioperative Genetics and Safety Outcomes Study (PEGASUS), we performed a genome-wide association study (GWAS) using a logistic regression model with a covariate adjustment for AF risk index. Single-nucleotide polymorphisms (SNPs) that met a P<5×10−5 were further tested using a replication dataset of 304 individuals from the CATHeterization GENetics (CATHGEN) biorepository, followed by meta-analysis. Potential pathways related to postoperative AF were identified through gene enrichment analysis using the top GWAS SNPs (P<10−4). RESULTS Nineteen SNPs met the a priori defined discovery threshold for replication, but only 3 met nominal significance (P<0.05) in the CATHGEN group, with only one – rs10504554, in the intronic region in lymphocyte antigen 96 (LY96) – showing the same direction of the effect for postoperative AF (odds ratio [OR]=0.48; 95% CI: 0.34–0.68, P=2.9×10−5 vs OR=0.55; 95% CI: 0.31–0.99, P=0.046), and strong overall association by meta-analysis (meta-P=4.0×10−6). Gene enrichment analysis highlighted the role of LY96 in pathways of biologic relevance to activation and modulation of innate immune responses. Our analysis also showed potential association between LY96 and nuclear factor NF-kappa-B interaction, and postoperative AF through their relevance to inflammatory signaling pathways. CONCLUSIONS In patients undergoing CABG surgery, we found genetic polymorphisms in LY96 associated with decreased risk for postoperative AF. PMID:26385043

  13. Coronary artery bypass grafts and diagnosis related groups: patient classification and hospital reimbursement in 10 European countries

    PubMed Central

    2014-01-01

    Background The prospective reimbursement of hospitals through the grouping of patients into a finite number of categories (Diagnosis Related Groups, DRGs), is common to many European countries. However, the specific categories used vary greatly across countries, using different characteristics to define group boundaries and thus those characteristics which result in different payments for treatment. In order to assist in the construction and modification of national DRG systems, this study analyses the DRG systems of 10 European countries. Aims To compare the characteristics used to categorise patients receiving a coronary artery bypass graft (CABG) surgery into DRGs. Further, to compare the structure into which DRGs are placed and the relative price paid for patients across Europe. Method Patients with a procedure of CABG surgery are analysed from Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden. Diagrammatic algorithms of DRG structures are presented for each country. The price in Euros of seven typical case vignettes, each made up of a set of a hypothetical patient’s characteristics, is also analysed for each country. In order to enable comparisons across countries the simplest case (index vignette) is taken as baseline and relative price levels are calculated for the other six vignettes, each representing patients with different combinations of procedures and comorbidities. Results European DRG payment structures for CABG surgery vary in terms of the number of different DRGs used and the types of distinctions which define patient categorisation. Based on the payments given to hospitals in different countries, the most resource intensive patient, relative to the index vignette, ranges in magnitude from 1.37 in Poland to 2.82 in Ireland. There is also considerable variation in how much different systems pay for particular circumstances, such as the occurrence of catheterisation or presence of comorbidity. Conclusion Past experience of the construction of DRG systems for CABG patients demonstrates the variety of options available. It also highlights the importance of updating systems as frequently as possible, to incentivise best practice. PMID:24949279

  14. Effect of Coronary Artery Bypass Grafting on Left Ventricular Ejection Fraction in Men Eligible for Implantable Cardioverter-Defibrillator.

    PubMed

    Vakil, Kairav; Florea, Viorel; Koene, Ryan; Kealhofer, Jessica Voight; Anand, Inderjit; Adabag, Selcuk

    2016-03-15

    Implantable cardioverter-defibrillator (ICD) therapy for primary prevention of sudden cardiac death is not routinely recommended within 90 days of coronary artery bypass grafting (CABG) because of the possibility of an improvement in left ventricular ejection fraction (EF) to>35% after revascularization. We sought to determine the incidence and predictors of EF improvement to >35% after isolated CABG in patients who had a preoperative EF ≤35%. We studied 375 patients who underwent CABG at a tertiary institution and had an echocardiogram preoperatively and postoperatively. Of these, 74 patients (20%) with a preoperative EF ≤35% were included in this analysis. Improvement in EF was defined as postoperative EF >35%. In the overall study population (n = 74), mean EF improved from 28 ± 6% preoperatively to 36 ± 12% postoperatively (p <0.0001). A total of 38 patients (51%) had postoperative improvement in EF to >35% (mean EF in these patients increased from 30 ± 5% to 46 ± 8%; p <0.0001). Patients with EF improvement had a higher preoperative EF than those with no improvement (30 ± 5% vs 26 ± 7%, p <0.005). Improvement in EF was 5 times more likely in patients with preoperative EF 26% to 35% (odds ratio 4.95, 95% CI 1.73 to 14.1; p = 0.003) than those with preoperative EF ≤25%. Other clinical characteristics were not significantly different between patients with versus without EF improvement. In conclusion, more than half of the ICD-eligible patients who underwent CABG improved their EF to >35% after surgery and became ineligible for a primary prevention ICD. EF improvement was unlikely in patients with preoperative EF <25%. PMID:26803382

  15. Sevoflurane exerts a more marked influence compared with propofol on gene expression in patients undergoing coronary artery bypass graft surgery

    PubMed Central

    LI, HUA; CANG, JING; ZHANG, XIAOGUANG

    2016-01-01

    The aim of the present study was to elucidate the influence of the anesthetics propofol and sevoflurane on gene expression in patients undergoing coronary artery bypass graft surgery (CABG) and to provide a basis for the selection of the appropriate anesthetic. The gene expression profiles of patients receiving one of the two anesthetics were analyzed prior to and following the induction of anesthesia. GSE4386 microarray data obtained from the Gene Expression Omnibus database was used to identify the differentially expressed genes (DEGs) by significance analysis of the microarray. The data set contained data regarding atrial tissue samples from 40 patients that underwent CABG, and that received either propofol (n=10) or sevoflurane (n=10) or were control subjects (n=20). The 20 control samples comprised the same patients prior to undergoing CABG. The Kyoto Encyclopedia of Genes and Genomes and Gene Ontology (GO) Enrichment Analysis was applied to the DEGs using the Database for Annotation, Visualization and Integration Discovery functional annotation bioinformatics microarray tool. A total of 242 and 560 DEGs were identified in the human atrial samples treated with propofol and sevoflurane, respectively. Among these, 116 upregulated DEGs and no downregulated DEGs were found to be unique to sevoflurane, while 10 upregulated and 212 downregulated DEGs were unique to propofol. The majority of the pathways that were significantly over-represented among the upregulated DEGs were associated with the immune response, such as Toll- and NOD-like receptors and Jak-STAT signaling pathways. GO enrichment analysis revealed that the downregulated DEGs unique to sevoflurane treatment were involved in the immune response and glucose metabolism, while the upregulated DEGs were associated with cellular ion homeostasis and epithelial cell development. Compared with propofol, sevoflurane appeared to exert a more marked effect on biological pathways, such as drug metabolism, glycolysis, cellular ion homeostasis and epithelial cell development. PMID:26893629

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

    PubMed Central

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

    2005-01-01

    Objective: To assess the determinants of poor mid-term health related quality of life (HRQoL) at one year after primary isolated coronary artery bypass grafting (CABG). Methods: 463 patients who underwent primary isolated CABG for multivessel disease and came for their annual follow up at the outpatient clinic during one year at Harefield Hospital, Middlesex, were approached to participate in the present study. Prospective clinical data were collected as part of the clinical care of the patients and were retrospectively analysed when the patients consented to participate in the study at their outpatient visit. After their consent they were given three HRQoL assessment questionnaires. Scores, together with clinical data, were analysed by both univariate and multivariate analyses with regard to poor HRQoL outcome. Results: 437 (94.4%) patients consented to participate in the study and filled in the HRQoL questionnaires. Ten variables were identified in the univariate analysis as potential predictors of poor scores of the physical element of HRQoL; however, only three variables—gastrointestinal problems, congestive heart failure, and type D personality trait—predicted poor physical scores independently. Eleven variables were identified in the univariate analysis as potential predictors of poor scores of the mental element of HRQoL; however, only three variables—peripheral vascular disease, infective complications, and type D personality trait—predicted poor physical scores independently. Conclusion: Preoperative gastrointestinal problems, preoperative congestive heart failure, and type D personality trait were independent predictors of the poor physical component of HRQoL. Peripheral vascular disease, infective complications, and type D personality trait were independent predictors of the poor mental component of HRQoL. Interestingly, patients with type D personality were more than twice as likely to have poor physical HRQoL and more than five times as likely to have poor mental HRQoL. PMID:16287740

  17. Numerical investigation of haemodynamics in a helical-type artery bypass graft using non-Newtonian multiphase model.

    PubMed

    Wen, Jun; Liu, Kai; Khoshmanesh, Khashayar; Jiang, Wentao; Zheng, Tinghui

    2015-01-01

    The classic single-phase Newtonian blood flow model ignores the motion of red blood cells (RBCs) and their interaction with plasma. To address these issues, we adopted a multiphase non-Newtonian model to carry out a comparative study between a helical artery bypass graft (ABG) and a conventional ABG in which the blood flow is composed of plasma and RBCs. The investigation focused on the mechanism of RBC buildup in an ABG but the haemodynamic parameters obtained by single-phase and multiphase models were also compared. The aggregation of RBCs along the inside wall of a conventional ABG and at the heel of its distal anastomosis was predicted while a poor aggregation was observed along the helical ABG. In addition, RBCs were observed to gradually sediment along the gravity direction. However, the computed haemodynamic parameters by multiphase model qualitatively agreed well with those by single-phase model. It was concluded that (1) the single-phase computational fluid dynamics (CFD) is reasonable to do the computation of haemodynamic parameters in ABGs; (2) secondary flow does not definitely produce buildup of RBCs in the inside curvature, its configuration played an important role in the movement of RBCs and the dominating one-way rotating flow in a helical ABG guaranteed no buildup of RBCs on its inside wall and (3) gravity direction is important for the movement of RBCs which may help to explain why doing exercise is good for human health. This study helps to shed light on the migration of RBCs in ABGs, which cannot be explored by single-phase CFD models, and provides more understanding of the underlying flow mechanism for ABG failure. PMID:24156553

  18. Poor Sleep Quality in Patients after Coronary Artery Bypass Graft Surgery: An Intervention Study Using the PRECEDE-PROCEED Model

    PubMed Central

    Ranjbaran, Soheila; Dehdari, Tahereh; Sadeghniiat-Haghighi, Khosro; Majdabadi, Mahmood Mahmoodi

    2015-01-01

    Abstract Background: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG. Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points. Results: The mean age of the patients in the intervention (24% women) and control (24% women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention. Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients. PMID:26157457

  19. The new method of time-lag ligation for portosystemic shunt using coronary artery bypass graft occluder for adult living donor liver transplantation.

    PubMed

    Kokai, H; Sato, Y; Yamamoto, S; Oya, H; Nakatsuka, H; Kobayashi, T; Watanabe, T; Takizawa, K; Hatakeyama, K

    2009-12-01

    We performed a living donor liver transplantation (LDLT) for a 57-year-old man who had end-stage liver failure with portal hypertension and an inferior mesenteric vein-left testicular vein (IMV-LTV) shunt. At operation, we did not clamp the shunt but encircled it with a coronary artery bypass graft (CABG) occluder (Sumitomo Bakelite K.K., Japan), which was passed outside the body through the abdominal wall to time-lag ligation (TLL). On postoperative day (POD) 5, we observed decreased portal flow. We performed TLL of the shunt using the CABG occluder without re-laparotomy. The portal flow increased, while the portal vein pressure increased slightly. In LDLT, portosystemic shunt has been reported to be a cause of portal thrombus formation or graft liver atrophy due to decreased PV flow in the mid postoperative period. However, perioperative ligation of a portosystemic shunt may prevent regeneration of the grafted liver because of excessive portal hypertension. Therefore the technique of time-lag ligation of a portosystemic shunt using a CABG occluder may be a minimally invasive, useful method to achieve physiological liver graft regeneration. PMID:20005380

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

    SciTech Connect

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

    1982-11-01

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

  1. Platform Technologies for Decellularization, Tunic-Specific Cell Seeding, and In Vitro Conditioning of Extended Length, Small Diameter Vascular Grafts

    PubMed Central

    Fercana, George; Bowser, Devon; Portilla, Margarita; Langan, Eugene M.; Carsten, Christopher G.; Cull, David L.; Sierad, Leslie N.

    2014-01-01

    The aim of this study was to generate extended length, small diameter vascular scaffolds that could serve as potential grafts for treatment of acute ischemia. Biological tissues are considered excellent scaffolds, which exhibit adequate biological, mechanical, and handling properties; however, they tend to degenerate, dilate, and calcify after implantation. We hypothesized that chemically stabilized acellular arteries would be ideal scaffolds for development of vascular grafts for peripheral surgery applications. Based on promising historical data from our laboratory and others, we chose to decellularize bovine mammary and femoral arteries and test them as scaffolds for vascular grafting. Decellularization of such long structures required development of a novel “bioprocessing” system and a sequence of detergents and enzymes that generated completely acellular, galactose-(α1,3)-galactose (α-Gal) xenoantigen-free scaffolds with preserved collagen, elastin, and basement membrane components. Acellular arteries exhibited excellent mechanical properties, including burst pressure, suture holding strength, and elastic recoil. To reduce elastin degeneration, we treated the scaffolds with penta-galloyl glucose and then revitalized them in vitro using a tunic-specific cell approach. A novel atraumatic endothelialization protocol using an external stent was also developed for the long grafts and cell-seeded constructs were conditioned in a flow bioreactor. Both decellularization and revitalization are feasible but cell retention in vitro continues to pose challenges. These studies support further efforts toward clinical use of small diameter acellular arteries as vascular grafts. PMID:24749889

  2. Platform technologies for decellularization, tunic-specific cell seeding, and in vitro conditioning of extended length, small diameter vascular grafts.

    PubMed

    Fercana, George; Bowser, Devon; Portilla, Margarita; Langan, Eugene M; Carsten, Christopher G; Cull, David L; Sierad, Leslie N; Simionescu, Dan T

    2014-12-01

    The aim of this study was to generate extended length, small diameter vascular scaffolds that could serve as potential grafts for treatment of acute ischemia. Biological tissues are considered excellent scaffolds, which exhibit adequate biological, mechanical, and handling properties; however, they tend to degenerate, dilate, and calcify after implantation. We hypothesized that chemically stabilized acellular arteries would be ideal scaffolds for development of vascular grafts for peripheral surgery applications. Based on promising historical data from our laboratory and others, we chose to decellularize bovine mammary and femoral arteries and test them as scaffolds for vascular grafting. Decellularization of such long structures required development of a novel "bioprocessing" system and a sequence of detergents and enzymes that generated completely acellular, galactose-(α1,3)-galactose (α-Gal) xenoantigen-free scaffolds with preserved collagen, elastin, and basement membrane components. Acellular arteries exhibited excellent mechanical properties, including burst pressure, suture holding strength, and elastic recoil. To reduce elastin degeneration, we treated the scaffolds with penta-galloyl glucose and then revitalized them in vitro using a tunic-specific cell approach. A novel atraumatic endothelialization protocol using an external stent was also developed for the long grafts and cell-seeded constructs were conditioned in a flow bioreactor. Both decellularization and revitalization are feasible but cell retention in vitro continues to pose challenges. These studies support further efforts toward clinical use of small diameter acellular arteries as vascular grafts. PMID:24749889

  3. A patent ductus arteriosus complicating cardiopulmonary bypass for combined coronary artery bypass grafting and aortic valve replacement only discovered by computed tomography 3D reconstruction.

    PubMed

    van Middendorp, Lars B; Maessen, Jos G; Sardari Nia, Peyman

    2014-12-01

    We describe the case of a 59-year old male patient undergoing combined coronary artery bypass grafting and aortic valve replacement. Manipulation of the heart during cardiopulmonary bypass significantly decreased venous return. Several measures were necessary to improve venous return to a level at which continuation of the procedure was safe. Based on the initial troubles with venous return, we decided to selectively cross-clamp the aorta. This resulted in a large amount of backflow of oxygenated blood from the left ventricle, necessitating additional vents in the pulmonary artery and directly in the left ventricle. The procedure was continued uneventfully, and postoperative recovery was without significant complications. Postoperative 2D computed tomography did not show any signs of a shunt, but 3D reconstruction showed a small patent ductus arteriosus. PMID:25164136

  4. Perioperative elafin for ischaemia-reperfusion injury during coronary artery bypass graft surgery: a randomised-controlled trial

    PubMed Central

    Alam, S R; Lewis, S C; Zamvar, V; Pessotto, R; Dweck, M R; Krishan, A; Goodman, K; Oatey, K; Harkess, R; Milne, L; Thomas, S; Mills, N M; Moore, C; Semple, S; Wiedow, O; Stirrat, C; Mirsadraee, S; Newby, D E; Henriksen, P A

    2015-01-01

    Background Elafin is a potent endogenous neutrophil elastase inhibitor that protects against myocardial inflammation and injury in preclinical models of ischaemic-reperfusion injury. We investigated whether elafin could inhibit myocardial ischaemia-reperfusion injury induced during coronary artery bypass graft (CABG) surgery. Methods and results In a randomised double-blind placebo-controlled parallel group clinical trial, 87 patients undergoing CABG surgery were randomised 1:1 to intravenous elafin 200 mg or saline placebo administered after induction of anaesthesia and prior to sternotomy. Myocardial injury was measured as cardiac troponin I release over 48 h (area under the curve (AUC)) and myocardial infarction identified with MRI. Postischaemic inflammation was measured by plasma markers including AUC high-sensitive C reactive protein (hs-CRP) and myeloperoxidase (MPO). Elafin infusion was safe and resulted in >3000-fold increase in plasma elafin concentrations and >50% inhibition of elastase activity in the first 24 h. This did not reduce myocardial injury over 48 h (ratio of geometric means (elafin/placebo) of AUC troponin I 0.74 (95% CI 0.47 to 1.15, p=0.18)) although post hoc analysis of the high-sensitive assay revealed lower troponin I concentrations at 6 h in elafin-treated patients (median 2.4 vs 4.1 μg/L, p=0.035). Elafin had no effect on myocardial infarction (elafin, 7/34 vs placebo, 5/35 patients) or on markers of inflammation: mean differences for AUC hs-CRP of 499 mg/L/48 h (95% CI −207 to 1205, p=0.16), and AUC MPO of 238 ng/mL/48 h (95% CI −235 to 711, p=0.320). Conclusions There was no strong evidence that neutrophil elastase inhibition with a single-dose elafin treatment reduced myocardial injury and inflammation following CABG-induced ischaemia-reperfusion injury. Trial registration number (EudraCT 2010-019527-58, ISRCTN82061264). PMID:26310261

  5. Potential Effect of L-Carnitine on the Prevention of Myocardial Injury after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Dastan, Farzaneh; Hajhossein Talasaz, Azita; Mojtahedzadeh, Mojtaba; Karimi, Abbasali; Salehiomran, Abbas; Bina, Payvand; Jalali, Arash; Aghaie, Zahra

    2015-01-01

    Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG) surgery. Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery) or a control group (n = 67). CK-MB (creatine kinase, muscle-brain subunits) and troponin T (TnT) levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively. Results: Our study included 134 patients (99 [73.8%] males) at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group) and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group) did not show any significant differences (p value=0.93 and 0.08, respectively). Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group), but the difference was not significant (p value = 0.28). TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34). Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels. PMID:26110005

  6. Effect of transfusion on dizziness in anemic patients after elective off-pump coronary artery bypass graft surgery

    PubMed Central

    Mirhosseini, Seyed Jalil; Zadeh, Mehdi Haddad; Ali-Hassan-Sayegh, Sadegh; Dehnavi, Naime Dehghan

    2013-01-01

    Background: Neurological disorders are common complications following coronary artery bypass graft (CABG). Dizziness in convalescence period is of high importance because it can prolong patient's stay at the hospital and decrease in sense of rehealing. Transfusion indication is seen in hemoglobin levels <7 g/dl; however, dizziness has been frequently observed in patients with hemoglobin levels 7-10 g/dl and they have dramatic response to transfusion. Therefore, this study was designed to evaluate effect of transfusion on dizziness in hemoglobin levels of 7-10 g/dl to set a more accurate indication for transfusion in anemic patients after elective off-pump CABG. Materials and Methods: This clinical trial study was conducted on 90 patients undergoing elective off-pump CABG surgery from January to June 2011, in Afshar cardiovascular center, Yazd, Iran. Patients with hemoglobin levels of 7-10 g/ dl measured 48 h after CABG were included in this study and those who stayed in ICU more than 48 h were excluded. The subjects were randomly divided into two groups: the experimental group received packed cell according to study protocol while the control group did not receive packed cell. Hemoglobin concentration was measured at 48 h and 72 h after CABG and discharge time, respectively. Dizziness was evaluated 72 h after surgery. Data were analyzed by ANOVA, Chi-square, and Fisher's exact test for quantitative and qualitative variables. Results: The mean age of the patients was 63.5 ± 10.67 years, from all of patients in which 50 cases (55.6%) were males and 40 cases (44.4%) were females. Dizziness after surgery occurred in 35 cases (38.8%), of whom, 27 cases (62.8%) were in the control group and 8 cases (17%) were in the transfusion group. Significantly a difference in the incidence of dizziness was found between two groups (P= 0.001). Conclusion: Transfusion in hemoglobin levels of 7-10 g/dl can be useful to decrease dizziness in anemic patients after elective off-pump CABG; however, the guidelines in textbooks suggest transfusion after CABG to be in hemoglobin levels <7 g/dl. PMID:23559766

  7. Effects of single antegrade hot shot in comparison with no hot shot administration during coronary artery bypass grafting

    PubMed Central

    Mirmohammadsadeghi, Pouya; Mirmohammadsadeghi, Mohsen

    2015-01-01

    BACKGROUND Superior results will be achieved from cardiac surgery by minimizing the effect of ischemia/reperfusion injury during cross-clamping of the aorta. Different cardioplegia solutions have been introduced, but the optimum one is still ambiguous. The aim of this study is to determine the effect of single antegrade hot shot terminal warm blood cardioplegia (TWBC) on patients who had undergone coronary artery bypass grafting (CABG). METHODS In total, 2488 patients who had CABG surgery in Sina Hospital, Isfahan, Iran, from 2003 to 2011 were enrolled in this case-control study. They were divided into two groups, those who received cold cardioplegia only and those who received a hot shot following cold cardioplegia. Demographics, and clinical data, such as; premature atrial contraction (PAC) arrhythmia, diabetes treatment, and left ventricular ejection fraction (EF), were collected and logistic regression analysis was used to analyze the data. RESULTS There were significant differences found between subjects receiving antegrade hot shot based on direct current (DC) shocks, with regard to; female, EF levels, diabetes treatment (P < 0.050). Those who did not receive the hot shot and were not diabetic received more DC shock (P = 0.019). The prevalence of subjects who did no need DC shock was significantly higher among male subjects who had good EF and acceptable diabetic treatment. Multiple logistic regression showed that PAC arrhythmia did not have a significant effect on receiving DC shock during CAGB [0.84 (0.25, 2.85), (P = 0.780)]. Having poor EF increased the risk of receiving DC shock among subjects by 2.81 [(1.69, 4.69), (P ≤ 0.001)] (P < 0.001). Among the diabetic subjects, receiving insulin decreased the risk of receiving DC shock by 0.54 (0.29, 0.98) (P = 0.042). CONCLUSION It was concluded that single antegrade hot shot following cold cardioplegia was not particularly effective in the CABG group. TWBC will decrease the need for DC shock. PMID:26405451

  8. Preoperative Prophylactic Intraaortic Balloon Pump Reduces the Incidence of Postoperative Acute Kidney Injury and Short-Term Death of High-Risk Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis of 17 Studies.

    PubMed

    Wang, Jiayang; Yu, Wenyuan; Gao, Mingxin; Gu, Chengxiong; Yu, Yang

    2016-05-01

    This meta-analysis investigated the effects of preoperative prophylactic intraaortic balloon pump placement on postoperative renal function and short-term death of high-risk patients undergoing coronary artery bypass grafting. We found that preoperative prophylactic intraaortic balloon pump support reduced the incidence of coronary artery bypass grafting-associated acute kidney injury and short-term death and dramatically decreased the incidence of postoperative renal replacement therapy by 82% compared with high-risk patients without the procedure. This is the first meta-analysis to demonstrate significant beneficial effects of preoperative prophylactic intraaortic balloon pump on renal function in high-risk patients undergoing coronary artery bypass grafting. PMID:27045229

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

    SciTech Connect

    Cho, Daniel S.; Linte, Cristian; Chen, Elvis C. S.; Bainbridge, Daniel; Wedlake, Chris; Moore, John; Barron, John; Patel, Rajni; Peters, Terry

    2012-03-15

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

  10. Coronary Artery Bypass Grafting

    MedlinePlus

    ... Before What To Expect During What To Expect After What Are the Risks Clinical Trials Links Related Topics Cardiac Rehabilitation Coronary Heart Disease Heart Attack Heart Surgery Percutaneous Coronary Intervention Send a link ...

  11. The monitoring of antiaggregation effect of acetylsalicylic acid therapy by measuring serum thromboxane B2 in patients with coronary artery bypass grafting.

    PubMed

    Klasic, Anita; Lakusic, Nenad; Gaspar, Ludovit; Kruzliak, Peter

    2016-06-01

    Cardiovascular patients take acetylsalicylic acid (ASA) for preventing myocardial infarction and other thromboembolic complications. It is already known that in some patients this therapy is not effective. The aim of this study was to assess the percentage of ASA resistance on the sample of patients with coronary artery bypass grafting. Our study included 105 patients with coronary artery bypass grafting treated with ASA 150 mg/day or lesser. Platelet aggregation was measured by serum thromboxane B2 level as well as impedance aggregometry from whole blood to determine ASA antiaggregation effect. The percentage of ASA resistance was 41.9% with impedance aggregometry, and after determining the serum thromboxane B2 level this percentage was only 8.6%. The correlation between these two methods was weak (r = 0.443; P < 0.0001). Thromboembolic complications still occur in ASA-treated patients because some patients are resistant to ASA therapy. It would be useful to monitor the effectiveness of ASA therapy and give another antiaggregation drug to these patients to reduce adverse events. The problem is which test is ideal because different tests show different percentages of ASA resistance. PMID:26575493

  12. Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts

    PubMed Central

    Frauenfelder, Thomas; Boutsianis, Evangelos; Schertler, Thomas; Husmann, Lars; Leschka, Sebastian; Poulikakos, Dimos; Marincek, Borut; Alkadhi, Hatem

    2007-01-01

    Purpose Coronary artery bypass graft (CABG) surgery represents the standard treatment of advanced coronary artery disease. Two major types of anastomosis exist to connect the graft to the coronary artery, i.e., by using an end-to-side or a side-to-side anastomosis. There is still controversy because of the differences in the patency rates of the two types of anastomosis. The purpose of this paper is to non-invasively quantify hemodynamic parameters, such as mass flow and wall shear stress (WSS), in end-to-side and side-to-side anastomoses of patients with CABG using computational fluid dynamics (CFD). Methods One patient with saphenous CABG and end-to-side anastomosis and one patient with saphenous CABG and side-to-side anastomosis underwent 16-detector row computed tomography (CT). Geometric models of coronary arteries and bypasses were reconstructed for CFD analysis. Blood flow was considered pulsatile, laminar, incompressible and Newtonian. Peri-anastomotic mass flow and WSS were quantified and flow patterns visualized. Results CFD analysis based on in-vivo CT coronary angiography data was feasible in both patients. For both types of CABG, flow patterns were characterized by a retrograde flow into the native coronary artery. WSS variations were found in both anastomoses types, with highest WSS values at the heel and lowest WSS values at the floor of the end-to-side anastomosis. In contrast, the highest WSS values of the side-to-side anastomosis configuration were found in stenotic vessel segments and not in the close vicinity of the anastomosis. Flow stagnation zones were found in end-to-side but not in side-to-side anastomosis, the latter also demonstrating a smoother stream division throughout the cardiac cycle. Conclusion CFD analysis of venous CABG based on in-vivo CT datasets in patients was feasible producing qualitative and quantitative information on mass flow and WSS. Differences were found between the two types of anastomosis warranting further systematic application of the presented methodology on multiple patient datasets. PMID:17897460

  13. Endothelial dysfunction and altered mechanical and structural properties of resistance arteries in a murine model of graft-versus-host disease.

    PubMed

    Schmid, Peter M; Bouazzaoui, Abdellatif; Doser, Kristina; Schmid, Karin; Hoffmann, Petra; Schroeder, Josef A; Riegger, Guenter A; Holler, Ernst; Endemann, Dierk H

    2014-10-01

    A putative involvement of the vasculature seems to play a critical role in the pathophysiology of graft-versus-host disease (GVHD). We aimed to characterize alterations of mesenteric resistance arteries in GVHD in a fully MHC-mismatched model of BALB/c mice conditioned with total body irradiation that underwent transplantation with bone marrow cells and splenocytes from syngeneic (BALB/c) or allogeneic (C57BL/6) donors. After 4 weeks, animals were sacrificed and mesenteric resistance arteries were studied in a pressurized myograph. The expression of endothelial (eNOS) and inducible nitric oxide (NO)-synthase (iNOS) was quantified and vessel wall ultrastructure was investigated with electron microscopy. The myograph study revealed an endothelial dysfunction in allogeneic-transplant recipients, whereas endothelium-independent vasodilation was similar to syngeneic-transplant recipients or untreated controls. The expression of eNOS was decreased and iNOS increased, possibly contributing to endothelial dysfunction. Additionally, arteries of allogeneic transplant recipients exhibited a geometry-independent increase in vessels strain. For both findings, electron microscopy provided a structural correlate by showing severe damage of the whole vessel wall in allogeneic-transplant recipient animals. Our study provides further data to prove, and is the first to characterize, functional and structural vascular alterations in the early course after allogeneic transplantation directly in an ex vivo setting and, therefore, strongly supports the hypothesis of a vascular form of GVHD. PMID:24813168

  14. Aortocoronary Saphenous Vein Graft Aneurysm with Fistula to the Right Atrium: Percutaneous Management of Surgical Complication.

    PubMed

    Barekatain, Armin; Fanari, Zaher; Weiss, Sandra A

    2015-12-01

    Aneurysmal dilatation of aortocoronary saphenous vein grafts (SVG) is a rare but known complication after coronary artery bypass grafting (CABG). They are most commonly found incidentally, although some may present with unstable angina or myocardial infarction (MI). Rarely, these aneurysms can develop into fistulas to the neighboring cardiac chambers. We report the case of a 66-year old woman with a history of CABG in 1996 with a left internal mammary artery (LIMA) graft to the left anterior descending and a SVG to distal right coronary artery presenting with non-ST segment elevation myocardial infarction (NSTEMI) complicated with congestive heart failure. Selective Coronary and Graft angiography showed an aneurysm in the mid SVG with a fistula into the right atrium (RA) resulting in a significant left to right shunt. The significant left to right shunt diverted blood flow from right coronary artery territory resulting in recurrent ischemia and angina and introduced a significant volume overload on the right ventricle resulting in over heart failure. Secondary to the course of LIMA graft along the sternum, surgery was not an option. Secondary to continued symptoms percutaneous intervention was performed with placement of two 6.0 x 50 mm Viabahn self-expanding covered stent with aggressive post-dilation resulting in successful closure with no residual flow. Percutaneous intervention is shown to be an effective approach to manage both aortocoronary fistula and grafts ruptures and is associated with better outcomes than surgical and conservative options. To the best of our knowledge, this is the first reported case of a successful closure of fistulous communication of a SVG aneurysm to the RA utilizing multiple peripheral covered stents. PMID:26852434

  15. Free-floating left atrial ball thrombus after mitral valve replacement with patent coronary artery bypass grafts: successful removal by a right minithoracotomy approach without aortic cross-clamp.

    PubMed

    Hisatomi, Kazuki; Hashizume, Koji; Tanigawa, Kazuyoshi; Miura, Takashi; Matsukuma, Seiji; Yokose, Shogo; Kitamura, Tessho; Shimada, Takashi; Eishi, Kiyoyuki

    2016-06-01

    A free-floating thrombus in the left atrium without attachment to either the atrial wall or the mitral valve is extremely rare. We describe a case in a 79-year-old woman with chronic atrial fibrillation and a recent stroke who had undergone mitral valve replacement 25 years previously and coronary artery bypass grafting 5 years previously. Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Median re-sternotomy can be particularly difficult in patients with functioning coronary artery grafts, where the risk of graft injury is a significant concern. Prompt surgical intervention was carried out, and to avoid the challenge of re-sternotomy in this patient with two prior thoracotomies, we successfully removed the thrombus by a right minithoracotomy approach without aortic cross-clamping. There was no postoperative occurrence of a new stroke or aggravation of the pre-existing stroke. PMID:25098689

  16. Sleep Quality and Emotional Correlates in Taiwanese Coronary Artery Bypass Graft Patients 1 Week and 1 Month after Hospital Discharge: A Repeated Descriptive Correlational Study

    PubMed Central

    Yang, Pei-Lin; Huang, Guey-Shiun; Tsai, Chien-Sung; Lou, Meei-Fang

    2015-01-01

    Background Poor sleep quality is a common health problem for coronary artery bypass graft patients, however few studies have evaluated sleep quality during the period immediately following hospital discharge. Purpose The aim of this study was to investigate changes in sleep quality and emotional correlates in coronary artery bypass graft patients in Taiwan at 1 week and 1 month after hospital discharge. Methods We used a descriptive correlational design for this study. One week after discharge, 87 patients who had undergone coronary artery bypass surgery completed two structured questionnaires: the Pittsburgh Sleep Quality Index and the Hospital Anxiety and Depression Scale. Three weeks later (1 month after discharge) the patients completed the surveys again. Pearson correlations, t-tests, ANOVA and linear multiple regression analysis were used to analyze the data. Results A majority of the participants had poor sleep quality at 1 week (82.8%) and 1 month (66.7%) post-hospitalization, based on the global score of the Pittsburgh Sleep Quality Index. Despite poor sleep quality at both time-points the sleep quality at 1 month was significantly better than at 1-week post hospitalization. Poorer sleep quality correlated with older age, poorer heart function, anxiety and depression. The majority of participants had normal levels of anxiety at 1 week (69.0%) and 1 month (88.5%) as measured by the Hospital Anxiety and Depression Scale. However, some level of depression was seen at 1 week (78.1%) and 1 month (59.7%). Depression was a significant predictor of sleep quality at 1 week; at 1 month after hospital discharge both anxiety and depression were significant predictors of sleep quality. Conclusion Sleep quality, anxiety and depression all significantly improved 1 month after hospital discharge. However, more than half of the participants continued to have poor sleep quality and some level of depression. Health care personnel should be encouraged to assess sleep and emotional status in patients after coronary artery bypass surgery and offer them appropriate management strategies to improve sleep and reduce anxiety and depression. PMID:26291524

  17. Successful use of the Impella Recover LP 5.0 device for circulatory support during off-pump coronary artery bypass grafting

    PubMed Central

    Pepino, Paolo; Coronella, Germano; Oliviero, Piermario; Monaco, Mario; Schiavone, Vincenzo; Finizio, Filippo; Biondi-Zoccai, Giuseppe; Frati, Giacomo; Giordano, Arturo

    2014-01-01

    INTRODUCTION Surgical coronary revascularization is being performed with ever increasing frequency in patients at high surgical risk. Off-pump coronary artery bypass grafting (OPCABG) is particularly appealing in such subjects, but may limit the options for concomitant mechanical circulatory support. PRESENTATION OF CASE We hereby report an original case of mechanical circulatory support with the Impella Recover LP 5.0 device during OPCABG in a 61-year-old gentleman with multiple comorbidities and severe left ventricular systolic dysfunction. Specifically, the soft tipped device did not impede surgical manipulation of the heart during the surgical procedure, providing uninterrupted circulatory support to the patient. DISCUSSION This clinical vignette supports the feasibility, safety and efficacy of the Impella Recover LP 5.0 device in patients undergoing OPCABG. CONCLUSION Pending further studies, use of the Impella Recover LP 5.0 device can be envisioned safely for OPCABG. PMID:25305600

  18. Health-related personal control predicts depression symptoms and quality of life but not health behaviour following coronary artery bypass graft surgery.

    PubMed

    Kidd, Tara; Poole, Lydia; Leigh, Elizabeth; Ronaldson, Amy; Jahangiri, Marjan; Steptoe, Andrew

    2016-02-01

    To determine the prospective association between health-related control beliefs, quality of life (QOL), depression symptoms, and health behaviours in coronary artery bypass graft (CABG) patients 6-8 weeks following surgery. 149 patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring health related personal control, treatment control, depression symptoms, QOL, and health behaviours prior to and 6-8 weeks after surgery. Higher levels of health-related personal control predicted better QOL, and lower levels of depression symptoms, but not adherence to medication, cardiac rehabilitation attendance, or physical activity. These results were independent of demographic, behavioural, and clinical covariates. Treatment control was not associated with any outcome. These results suggest that perceived health-related personal control is associated with key aspects of short-term recovery from CABG surgery. Targeted interventions aimed at improving perceptions of health-related personal control may improve health outcomes in this cardiac population. PMID:26341356

  19. Comparison Between Effects of Home Based Cardiac Rehabilitation Programs Versus Usual Care on the Patients’ Health Related Quality of Life After Coronary Artery Bypass Graft

    PubMed Central

    Salavati, Mohsen; Falahinia, Gholamhossein; Vardanjani, Ali Esmaeili; Rafiei, Hossein; Moosavi, Saeid; Torkamani, Mehdi

    2016-01-01

    Background & Aim: To compare home-based cardiac rehabilitation with usual care on the patients’ Health Related Quality of Life (HRQoL) after coronary artery bypass graft in patients with coronary artery bypass graft (CABG) surgery. Methods: In a randomized controlled clinical conducted from March 2013 to June 2013, 110 patients with CABG surgery were randomly assigned into two groups. While patients in group I, were received usual care and patients in group II, in addition to the usual care were received home-based cardiac rehabilitation programs. The 27-item MacNew Heart Disease HRQoL questionnaire was used to evaluate the patient’s HRQoL under and over 2 months after intervention. Results: At the time of 0, mean score of HRQoL was 67.86±7.5 and 64.76±8.4 in patients in group I and group II, respectively (P> 0.05). Although mean score of HRQoL in all patients in both groups increased two month after intervention, but this increase in patients in group II were higher than patients in group I (154.93±4.6 vs 134.20±8.2). This difference were statistically significant (P< 0.05). Conclusion: Quality of Life (QoL) can be considered as a quality indicator of health care systems. Results of present study showed that home-based cardiac rehabilitation program improved patients HRQoL after CABG surgery. PMID:26573042

  20. Frequency Rate of Atelectasis in Patients Following Coronary Artery Bypass Graft and Its Associated Factors at Mazandaran Heart Center in 2013-2014

    PubMed Central

    Saffari, Neshat Hasan Niyayeh; Nasiri, Ebrahim; Mousavinasab, Seyed Nouraddin; Ghafari, Rahman; Soleimani, Aria; Esmaeili, Ravanbakhsh

    2015-01-01

    Introduction: As the most common postoperative pulmonary complications after cardiac surgery, atelectasis is one of the most important and serious early postoperative complications and one of the most important causes of prolonged hospitalization, increased costs, and mortality rise. Therefore, the present study was aimed at specifying the frequency of atelectasis in patients following coronary artery bypass graft and its associated factors in Mazandaran Heart Center in 2013-2014. Materials: The present investigation was a descriptive cross-sectional study in which sequential sampling was used. It was conducted on 375 patients whose coronary artery bypass graft had been performed by the same surgeon and anesthesiologist. For data collection, first the patients’ demographic variables and the information of their surgery were retrieved through their profiles, direct observation, patient inquiry, and the collected data were recorded in the data collection forms. Then, atelectasis was measured before the surgery and on the first and second days after it by taking CXR whose results were checked by two radiologists who were not aware of the previous observations. Data were analyzed through t-test, Pearson test, and Chi-square test using SPSS 16.0. Results: The results of the present study indicated that, 123 out of 375 patients (32.8%) were diagnosed with at least one type of tattletales during the first three days after the surgery. The mean age of the patients who were diagnosed with atelectasis was 62.9 and most of them were female. The results also showed that there was a significant relationship between postoperative frequency of atelectasis and the patients’ pulmonary diseases and underlying diseases like diabetes and hyperlipidemia, smoking and alcohol use before the surgery, and transfusion of 4 units of packed red blood cells during the surgery (p<0.05). Conclusion: Atelectasis is the most common postoperative complication which emerges more in patients with pulmonary and underlying diseases than other patients. PMID:26153209

  1. Cardiac arrest in an 18-year-old man caused by anomalous right coronary artery origin.

    PubMed

    Cronin, Heather; Curtin, Ronan

    2016-01-01

    An 18-year-old man presented to hospital following an out of hospital ventricular fibrillation cardiac arrest, with successful resuscitation at the scene. The incident happened during a competitive football match in which the man was playing. In the course of an extensive work up, a CT coronary angiogram demonstrated an anomalous right coronary artery (RCA) origin in the left coronary sinus. The RCA followed an initial intramural and subsequent interarterial course between the ascending aorta and pulmonary artery trunk. Cardiac MRI showed a small subendocardial area of delayed gadolinium enhancement in the inferoseptal wall, consistent with a small infarct. Treatment involved elective coronary artery bypass of the RCA with a right internal mammary artery graft. The patient made a full recovery. An implantable cardioverter-defibrillator was not inserted and he was advised not to return to competitive sports. PMID:26961556

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

    PubMed Central

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

    2014-01-01

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

  3. Measuring spatial effects in time to event data: a case study using months from angiography to coronary artery bypass graft (CABG).

    PubMed

    Crook, Angela M; Knorr-Held, Leonhard; Hemingway, Harry

    2003-09-30

    The application of Bayesian hierarchical models to measure spatial effects in time to event data has not been widely reported. This case study aims to estimate the effect of area of residence on waiting times to coronary artery bypass graft (CABG) and to assess the role of important individual specific covariates (age, sex and disease severity). The data involved all patients with definite coronary artery disease who were referred to one cardiothoracic unit from five contiguous health authorities covering 488 electoral wards (areas). Time to event was the waiting time in months from angiography (diagnosis) to CABG (event). A number of discrete time survival models were fitted to the data. A discrete baseline hazard was estimated by fitting waiting time non-parametrically into the models. Ward was fitted as a spatial effect using a Gaussian Markov random field prior. Individual specific covariates considered were age, sex and number of diseased vessels. The recently proposed DIC criteria was used for comparing models. Results showed a marked spatial effect on time to bypass surgery after including age, sex and disease severity in the model. Notably this spatial effect was not apparent when these covariates were not included in the model. The observed small area spatial variation in time to CABG warrants further investigation. PMID:12953290

  4. Quality-of-Life Outcomes in Surgical Treatment of Ischemic Heart Failure Quality-of-Life Outcomes With Coronary Artery Bypass Graft Surgery in Ischemic Left Ventricular Dysfunction

    PubMed Central

    Mark, Daniel B.; Knight, J. David; Velazquez, Eric J.; Wasilewski, Jaroslaw; Howlett, Jonathan G.; Smith, Peter K.; Spertus, John A.; Rajda, Miroslaw; Yadav, Rakesh; Hamman, Baron L.; Malinowski, Marcin; Naik, Ajay; Rankin, Gena; Harding, Tina M.; Drew, Laura A.; Desvigne-Nickens, Patrice; Anstrom, Kevin J.

    2014-01-01

    Background: The STICH (Surgical Treatment for Ischemic Heart Failure) trial compared a strategy of routine coronary artery bypass grafting (CABG) with guideline-based medical therapy for patients with ischemic left ventricular dysfunction. Objective: To describe treatment-related quality-of-life (QOL) outcomes, a major prespecified secondary end point in the STICH trial. Design: Randomized trial. (ClinicalTrials.gov: NCT00023595) Setting: 99 clinical sites in 22 countries. Patients: 1212 patients with a left ventricular ejection fraction of 0.35 or less and coronary artery disease. Intervention: Random assignment to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). Measurements: A battery of QOL instruments at baseline (98.9% complete) and 4, 12, 24, and 36 months after randomization (collection rates were 80% to 89% of those eligible). The principal prespecified QOL measure was the Kansas City Cardiomyopathy Questionnaire, which assesses the effect of heart failure on patients’ symptoms, physical function, social limitations, and QOL. Results: The Kansas City Cardiomyopathy Questionnaire overall summary score was consistently higher (more favorable) in the CABG group than in the medical therapy group by 4.4 points (95% CI, 1.8 to 7.0 points) at 4 months, 5.8 points (CI, 3.1 to 8.6 points) at 12 months, 4.1 points (CI, 1.2 to 7.1 points) at 24 months, and 3.2 points (CI, 0.2 to 6.3 points) at 36 months. Sensitivity analyses to account for the effect of mortality on follow-up QOL measurement were consistent with the primary findings. Limitation: Therapy was not masked. Conclusion: In this cohort of symptomatic high-risk patients with ischemic left ventricular dysfunction and multivessel coronary artery disease, CABG plus medical therapy produced clinically important improvements in several health status domains compared with medical therapy alone over 36 months. Primary Funding Source: National Heart, Lung, and Blood Institute. PMID:25222386

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

    PubMed

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

    2010-07-01

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

  6. Evolution of the management of anomalous left coronary artery: a new surgical approach.

    PubMed

    Vigneswaran, W T; Campbell, D N; Pappas, G; Wiggins, J W; Wolfe, R W; Clarke, D R

    1989-10-01

    Twelve patients with anomalous left coronary artery (LCA) from the pulmonary artery were treated surgically. Mean age was 13 months and mean weight, 7.7 kg. One of the following techniques was used in 8 patients: suture obliteration of the coronary orifice, ligation of the anomalous LCA and grafting of the internal mammary artery to the distal LCA, aortic reimplantation of the anomalous LCA, creation of an aortopulmonary window, and direct anastomosis to the right subclavian artery. In 4 patients, a new technique to establish a two-coronary artery system involved tube extension of the anomalous LCA with pulmonary artery wall and then anastomosis to the right subclavian artery using cardiopulmonary by-pass without aortic cross-clamping. There were two hospital deaths (17%) and one late death. The condition of the 9 long-term survivors was improved at late follow-up. Postoperative assessment showed smaller Q wave on the electrocardiogram, reduced cardiac size, and good left ventricular function. All patients in whom the repair was done using the new technique were free from postoperative cardiac complications, had shortened hospital stays, and were alive with a patent two-coronary artery system at late follow-up. We believe this approach is a safer method for establishing a two-coronary artery system in infants and small children with an anomalous LCA arising from the pulmonary artery. PMID:2802857

  7. Minimally invasive direct coronary artery bypass for left anterior descending artery revascularization – analysis of 300 cases

    PubMed Central

    Zhang, Lufeng; Cui, Zhongqi; Song, Zhiming; Yang, Hang; Fu, Yuanhao; Gong, Yichen

    2015-01-01

    Introduction Minimally invasive direct coronary artery bypass (MIDCAB) grafting is performed via small, left anterolateral thoracotomy. The left internal mammary artery was grafted to the left anterior descending (LAD) artery in 300 consecutive patients. Aim In-hospital results were evaluated and compared with the conventional, off-pump coronary artery bypass graft procedure. Material and methods One hundred and sixty-three (54.33%) of 300 patients underwent staged hybrid coronary revascularization, 93 (31%) were treated for a single LAD lesion, and 44 (14.67%) were treated for multi-vessel disease with reasonably incomplete revascularization. Major in-hospital cardiac adverse events and postoperative data were compared between groups. Results Preoperative data were similar between groups. However, the difference in left ventricular ejection fraction (p < 0.001) was significant. No conversions to sternotomy occurred during the primary MIDCAB procedures. Shorter operation time (p < 0.001), shorter postoperative mechanical ventilation time (p < 0.001), shorter intensive care unit stay (p < 0.001), and less red blood cell transfusion (p < 0.001) were noted in the MIDCAB group. Postoperative coronary angiography conducted in the MIDCAB group within one week after the operation showed that 2 of 163 patients developed graft occlusion. These patients underwent conventional CABG and recovered well. No significant differences were observed in postoperative MI, delayed wound healing or 30-day in-hospital mortality between the two groups. Conclusions The use of a chest wall lifting system and modified stabilizer makes the MIDCAB procedure safer and easier. The MIDCAB procedure is demonstrated to be a feasible and minimally invasive alternative for patients with coronary artery disease involving LAD lesions. PMID:26865891

  8. Preoperative atrial fibrillation is an independent risk factor for mid-term mortality after concomitant aortic valve replacement and coronary artery bypass graft surgery

    PubMed Central

    Saxena, Akshat; Dinh, Diem; Dimitriou, Jim; Reid, Christopher; Smith, Julian; Shardey, Gilbert; Newcomb, Andrew

    2013-01-01

    OBJECTIVES Preoperative atrial fibrillation (PAF) has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery. Few studies, however, have evaluated the impact of PAF on early and mid-term outcomes after concomitant aortic valve replacement and coronary aortic bypass graft (AVR-CABG) surgery. METHODS Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program was retrospectively analysed. Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded. Demographic and operative data were compared between patients undergoing concomitant AVR-CABG who presented with PAF and those who did not using chi-square and t-tests. The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression, respectively. RESULTS Concomitant AVR-CABG surgery was performed in 2563 patients; 322 (12.6%) presented with PAF. PAF patients were generally older (mean age 76 vs 74 years; P < 0.001) and presented more often with comorbidities including congestive heart failure, chronic pulmonary disease and cerebrovascular disease (all P < 0.05). PAF was associated with 30-day mortality on univariate analysis (P = 0.019) but not multivariate analysis (P = 0.53). The incidence of early complications was not significantly higher in the PAF group. PAF was independently associated with reduced mid-term survival (HR, 1.58; 95% CI, 1.14–2.19; P = 0.006). CONCLUSIONS PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery. Patients with PAF undergoing AVR-CABG should be considered for a concomitant surgical ablation procedure. PMID:23287590

  9. Three-Year Clinical and Angiographic Outcomes After Everolimus-Eluting Stent Implantation in Patients With a History of Coronary Artery Bypass Grafting.

    PubMed

    Nomura, Takahiro; Suzuki, Nobuaki; Takamura, Shintaro; Kyono, Hiroyuki; Kozuma, Ken

    2016-03-22

    The clinical and angiographic outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stent (EES) implantation in patients with a history of coronary artery bypass grafting (CABG) have yet to be fully investigated. The aim of the present study was to investigate 3-year clinical outcomes after EES implantation in patients with a history of CABG.We retrospectively enrolled 176 consecutive patients who had undergone EES implantation. Three-year clinical follow-up data were obtained from all patients. Follow-up angiograms and serial quantitative coronary angiography analysis (QCA) were performed for 139 (79.0%) patients. Patients from the prior CABG (+) group (n = 17; 9.7%) had higher incidences of target lesion revascularization (TLR; 41.2% versus 3.8%, P < 0.001) and major adverse cardiac events (47.1% versus 15.1%, P = 0.004). A landmark analysis conducted 1 year into our study showed a higher incidence of TLR in the prior CABG (+) group (20.0% versus 3.0%, P = 0.017).The reason for EES implantation in the prior CABG (+) group was saphenous vein graft (SVG) failure in 19 (79.2%) lesions, although the target vessel was the SVG in 8 (33.3%) lesions. There were no significant differences in clinical and follow-up QCA data between the native vessel and SVG PCI groups.This study revealed that a history of CABG was a risk factor for TLR after EES implantation. The major reason for PCI after CABG was SVG failure; both native vessel and SVG PCI showed poor outcomes. Further investigations may be warranted to determine which interventions are most effective in this high-risk subset. PMID:26973268

  10. Vein graft failure

    PubMed Central

    Owens, Christopher D.; Gasper, Warren J.; Rahman, Amreen S.; Conte, Michael S

    2013-01-01

    Following the creation of an autogenous lower extremity bypass graft, the vein must undergo a series of dynamic structural changes to stabilize the arterial hemodynamic forces. These changes, commonly referred to as remodeling, include an inflammatory response, the development of a neointima, matrix turnover, and cellular proliferation and apoptosis. The sum total of these processes results in dramatic alterations in the physical and biomechanical attributes of the arterialized vein. The most clinically obvious and easily measured of these is lumen remodeling of the graft. However, though somewhat less precise, wall thickness, matrix composition, and endothelial changes can be measured in vivo within the healing vein graft. Recent translational work has demonstrated the clinical relevance of remodeling as it relates to vein graft patency and the systemic factors influencing it. By correlating histologic and molecular changes in the vein, insights into potential therapeutic strategies to prevent bypass failure and areas for future investigation are explored. PMID:24095042

  11. Improved perioperative neurological monitoring of coronary artery bypass graft patients reduces the incidence of postoperative delirium: the Haga Brain Care Strategy

    PubMed Central

    Palmbergen, Wijnand A.C.; van Sonderen, Agnes; Keyhan-Falsafi, Ali M.; Keunen, Ruud W.M.; Wolterbeek, Ron

    2012-01-01

    OBJECTIVES Postoperative delirium is a major cause of morbidity and mortality after cardiovascular surgery. Risk factors for postoperative delirium include poor cerebral haemodynamics and perioperative cerebral desaturations. Our aim was to reduce the postoperative delirium rate by using a new prevention strategy called the Haga Brain Care Strategy. This study evaluates the efficacy of the implementation of the Haga Brain Care Strategy to reduce the postoperative delirium rate after elective coronary artery bypass graft (CABG) procedures. The primary endpoint was the postoperative delirium rate, and the secondary endpoint was the length of stay in the intensive care unit. METHODS The Haga Brain Care Strategy consisted of the conventional screening protocol for delirium with the addition of preoperative transcranial Doppler examinations, perioperative cerebral oximetry, modified Rankin score, delirium risk score and (if indicated) duplex examination of the carotid arteries. In case of poor preoperative haemodynamics, the cerebral blood flow was optionally optimized by angioplasty or the patient was operated on under mild hypothermic conditions. Perioperative cerebral desaturations >20% outside the normal range resulted in intervention to restore cerebral oxygenation. Cerebral oximetry was discontinued when patients regained consciousness. Patients undergoing elective CABG procedures in 2010 were compared with patients scheduled for coronary bypass graft procedures in 2009 who had not been exposed to additional Haga Brain Care Strategy assessment. RESULTS A total of 233 and 409 patients were included in 2009 and 2010, respectively. The number of patients subjected in 2010 to transcranial Doppler examinations, cerebral oximetry or both (Haga Brain Care Strategy) were 262 (64.1%), 201 (49.1%) and 139 (34.0%), respectively. The overall rate of postoperative delirium decreased from 31 (13.3%) in 2009 to 30 (7.3%) in 2010 (P = 0.019). A binary logistic regression model showed that the Haga Brain Care Strategy was an independent predictor of a reduced risk of developing a postoperative delirium (odd ratio = 0.37, P = 0.021). CONCLUSIONS With the implementation of the Haga Brain Care Strategy in 2010, a reduction of the incidence of postoperative delirium in patients undergoing elective CABG procedures was observed. In addition, the length of stay in the intensive care unit showed an overall tendency to decline. The limited number of observations and the current study design do not allow a full evaluation of the Haga Brain Care Strategy but the data support the idea that a sophisticated preoperative assessment of cerebral haemodynamics and perioperative monitoring of cerebral oximetry reduce the incidence of the postoperative delirium in CABG surgery. PMID:22778141

  12. Coronary artery bypass grafting in high-RISk patients randomised to off- or on-Pump surgery: a randomised controlled trial (the CRISP trial).

    PubMed Central

    Rogers, Chris A; Pike, Katie; Campbell, Helen; Reeves, Barnaby C; Angelini, Gianni D; Gray, Alastair; Altman, Doug G; Miller, Helen; Wells, Sian; Taggart, David P

    2014-01-01

    BACKGROUND Coronary artery bypass grafting (CABG) is the treatment of choice for patients with multivessel coronary artery disease (CAD). Evidence from randomised controlled trials (RCTs) in low-risk populations shows that 'off-pump' CABG is at least as safe as 'on-pump' CABG, but high-quality trial data in high-risk populations are lacking. OBJECTIVES To test the hypothesis that, in high-risk patients, off-pump coronary artery bypass grafting (OPCABG) reduces mortality and morbidity without causing a higher risk of reintervention compared with on-pump coronary artery bypass grafting (ONCABG). DESIGN Open parallel-group RCT with a 1 : 1 allocation ratio and expertise-based randomisation. SETTING Eight specialist cardiac surgery centres in the UK and one specialist centre in Kolkata, India. PARTICIPANTS Patients with an additive European system for cardiac operative risk evaluation score (EuroSCORE) of ≥ 5, undergoing non-emergency isolated CABG via a median sternotomy. INTERVENTIONS CABG without cardiopulmonary bypass (CPB), i.e. OPCABG on the beating heart, or CABG with CPB, i.e. ONCABG on a chemically arrested heart. MAIN OUTCOME MEASURES Primary outcome - a composite of death or serious morbidity [all-cause mortality, myocardial infarction (MI), stroke, prolonged initial ventilation, sternal wound dehiscence] within 30 days of surgery. Secondary outcomes - quality of life (QoL) [Rose Angina Questionnaire, Canadian Cardiovascular Society (CCS) angina class, European QoL-5 Dimensions (EQ-5D), Coronary Revascularisation Outcome Questionnaire (CROQ)] and resource utilisation. RESULTS The organisation of a tertiary cardiac surgery service in the UK presented several barriers to recruitment. Referral information was often inadequate to confirm eligibility. Limited surgeon participation at a centre, the need to meet referral-to-treatment performance targets and complex referral pathways did not support an expertise-based allocation. Urgent patients waiting for surgery in local 'feeder' hospitals were often not transferred until late the night before surgery, which limited the time available to take consent and organise the surgery on an expertise basis. Several elective patients declined to take part because they wanted the surgeon they had met when the surgery was first discussed in clinic to operate. Several initiatives were explored to boost recruitment. After 10 months of recruitment, the trial design was modified to permit both within-surgeon and expertise-based randomisation within a centre. However, this did not have sufficient impact and the trial was stopped on the grounds of futility after 106 patients (< 2% of the target sample size) had been recruited in 18 months. Ninety-eight patients were included in the trial analyses, six patients were withdrawn and two died before surgery. In both groups, 6% of patients experienced the primary outcome [adjusted odds ratio (OR) (OPCABG to ONCABG) 1.07; 95% confidence interval (CI) 0.27 to 4.14]. QoL scores at 4-8 weeks post surgery were similar in the two groups. Patients randomised to OPCABG had a shorter stay in the intensive care unit and in hospital after surgery (median 26.0 vs. 27.7 hours in intensive care and 7 vs. 8 days in hospital). CONCLUSIONS The Coronary artery bypass grafting in high-RISk patients randomised to off- or on-Pump surgery (CRISP) trial was not successful for a range of logistical reasons. However, the experience gained is of value for the design and conduct of future trials. The surgical community have polarised views. A qualitative evaluation of the reasons behind the views held by the advocates of the two techniques is an area for future research. TRIAL REGISTRATION Current Controlled Trials ISRCTN29161170. FUNDING This project was funded by the Medical Research Council/National Institute for Health Research (NIHR) Efficacy and Mechanism Evaluation programme and will be published in full in Health Technology Assessment; Vol. 18, No. 44. See the NIHR Journals Library website for further project information. PMID:25023641

  13. Effect of novel modified bipolar radiofrequency ablation for preoperative atrial fibrillation combined with off-pump coronary artery bypass grafting surgery.

    PubMed

    Jiang, Zhaolei; Ma, Nan; Tang, Min; Liu, Hao; Ding, Fangbao; Yin, Hang; Mei, Ju

    2015-11-01

    We described a novel modified bipolar radiofrequency (RF) ablation for preoperative atrial fibrillation (AF) combined with off-pump coronary artery bypass grafting (OPCABG) for patients with AF and coronary artery disease (CAD). The aim of this study was to assess the effect of this novel procedure and to determine whether it can eliminate AF for CAD patients. From January 2007 to June 2013, 45 patients (26 male patients) with AF (9 paroxysmal, 17 persistent, and 19 long-standing persistent) and CAD underwent the novel modified bipolar RF ablation combined with OPCABG in our department. After median sternotomy, the modified bipolar RF ablation and OPCABG were performed on beating heart without cardiopulmonary bypass. Pulmonary vein isolation and left atrium ablation were achieved using a bipolar RF champ. Mitral annular lesion and ganglionic plexus were ablated with a bipolar RF pen. The left atrial appendage was excluded using a surgical stapler. 24 h holter monitoring and echocardiography were performed at discharge and 3, 6, 12 months postoperatively as well as every year thereafter. The modified bipolar RF ablation and OPCABG were performed successfully in all patients. Mean AF ablation time was 33.6 ± 4.2 min, and mean OPCABG time was 87.6 ± 13.3 min. Mean postoperative hospital stay was 12.6 ± 5.5 days. The maintenance of sinus rhythm was 95.6 % (43/45) at discharge. There was no early death and permanent pacemaker implantation in perioperation. At a mean follow-up of 29.8 ± 10.2 months, 38 of 45 (84.4 %) patients were in sinus rhythm. Follow-up TTE at 6 months postoperatively showed that left atrial diameter was significantly reduced and left ventricular ejection fraction was significantly increased. The novel modified bipolar RF ablation procedure was safe, feasible and effective. It may be useful in selecting the best ablation approaches for patients with AF and CAD. PMID:24820449

  14. Time-driven activity-based costing of multivessel coronary artery bypass grafting across national boundaries to identify improvement opportunities: study protocol

    PubMed Central

    Erhun, F; Mistry, B; Platchek, T; Milstein, A; Narayanan, V G; Kaplan, R S

    2015-01-01

    Introduction Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease—a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32 201±$23 059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery. Methods and analysis We use time-driven activity-based costing (TDABC) to quantify the hospitals’ costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labour and non-labour resources utilised to perform each activity) with the unit cost of each resource used to provide the care. Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews. Unit costs were calculated as a capacity cost rate, measured as a $/min, for each resource consumed in CABG production. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost of CABG production at each site. We will conclude by conducting a variance analysis of labour costs to reveal opportunities to bend the cost curve for CABG production in the USA. Ethics and dissemination All our methods were exempted from review by the Stanford Institutional Review Board. Results will be published in peer-reviewed journals and presented at scientific meetings. PMID:26307621

  15. Compliant electrospun silk fibroin tubes for small vessel bypass grafting.

    PubMed

    Marelli, Benedetto; Alessandrino, Antonio; Farè, Silvia; Freddi, Giuliano; Mantovani, Diego; Tanzi, Maria Cristina

    2010-10-01

    Processing silk fibroin (SF) by electrospinning offers a very attractive opportunity for producing three-dimensional nanofibrillar matrices in tubular form, which may be useful for a biomimetic approach to small calibre vessel regeneration. Bypass grafting of small calibre vessels, with a diameter less than 6mm, is performed mainly using autografts, like the saphenous vein or internal mammary artery. At present no polymeric grafts made of SF are commercially available, mainly due to inadequate properties (low compliance and lack of endothelium cells). The aim of this work was to electrospin SF into tubular structures (Ø=6mm) for small calibre vessel grafting, characterize the morphological, chemico-physical and mechanical properties of the electrospun SF structures and to validate their potential to interact with cells. The morphological properties of electrospun SF nanofibres were investigated by scanning electron microscopy. Chemico-physical analyses revealed an increase in the crystallinity of the structure of SF nanofibres on methanol treatment. Mechanical tests, i.e. compliance and burst pressure measurements, of the electrospun SF tubes showed that the inner pressure to radial deformation ratio was linear for elongation up to 15% and pressure up to 400 mm Hg. The mean compliance value between 80 and 120 mm Hg was higher than the values reported for both Goretex(R) and Dacron(R) grafts and for bovine heterografts, but still slightly lower than those of saphenous and umbilical vein, which nowadays represent the gold standard for the replacement of small calibre arteries. The electrospun tubes resisted up to 575+/-17 mmHg, which is more than four times the upper physiological pressure of 120 mmHg and more than twice the pathological upper pressures (range 180-220 mmHg). The in vitro tests showed a good cytocompatibility of the electrospun SF tubes. Therefore, the electrospun SF tubes developed within this work represent a suitable candidate for small calibre blood vessel replacement. PMID:20466080

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

    PubMed Central

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

    2013-01-01

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

  17. Accuracy of cardiac output measurements during off-pump coronary artery bypass grafting: according to the vessel anastomosis sites

    PubMed Central

    Park, Sung Yong; Kim, Dae Hee; Joe, Han Bum; Yoo, Ji Young; Kim, Jin Soo; Kang, Min

    2012-01-01

    Background During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites. Methods This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO. Results CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques. Conclusions In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB. PMID:22679538

  18. Management of the left subclavian artery during endovascular repair of the thoracic aorta.

    PubMed

    Noor, Nadim; Sadat, Umar; Hayes, Paul D; Thompson, Matthew M; Boyle, Jonathan R

    2008-04-01

    Endovascular repair is rapidly becoming the treatment of choice for thoracic aortic disease, which oftentimes involves or lies in close proximity to the left subclavian artery (LSA). In order to extend the proximal landing zone for the stent-graft and obtain an adequate seal, the LSA ostium is often covered, with or without concomitant subclavian artery revascularization. In this article, we review the LSA anatomy and consequences of LSA coverage as a backdrop for a discussion of the ramifications of LSA coverage during endovascular thoracic aortic repair (TEVAR). Early series reported high rates of LSA revascularization as an adjunct to endovascular repair for aortic pathology adjacent to the LSA ostium. Initial reports of low morbidity associated with simple LSA ostium coverage are not supported by contemporary literature, which suggests revascularization reduces the risks of cerebrovascular accident and spinal cord ischemia. Coverage of the LSA without revascularization may be justified only in emergency situations or when thorough investigations of cerebral and vertebrobasilar circulation have concluded that the risk to brain and spinal cord is low. Subclavian revascularization should be considered in the presence of a dominant left vertebral artery, bilateral carotid artery disease, an occluded/stenosed right vertebral artery, presence of a left internal mammary artery graft, or when a long length of thoracic aorta is covered. PMID:18426279

  19. Implantation of a Novel Allogeneic Mesenchymal Precursor Cell Type in Patients with Ischemic Cardiomyopathy Undergoing Coronary Artery Bypass Grafting: an Open Label Phase IIa Trial.

    PubMed

    Anastasiadis, Kyriakos; Antonitsis, Polychronis; Westaby, Stephen; Reginald, Ajan; Sultan, Sabena; Doumas, Argirios; Efthimiadis, George; Evans, Martin John

    2016-06-01

    Heart failure is a life-limiting condition affecting over 40 million patients worldwide. Ischemic cardiomyopathy (ICM) is the most common cause. This study investigates in situ cardiac regeneration utilizing precision delivery of a novel mesenchymal precursor cell type (iMP) during coronary artery bypass surgery (CABG) in patients with ischemic cardiomyopathy (LVEF < 40 %). The phase IIa safety study was designed to enroll 11 patients. Preoperative scintigraphy imaging (SPECT) was used to identify hibernating myocardium not suitable for conventional myocardial revascularization for iMP implantation. iMP cells were implanted intramyocardially in predefined viable peri-infarct areas that showed poor perfusion, which could not be grafted due to poor target vessel quality. Postoperatively, SPECT was then used to identify changes in scar area. Intramyocardial implantation of iMP cells with CABG was safe with preliminary evidence of efficacy of improved myocardial contractility and perfusion of nonrevascularized territories resulting in a significant reduction in left ventricular scar area at 12 months after treatment. Clinical improvement was associated with a significant improvement in quality of life at 6 months posttreatment in all patients. The results suggest the potential for in situ myocardial regeneration in ischemic heart failure by delivery of iMP cells. PMID:27037806

  20. Preoperative factors affecting cost and length of stay for isolated off-pump coronary artery bypass grafting: hierarchical linear model analysis

    PubMed Central

    Shinjo, Daisuke; Fushimi, Kiyohide

    2015-01-01

    Objective To determine the effect of preoperative patient and hospital factors on resource use, cost and length of stay (LOS) among patients undergoing off-pump coronary artery bypass grafting (OPCAB). Design Observational retrospective study. Settings Data from the Japanese Administrative Database. Participants Patients who underwent isolated, elective OPCAB between April 2011 and March 2012. Primary outcome measures The primary outcomes of this study were inpatient cost and LOS associated with OPCAB. A two-level hierarchical linear model was used to examine the effects of patient and hospital characteristics on inpatient costs and LOS. The independent variables were patient and hospital factors. Results We identified 2491 patients who underwent OPCAB at 268 hospitals. The mean cost of OPCAB was $40 665 ±7774, and the mean LOS was 23.4±8.2 days. The study found that select patient factors and certain comorbidities were associated with a high cost and long LOS. A high hospital OPCAB volume was associated with a low cost (−6.6%; p=0.024) as well as a short LOS (−17.6%, p<0.001). Conclusions The hospital OPCAB volume is associated with efficient resource use. The findings of the present study indicate the need to focus on hospital elective OPCAB volume in Japan in order to improve cost and LOS. PMID:26576810

  1. A meta-analysis of randomized trials for repeat revascularization following off-pump versus on-pump coronary artery bypass grafting.

    PubMed

    Takagi, Hisato; Mizuno, Yusuke; Niwa, Masao; Goto, Shin-nosuke; Umemoto, Takuya

    2013-11-01

    To determine whether repeat revascularization rates are increased following off-pump coronary artery bypass grafting (CABG), we performed a meta-analysis of randomized controlled trials of off-pump vs on-pump CABG. Databases including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through March 2013 using web-based search engines (PubMed, OVID). Studies considered for inclusion met the following criteria: the design was a prospective randomized controlled clinical trial; the study population was patients undergoing CABG; patients were randomly assigned to off-pump vs on-pump CABG and outcomes included repeat revascularization rates at ?1 year. Our exhaustive search identified 12 prospective randomized controlled trials of off-pump vs on-pump CABG. Pooled analysis demonstrated a statistically significant 38% increase in repeat revascularization rates with off-pump relative to on-pump CABG in the fixed-effects model (odds ratio, 1.38; 95% confidence interval, 1.09-1.76; P = 0.008). In general, exclusion of any single trial from the analysis did not substantively alter the overall result of our analysis. There was no evidence of significant publication bias. The results of our analysis suggest that off-pump CABG may increase repeat revascularization rates by 38% over on-pump CABG. PMID:23876842

  2. A meta-analysis of adjusted risk estimates for survival from observational studies of complete versus incomplete revascularization in patients with multivessel disease undergoing coronary artery bypass grafting.

    PubMed

    Takagi, Hisato; Watanabe, Taku; Mizuno, Yusuke; Kawai, Norikazu; Umemoto, Takuya

    2014-05-01

    To determine whether coronary artery bypass grafting (CABG) with complete revascularization improves survival in patients with multivessel disease (MVD) over CABG with incomplete revascularization, we performed a meta-analysis of adjusted (but not unadjusted) risk estimates from observational studies. Databases including MEDLINE and EMBASE were searched through October 2013 using Web-based search engines (PubMed, OVID). Eligible studies were observational studies of complete- versus incomplete-revascularization CABG enrolling ? 100 patients with MVD in each treatment arm and reporting an adjusted hazard ratio for follow-up mortality. Mixed-effects meta-regression analyses were performed to determine whether the effects of complete-revascularization CABG on survival were modulated by the prespecified factors. Fourteen observational studies enrolling 30 389 patients were identified and included. A pooled analysis demonstrated a statistically significant 37% reduction in follow-up mortality with complete- relative to incomplete-revascularization CABG (hazard ratio, 0.63; 95% confidence interval, 0.53-0.75; P < 0.00001). Although meta-regression coefficients were not statistically significant for mean follow-up duration and age and proportion of men and patients undergoing off-pump CABG, that for proportion of patients with diabetes was significantly negative (P = 0.03), which would indicate that as patients with diabetes increase, complete-revascularization CABG is more beneficial for survival. In conclusion, complete-revascularization CABG appears to improve survival over incomplete-revascularization CABG in patients with MVD. PMID:24532310

  3. Concomitant off-pump coronary artery bypass grafting and total thyroidectomy for a large retrosternal goitre: a case report and review of the literature

    PubMed Central

    Lau, Man Chi; Mhandu, Peter; Parissis, Haralabos

    2016-01-01

    A 76-year-old male presented with angina and a large retrosternal goitre causing marked dyspnoea. Coronary angiography revealed triple vessel disease and moderately impaired left ventricular function. CT imaging demonstrated a substantial multinodular goitre extending into the posterior mediastinum to the level of the carina, with associated compression of the trachea and oesophagus. Preoperative thyroid function tests showed euthyroid state. The patient subsequently underwent off-pump coronary artery bypass grafting (OPCABG) ×2 with concomitant total thyroidectomy. A thyroid mass of dimensions 19 cm × 16 cm × 5.5 cm and weight 439 g was confirmed to be a multinodular goitre. Postoperative complications included bilateral recurrent laryngeal nerve damage, hypocalcaemia and ventilator-associated pneumonia. The patient was discharged 36 days postoperatively and remained asymptomatic at 1 year follow up. This case provides further evidence that concomitant OPCABG and thyroidectomy for the treatment of large retrosternal goitre can be safely and effectively performed, provided that perioperative levels of thyroid hormones are maintained at euthyroid or hypothyroid levels. PMID:27162701

  4. Comparison of the Effect of Anesthesia With Midazolam-Fentanyl Versus Propofol-Remifentanil on Bispectral Index in Patients Undergoing Coronary Artery Bypass Graft

    PubMed Central

    Hemmati, Naser; Zokaei, Abdol Hamid

    2015-01-01

    The aim of this study was to compare the effect of anesthesia with midazolam-fentanyl versus propofol-remifentanil on the BIS (bispectral index) in patients undergoing coronary artery bypass grafting (CABG). Sixty-four patients undergoing CABG were randomly assigned to one of two study groups: midazolam-fentanyl (MF, N= 32) or propofol-remifentanil (PR, N= 32). The BIS was measured before induction of anesthesia, five minutes after induction of anesthesia, at skin incision, sternotomy, pericardiotomy, aorta cannulation, onset of cardiopulmonary bypass, during rewarming, five minutes after separation from cardiopulmonary bypass, at thorax closure, and at the end of the surgery. There were no significant differences between the two groups with regard to age and gender. The difference in mean BIS between the two groups was significant (P < 0.05) at all times, except before induction, five minutes after induction, at skin incision and on rewarming. Changes in the BIS were lower in the PR group than in the MF group. Both techniques can provide adequate anesthesia in patients undergoing CABG. However, the probability of awareness during anesthesia is lower with propofol-remifentanil than with midazolam-fentanyl. PMID:26156911

  5. Fast simulations of patient-specific haemodynamics of coronary artery bypass grafts based on a POD-Galerkin method and a vascular shape parametrization

    NASA Astrophysics Data System (ADS)

    Ballarin, Francesco; Faggiano, Elena; Ippolito, Sonia; Manzoni, Andrea; Quarteroni, Alfio; Rozza, Gianluigi; Scrofani, Roberto

    2016-06-01

    In this work a reduced-order computational framework for the study of haemodynamics in three-dimensional patient-specific configurations of coronary artery bypass grafts dealing with a wide range of scenarios is proposed. We combine several efficient algorithms to face at the same time both the geometrical complexity involved in the description of the vascular network and the huge computational cost entailed by time dependent patient-specific flow simulations. Medical imaging procedures allow to reconstruct patient-specific configurations from clinical data. A centerlines-based parametrization is proposed to efficiently handle geometrical variations. POD-Galerkin reduced-order models are employed to cut down large computational costs. This computational framework allows to characterize blood flows for different physical and geometrical variations relevant in the clinical practice, such as stenosis factors and anastomosis variations, in a rapid and reliable way. Several numerical results are discussed, highlighting the computational performance of the proposed framework, as well as its capability to carry out sensitivity analysis studies, so far out of reach. In particular, a reduced-order simulation takes only a few minutes to run, resulting in computational savings of 99% of CPU time with respect to the full-order discretization. Moreover, the error between full-order and reduced-order solutions is also studied, and it is numerically found to be less than 1% for reduced-order solutions obtained with just O(100) online degrees of freedom.

  6. Comparison of ventilatory and haemodynamic effects of BIPAP and S-IMV/PSV for postoperative short-term ventilation in patients after coronary artery bypass grafting.

    PubMed

    Kazmaier, S; Rathgeber, J; Buhre, W; Buscher, H; Busch, T; Mensching, K; Sonntag, H

    2000-10-01

    The aim of the present multiple cross-over study was to compare the effects of biphasic positive airway pressure (BIPAP) ventilation with synchronized intermittent mandatory ventilation combined with pressure support ventilation (S-IMV/PSV) in sedated and awake patients after coronary artery bypass grafting (CABG) surgery. Twenty-four patients with no evidence of preoperative respiratory dysfunction and an uncomplicated intraoperative course were investigated. The patients were randomly assigned to one of two groups starting with either BIPAP or S-IMV/PSV mode. Haemodynamic measurements and blood gas analyses were performed during sedation with 2.0 mg kg(-1) h(-1) propofol in the primary mode, after switching to the alternative ventilatory mode, and in the primary mode again. The same sequence of measurements was repeated in awake patients who had reached extubation criteria. In awake patients, PSV was performed instead of S-IMV. Statistical analysis of data was performed using non-parametric tests. Inspiratory peak pressure increased significantly during S-IMV/PSV in sedated patients in both groups. Other ventilatory parameters did not differ significantly between BIPAP and S-IMV/PSV in both groups. Similarly, haemodynamic parameters and blood-gas analyses did not vary with the ventilatory mode. Our results demonstrate that BIPAP ventilation has comparable effects on haemodynamics and pulmonary gas exchange compared with S-IMV/PSV and PSV when used for short-term ventilatory support in patients after cardiac surgery. PMID:11050517

  7. Transradial Coronary Intervention Versus Coronary Artery Bypass Grafting for Unprotected Left Main and/or Multivessel Disease in Patients With Acute Coronary Syndrome.

    PubMed

    Gao, Fei; Zhou, Yu Jie; Wang, Zhi Jian; Yan, Zhen Xian; Liu, Xiao Li; Shen, Hua

    2016-01-01

    The overall safety and efficacy of transradial coronary intervention (TRI) versus coronary artery bypass grafting (CABG) for patients with unprotected left main (UPLM) disease and/or multivessel coronary disease (MVD) presenting with acute coronary syndrome (ACS) have not been established. Consecutive patients with ACS undergoing TRI with drug-eluting stent (n = 1431) or CABG (n = 651) for UPLM and/or MVD were included. A propensity-score matching was performed to adjust for differences in baseline characteristics between the 2 cohorts, yielding 524 pairs of matched patients. Median clinical follow-up was 32 months. After propensity-score adjustment, no significant difference was observed between the TRI and CABG groups in all-cause mortality (4.0% vs 5.2%; P = .375). Transradial coronary intervention was favored by a significant increase in the incidence of stroke in the CABG group (0.4% vs 1.9%; P = .020), whereas a significantly increased target vessel revascularization rate (16.8% vs 6.3%; P < .0001) observed in the TRI group favored CABG. Composite outcome (death/myocardial infarction/stroke) was comparable between the TRI and the CABG groups (8.0% vs 11.5%; P = .061). Clinical outcomes of TRI on UPLM and/or MVD for patients with ACS are comparable to CABG in composite safety outcomes with the advantage to TRI for avoiding a stroke. PMID:25818105

  8. Comparison of the Complications between Left Side and Right Side Subclavian Vein Catheter Placement in Patients Undergoing Coronary Artery Bypass Graft Surgery

    PubMed Central

    Tarbiat, Masoud; Manafi, Babak; Davoudi, Maryam; Totonchi, Ziae

    2014-01-01

    Introduction: Percutaneous subclavian vein catheterization is one of the most common invasive procedures performed in cardiac surgery. The aim of this study was to compare left and right subclavian vein catheter placement via the infraclavicular approach in patients who undergo coronary artery bypass graft (CABG) surgery. Methods: This prospective, randomized clinical trial was performed in193 patients. The technique applied for cannulation was infraclavicular approach for both the right and the left sides. Subclavian vein of other side was attempted only when catheterization at initial side was unsuccessful at two attempts. The success and complication rates were compared for the two sides. Results: On193 patients, catheterization attempts were performed. Overall 177 catheterizations (91.7%) were successful during the first attempt, 105 (92.1%) on the right side and 72 (91.1%) on the left side. There was no significant difference between success rate and side of catheterization. Malposition of the catheter tip on the right side (9.6%) was significantly more than the left side (0%) (P= 0.003). The differences in other complications on two sides were statistically insignificant. Conclusion: Compared with the right side, insertion of the cannula on the left side resulted in fewer catheter tip misplacements. Incidence of cannulation failure and other complications were similar on both sides. PMID:25320661

  9. Neurological Complications Comparing Endoscopically vs. Open Harvest of the Radial Artery

    ClinicalTrials.gov

    2015-02-28

    Complications Due to Coronary Artery Bypass Graft; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Heart Diseases; Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases

  10. Mini-extracorporeal circulation minimizes coagulation abnormalities and ameliorates pulmonary outcome in coronary artery bypass grafting surgery.

    PubMed

    Zeitani, J; Buccisano, F; Nardella, S; Flaminio, M; Prati, P; Chiariello, G; Venditti, A; Chiariello, L

    2013-07-01

    Hemostasis is impaired during CABG and coagulation abnormalities often result in clinically relevant organ dysfunctions, eventually increasing morbidity and mortality rates. Fifteen consecutive patients with coronary artery disease submitted to conventional extracorporeal circulation (cECC) have been compared with 15 matched patients, using mini-ECC (MECC). Postoperative lung function was evaluated according to gas exchange, intubation time and lung injury score. In the MECC group, thrombin-antithrombin complex levels (TaTc), prothrombin fragments (PF1+2) formation and thromboelastography (TEG) clotting times were lower compared to the cECC group (p=0.002 and p<0.001, respectively) whereas postoperative blood loss was higher in the cECC group (p=0.030) and more patients required blood transfusion (p=0.020). In the MECC group, postoperative gas exchange values were better, intubation time shorter and lung injury score lower (p<0.001 for all comparisons). Our study suggests that MECC induces less coagulation disorders, leading to lower postoperative blood loss and better postoperative lung function. This approach may be advantageous in high-risk patients. PMID:23411504

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

    SciTech Connect

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

    1982-11-01

    Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The right anterior oblique gated first-pass technique was used to assess LVEF response to maximal exercise (Wmax), while the left anterior oblique equilibrium-gated technique was used to assess LVEF and relative LV volume changes during graded submaximal exercise. Mean LVEF was unchanged at rest after CABG by both the first-pass (60 +/- 12% vs 60 +/- 12%) and equilibrium-gated (61 +/- 13% vs 62 +/- 13%) measurements. At Wmax, mean first-pass LVEF was significantly higher postoperatively than preoperatively (63 +/- 17% vs 53 +/- 17%; p less than 0.01) with a higher Wmax (750 +/- 182 vs 590 +/- 202 kpm/min; p less than 0.001) and higher rate-pressure product (302 +/- 59 vs 222 +/- 57 units; p less than 0.001). Similarly, equilibrium-gated LVEF levels during graded exercise, using stepwise regression analysis, were significantly higher postoperatively than preoperatively (p less than 0.001); at the highest graded work load, they averaged 63 +/- 19% postoperatively and 53 +/- 17% preoperatively, with higher work loads (500 +/- 190 vs 417 +/- 155; p less than 0.05) and higher rate-pressure products (271 +/- 55 vs 207 +/- 53; p less than 0.001). The increase in exercise LVEF after surgery was due to a marked decrease in the ratio, relative to resting values, of counts-based end-systolic volumes during submaximal exercise (preoperatively 1.91 +/- 1.04; postoperatively 1.14 +/- 0.46; p less than 0.01). The five subjects in whom LVEF decreased significantly during exercise postoperatively all had one or more blocked or stenosed grafts. This study documents, by two independent radionuclide techniques, an improved LVEF during exercise at an increased maximal work capacity and rate-pressure product 3 months after successful CABG.

  12. High-sensitivity cardiac troponin T is more helpful in detecting peri-operative myocardial injury and apoptosis during coronary artery bypass graft surgery

    PubMed Central

    Kocak, Emel Fatma; Altuntas, Irfan; Kocak, Cengiz; Aksoy, Ahmet; Ozdomanic, Ibrahim Fevzi; Isiklar, Ozden Ozben; Akcilar, Raziye; Unsal, Cevher; Celenk, Merve

    2015-01-01

    Summary Aim To determine whether there is a correlation between cardiac markers and peri-operative myocardial injury (PMI) and apoptosis in coronary artery bypass graft (CABG) surgery and to compare the efficacy of cardiac markers to detect PMI. Methods The study population consisted of 37 patients (24 male, 13 female, mean age 63.4 ± 8.9 years) undergoing elective CABG. Arterial and coronary sinus blood samples were collected just before aortic cross-clamping (pre-ACC) and after aortic declamping (post-ACC). Creatine kinase-MB isoenzyme (CK-MB) activity, and high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase-MB isoenzyme mass (CK-MB mass) and cardiac troponin I (cTnI) concentrations were measured in blood samples. Myocardial injury and apoptosis were examined in atrial biopsies. Results CABG caused PMI and apoptosis in all cases. Concentrations and net releases of cardiac markers significantly increased after aortic declamping (p < 0.001 for CK-MB and CK-MB mass, p < 0.01 for cTnI, p < 0.05 for hs-cTnT). A positive correlation was found between apoptotic index (r = 0.611, p < 0.001 for cTnI; r = 0.806, p < 0.001 for hs-cTnT), myocardial injury score (r = 0.544, p < 0.001 for cTnI; r = 0.719, p < 0.001 for hs-cTnT) and cTnI and hs-cTnT values in the post-ACC period. A positive correlation was found between apoptotic index (r = 0.507, p < 0.001), myocardial injury score (r = 0.416, p = 0.010) and net release of hs-cTnT. Furthermore, a positive correlation was found between aortic cross-clamp (ACC) time (r = 0.448, p = 0.007), cardiopulmonary bypass (CPB) time (r = 0.342, p = 0.047) and net release of hs-cTnT. Conclusion Although both cTnI and hs-cTnT may be specific and efficacious markers of myocardial apoptosis and injury occurring during CABG with CPB, hs-cTnT may be a more useful marker than cTnI to detect peri-operative myocardial apoptosis and injury. PMID:26212819

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

    PubMed Central

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

    2014-01-01

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

  14. Epicardial and Subcutaneous Adipose Tissue Fatty Acids Profiles in Diabetic and Non-Diabetic Patients Candidate for Coronary Artery Bypass Graft

    PubMed Central

    Pezeshkian, Masood; Mahtabipour, Mohammad-Reza

    2013-01-01

    Introduction: We have recently shown that in high cholesterol-fed rabbits, the sensitivity of epicardial adipose tissue to changes in dietary fat is higher than that of subcutaneous adipose tissue. Although the effects of diabetes on epicardial adipose tissue thickness have been studied, the influence of diabetes on profile of epicardial free fatty acids (FFAs) has not been studied. The aim of this study is to investigate the effect of diabetes on the FFAs composition in serum and in the subcutaneous and epicardial adipose tissues in patients undergoing coronary artery bypass graft (CABG). Methods: Forty non-diabetic and twenty eight diabetic patients candidate for CABG with >75% stenosis participated in this study. Fasting blood sugar (FBS) and lipid profiles were assayed by auto analyzer. Phospholipids and non-estrified FFA of serum and the fatty acids profile of epicardial and subcutaneous adipose tissues were determined using gas chromatography method. Results: In the phospholipid fraction of diabetic patients’ serum, the percentage of 16:0, 18:3n-9, 18:2n-6 and monounsaturated fatty acids (MUFAs) was lower than the corresponding values of the non-diabetics; whereas, 18:0 value was higher. A 100% increase in the amount of 18:0 and 35% decrease in the level of 18:1n-11 was observed in the diabetic patients’ subcutaneous adipose tissue. In epicardial adipose tissue, the increase of 18:0 and conjugated linolenic acid (CLA) and decrease of 18:1n-11, w3 (20:5n-3) and 22:6n-3 were significant; but, the contents of arachidonic acid and its precursor linoleic acid were not affected by diabetes. Conclusion: The fatty acids’ profile of epicardial and subcutaneous adipose tissues is not equally affected by diabetes. The significant decrease of 16:0 and w3 fatty acids and increase of trans and conjugated fatty acids in epicardial adipose tissue in the diabetic patients may worsen the formation of atheroma in the related arteries. PMID:23878791

  15. Bone Grafts

    MedlinePlus

    A bone graft transplants bone tissue. Surgeons use bone grafts to repair and rebuild diseased bones in your hips, knees, ... fractures or cancers. Once your body accepts the bone graft, it provides a framework for growth of new, ...

  16. Emotional Processes in Patients Undergoing Coronary Artery Bypass Graft Surgeries with Extracorporeal Circulation in View of Selected Indicators of the Inflammatory Condition

    PubMed Central

    Płotek, Włodzimierz; Pielok, Joanna; Cybulski, Marcin; Samborska, Regina

    2015-01-01

    Background The aim of this study was to describe positive and negative emotions in patients undergoing coronary artery bypass graft (CABG) surgeries with extracorporeal circulation and the correlations between emotions and basic indicators of the inflammatory condition: C-reactive protein (CRP) concentration, body temperature, and leukocyte count. Material/Methods Standardized tools were used to select 52 patients (aged 47–63 years, 6 women – 11.5% and 46 men – 88.5%) without dementia or depression. The Positive and Negative Affect Schedule (PANAS) was used to examine positive affect (PA) and negative affect (NA) and the State-Trait Anxiety Inventory (STAI X1 and X2) was used to examine the anxiety level. The patients underwent CABG surgery according to a common anesthesia protocol and for 5 consecutive days they were observed in the ward, where selected indicators of the inflammatory condition were monitored. Results A detailed description of the results of examinations of emotions was presented. The patients with low PA-trait level, high NA-trait level, and high anxiety-trait level (STAI X2) exhibited statistically significantly higher body temperatures than the other patients in the postoperative period. The patients with high NA-trait and anxiety-state levels (STAI X1) had statistically significantly lower CRP levels in the postoperative period than the patients with low NA-trait and anxiety-state levels (STAI X1). Conclusions Patients undergoing CABG operations express both positive and negative affects. The changes in the inflammatory markers are expressed mostly by CRP concentration. There exist relationships between the result of tests assessing emotions and the markers of the inflammatory condition. PMID:25573296

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

    PubMed Central

    Ben-Shlomo, Y; Chaturvedi, N

    1995-01-01

    STUDY OBJECTIVES--Equity should be monitored routinely for all health care services, but ideal studies for each service would be prohibitively expensive and time consuming. A simple, quick, and cheap method for the preliminary exploration of equity in health care provision using routine data was devised. This method was illustrated by examining whether coronary artery bypass graft (CABG) operations reflect socioeconomic differences in ischaemic heart disease (IHD) mortality. DESIGN--Ecological comparison of operation rates was undertaken for CABG for 1991 and IHD mortality for 1981-85 by quartiles of Townsend deprivation score. SETTING--North East Thames Regional Health Authority, London, UK. SUBJECTS--All residents of this region aged 35-74 were the denominator population. Numerators were 26,834 IHD deaths and 1041 CABG operations for the defined time periods. MAIN RESULTS--IHD mortality showed a steady, significant increase with increasing area deprivation scores for both men and women. CABG rate ratios increased linearly for women, while for men there was a U shaped pattern, being lowest for the second and third quartiles. This pattern was attenuated, but not abolished, when adjusted for geographical proximity to cardiothoracic surgical units. The ratio of CABG operations to IHD mortality by deprivation was relatively constant in women suggesting equitable provision. In men, this ratio was significantly lower for the third quartile. CONCLUSIONS--Inequities may exist in the provision of CABG operations for men in this region and this finding should be the stimulus for further detailed studies. Other health care systems should also examine equity in provision. PMID:7798051

  18. The effect of education based on the main concepts of logotherapy approach on the quality of life in patients after coronary artery bypass grafting surgery

    PubMed Central

    Mahdizadeh, Mostafa; Alavi, Mousa; Ghazavi, Zahra

    2016-01-01

    Background: Improving the patients’ quality of life (QOL) after coronary artery bypass grafting (CABG) is one of the main concerns of the treatment team. Educational interventions may affect the aspects of QOL in various ways. The present study aimed to investigate the effect of education based on the main concepts of logotherapy approach on the CABG patients’ quality of life. Materials and Methods: In this quasi-experimental study, a convenient sample of 67 patients who had undergone CABG in Isfahan Chamran hospital were randomly allocated to two groups of experimental (n = 35) and control (n = 32). While the control group received routine care, the experiment group benefitted from logotherapy-based education program (six 90-min sessions, twice a week). SF-36 questionnaire was completed by both two groups (before and 1 month after intervention). Descriptive and inferential statistical tests (consisting of independent t-test) were employed to analyze data in SPSS version 13. Results: The pre-test mean total score of SF-36 questionnaire and also the mean scores of its eight dimensions were not significantly different between the two groups. The post-test mean score change [Standard Error (SE)] in the intervention group was 24.95 (3) and in the control group was 9.27 (0.82). There were significant differences between the two groups (P < 0.001). Moreover, the mean scores of six dimensions of QOL (vitality, bodily pain, general health, emotional role, social functioning, and mental health) changed significantly in the intervention group. Conclusions: Our findings indicated that the intervention has improved the patients’ QOL after CABG. Integration of such an intervention in these patients’ rehabilitation programs is recommended. PMID:26985218

  19. Does Early Post-operative Administration of Aspirin Influence the Risk of Bleeding After Coronary Artery Bypass Graft Surgery? A Prospective Observational Study

    PubMed Central

    Nouraei, Seyed Mahmood; Gholipour Baradari, Afshin; Emami Zeydi, Amir

    2015-01-01

    Background: Aspirin has a proven role in preventing thrombotic diseases. However, given its anti-platelet activity, it is often assumed that its early post-operative administration significantly increase the amount of post-operative bleeding. Aim: The aim of this study was to determine whether early post-operative administration of aspirin influence the risk of bleeding in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: In a prospective observational study, 100 consecutive patients undergoing first time elective CABG surgery were include in the study. Patients received a low dose of aspirin (75-150 mg per day) either 1 hours (the early aspirin group; n=43) or 6 hours after surgery (the late aspirin group; n=57). Total mediastinal blood drainage, blood drainage after 6 hours, incidences of re-operation for the control of bleeding and transfusion of red blood cells (RBCs) and blood products were recorded and followed until chest tube removal. Results: The groups were found to be matched for the confounding variables and no significant differences were found between post-aspirin bleeding (p=0.37), RBCs and blood product usage (p=0.90) or incidences of re-operation for control of bleeding (p=1.00) between the two groups. Conclusions: Early administration (1 hour after surgery) of aspirin did not appear to increase the risk of post-operative bleeding in patients undergoing CABG. Thereby, its early administration in such cases may be considered. Although further well-designed randomized controlled trials to confirm the safety and efficacy of early administration of aspirin after CABG surgery are warranted. PMID:26843729

  20. The effects of tranexamic acid and 6% hydroxyethyl starch (HES) solution (130/0.4) on postoperative bleeding in coronary artery bypass graft (CABG) surgery

    PubMed Central

    Yanartas, M; Baysal, A; Ayd?n, C; Ay, Y; Kara, ?; Ayd?n, E; Cevirme, D; Kksal, C; Sunar, H

    2015-01-01

    Background: The addition of 6% hydroxyethyl starch (HES) into Ringer lactate priming solution may have adverse effects on hemostasis in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) with or without the use of tranexamic acid. Methods: In a prospective, randomized clinical trial, 132 patients were assigned to receive 20 ml/kg of Ringer priming solution with or without tranexamic acid (TA) (Group RS-TA, n=34 and Group RS-noTA, n=32) or 10 ml/kg of 6% HES plus 10 ml/kg of RS priming solution with or without intravenous tranexamic acid (Group HES-TA, n=35 and Group HES-noTA, n=31). Estimated blood loss, chest tube drainage, amount of blood products, hemoglobin, hematocrit, platelet and coagulation parameters were examined before and 24 hour after surgery. Results: For Group HES with tranexamic acid, when compared to other groups, estimated blood loss, postoperative 24 hour drainage loss and blood product transfusions were less (P=0.023; P=0.003; P=0.001; respectively) and hemoglobin, hematocrit values at 12 and 24 hours after surgery increased in comparison to other groups (P=0.041, P=0.034, P=0.004, P=0.001; respectively). Platelet concentrations were similar between groups (P>0.05). Conclusions: In CABG, the administration of tranexamic acid in HES 130/0.4 prime solution study group decreased estimated blood loss and chest tube drainage in comparison to patients receving Ringer prime solution with or without tranexamic acid postoperatively however, no effects on renal functions or postoperative complications were shown. PMID:26131192

  1. Predicting emergency coronary artery bypass graft following PCI: application of a computational model to refer patients to hospitals with and without onsite surgical backup

    PubMed Central

    Syed, Zeeshan; Moscucci, Mauro; Share, David; Gurm, Hitinder S

    2015-01-01

    Background Clinical tools to stratify patients for emergency coronary artery bypass graft (ECABG) after percutaneous coronary intervention (PCI) create the opportunity to selectively assign patients undergoing procedures to hospitals with and without onsite surgical facilities for dealing with potential complications while balancing load across providers. The goal of our study was to investigate the feasibility of a computational model directly optimised for cohort-level performance to predict ECABG in PCI patients for this application. Methods Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry data with 69 pre-procedural and angiographic risk variables from 68 022 PCI procedures in 2004–2007 were used to develop a support vector machine (SVM) model for ECABG. The SVM model was optimised for the area under the receiver operating characteristic curve (AUROC) at the level of the training cohort and validated on 42 310 PCI procedures performed in 2008–2009. Results There were 87 cases of ECABG (0.21%) in the validation cohort. The SVM model achieved an AUROC of 0.81 (95% CI 0.76 to 0.86). Patients in the predicted top decile were at a significantly increased risk relative to the remaining patients (OR 9.74, 95% CI 6.39 to 14.85, p<0.001) for ECABG. The SVM model optimised for the AUROC on the training cohort significantly improved discrimination, net reclassification and calibration over logistic regression and traditional SVM classification optimised for univariate performance. Conclusions Computational risk stratification directly optimising cohort-level performance holds the potential of high levels of discrimination for ECABG following PCI. This approach has value in selectively referring PCI patients to hospitals with and without onsite surgery. PMID:26688738

  2. Preventive Use of Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Coronary Artery Bypass Grafting: A Retrospective Study

    PubMed Central

    Zhang, Jingchao; Lang, Yan; Guo, Longhui; Song, Xiaodong; Shu, Liliang; Su, Gang; Liu, Hai; Xu, Jing

    2015-01-01

    Background Coronary artery bypass grafting (CABG) is an important therapeutic measure for CHD patients. The patients who score more than 12 EuroSCORE points cannot achieve good results because of their low cardiac output and delicate left ventricular function. Therefore, use of an intra-aortic balloon pump (IABP) is essential for coronary surgical patients in the peri-operative period. At present, there is no unified standard about when to insert an IABP. This study aimed to compare the short-term clinical outcomes of the IABP inserted in the preoperative condition with its use in the emergency condition for extremely high-risk patients. Material/Methods IABP support time, respirator support time, and ICU stay time were significantly shorter (all p<0.05) in the preoperative IABP group compared to the emergency IABP group, and the rates of low cardiac output syndrome (LCOS), acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower in the preoperative IABP group (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between two groups. Results Compared to the emergency IABP group, the IABP support time, respirator support time and ICU stay time were significantly lower in the preoperative IABP group (all p<0.05), and the rates of LCOS, acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between the 2 groups. Conclusions For high-risk patients with CABG, preoperative IABP insertion is a safe and effective measure. PMID:25797193

  3. Effects of Metabolic Syndrome with or without Obesity on Outcomes after Coronary Artery Bypass Graft. A Cohort and 5-Year Study

    PubMed Central

    Ao, Hushan; Xu, Fei; Wang, Xianqiang; Tang, Xinran; Zheng, Zhe; Hu, Shengshou

    2015-01-01

    Background Metabolic syndrome (MetS) and obesity are risk factors for cardiovascular disease, however, it remains unclear about effects of MetS with or without obesity on perioperative and long-term morbidity and mortality after coronary artery bypass graft (CABG). Methods An observational cohort study was performed on 4,916 consecutive patients receiving isolated primary CABG in Fuwai hospital. Of all patients, 1238 patients met the inclusion criteria and were divided into three groups: control, MetS with obesity and MetS without obesity (n = 868, 76 and 294 respectively). The patient’s 5-year survival and major adverse cerebral and cardiovascular events (MACCE) were studied. Results Among all three groups, there were no significant differences in in-hospital postoperative complications, epinephrine use, stroke, ICU stay, ventilation time, atrial fibrillation, renal failure, coma, myocardial infarction, repeated revascularization, and long-term stroke. The patients in MetS without obesity group were not associated with increased perioperative or long-term morbidities and mortality. In contrast, the patients in MetS with obesity group were associated with significant increased perioperative complications including MACCE (30.26% vs. 20.75%, 16.7%, p = 0.0074) and mortality (11.84% vs. 3.74%, 3.11%, p = 0.0007) respectively. Patients in MetS with obesity group was associated with significantly increased long-term of MACCE (adjusted OR:2.040; 95%CI:1.196–3.481; P<0.05) and 5-years of mortality (adjusted HR:4.659; 95%CI:1.966–11.042; P<0.05). Conclusions Patients with metabolic syndrome and obesity are associated with significant increased perioperative and long-term complications and mortality, while metabolic syndrome without obesity do not worsen outcomes after CABG. PMID:25679397

  4. Predicting reintubation, prolonged mechanical ventilation and death in post-coronary artery bypass graft surgery: a comparison between artificial neural networks and logistic regression models

    PubMed Central

    Mendes, Renata G.; de Souza, César R.; Machado, Maurício N.; Correa, Paulo R.; Di Thommazo-Luporini, Luciana; Arena, Ross; Myers, Jonathan; Pizzolato, Ednaldo B.

    2015-01-01

    Introduction In coronary artery bypass (CABG) surgery, the common complications are the need for reintubation, prolonged mechanical ventilation (PMV) and death. Thus, a reliable model for the prognostic evaluation of those particular outcomes is a worthwhile pursuit. The existence of such a system would lead to better resource planning, cost reductions and an increased ability to guide preventive strategies. The aim of this study was to compare different methods – logistic regression (LR) and artificial neural networks (ANNs) – in accomplishing this goal. Material and methods Subjects undergoing CABG (n = 1315) were divided into training (n = 1053) and validation (n = 262) groups. The set of independent variables consisted of age, gender, weight, height, body mass index, diabetes, creatinine level, cardiopulmonary bypass, presence of preserved ventricular function, moderate and severe ventricular dysfunction and total number of grafts. The PMV was also an input for the prediction of death. The ability of ANN to discriminate outcomes was assessed using receiver-operating characteristic (ROC) analysis and the results were compared using a multivariate LR. Results The ROC curve areas for LR and ANN models, respectively, were: for reintubation 0.62 (CI: 0.50–0.75) and 0.65 (CI: 0.53–0.77); for PMV 0.67 (CI: 0.57–0.78) and 0.72 (CI: 0.64–0.81); and for death 0.86 (CI: 0.79–0.93) and 0.85 (CI: 0.80–0.91). No differences were observed between models. Conclusions The ANN has similar discriminating power in predicting reintubation, PMV and death outcomes. Thus, both models may be applicable as a predictor for these outcomes in subjects undergoing CABG. PMID:26322087

  5. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study

    PubMed Central

    Lee, Trevor W. R.; Kowalski, Stephen; Falk, Kelsey; Maguire, Doug; Freed, Darren H.; HayGlass, Kent T.

    2016-01-01

    Background Cardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery. Methods This prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2), anti-inflammatory (IL-10, TNF-RII, IL-1Ra), acute phase protein (CRP, PTX3) and cardiovascular risk (sST2) biomarkers. Results The kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005). Conclusions This hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia. Trial Registration ClinicalTrials.gov NCT00348920 PMID:26930568

  6. Comparison of clinical and economic outcomes of two antibiotic prophylaxis regimens for sternal wound infection in high‐risk patients following coronary artery bypass grafting surgery: a prospective randomised double‐blind controlled trial

    PubMed Central

    Dhadwal, Kay; Al‐Ruzzeh, Sharif; Athanasiou, Thanos; Choudhury, Marina; Tekkis, Paris; Vuddamalay, Pynee; Lyster, Haifa; Amrani, Mohamed; George, Shane

    2007-01-01

    Objective Prospective studies show a 10% incidence of sternal wound infection (SWI) after 90 days of follow‐up, compared with infection rates of 5% reported by the National Nosocomial Infections Surveillance System after only 30 days of follow‐up. This incidence increases 2–3 times in high‐risk patients. Design Prospective randomised double‐blind controlled clinical trial. Setting Cardiothoracic centre, UK. Patients Patients were eligible if they were undergoing median sternotomy for primary isolated coronary artery bypass grafting, with at least one internal thoracic artery used for coronary grafting and having one or more of the following three risk factors: (1) obesity, defined as body mass index 30 kg/m2; (2) diabetes mellitus; or (3) bilateral internal thoracic artery grafts (ie, the use of the other internal thoracic artery). Interventions The study group received a single dose of gentamicin 2 mg/kg, rifampicin 600 mg and vancomycin 15 mg/kg, with three further doses of 7.5 mg/kg at 12‐hour intervals. The control group received cefuroxime 1.5 g at induction and three further doses of 750 mg at 8‐hour intervals. Main outcome measures The primary end point was the incidence of SWI at 90 days. The secondary end point was the antibiotic and hospital costs. Results During the study period, 486 patients underwent isolated coronary artery bypass grafting with a 30‐day SWI of 7.6%. 186 high‐risk patients were recruited and analysed: 87 in the study group and 99 in the control group. 90‐day SWI was significantly reduced in 8 patients in the study group (9.2%; 95% CI 3.5% to 15.3%) compared with 25 patients in the control group (25.2%; 95% CI 19.5% to 39.4%; p = 0.004). The study group had a significantly lower cost of antibiotics (21.2% reduction—US$96/patient; p<0.001), and a significantly lower hospital cost (20.4% reduction in cost—US$3800/patient; p = 0.04). Conclusions Longer and broader‐spectrum antibiotic prophylaxis significantly reduces the incidence of SWI in high‐risk patients, with a significant economic benefit in costs of antibiotics as well as hospital costs. PMID:17309908

  7. Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease

    PubMed Central

    Yu, Xian-Peng; Wu, Chang-Yan; Ren, Xue-Jun; Yuan, Fei; Song, Xian-Tao; Luo, Ya-Wei; He, Ji-Qiang; Gao, Yue-Chun; Huang, Fang-Jiong; Gu, Cheng-Xiong; Sun, Li-Zhong; Lyu, Shu-Zheng; Chen, Fang

    2016-01-01

    Background: There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events. Methods: All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. Results: Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group. Conclusions: During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group. PMID:26996469

  8. [The saphenous vein graft diseases].

    PubMed

    Yavuz, Turhan; Kutsal, Ali

    2002-03-01

    Graft occlusions are the main problems that may arise during long-term follow-up period after coronary artery bypass surgery. Knowledge of pathologies developed in saphenous grafts and attempts to reduce their frequency are important for reduction of the incidence of saphenous graft vein occlusions. For today the patency rate for 10 years saphenous vein grafts are about 60%. Along with intraoperative technical factors, there are a lot of factors contributed to the development occlusion during long-term follow-up period. In this review we aimed to analyze the factors affecting saphenous vein pathologies and propose preventive measures. PMID:12101795

  9. Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study

    PubMed Central

    2010-01-01

    Preoperative medication by inhibitors of angiotensin-converting enzyme (ACE) in coronary artery patients predisposes to vasoplegic shock early after coronary artery bypass grafting. Although in the majority of the cases this shock is mild, in some of them it appears as a situation, "intractable" to high-catecholamine dose medication. In this study we examined the possible role of prophylactic infusion of low-dose vasopressin, during and for the four hours post-bypass after cardiopulmonary bypass, in an effort to prevent this syndrome. In addition, we studied the influence of infused vasopressin on the hemodynamics of the patients, as well as on the postoperative urine-output and blood-loss. In our study 50 patients undergoing coronary artery bypass grafting were included in a blind-randomized basis. Two main criteria were used for the eligibility of patients for coronary artery bypass grafting: ejection fraction between 30-40%, and patients receiving ACE inhibitors, at least for four weeks preoperatively. The patients were randomly divided in two groups, the group A who were infused with 0.03 IU/min vasopressin and the group B who were infused with normal saline intraoperativelly and for the 4 postoperative hours. Measurements of mean artery pressure (MAP), central venous pressure (CVP), systemic vascular resistance (SVR), ejection fracture (EF), heart rate (HR), mean pulmonary artery pressure (MPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were performed before, during, and after the operation. The requirements of catecholamine support, the urine-output, the blood-loss, and the requirements in blood, plasma and platelets for the first 24 hours were included in the data collected. The incidence of vasodilatory shock was significantly lower (8% vs 20%) in group A and B respectively (p = 0,042). Generally, the mortality was 12%, exclusively deriving from group B. Postoperatively, significant higher values of MAP, CVP, SVR and EF were recorded in the patients of group A, compared to those of group B. In group A norepinephrine was necessary in fewer patients (p = 0.002) and with a lower mean dose (p = 0.0001), additive infusion of epinephrine was needed in fewer patients (p = 0.001), while both were infused for a significant shorter infusion-period (p = 0.0001). Vasopressin administration (for group A) was associated with a higher 24 hour diuresis) (0.0001). In conclusion, low-dose of infused vasopressin during cardiopulmonary bypass and for the next 4 hours is beneficial for its postoperative hemodynamic profile, reduces the doses of requirements of catecholamines and contributes to prevention of the postcardiotomy vasoplegic shock in the patient with low ejection fraction who is receiving ACE preoperatively. PMID:20346182

  10. Cortactin-binding protein 90 (CBP90) expression in the mouse mammary glands during prolactin-induced lobuloalveolar development.

    PubMed

    Imaoka, Tatsuhiko; Horseman, Nelson D; Lockefeer, Jason A; Mori, Takao; Matsuda, Manabu

    2002-04-01

    We have previously performed suppression subtractive hybridization to identify genes that were induced during prolactin (PRL)-driven lobuloalveolar development of the mammary gland. This suggested that cortactin-binding protein 90 (CBP90), which is known to be a brain-specific protein that binds to cortactin, was expressed under the regulation of PRL in the mammary glands (preliminary observation). In this study, the expression of CBP90 was examined in the mammary glands of mice under manipulated hormonal circumstances. PRL treatment by 9 days of pituitary grafting induced CBP90 expression in the normal mammary glands but not in the cleared fat pads, while cortactin was expressed constitutively in both the normal mammary glands and the cleared fat pads. Unlike milk proteins, longer treatment with PRL (36 days of pituitary grafting) did not increase the expression level of CBP90 mRNA, while it slightly increased the cortactin mRNA level. Mammary CBP90 mRNA expression was induced by pituitary grafting but not by progesterone treatment in PRL-deficient mice, while pituitary grafting induced mammary CBP90 expression in ovariectomized PRL-deficient mice only when estrogen and progesterone were appropriately supplemented to permit the formation of alveolar buds. The CBP90 protein was detected by immunohistochemistry in the luminal epithelium of the alveolar buds and more faintly in the ductal epithelium. Thus, from the unique expression pattern, CBP90 may be useful as a molecular marker for the hormone-stimulated development of mammary alveolar buds. PMID:12130822

  11. Comparison of 30-day and 5-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients aged≤50 years (the Coronary aRtery diseAse in younG adultS Study).

    PubMed

    Biancari, Fausto; Gudbjartsson, Tomas; Heikkinen, Jouni; Anttila, Vesa; Mäkikallio, Timo; Jeppsson, Anders; Thimour-Bergström, Linda; Mignosa, Carmelo; Rubino, Antonino S; Kuttila, Kari; Gunn, Jarmo; Wistbacka, Jan-Ola; Teittinen, Kari; Korpilahti, Kari; Onorati, Francesco; Faggian, Giuseppe; Vinco, Giulia; Vassanelli, Corrado; Ribichini, Flavio; Juvonen, Tatu; Axelsson, Tomas A; Sigurdsson, Axel F; Karjalainen, Pasi P; Mennander, Ari; Kajander, Olli; Eskola, Markku; Ilveskoski, Erkki; D'Oria, Veronica; De Feo, Marisa; Kiviniemi, Tuomas; Airaksinen, K E Juhani

    2014-07-15

    Data on the outcome of young patients after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are scarce. Data on 2,209 consecutive patients aged≤50 years who underwent CABG or PCI were retrospectively collected from 15 European institutions. PCI and CABG had similar 30-day mortality rates (0.8% vs 1.4%, p=0.27), late survival (at 5 years, 97.8% vs 94.9%, p=0.082), and freedom from stroke (at 5 years, 98.0% and 98.0%, p=0.731). PCI was associated with significantly lower freedom from major adverse cardiac and cerebrovascular events (at 5 years, 73.9% vs 85.0%, p<0.0001), repeat revascularization (at 5 years, 77.6% vs 92.5%, p<0.0001), and myocardial infarction (at 5 years, 89.9% vs 96.6%, p<0.0001) compared with CABG. These findings were confirmed in propensity score-adjusted and matched analyses. Freedom from major adverse cardiac and cerebrovascular events after PCI was particularly low in diabetics (at 5 years, 58.0% vs 75.9%, p<0.0001) and in patients with multivessel disease (at 5 years, 63.6% vs 85.1%, p<0.0001). PCI in patients with ST elevation myocardial infarction was associated with significantly better 5-year survival (97.5% vs 88.8%, p=0.001), which was driven by its lower 30-day mortality rate (1.5% vs 6.0%, p=0.017). In conclusion, patients aged≤50 years have an excellent immediate outcome after either PCI or CABG with similar long-term survival when used according to the current clinical practice. PCI was associated with significantly lower freedom from myocardial infarction and repeat revascularization. PMID:24878127

  12. Developments in parallel grafts for aortic arch lesions.

    PubMed

    Kolvenbach, Ralf R; Rabin, Asaf; Karmeli, Ron; Alpaslan, Alper; Schwierz, Elizabeth

    2016-06-01

    Due to the shortage of commercially available off the shelf aortic arch grafts since the last years parallel grafts or chimney grafts have played an increasing role in the treatment of patients with aortic arch lesions. Although there are still issues with type endoleaks and gutters between the chimney graft and the aortic stent-graft remaining. We report our results with the Medtronic thoracic graft in combination with long self-expanding parallel grafts, to ensure an overlapping zone of more than 7 cm between the different grafts. Alternatively, sandwich configurations are used where a direct contact between the parallel graft and the aortic wall is avoided. We have placed a total of 65 parallel grafts into supra-aortic branches. In 21 cases chimney grafts were placed into the carotid artery, in most cases into the left common carotid artery. In 36 cases chimney grafts were placed into left subclavian artery. A maximum number of 4 parallel grafts were placed for total endovascular debranching. In addition, in 8 patients a parallel graft had to be placed into the innominate artery. There was a patency of 69% for all subclavian artery chimney grafts versus 73% for carotid artery parallel grafts. Of note is a stroke rate of 5.2% in all these cases. Only 2 of the patients with an occluded left subclavian artery chimney graft required a bypass procedure for arm claudication or ischemia. We had a primary type I endoleak rate of 28%. In almost 25% secondary interventions were required mainly to treat type I leaks, in those cases where the leak did not resolve spontaneously. The overall mortality rate was 3.5%. The results of parallel graft in the aortic arch are promising, but of major concern is still the high rate of type I endoleaks as well as the neurological complication rate, most probably due to catheter manipulation in patients with severe atherosclerotic arch lesions. PMID:27029672

  13. CT Study of the Relationship Between the Common Iliac Artery and Vein and Their Juxtaposition: Implications for Conduit Construction Prior to Endosvascular Stent-Graft Repair of Aortic Aneurysms

    SciTech Connect

    Lenton, James; Homer-Vanniasinkam, Shervanthi; Kent, Patrick; Nicholson, Tony

    2008-11-15

    The objective of this study was to determine the anatomical relationship and juxtaposition between the common iliac artery and vein in a population of patients with aortic aneurysmal disease and a population clinically and radiologically free of atheroma. It was a retrospective study of 100 consecutive patients undergoing computed tomographic assessment of abdominal aortic aneurysm prior to endovascular or open surgical repair and 100 patients undergoing computed tomographic assessment for other pathologies who did not have clinical or imaging signs of aorto-iliac atheroma. In both groups the anatomical relationship between the right and left iliac artery and vein was studied, and the thickness of the fat plane separating the artery from the vein measured. The right iliac vein was posterolateral to the artery at the level of the common iliac artery bifurcation in 95% of patients in both groups. At the same level the left iliac vein was posterior in 23% (p {<=} 0.001). Eighty-three percent of patients in the aneurysm group had a fat plane between the right artery and vein that measured 0 mm (no visible fat plane = 52%) to 1 mm (= 31%). Ninety-eight percent of patients in the aneurysm group had a measurable fat plane between the left iliac artery and vein of up to 5 mm (p = 0.001). Six percent of the control group demonstrated no visible fat plane between the right iliac artery and vein (p {<=} 0.001), while the fat plane measured more than 1 mm (1-5 mm) on the left in 100%. We conclude that in patients where conduit construction is required for aortic stent-graft access, the anatomical configuration and intimate relationship of the iliac arteries and veins should be assessed and taken into account at CT scan evaluation. The distal right common iliac artery should not be used, as venous damage can be predicted from the anatomical and intimate relationship of the iliac artery and vein at this level in patients with atheroma and the difficulties this relationship presents if venous repair is necessary.

  14. Massive Chylopericardium after Coronary Artery Bypass Surgery

    PubMed Central

    Pellegrini, Ronald V.; Travers, Daniel J.; Marrangoni, Albert G.; Dimarco, Ross F.; Bekoe, Seth; Grant, Kathleen J.; Woelfel, George F.

    1987-01-01

    Massive isolated chylopericardium is a rare postoperative complication of coronary artery bypass surgery. In the following case, massive chylopericardium developed after a coronary artery bypass procedure in which the left internal mammary artery was used for revascularization. The chylopericardium resulted from direct trauma to the thoracic duct during mobilization of the left internal mammary artery to its origin at the subclavian artery. With adequate drainage, the problem was resolved. In cases in which drainage persists, ligation of the thoracic duct may be necessary. (Texas Heart Institute Journal 1987; 14:318-320) Images PMID:15227320

  15. Lung Transplant for Pulmonary Arterial Hypertension After Arterial Switch Operation.

    PubMed

    Watanabe, Tatsuaki; Adachi, Osamu; Suzuki, Yasuto; Notsuda, Hirotsugu; Niikawa, Hiromichi; Matsuda, Yasushi; Noda, Masafumi; Sado, Tetsu; Hoshikawa, Yasushi; Akiba, Miki; Tatebe, Shunsuke; Saiki, Yoshikatsu; Okada, Yoshinori

    2015-12-01

    Pulmonary arterial hypertension after arterial switch operation for transposition of the great arteries is an infrequent but life-threatening complication. We report successful lung transplantation in a case of pulmonary hypertension after arterial switch operation. Cardiopulmonary bypass outflow was established through the right subclavian and femoral arteries because of the previous arterial switch operation. Abnormal anatomy and severe pleural and pericardial adhesions as a result of previous operations resulted in prolonged graft ischemic and operation times. Despite delayed left heart adaptation and primary graft dysfuncti