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1

Free Internal Mammary Artery Graft Reimplantation on the Same Vessel in Repeat Coronary Revascularization  

PubMed Central

We describe the case of a 62-year-old man who needed a 3-vessel coronary artery bypass reoperation and mitral valve replacement. The patient's existing free left internal mammary artery graft was not functioning because of a critical stenosis in the native vessel just after the distal anastomosis. The free graft itself was in perfect condition, and we decided to reuse it. Because the course of the graft was so tortuous, we concluded that skeletonization would yield the extra length needed for reimplantation. After reimplanting the graft, we performed venous grafting and mitral valve replacement. The patient was well and had no signs of ischemia at 29 months postoperatively. There have been few reports on recycling internal mammary artery grafts in repeat coronary artery bypass grafting. To our knowledge, ours is the first report of the reimplantation of a free internal mammary artery graft on the same vessel. We describe the procedure and our decision-making process.

Conocchia, Massimo; Patanè, Rosario; Micalizzi, Ezio

2015-01-01

2

Evaluation of postoperative flow reserve in internal mammary artery bypass grafts  

SciTech Connect

The internal mammary artery has been advocated for use in bypass grafting owing to its superior long-term patency when compared to saphenous vein grafts. Concern exists that the flow through the internal mammary artery may be inadequate during periods of peak myocardial demand. This flow was investigated in 24 consecutive patients with a mean proximal left anterior descending artery stenosis of 87.5% who were selected for coronary bypass using the internal mammary artery. Within 8 weeks of operation, all were evaluated by exercise thallium 201 scintigraphy. Thallium activity, expressed as a ratio of anteroseptal activity to posterolateral wall activity (or inferior wall activity if the posterolateral wall was deemed abnormal), was 0.97 +/- 0.15. A second group of 25 patients, with normal coronary arteries, was similarly evaluated. The mean septal to posterolateral wall thallium activity ratio for these control patients was 1.0 +/- 0.15. A third group of 26 patients who underwent single-vessel percutaneous transluminal coronary angioplasty of the left anterior descending artery and a fourth group of 28 saphenous vein graft recipients were compared by stress thallium scintigraphy. Thallium 201 activity for the vein graft group (0.96 +/- 0.19) was not significantly different from that for the mammary artery group, whereas the flows obtained with a single attempt at angioplasty were significantly inferior (p less than 0.05). The internal mammary artery provides excellent coronary flow at peak myocardial demand and compares favorably to angioplasty and saphenous vein grafting.

Johnson, A.M.; Kron, I.L.; Watson, D.D.; Gibson, R.S.; Nolan, S.P.

1986-11-01

3

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

PubMed

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

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

2012-05-01

4

Strategies to reduce deep sternal wound infection after bilateral internal mammary artery grafting.  

PubMed

Deep sternal wound infections (DSWI) continue to be an infrequent but potentially devastating complication after cardiac surgical procedures. Its prevalence is more after coronary artery bypass grafting using single internal mammary artery (IMA) graft. Bilateral internal mammary artery (BIMA) harvesting carries a higher risk of sternal infection than harvesting single IMA. Several risk factors have been identified with sternal wound infections and a few are modifiable. Strategies that reduce DSWI target the modifiable risk factors that include microbiological factors, appropriate antibiotic prophylaxis, tight glycemic control. Surgical strategies to reduce DSWI following BIMA harvest include techniques of IMA harvesting with lesser devascularization of sternum using skeletonized, semiskeletonized and modified pedicle harvest are associated with greater preservation of sternal blood supply and sternal closure and stability techniques. The various strategies to minimize sternal wound infections during preoperative, intra and postoperative periods are summarized in this article. PMID:25463763

Sajja, Lokeswara Rao

2014-11-18

5

Radial artery in CABG: could the early results be comparable to internal mammary artery graft?  

Microsoft Academic Search

Background. The accidental detection of patency of radial artery grafts, by Acar, which had been labeled as blocked 18 years earlier, has led to its revival as a conduit in coronary artery bypass surgery. We used radial artery as one of the grafts in 287 patients from February 1996 to June 1998. Here we present our early clinical experience and

Anil Bhan; Vivek Gupta; Shiv Kumar Choudhary; Rajesh Sharma; Balbir Singh; Rajiv Aggarwal; Balram Bhargava; Ashutosh V Sharma; Panangipalli Venugopal

1999-01-01

6

Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries.  

PubMed Central

OBJECTIVES: This study evaluated the risks of sternal wound infections in patients undergoing myocardial revascularization using bilateral skeletonized internal mammary arteries (IMAs). BACKGROUND: The skeletonized IMA is longer than the pedicled one, thus providing the cardiac surgeon with increased versatility for arterial myocardial revascularization without the use of vein grafts. It is isolated from the chest wall gently with scissors and silver clips, and no cauterization is employed. Preservation of collateral blood supply to the sternum and avoidance of thermal injury enable more rapid healing and decrease the risk of sternal wound infection. METHODS: From April 1996 to August 1997, 545 patients underwent arterial myocardial revascularization using bilateral skeletonized IMAs. The right gastroepiploic artery was used in 100 patients (18%). The average age of the patients was 65 years; 431 (79%) were men and 114 (21%) were women; 179 (33%) were older than 70 years of age; 166 (30%) were diabetics. The average number of grafts was 3.2 per patient. RESULTS: The 30-day operative mortality rate was 2% (n = 11). There were six perioperative infarcts (1.1%) and six strokes (1.1%); 9 patients had sternal infection (1.7%) and 15 (2.8%) had superficial infection. Risk factors for sternal infection were chronic obstructive pulmonary disease and emergency operation. Superficial sternal wound infections were more common in women and in patients with chronic obstructive pulmonary disease, renal failure, or peripheral vascular disease. The 1-year actuarial survival rate was 97%. Two of the six late deaths were not cardiac-related. Late dehiscence occurred in three patients (0.6%). The death rate (early and late) of patients with any sternal complication was higher than that of patients without those complications (33% vs. 2.7%). CONCLUSIONS: Routine arterial myocardial revascularization using bilateral skeletonized IMAs is safe, and postoperative morbidity and mortality rates are low, even in elderly patients and those with diabetes. Chronic obstructive pulmonary disease and emergency operations were found to be associated with an increased risk of sternal infections, and the authors recommend avoiding the use of bilateral skeletonized IMAs in patients with these preoperative risk factors. PMID:10203094

Sofer, D; Gurevitch, J; Shapira, I; Paz, Y; Matsa, M; Kramer, A; Mohr, R

1999-01-01

7

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

PubMed Central

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

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

2008-01-01

8

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

NASA Technical Reports Server (NTRS)

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

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

2001-01-01

9

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

SciTech Connect

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

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

1985-05-01

10

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

Microsoft Academic Search

BACKGROUND: While it is believed that total arterial grafting (TAG) for coronary artery bypass grafting (CABG) confers improved long-term outcomes when compared to conventional grafting with left internal mammary artery and saphenous vein grafts (LIMA+SVG), to date, this has not become the standard of care. In this study, we assessed the impact of TAG on medium-term outcomes after CABG. METHODS:

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

2007-01-01

11

Coronary bypass using bilateral internal mammary arteries in an achondroplast.  

PubMed

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

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

2015-01-01

12

Mammary artery harvesting using the Da Vinci Si robotic system  

PubMed Central

Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system. PMID:24896171

Canale, Leonardo Secchin; Bonatti, Johannes

2014-01-01

13

Arterial grafts: clinical classification and pharmacological management  

PubMed Central

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

2013-01-01

14

Reactivity of the human internal mammary artery and the gastroepiploic artery to constrictor substances  

Microsoft Academic Search

The internal mammary artery (IMA) and the gastroepiploic artery (GEA) are frequently used to construct coronary artery bypass grafts. In order to determine and to compare their contractile properties, we studied the effects of constricting agents which are liberated or infused during coronary bypass surgery. IMA and GEA were arranged as ring segments and suspended in organ baths at optimal

Jean-Luc Cracowski; Françoise Stanke Labesque; Olivier Chavanon; Dominique Blin; Germain Bessard; Philippe Devillier

1999-01-01

15

Idiopathic internal mammary artery aneurysm  

PubMed Central

Aneurysms of the internal mammary artery are extremely rare, and their presentation and treatment are variable. Since these aneurysms often tend to rupture and cause haemothorax and life-threatening conditions, the knowledge of secure treatment options is indispensable. We here report the case of an idiopathic internal mammary aneurysm in a 46-year-old man. Open surgical resection of the aneurysm was performed in this case without any complications. The postoperative course was uneventful and the patient was in a good physical condition without any vascular or neurological abnormalities during follow-up. PMID:25452261

Heyn, Jens; Zimmermann, Hanna; Klose, Alexander; Luchting, Benjamin; Hinske, Christian; Sadeghi-Azandaryani, Mojtaba

2014-01-01

16

Comparing the Prevalence of Chronic Pain After Sternotomy in Patients Undergoing Coronary Artery Bypass Grafting Using The Internal Mammary Artery and Other Open Heart Surgeries  

PubMed Central

Background: The prevalence of chronic postoperative pain after cardiac surgery has been reported from 17% to 56%. Objectives: We aimed to compare the prevalence of postoperative pain between patients who had undergone CABG using the internal mammary artery (IMA) and those who had undergone other cardiac surgeries including CABG using the saphenous vein or cardiac valvular surgeries. Patients and Methods: In this cohort study, medical records of 188 patients were evaluated and divided into two equal groups (94 in each group); patients who had undergone CABG using the IMA (IMA group) and those who had undergone other cardiac surgeries using the saphenous vein or other cardiac valvular surgeries (non-IMA group). The patients' data were recorded in a self-structured questionnaire and then phone interviews were performed 3 months after the operations regarding the rate of postoperative pain. The severity of chronic pain was rated based on the numerical rating pain scale. Results: The two groups differed significantly regarding the prevalence of pain (P = 0.023). In the IMA group, 83 (88.3%) patients experienced pain lasting for more than three months compared to 71 (75.5%) patients in non-IMA group. The two groups differed significantly with respect to the severity of chronic pain after cardiac surgery via sternotomy (P = 0.001). The groups did not differ significantly regarding the effects of chronic pain on their sleep, referral to a physician, and drug consumption to alleviate their pain. The IMA group experienced more complications at work and during their occupational activity. Conclusions: The rate and severity of chronic pain after cardiac surgery via sternotomy was higher in patients undergoing CABG with separation of IMA for revascularization. PMID:25289372

Kamalipour, Hamid; Vafaei, Ali; Parviz Kazemi, Asef; Khademi, Saeed

2014-01-01

17

Coronary Artery Bypass Graft  

NSDL National Science Digital Library

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

Patient Education Institute

18

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

SciTech Connect

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

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

2004-01-15

19

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

Microsoft Academic Search

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

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

2010-01-01

20

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

E-print Network

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

Marsden, Alison L.

21

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

SciTech Connect

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

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

2006-04-15

22

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

Microsoft Academic Search

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

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

2000-01-01

23

Noradrenaline-induced contraction of human saphenous vein and human internal mammary artery: involvement of different a-adrenoceptor subtypes  

Microsoft Academic Search

Although saphenous veins and internal mammary arteries are commonly used for coronary artery bypass grafting, only a very few comparative studies are available on !-adrenoceptor-mediated vasoconstriction in these vessels. Thus, we determined, in isolated rings from human saphenous vein and human internal mammary artery, contractile responses to noradrenaline (10-8-10-4 M) in the absence and presence of the !-adrenoceptor antagonists yohimbine

Christine Giessler; Thekla Wangemann; Rolf-Edgar Silber; Stefan Dhein; Otto-Erich Brodde

2002-01-01

24

Total arterial revascularization of the heart using both mammary arteries and the right gastroepiploic artery.  

PubMed

From April 1988 to April 1989, nine patients (seven men and two women) with coronary three-vessel disease and disabling angina underwent elective myocardial revascularization. None of the patients had available veins because of previous bypass procedures (three) or extensive varicosis (six). On standard cardiopulmonary bypass and cardioplegic arrest the right and the left mammary arteries (RIMA, LIMA) and the right gastroepiploic artery (RGEA) were anastomosed each to a major coronary branch (none of them as free graft) in each patient. All patients survived the operation but one, who died 2 weeks after the operation of a bilateral pneumonia. Autopsy revealed patent anastomoses. One patient had to be reexplored for bleeding. Two patients required temporary inotropic support. There was no perioperative myocardial infarction. All survivors were discharged home in an average of 18.7 days after the operation, are free from angina, and all have negative stress tests (mean follow-up 7.7 months) but one with severe coronary atherosclerosis who experiences slight exertional angina despite good patency of the grafts. Five patients were recatheterized after a mean interval of 5.4 months after operation revealing in all cases patent anastomoses. Total revascularization of the heart with arterial grafts is feasible, safe, and it could become the method of choice if patency persists in the long run. PMID:2133862

Siclari, F; Hueblein, B; Schaps, D

1990-12-01

25

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 ...

26

Non-invasive assessment of coronary flow velocity reserve before and after angioplasty in a patient with mammary graft stenosis.  

PubMed

We report the diagnosis of mammary artery graft dysfunction by high-resolution transthoracic Doppler and venous adenosine infusion. The patient was treated by percutaneous balloon angioplasty, with optimal angiographic results. Coronary flow reserve in the distal left anterior descending artery was abnormal before angioplasty, and recovered soon after the procedure. The utility of this new non-invasive technique in the diagnosis of flow-limiting stenoses and follow-up of coronary angioplasty is described. PMID:11130844

Pizzuto, F; Voci, P; Sinatra, R; Sardella, G; Nigri, A

2000-09-01

27

Mitral valve surgery after previous CABG with functioning IMA grafts  

Microsoft Academic Search

Background. Mitral valve surgery after previous coronary artery bypass grafting presents a challenging problem for the cardiac surgeon. An injury to patent coronary artery bypass grafts, especially internal mammary artery grafts, during reoperation via a redo sternotomy, may be fatal. Therefore, a reliable alternative to the redo sternotomy is desirable to minimize potential injury to internal mammary artery grafts.Methods. Between

John G Byrne; Sary F Aranki; David H Adams; Robert J Rizzo; Gregory S Couper; Lawrence H Cohn

1999-01-01

28

Composite Arterial Y Graft Has Less Coronary Flow Reserve Than Independent Grafts  

Microsoft Academic Search

Background. It is not known whether a composite Y graft of the left internal thoracic artery can provide sufficient blood flow to the whole left coronary system. The aim of this study was to compare regional myocar- dial blood flow (MBF) and coronary flow reserve after coronary artery bypass grafting using arterial composite Y graft or independent arterial grafts. Methods.

Genichi Sakaguchi; Eiji Tadamura; Motoaki Ohnaka; Keiichi Tambara; Kazunobu Nishimura; Masashi Komeda

2010-01-01

29

Composite arterial Y graft has less coronary flow reserve than independent grafts  

Microsoft Academic Search

Background. It is not known whether a composite Y graft of the left internal thoracic artery can provide sufficient blood flow to the whole left coronary system. The aim of this study was to compare regional myocardial blood flow (MBF) and coronary flow reserve after coronary artery bypass grafting using arterial composite Y graft or independent arterial grafts.Methods. Positron emission

Genichi Sakaguchi; Eiji Tadamura; Motoaki Ohnaka; Keiichi Tambara; Kazunobu Nishimura; Masashi Komeda

2002-01-01

30

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

PubMed Central

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

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

2015-01-01

31

Endoscopic radial artery harvesting procedure for coronary artery bypass grafting  

PubMed Central

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

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

2013-01-01

32

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

PubMed Central

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

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

2014-01-01

33

Mitral Valve Surgery After Previous CABG With Functioning IMA Grafts  

Microsoft Academic Search

Background. Mitral valve surgery after previous coro- nary artery bypass grafting presents a challenging prob- lem for the cardiac surgeon. An injury to patent coronary artery bypass grafts, especially internal mammary artery grafts, during reoperation via a redo sternotomy, may be fatal. Therefore, a reliable alternative to the redo sternot- omy is desirable to minimize potential injury to internal mammary

John G. Byrne; Sary F. Aranki; David H. Adams; Robert J. Rizzo; Gregory S. Couper; Lawrence H. Cohn

34

Economics of coronary artery bypass grafting  

Microsoft Academic Search

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

Alan Williams

1985-01-01

35

Preventing Deep Wound Infection after Coronary Artery Bypass Grafting  

PubMed Central

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

Bryan, Charles S.; Yarbrough, William M.

2013-01-01

36

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

PubMed

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

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

2006-09-01

37

Infected Viabahn stent graft in the superficial femoral artery.  

PubMed

We present a case of an infected stent graft in the superficial femoral artery (SFA). A 67-year-old woman underwent excision of an infected Viabahn stent graft. At exploration there was no apparent artery around the majority of the stent graft, suggesting that the SFA had been autolysed. Infected stents and stent grafts are rare in the SFA position. The risk of infection is likely minimised with standard treatments including drainage of infection prior to stent graft placement and periprocedural antibiotic administration. Successful management will, in most cases, require excision of the stent graft and adjunctive arterial reconstruction, as necessary. PMID:21889371

Schneider, J R; Patel, N H; Hashemi, F; Kim, S; Verta, M J

2011-11-01

38

First jejunal artery, an alternative graft for right hepatic artery reconstruction  

PubMed Central

Common bile duct cancer invading right hepatic artery is sometimes diagnosed intraoperatively. Excision and safe reconstruction of the artery with suitable graft is essential. Arterial reconstruction with autologous saphenous vein graft is the preferred method practiced routinely. However the right hepatic artery reconstruction has also been carried out with several other vessels like gastroduodenal artery, right gastroepiploic artery or the splenic artery. We report a case of 63-year-old man presenting with history of progressive jaundice, pruritus and impaired appetite. Following various imaging modalities including computed tomography, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, intraductal ultrasound extrahepatic bile duct cancer was diagnosed; however, none of those detected vessel invasion. Intraoperatively, right hepatic artery invasion was revealed. Right hepatic artery was resected and reconstructed with a graft harvested from the first jejunal artery (JA). Postoperative outcome was satisfactory with a long-term graft patency. First JA can be a reliable graft option for right hepatic artery reconstruction. PMID:25866610

Aryal, Bibek; Komokata, Teruo; Kadono, Jun; Motodaka, Hiroyuki; Ueno, Tetsuya; Furoi, Akira; Imoto, Yutaka

2015-01-01

39

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- ...

40

Platelet--arterial synthetic graft interaction and its modification  

SciTech Connect

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.

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

1982-11-01

41

Intraoperative graft assessment during coronary artery bypass surgery.  

PubMed

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

Fukui, Toshihiro

2015-03-01

42

Two internal thoracic artery grafts are better than one  

Microsoft Academic Search

Objective: Does the use of bilateral internal thoracic artery (ITA) grafts provide incremental benefit relative to the use of a single ITA graft? Methods: We conducted a retrospective, nonrandomized, long-term (mean follow-up interval of 10 postoperative years) study of patients undergoing elective primary isolated coronary bypass surgery who received either single (8123 patients) or bilateral ITA grafts (2001 patients), with

Bruce W. Lytle; Eugene H. Blackstone; Floyd D. Loop; Penny L. Houghtaling; John H. Arnold; Rami Akhrass; Patrick M. McCarthy; Delos M. Cosgrove

1999-01-01

43

Noradrenaline-induced contraction of human saphenous vein and human internal mammary artery: involvement of different alpha-adrenoceptor subtypes.  

PubMed

Although saphenous veins and internal mammary arteries are commonly used for coronary artery bypass grafting, only a very few comparative studies are available on alpha-adrenoceptor-mediated vasoconstriction in these vessels. Thus, we determined, in isolated rings from human saphenous vein and human internal mammary artery, contractile responses to noradrenaline (10(-8)-10(-4) M) in the absence and presence of the alpha-adrenoceptor antagonists yohimbine (alpha(2)-adrenoceptor antagonist, 10(-8)-10(-6) M), prazosin (alpha(1)-adrenoceptor antagonist, 10(-9)-10(-7) M), 5-methyl-urapidil (5-MU, alpha(1A)-adrenoceptor antagonist, 10(-8)-10(-6) M), BMY 7378 (alpha(1D)-adrenoceptor antagonist, 10(-7)-10(-6) M), and chloroethylclonidine (CEC, irreversible alpha(1B)-adrenoceptor antagonist, 3x10(-5) M for 30 min). All experiments were carried out in the presence of 10(-7) M propranolol and 10(-5) M cocaine. In both vessel types noradrenaline evoked concentration-dependent contractions. In saphenous veins yohimbine was a potent antagonist (pA(2)-value 8.32) while prazosin, 5-MU and BMY exhibited only marginal antagonistic effects. CEC, however, significantly decreased noradrenaline-induced contractions. In contrast, in internal mammary arteries prazosin (pA(2)-value 9.65) and 5-MU (pK(B)-values 7.2-7.5) were potent antagonists, while yohimbine and BMY exhibited only weak antagonistic effects. CEC, however, significantly decreased noradrenaline-induced contractions. We conclude that in saphenous vein the contractile response to noradrenaline is mediated predominantly by alpha(2)-adrenoceptors, while in internal mammary artery it is mediated (to a major part) by alpha(1B)- and (to a minor part) by alpha(1A)-adrenoceptors. PMID:12122495

Giessler, Christine; Wangemann, Thekla; Silber, Rolf-Edgar; Dhein, Stefan; Brodde, Otto-Erich

2002-08-01

44

The relevance of arterial wall microbiology to the treatment of prosthetic graft infections: graft infection vs. arterial infection.  

PubMed

One potential, but poorly studied source for intraoperative contamination of vascular grafts is the native artery to which the prosthetic graft is attached. The purpose of this study was to analyze the relationship between arterial wall microbiology and graft infection. Between July 1, 1981, and March 31, 1982, arterial specimens were cultured from 88 (30%) of 298 patients undergoing clean, elective arterial reconstructive procedures. Control cultures were obtained from adjacent adipose or lymph node tissue. Positive cultures were obtained from 38 of 88 (43%) of the arterial walls cultured but from none of the control cultures (0 of 20) (p less than 0.001). The most common organism cultured was Staphylococcus epidermidis (27 of 38; 71%). Our overall graft infection rate since January 1, 1981, is 0.9% (3 of 335). All three graft infections occurred in patients with positive arterial cultures. Arterial and graft cultures were also obtained from 20 patients treated for 22 graft infections over the past 13 years. Organisms recovered included staphylococcal species (36%), enteric organisms (46%), and mixtures of the two (18%). These patients with culture-positive graft infections were divided retrospectively into two groups: those with positive and those with negative arterial cultures. Positive arterial cultures were associated with suture line disruption in 8 of 14 cases (57%), but there were no arterial disruptions in patients with negative cultures (0 of 8) (p less than 0.01). These data document a significant correlation between positive arterial wall cultures and subsequent prosthetic infection and also suggest that infection involving the arterial wall is a major determinant of the morbidity and mortality associated with the treatment of prosthetic graft sepsis. PMID:6436515

Macbeth, G A; Rubin, J R; McIntyre, K E; Goldstone, J; Malone, J M

1984-11-01

45

Effects of competitive blood flow on arterial graft patency and diameter  

Microsoft Academic Search

To identify predictors of arterial graft patency, we followed up 30 internal thoracic arterial grafts and 23 right gastroepiploic arterial grafts in situ with patency documented during postoperative angiography. After 24 months of follow–up on average, repeat angiography detected that one internal thoracic artery and two gastroepiploic arteries were anatomically occluded and that the other three gastroepiploic arteries were nonfunctioning.

Hideki Hashimoto; Takaaki Isshiki; Yuji Ikari; Kazuhiro Hara; Fumihiko Saeki; Tsutomu Tamura; Tetsu Yamaguchi; Hisayoshi Suma

1996-01-01

46

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

Microsoft Academic Search

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

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

2010-01-01

47

Use of varicose veins as arterial bypass grafts.  

PubMed

Varicose veins are not generally used as arterial bypass grafts despite their physiological endothelial flow surface. The large, irregular diameter and the thin wall renders these veins inadequate. Experimental studies have shown that a considerable reduction in the diameter of veins can be achieved by external wrapping without the generation of obstructing folds of the vein wall. A Dacron mesh tube surrounding varicose veins was used as a bypass graft in 13 infrainguinal arterial reconstructions. Ligated larger side branches and connections of the mesh segments caused irregularities of the otherwise smooth flow surfaces. Ten grafts were patent after a mean follow-up of 17 months. Two grafts have remained patent despite severe outflow obstruction in one and proximal occlusion in the other; both underwent successful interventions. The antithrombogenic properties of these grafts were partly due to a marked increase of the vasa vasorum. Externally constricted varicose veins may be used as arterial bypass conduits with good intermediate-term patency. PMID:8076087

Moritz, A; Grabenwöger, F; Raderer, F; Ptakovsky, H; Magometschnigg, H; Ullrich, R; Staudacher, M

1993-10-01

48

Endothelium-derived relaxing factor and protection against contractions induced by histamine and serotonin in the human internal mammary artery and in the saphenous vein.  

PubMed

We investigated the release of endothelium-derived relaxing factor (EDRF) in response to serotonin and histamine in the human internal mammary artery and saphenous vein. The arteries and veins were obtained intraoperatively and were suspended in organ chambers to record isometric tension. In mammary arteries, histamine (10(-8) to 3 X 10(-6) M) induced relaxations in rings with (70 +/- 5%, IC50, 6.5 +/- 0.2) but not without endothelium (p less than 0.005 for rings with compared with those without endothelium, n = 7-10). The response was inhibited by methylene blue or hemoglobin, but not meclofenamate, and, therefore, EDRF was delineated as the mediator. Because chlorpheniramine but not cimetidine inhibited the response, EDRF was released by the H1-histaminergic receptor (n = 5-8). In contrast, in saphenous veins, histamine caused only weak or absent endothelium-dependent relaxations, but contractions were enhanced in rings with endothelium (p less than 0.05, n = 6). Serotonin did not induce endothelium-dependent relaxations, but contractions were markedly greater in veins compared with arteries (p less than 0.005, n = 6). The endothelium inhibited the maximal contraction to serotonin in arteries (p less than 0.034) but not in veins. Thus, EDRF protects against contractions induced by histamine and serotonin in the mammary artery but not in the saphenous vein. This may be important for improved graft function and patency of the artery compared with that of the vein. PMID:2791236

Yang, Z H; Diederich, D; Schneider, K; Siebenmann, R; Stulz, P; von Segesser, L; Turina, M; Bühler, F R; Lüscher, T F

1989-10-01

49

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 ...

50

Factors influencing acute thrombus formation on carotid artery vascular grafts  

SciTech Connect

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

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

1988-10-01

51

Awake coronary artery bypass grafting: utopia or reality?  

Microsoft Academic Search

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

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

2003-01-01

52

Beating heart composite valve graft replacement and hemiarch aortic reconstruction in a patient with patent internal thoracic artery graft.  

PubMed

Effective myocardial protection is often challenging in patients who have undergone prior myocardial revascularization and require reintervention on the aortic root with patent grafts. We report the case of a patient who underwent composite valve graft replacement and hemiarch aortic reconstruction after repair of a ruptured aneurysm of the right coronary sinus of valsalva combined with a right internal thoracic artery to right coronary artery bypass grafting. Because the right coronary artery ostium was obstructed by the previously placed patch, we performed the redo operation on the beating heart using continuous patent graft flow and left coronary artery ostial perfusion. PMID:20395254

Morimoto, Hironobu; Hirayama, Toitsu; Misumi, Hiroyasu; Uesugi, Hideyuki

2010-07-01

53

The radial artery versus the saphenous vein graft in contemporary CABG: a case-matched study  

Microsoft Academic Search

Background. Although use of the internal thoracic artery has been shown to improve outcomes after coronary artery bypass grafting, the same cannot be said of alternative arterial conduits. To determine the benefit of radial artery (RA) grafting, a case-matched review was undertaken.Methods. Between March 1994 and March 1999, 2,847 patients underwent isolated coronary artery bypass grafting with a left internal

Gideon Cohen; Miguel G Tamariz; Jeri Y Sever; Negin Liaghati; Veena Guru; George T Christakis; Gopal Bhatnagar; Charles Cutrara; Labib Abouzahr; Bernard S Goldman; Stephen E Fremes

2001-01-01

54

Endovascular Stent-Grafting for Infected Iliac Artery Pseudoaneurysms  

SciTech Connect

We report two cases of acutely infected pseudoaneurysms of the iliac arteries, successfully treated with endovascular stent-grafting. Two patients underwent stent-graft treatment for erosive rupture of the iliac artery caused by surrounding infection. The first case is that of a 61-year-old man who had undergone Miles' operation for an advanced rectal cancer. Postoperatively, he developed intrapelvic abscess formation, from which methicillin-resistant Staphylococcus aureus was cultured, followed by rupture of the right external iliac artery. The second case is that of a 60-year-old man who had a pseudoaneurysm of the left common iliac artery, which was contiguous with a left psoas muscle abscess, from which Streptococcus agalactiae was cultured. Both patients were successfully treated with only a stent-graft and antibiotic therapy, and remained symptom-free 12 months and 10 months later. Although endovascular stent-grafting should not be considered standard therapy for infected aneurysms, our cases suggest that it can result in repair of infected aneurysms even in the uncontrolled active stage.

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

2005-01-15

55

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

PubMed

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

Kobayashi, Junjiro

2006-01-01

56

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

Microsoft Academic Search

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

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

2009-01-01

57

What Is Coronary Artery Bypass Grafting (CABG)?  

MedlinePLUS

... with arteries with the aim of reducing the patient's risk of needing another operation. Another technique aimed at ... keep in mind that estimates of a particular patient's risk of any of these complications can only be ...

58

Extra-anatomical revascularization of the Adamkiewicz artery using the internal mammary artery: preliminary anatomical study.  

PubMed

Ischemic spinal cord injury remains a major complication of both open and endovascular repairs of extensive lesions of the thoracic or thoracoabdominal aorta. Patients undergoing endovascular treatment cannot benefit from direct revascularization of the Adamkiewicz artery (AA). Primary revascularization of the intercostal artery (ICA) giving rise to the AA using the internal mammary artery (IMA) could ensure uninterrupted flow in the AA even if the origin of the feeding ICA was obstructed. The purpose of this study was to assess the anatomical feasibility of revascularization of the ICA giving rise to the AA using the IMA. Twenty-four dissections were carried out on 12 cadavers (eight men, four women) with a mean age of 76 at the time of death. Preparation consisted of intra-arterial injection of polymethylsiloxane (Rhodorsil, Rhodia, France). For each IMA, the following parameters were determined: diameter in relation to the ICA in the paravertebral region before division, length, and level of the intercostal space in which direct anastomosis was possible. Dissection showed that the mean diameter at the end of the IMA was 1.8mm (range 1.2-2.4). The mean diameter of the ICA in the paravertebral region was compatible with that of the IMA, i.e., 1.6mm (range 0.9-2.5). The mean length of the IMA was 185 mm (range 165-230). The lowest intercostal space available in the paravertebral region for direct anastomosis between the IMA and ICA was the seventh space in one case, the eighth in 12, the ninth in eight, and the tenth in three. The findings of this preliminary study document the feasibility of using the IMA to revascularize the ICA in the paravertebral region. This technique could provide a means of preserving spinal cord vascularization during endovascular treatment of thoracic or thoracoabdominal aortic lesions. PMID:19875011

Malikov, Serguei; Magnan, Pierre-Edouard; Branchereau, Alain; Bartoli, Jean-Michel; Champsaur, Pierre

2009-01-01

59

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

NASA Astrophysics Data System (ADS)

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

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

2005-07-01

60

Neointimal Hyperplasia after Stenting in a Human Mammary Artery Organ Culture  

Microsoft Academic Search

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

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

2004-01-01

61

Development of Small Diameter Nanofiber Tissue Engineered Arterial Grafts  

PubMed Central

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 ?-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

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

62

Histological comparison of the candidate arteries for bypass grafting of the posterior interventricular artery.  

PubMed

This study evaluated five vessels as potential candidates for coronary artery bypass grafting at the posterior interventricular artery (PIVA) blockage site. We used light microscopy and digital image analysis of H&E and Van Gieson's-stained slides to investigate luminal diameter, arterial wall thickness, and relative muscularity and elasticity of candidate vessels. Results from our sample indicate that the inferior epigastric artery (IEA) may be the preferred graft to the PIVA based on overall similarities in these measurements. Other arteries provided a favorable match based on a single measurement, but the IEA agreed most consistently with the PIVA. When choosing a vessel to bypass blockage at the PIVA, cardiothoracic surgeons should be aware of the many favorable features of the IEA. PMID:22648396

Appleson, Tova; Hill, Robert V

2012-09-01

63

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

PubMed

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

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

2005-06-01

64

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

PubMed Central

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

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

65

Interposition saphenous vein bypass graft between the common and intracranial internal carotid arteries  

Microsoft Academic Search

22 common carotid to intracranial internal carotid artery bypass grafts with interposition saphenous vein were performed in 20 patients over a four year period. The distal anastomosis was end-to-end on the internal carotid artery at a site between the ophthalmic and posterior communicating arteries. Early occlusion (rendered patent with Urokinase) occurred in one graft resulting in fatal infarction. Flow included

Michael K Morgan; Jeffrey Brennan; M. Jerome Day

1996-01-01

66

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

SciTech Connect

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

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

2008-09-15

67

Comparison of flow characteristics and vascular reactivity of radial artery and long saphenous vein grafts [NCT00139399  

Microsoft Academic Search

BACKGROUND: The morphological and functional differences between arteries and veins may have implications on coronary artery bypass graft (CABG) survival. Although subjective differences have been observed between radial artery (RA) and long saphenous venous (LSV) grafts, these have not been quantified. This study assessed and compared the flow characteristics and in-vivo graft flow responses of RA and LSV aorto-coronary grafts.

William CF Chong; Peter Collins; Carolyn M Webb; Anthony C De Souza; John R Pepper; Christopher S Hayward; Neil E Moat

2006-01-01

68

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

PubMed

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

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

1994-09-01

69

5Hydroxytryptamine induces contraction in isolated human mammary artery: Effect of ketanserin  

Microsoft Academic Search

5-hydroxytryptamine (5HT) treatment produced dose-related contractions in the human internal mammary artery with an EC50 value of 3.4×10-7M. The 5HT2 receptor antagonist ketanserin reversed the contractions evoked by 5HT in a competitive manner at a low concentration (10-6 M), whereas a noncompetitive antagonism was apparent at higher concentrations (5× 10-8 M to 5×10-7 M). The alpha1-blocking component of ketanserin was

Angela Monopoli; Annamaria Conti; Angelo Forlani; Ennio Ongini; Carlo Antona; Paolo Biglioli

1990-01-01

70

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

PubMed

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

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

2014-07-15

71

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

PubMed

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

Maruyama, Yuji; Ochi, Masami

2014-09-01

72

Endothelium-dependent relaxation in perforating branch of human internal mammary artery  

Microsoft Academic Search

The purpose of the present study was to examine the effect of acetylcholine on perforating branch of the human internal mammary artery (HIMA). Acetylcholine (10?9–10?5M) induced concentration- and endothelium-dependent relaxation (pEC50=7.54±0.03, maximal response was 98±1.3%) of the precontracted arterial segments. Indomethacin, 4-aminopyridine (10?5M) and precontraction with K+-rich Krebs–Ringer–bicarbonate solution had no effect on acethylcholine-induced relaxation. NG-monomethyl-L-arginine (L-NMMA) (10?5M) inhibited relaxation

S Peši?; A Jovanovi?; L Grbovi?; M Ini?; N Munjas

2000-01-01

73

Massive intracardiac thrombosis during coronary artery bypass grafting surgery  

PubMed Central

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

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

2015-01-01

74

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

Microsoft Academic Search

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

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

2003-01-01

75

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

Microsoft Academic Search

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

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

2003-01-01

76

In situ arterial allografting for aortoiliac graft infection: a 6-year experience  

Microsoft Academic Search

Between October 1988 and May 1994, all aortoiliac graft infections seen in the authors' service were treated by in situ arterial allografting after resection of any infected graft or tissue. Some 83 consecutive cases were treated; there were 68 isolated primary prosthetic infections (82%) and 15 aortoenteric fistulae (18%). Emergency arterial allografting was performed in five cases (6%), elective allografting

F Koskas; D Plissonnier; A Bahnini; C Ruotolo; E Kieffer

1996-01-01

77

Treatment of a Hepatic Artery Aneurysm by Endovascular Stent-Grafting  

SciTech Connect

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

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

2007-06-15

78

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

SciTech Connect

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

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

1989-11-01

79

Fibrin-polylactide-based tissue-engineered vascular graft in the arterial circulation  

Microsoft Academic Search

There is a clear clinical requirement for the design and development of living, functional, small-calibre arterial grafts. Here, we investigate the potential use of a small diameter, tissue-engineered artery in a pre-clinical study in the carotid artery position of sheep. Small-calibre (?5 mm) vascular composite grafts were molded using a fibrin scaffold supported by a poly(L\\/D)lactide 96\\/4 (P(L\\/D)LA 96\\/4) mesh, and

Sabine Koch; Thomas C. Flanagan; Joerg S. Sachweh; Fadwa Tanios; Heike Schnoering; Thorsten Deichmann; Ville Ellä; Minna Kellomäki; Nina Gronloh; Thomas Gries; René Tolba; Thomas Schmitz-Rode; Stefan Jockenhoevel

2010-01-01

80

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

SciTech Connect

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

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

1987-02-01

81

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

Microsoft Academic Search

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

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

1999-01-01

82

Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms  

Microsoft Academic Search

Purpose: During endovascular grafting of an abdominal aortic aneurysm (AAA), iliac limb extension to the external iliac artery may be indicated when the common iliac artery is ectatic or aneurysmal. Preliminary or concomitant coil embolization of the internal iliac artery (IIA) is thus necessary to prevent potential reflux and endoleak. We sought to determine the safety of hypogastric flow interruption

Frank J. Criado; Eric P. Wilson; Omaida C. Velazquez; Jeffrey P. Carpenter; Clyde Barker; Eric Wellons; Omran Abul-Khoudoud; Ronald M. Fairman

2000-01-01

83

Conservative Management of Chylothorax after Coronary Artery Bypass Grafting  

PubMed Central

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.

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

2015-01-01

84

Hydrodynamic simulation of arterial networks which include compliant and rigid bypass grafts.  

PubMed

The conditions required to produce an ideal bypass graft have not yet been determined. In order to understand the hemodynamic impact of bypass grafts on cardiovascular function, a hydrodynamic model for the part of the human arterial network below the renal arteries has been constructed. The results from this physical model were used to validate a digital computer model of the arterial network developed by the authors, that incorporated loops which occur due to bypass grafts. The hydrodynamic model was designed to study the interaction between an arterial stenosis and bypass graft and, in particular, the effect of the compliance of the graft on their function. In the model, similarity laws have been maintained with regard to geometry, viscosity, peripheral resistance, wall elastic properties, pulse shape, and blood flow rate. Measured and predicted pressure and flow wave-forms showed an increase in their mean and peak values for the healthy leg when the bypass graft was closed. There was also a severe pressure drop across the stenosis and a marked decrease in mean and pulsatile flow in the stenotic leg. The stenosis in the hydrodynamic model produced similar behaviour to published results obtained on animals. When the graft was open, the agreement between our experimental and theoretical model was within 5% and both the pressure and flow waves were almost similar at the maxima and minima in both legs. Although the arterial system is non-linear, the non-linearities are shown to be of insignificant magnitude and therefore, we have concluded that the pressure flow relationship is essentially linear. The effect of the degree of compliance of the graft and the 'steal' phenomenon due to the graft have been investigated. It was found that there were no significant differences in the flow delivery between the compliant graft and stiff graft. Also, there was no 'steal'. Thus the compliance of the graft is not a significant factor in promoting its patency. PMID:8051188

Helal, M A; Watts, K C; Marble, A E

1994-03-01

85

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

PubMed Central

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

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

86

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

SciTech Connect

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

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

2009-01-15

87

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

SciTech Connect

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

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

1982-08-01

88

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

PubMed Central

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

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

2014-01-01

89

The natural history of endothelial structure and function in arterialized vein grafts.  

PubMed

When the saphenous vein is used in the in situ position for arterial bypass surgery, it is associated with more optimal preservation of the endothelial lining and with improved graft patency compared with reversed vein grafts. However, it is not clear whether preservation of endothelial integrity persists after arterialization. The goal of this study was to establish whether preservation of the endothelium before arterialization is a critical factor in the development of late functional and morphologic abnormalities of autogenous vein grafts. Paired reversed and in situ vein grafts were created in 75 mongrel dogs. Veins to be used in the reversed position were excised and stored in either heparinized whole blood at 37 degrees C or saline solution at 4 degrees C. Veins were studied before and after arterialization. The veins were arterialized by anastomosis to the carotid artery and excised at intervals of 1 day to 12 weeks for studies of the luminal production of prostacyclin and thromboxane A2 in addition to luminal morphology. Before arterialization, normothermic whole blood preserved biochemical function of the endothelium significantly better than hypothermic saline solution, but not as well as the in situ vein procedure. Soon after arterialization, all three vein grafts showed significant functional and morphologic abnormalities consistent with injury of the vein graft. Morphologic healing of the endothelial monolayer progressed slowly back to normal; however, the biochemical capacity of the vein graft never matched that of the prearterialized vein, nor that of normal host arteries. Regardless of surgical technique, all vein grafts exhibited a period of abnormal structure and function, which exposed them to the risk of thrombogenesis. This period of potential leukocyte or platelet interaction with the vein wall could lead to release phenomena as well as proliferative changes in the vessel wall. PMID:3511302

Bush, H L; Jakubowski, J A; Curl, G R; Deykin, D; Nabseth, D C

1986-02-01

90

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

Microsoft Academic Search

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

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

2006-01-01

91

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

Microsoft Academic Search

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

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

2001-01-01

92

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

SciTech Connect

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

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

2009-05-15

93

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

SciTech Connect

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

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

2007-02-15

94

An impedance matching of femoral-popliteal arterial grafts: a theoretical study.  

PubMed

We have proposed a mathematical method to investigate the matching conditions for an arterial graft in the femoral-popliteal region from a mechanical stand-point. Pulsatory blood flow, arterial wall motions, and conservation law are expressed by linear dynamical equations based on strict mechanical and constitutional considerations. To express the physiological blood flow in an actual arterial system, the tethering effects from the surrounding tissue and wall tensions were incorporated. The physiological parameters of arterial wall and tethering were utilized from reported experimental data. By complex analysis, mathematical expressions for the local impedance and reflection coefficient were obtained. They include not only blood properties such as viscosity and density, but also arterial properties including elastic modulus, radius, Poisson ratio, wall thickness, wall tension, frequency, and tethering effects from surrounding tissue. A matching condition was defined for minimizing the local impedance and reflection coefficient. The biophysical background was to reduce any mechanical mismatches, thus minimizing the disturbance of the flow velocity profile and shear stress distribution within the artery. Impedance matching in turn diminishes the negative factors for graft substitution represented by intimal hyperplasia and thrombosis. The calculated impedance and reflection coefficient inversed parabolically to functions of the resistance of the host artery, and there was one host arterial resistance that minimized the impedance and reflection coefficient. The present analysis revealed that for matching host artery with an elevated resistance, the dynamic elastic modulus of the wall of the graft that minimizes the impedance and reflection coefficient was increased. This indicates that for a host artery with a high resistance, an impedance matched stiff wall graft is preferable. For a large radius and a compliant host artery on the other hand, a large compliant graft should be linked. The present theoretical matching conditions will prevent anastomotic hyperplasia and thrombosis in graft substitution. PMID:9129769

Hirayama, H; Nishimura, T; Fukuyama, Y

1997-05-01

95

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

Microsoft Academic Search

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

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

1989-01-01

96

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

Microsoft Academic Search

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

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

1995-01-01

97

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

PubMed Central

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

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

2014-01-01

98

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

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

2014-01-01

99

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

PubMed

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

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

2004-12-01

100

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

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

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

2015-01-01

101

Coronary Arteries Bypass Grafting Surgery in Elderly Patients  

PubMed Central

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

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

2013-01-01

102

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

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.

Treitl, Marcus, E-mail: Marcus.Treitl@med.uni-muenchen.de [Clinical Center of the Ludwig-Maximilians-University of Munich, Department for Clinical Radiology (Germany); Rademacher, Antje [Clinical Center of the Ludwig-Maximilians-University of Munich, Division of Vascular Medicine, Medical Policlinic (Germany); Becker-Lienau, Johanna; Reiser, Maximilian F. [Clinical Center of the Ludwig-Maximilians-University of Munich, Department for Clinical Radiology (Germany); Hoffmann, Ulrich; Czihal, Michael [Clinical Center of the Ludwig-Maximilians-University of Munich, Division of Vascular Medicine, Medical Policlinic (Germany)

2011-06-15

103

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

PubMed Central

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

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

2012-01-01

104

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

Microsoft Academic Search

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

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

2010-01-01

105

Percutaneous placement of a balloon-expandable intraluminal graft for life-threatening subclavian arterial hemorrhage.  

PubMed

A balloon-expandable intraluminal graft was percutaneously deployed in the left subclavian artery of a 43-year-old woman. This graft was made of a stainless steel, 30-mm Palmaz balloon-expandable iliac stent completely covered with a thin coat of silicone. The procedure was successful in managing and preventing life-threatening hemorrhage as a large-bore catheter was removed from the subclavian artery via its subcutaneous tunnel. Surgical repair of the high brachial-axillary sheath insertion site was required after percutaneous deployment of the graft. However, the grafting procedure succeeded in obviating a thoracotomy. At follow-up of 6 months, despite diminution in brachial pulse volume recordings, the patient is asymptomatic at rest. She experiences mild fatigue with extremes of upper extremity exercise and declines angiographic follow-up and further intervention. PMID:1799760

Becker, G J; Benenati, J F; Zemel, G; Sallee, D S; Suarez, C A; Roeren, T K; Katzen, B T

1991-05-01

106

Endovascular treatment of isolated iliac artery aneurysms with anaconda stent graft limb.  

PubMed

Isolated aneurysms of the iliac arteries are relatively rare conditions that traditionally have been treated by surgical reconstruction. We report our experience with endovascular treatment of iliac artery aneurysms (IAAs) with Anaconda stent graft limb. Two male patients were found to have 4.5 and 3.6?cm isolated common IAAs, respectively. The endograft was successfully advanced and deployed precisely to the intended position in both cases. In one case the internal iliac artery was embolized. No type I or II endoleak was observed immediately after the procedure. In one patient postimplantation fever (>38°C) and gluteal claudication occurred. After 2?years followup both iliac endovascular stent grafts are patent and without endoleak. Endovascular treatment with Anaconda limb stent graft seems to be a safe and feasible alternative to open surgery. PMID:23862094

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

2013-01-01

107

Theoretical model for assessing haemodynamics in arterial networks which include bypass grafts.  

PubMed

The paper presents a theoretical model which can be used to simulate a vascular network which includes loops and bypass grafts, a feature not possible with previous models. Using the linearised Navier-Stokes equations, the linearised equation of a uniform thick-walled viscoelastic tube, and the equation of continuity, the model is applied to a vascular network which includes a bypass graft. This method represents each segment of an artery or graft by a four-terminal-network whose A, B, C, D parameters are functions of the frequency and physical characteristics of the segment. The model predicts the flow and pressure waveforms at any point in the human arterial network very accurately when compared with data obtained from normal patients, patients with arterial stenoses and for hypertensive patients. The model also gives results which are in close agreement with hydraulic experimental data for the input impedance of systems with bypass loops. PMID:2277547

Helal, M A; Watts, K C; Marble, A E; Sarwal, S N

1990-09-01

108

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

PubMed

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

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

2014-01-01

109

Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment  

PubMed Central

The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA). A 72-year-old female with a 6?cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR. PMID:25544930

Bracale, Umberto Marcello; Giribono, Anna Maria; Vitale, Gaetano; Narese, Donatella; Santini, Gianpaolo; del Guercio, Luca

2014-01-01

110

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

SciTech Connect

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

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

1987-08-01

111

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

PubMed

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

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

2014-04-01

112

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

PubMed

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(P?), 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 EP? (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(P?) (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

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

2014-12-01

113

Role of graft flow measurement technique in anastomotic quality assessment in minimally invasive CABG  

Microsoft Academic Search

Background. Anastomotic quality is currently the critical issue in minimally invasive coronary surgery. Although little is known about its effectiveness, surgeons routinely assess grafts intraoperatively using flow probes. This study was designed to determine whether mean flow and the pattern of flow tracing in internal mammary artery grafts obtained with a transit-time flow probe are reliable indicators of anastomotic quality.Methods.

Saad F. Jaber; Steven C. Koenig; Bobby BhaskerRao; Daniel J. VanHimbergen; Patricia B. Cerrito; Daniel J. Ewert; Laman A. Gray; Paul A. Spence

1998-01-01

114

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

SciTech Connect

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

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

1998-03-15

115

Post-mortem cast angiography in the diagnostics of graft complications in patients with fatal outcome following coronary artery bypass grafting (CABG)  

Microsoft Academic Search

The advantages and limitations of a novel post-mortem angiographic method using solidifying silicone rubber and lead oxide\\u000a as a contrast medium in detecting coronary artery graft complications on a routine basis were evaluated in a series of 223\\u000a consecutive patients with fatal outcome within 30 days following coronary artery bypass grafting (CABG). Of these patients,\\u000a 166 (74.4%) were male and

S. M. Weman; A. Penttilä; A. Männikkö; P. J. Karhunen

1999-01-01

116

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

PubMed Central

Tissue-engineered arteries based on entrapment of human dermal fibroblasts in fibrin gel yield completely biological vascular grafts that possess circumferential alignment characteristic of native arteries and essential to their mechanical properties. A bioreactor was developed to condition six grafts in the same culture medium while being subjected to similar cyclic distension and transmural flow resulting from pulsed flow distributed among the graft lumens via a manifold. The lumenal pressure and circumferential stretch were noninvasively monitored and used to calculate stiffness in the range of 80-120 mmHg and then to successfully predict graft burst strength. The length of the graft was incrementally shortened during bioreactor culture to maintain circumferential alignment and achieve mechanical anisotropy comparable to native arteries. After 7-9 weeks of bioreactor culture, the fibrin-based grafts were extensively remodeled by the fibroblasts into circumferentially-aligned tubes of collagen and other extracellular matrix with burst pressures in the range of 1400-1600 mmHg and compliance comparable to native arteries. The tissue suture retention force was also suitable for implantation in the rat model and, with poly(lactic acid) sewing rings entrapped at both ends of the graft, also in the ovine model. The strength achieved with a biological scaffold in such a short duration is unprecedented for an engineered artery. PMID:20934214

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

2011-01-01

117

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

SciTech Connect

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

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

1989-06-15

118

Giant aneurysms of coronary arteries and saphenous vein grafts: angiographic findings and histopathological correlates  

Microsoft Academic Search

Introduction: Giant aneurysms that develop in native coronary arteries or saphenous vein grafts are morphologically defined as abnormally expanded outpouching vascular structures >4 cm in diameter. The location, morphology, and content of giant aneurysms account for adverse cardiovascular effects. Methods: Two cases of giant aneurysms were studied comprehensively by noninvasive and invasive cardiac methods and subsequent histopathology. The first patient

On Topaz; Molly S. Rutherford; Shannon Mackey-Bojack; Andreas W. Prinz; Sadasiv Katta; David Salter; Jack L. Titus

2005-01-01

119

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

Microsoft Academic Search

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

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

2004-01-01

120

Effect of Aspirin on Postoperative Bleeding in Coronary Artery Bypass Grafting  

Microsoft Academic Search

Purpose: It is not uncommon for aspirin therapy to be withheld before coronary artery by- pass grafting (CABG) because it is thought to increase the risk of postoperative bleeding. Many studies have shown that continued aspirin therapy reduces postoperative myocardial infarction and increases survival. The purpose of this study is to analyze the effect of preop- erative aspirin on postoperative

Muhammad Kamran; Ali Ahmed; Mudassir Iqbal Dar; Abdul Bari Khan

121

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

Microsoft Academic Search

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

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

2007-01-01

122

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

Microsoft Academic Search

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

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

1997-01-01

123

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

Microsoft Academic Search

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

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

124

UNCORRECTED 1 Computer-Aided Patient-Specific Coronary Artery Graft Design  

E-print Network

-specific coronary artery by-pass graft 19 (CABG) design and, (iii) compare the hemodynamic effi- 20 ciency of the sequential CABG, i.e., raising a daughter 21 parallel branch from the parent CABG in patient-specific 3D 22

Pekkan, Kerem

125

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

Microsoft Academic Search

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

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

2002-01-01

126

Clinical Features of Elderly Patients Submitted to Coronary Artery Bypass Graft  

Microsoft Academic Search

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

Franklin Santana Santos; Irineu Tadeu Velasco

2005-01-01

127

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

Microsoft Academic Search

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

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

2010-01-01

128

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

Microsoft Academic Search

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

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

2003-01-01

129

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

Microsoft Academic Search

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

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

2007-01-01

130

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

Microsoft Academic Search

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

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

2011-01-01

131

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

Microsoft Academic Search

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

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

2012-01-01

132

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

Microsoft Academic Search

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

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

2010-01-01

133

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

Microsoft Academic Search

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

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

1999-01-01

134

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

Microsoft Academic Search

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

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

2010-01-01

135

Pleural Effusions Following Cardiac Injury and Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

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

Richard W. Light

2001-01-01

136

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

PubMed

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

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

2010-07-01

137

Management of iatrogenic RV injury — RV packing and CPB through PTFE graft attached to femoral artery  

PubMed Central

Cardiac injuries during repeat sternotomy are rare. While undergoing debridement for chronic osteomyelitis (post arterial septal defect closure), a 4-year-old girl sustained significant right ventricular (RV) injury. Bleeding from the RV was controlled by packing the injury site, which helped in maintaining stable hemodynamics till arrangements were made for instituting cardiopulmonary bypass (CPB). Since the femoral artery was very small and unsuitable for direct cannulation, a polytetrafluoroethylene (PTFE) graft sutured end-to-side to the femoral artery was used for establishing CPB. The injury was successfully repaired. PMID:25684889

Mangukia, Chirantan V; Agarwal, Saket; Satyarthy, Subodh; Aggarwal, Satish Kumar; Datt, Vishnu; Satsangi, Deepak Kumar

2015-01-01

138

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

PubMed Central

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

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

2013-01-01

139

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

PubMed Central

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

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

2015-01-01

140

Extracranial-Intracranial Bypass Surgery Using a Radial Artery Interposition Graft for Cerebrovascular Diseases  

PubMed Central

Objective To investigate the efficacy of extracranial-intracranial (EC-IC) bypass surgery using a radial artery interposition graft (RAIG) for surgical management of cerebrovascular diseases. Methods The study involved a retrospective analysis of 13 patients who underwent EC-IC bypass surgery using RAIG at a single neurosurgical institute between 2003 and 2009. The diseases comprised intracranial aneurysm (n=10), carotid artery occlusive disease (n=2), and delayed stenosis in the donor superficial temporal artery (STA) following previous STA-middle cerebral artery bypass surgery (n=1). Patients were followed clinically and radiographically. Results Bypass surgery was successful in all patients. At a mean follow-up of 53.4 months, the short-term patency rate was 100%, and the long-term rate was 92.3%. Twelve patients had an excellent clinical outcome of Glasgow Outcome Scale (GOS) 5, and one case had GOS 3. Procedure-related complications were a temporary dysthesia on the graft harvest hand (n=1) and a hematoma at the graft harvest site (n=1), and these were treated successfully with no permanent sequelae. In one case, spasm occurred which was relieved with the introduction of mechanical dilators. Conclusion EC-IC bypass using a RAIG appears to be an effective treatment for a variety of cerebrovascular diseases requiring proximal occlusion or trapping of the parent artery. PMID:22102946

Roh, Sung Woo; Sung, Han Yoo; Jung, Young Jin; Kwun, Byung Duk; Kim, Chang Jin

2011-01-01

141

Sympathetic denervation in association with coronary artery grafting in patients with Prinzmetals' angina.  

PubMed

Myocardial revascularization in patients with Prinzmetal's angina has yielded variable results. Two patients are presented who underwent partial cardiac sympathectomy in combination with coronary artery grafting for typical variant angina associated with severe organic obstructive coronary artery disease. Late results 12 and 18 months postoperatively have been excellent in both instances as shown by clinical and angiographic evaluation. Although the exact mechanism responsible for Prinzmetal's angina is not known, it is believed that spasm through increased activity of vasomotor tone or of the autonomic nervous system plays a major role. Since this variant form of angina encompasses a whole spectrum at angiography, ranging from normal arteries to severely narrowed ones, including those with spasm, it is suggested that surgical treatment be planned accordingly. Thus, in patients who have organic stenoses with and without spasm, operative treatment may consist of removal of the preaortic or pretracheal plexus in association with conventional coronary artery grafting. In patients who have intractable episodes of ventricular arrhythmia or angina and who angiogram is normal or shows isolated spasm, coronary artery grafting should be abandoned, in view of the poor results reported in the literature in these circumstances, and cervicothoracic sympathectomy should be considered. PMID:300006

Grondin, C M; Limet, R

1977-02-01

142

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

PubMed Central

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

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

2013-01-01

143

Coronary Artery Bypass Graft Surgery (Beyond the Basics)  

MedlinePLUS

... taken from the inner forearm. The long-term outcome with these arteries is also excellent and almost ... with wide experience using this technique, long-term outcomes seem to be comparable to the standard CABG ...

144

Dealing with a Porcelain Aorta during Coronary Artery Bypass Grafting  

PubMed Central

We report a complex case of multivessel CAD in a patient with a porcelain aorta and high-grade left subclavian artery stenosis. Utilizing a staged left subclavian artery stent placement with a next-day plan for a four-vessel, on-pump CABG and ascending aortic replacement, this case highlights an organized approach to diagnosing and dealing with a heavily calcified aorta while describing a stepwise algorithm to deal with aortic calcifications prior to initiating cardiac surgery. PMID:25610695

Adesanya, T. M. Ayodele

2014-01-01

145

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

PubMed

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

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

2013-06-01

146

Minimally invasive coronary artery revascularization on the beating heart  

Microsoft Academic Search

Background. The quality of surgical beating heart revascularization is frequently questioned, especially when the surgical access is limited. Nevertheless, the number of off-pump coronary procedures is expanding worldwide.Methods. Since getting started with minimally invasive direct coronary artery bypass to anterior myocardial vessels in June 1996, 306 patients received left internal mammary artery grafting through an anterior minithoracotomy. Risk increasing comorbidities

Jochen T Cremer; Thorsten Wittwer; Andreas Böning; Marcel B Anssar; Theo Kofidis; Andreas Mügge; Axel Haverich

2000-01-01

147

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

PubMed

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

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

2009-01-01

148

Use of Pulmonary Artery Catheter in Coronary Artery Bypass Graft. Costs and Long-Term Outcomes  

PubMed Central

Background Pulmonary artery catheters (PAC) are used widely to monitor hemodynamics in patients undergoing coronary bypass graft (CABG) surgery. However, recent studies have raised concerns regarding both the effectiveness and safety of PAC. Therefore, our aim was to determine the effects of the use of PAC on the short- and long-term health and economic outcomes of patients undergoing CABG. Methods 1361 Chinese patients who consecutively underwent isolated, primary CABG at the Cardiovascular Institute of Fuwai Hospital from June 1, 2012 to December 31, 2012 were included in this study. Of all the patients, 453 received PAC during operation (PAC group) and 908 received no PAC therapy (control group). Short-term and long-term mortality and major complications were analyzed with multivariate regression analysis and propensity score matched-pair analysis was used to yield two well-matched groups for further comparison. Results The patients who were managed with PAC more often received intraoperative vasoactive drugs dopamine (70.9% vs. 45.5%; P<0.001) and epinephrine (7.7% vs. 2.6%; P<0.001). In addition, costs for initial hospitalization were higher for PAC patients ($14,535 vs. $13,873, respectively, p = 0.004). PAC use was neither associated with the perioperative mortality or major complications, nor was it associated with long-term mortality and major adverse cardiac and cerebrovascular events. In addition, comparison between two well-matched groups showed no significant differences either in baseline characteristics or in short-term and long-term outcomes. Conclusions There is no clear indication of any benefit or harm in managing CABG patients with PAC. However, use of PAC in CABG is more expensive. That is, PAC use increased costs without benefit and thus appears unjustified for routine use in CABG surgery. PMID:25689312

Xu, Fei; Wang, Qian; Zhang, Heng; Chen, Sipeng; Ao, Hushan

2015-01-01

149

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

PubMed

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

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

2015-01-01

150

Implantation of a stent graft in the right pulmonary artery enables radical resection of a central endothelial sarcoma of the left pulmonary artery.  

PubMed

In a patient with a huge endothelial sarcoma of the left pulmonary artery, we report successful implantation of a stent graft in the right pulmonary artery, including the pulmonary arterial trunk. This preoperative measure enabled a safe and radical left-sided pneumonectomy, including the tumor and the central parts of the left pulmonary artery. No major blood loss occurred, and neither use of a heart-lung machine nor cardiopulmonary bypass was necessary. PMID:23466184

Kissling, Pascal; Brosi, Philippe; Kull, Christof; Toia, Damien; Maurer, Christoph Andreas

2013-09-01

151

Ketoprofen combined with artery graft entubulization improves functional recovery of transected peripheral nerves.  

PubMed

The objective was to assess the local effect of ketoprofen on sciatic nerve regeneration and functional recovery. Eighty healthy male white Wistar rats were randomized into four experimental groups of 20 animals each: In the transected group (TC), the left sciatic nerve was transected and nerve cut ends were fixed in the adjacent muscle. In the treatment group the defect was bridged using an artery graft (AG/Keto) filled with 10 microliter ketoprofen (0.1 mg/kg). In the artery graft group (AG), the graft was filled with phosphated-buffer saline alone. In the sham-operated group (SHAM), the sciatic nerve was exposed and manipulated. Each group was subdivided into four subgroups of five animals each and regenerated nerve fibres were studied at 4, 8, 12 and 16 weeks post operation. Behavioural testing, sciatic nerve functional study, gastrocnemius muscle mass and morphometric indices showed earlier regeneration of axons in AG/Keto than in AG group (p < 0.05). Immunohistochemical study clearly showed more positive location of reactions to S-100 in AG/Keto than in AG group. When loaded in an artery graft, ketoprofen improved functional recovery and morphometric indices of the sciatic nerve. Local usage of this easily accessible therapeutic medicine is cost saving and avoids the problems associated with systemic administration. PMID:23932540

Mohammadi, Rahim; Mehrtash, Moein; Nikonam, Nima; Mehrtash, Moied; Amini, Keyvan

2014-12-01

152

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

PubMed

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

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

2008-11-01

153

Internal Mammary Arterial Injury from Lead Extraction: A Clinically Subtle yet Important Complication of Implantable Device Removal  

PubMed Central

Percutaneous implantable device extraction has increased in recent years and is associated with small but significant risk. Arteriovenous fistula formation is an uncommon complication of this procedure. We report two cases where lead extraction was complicated by an arteriovenous fistula between the left internal mammary artery and the left brachiocephalic vein. In both cases, the patients were asymptomatic and the presence of a continuous murmur in the left subclavicular region led to the appropriate diagnosis. These were successfully treated with coil embolization. Auscultation around prior extraction sites should be routinely done to aid in the diagnosis of this potentially harmful complication. PMID:21629794

Cruz, Cesar; Langberg, Jonathan; Lerakis, Stamatios; Veeraswamy, Ravi; Lloyd, Michael

2011-01-01

154

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

PubMed

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

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

2012-10-01

155

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

SciTech Connect

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

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

2009-07-15

156

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

PubMed Central

We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm. PMID:23690714

Kang, Ung Rae; Lee, Young-Hwan

2013-01-01

157

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

SciTech Connect

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.

Brechtel, Klaus, E-mail: klaus.brechtel@med.uni-tuebingen.de; Ketelsen, Dominik [Eberhard-Karls-University, Department of Diagnostic and Interventional Radiology (Germany); Endisch, Andrea [Eberhard-Karls-University, Department of Thoracic and Cardiovascular Surgery (Germany); Heller, Stephan; Heuschmid, Martin [Eberhard-Karls-University, Department of Diagnostic and Interventional Radiology (Germany); Stock, Ulrich A.; Kalender, Guenay [Eberhard-Karls-University, Department of Thoracic and Cardiovascular Surgery (Germany)

2012-04-15

158

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

Microsoft Academic Search

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

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

2002-01-01

159

New Technologies in Coronary Artery Surgery  

PubMed Central

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

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

2013-01-01

160

Supplemental oxygen controls cellular proliferation and anastomotic intimal hyperplasia at a vascular graft-to-artery anastomosis in the rabbit  

Microsoft Academic Search

Purpose: The purpose of this study was to determine whether the administration of 40% supplemental oxygen (O2 ) will decrease cellular proliferation and intimal hyperplasia (IH) at a prosthetic vascular graft (PVG)–to-artery anastomosis. Methods: Twenty New Zealand white rabbits underwent placement of a 3-mm polytetrafluoroethylene graft in their infrarenal aorta. Four groups of five rabbits were placed either in a

Eugene S. Lee; Michael P. Caldwell; Alexander S. Tretinyak; Steven M. Santilli

2001-01-01

161

Interactions between calcium channel blockers and alpha-adrenoceptors in the human coronary and mammary arteries: a radioligand binding study.  

PubMed

The study was designed to assess whether Ca2+ channel blockers of the dihydropyridine family (felodipine, nicardipine, nifedipine, nimodipine, nitrendipine and nisoldipine), and of the phenylalkylamine family (verapamil) have any effect on alpha-adrenoceptor binding to sections of the human right coronary and mammary arteries, measured using [3H]-dihydroergocryptine (DHT) as a ligand. Increasing concentrations of nicardipine, verapamil and nitrendipine competed with [3H]-DHT binding to sections of the human coronary and mammary arteries. The other compounds tested were without effect. Among the competitors of [3H]-DHT binding, nicardipine was the most powerful, with a 50% inhibition (IC50) value of approximately 10 nM. The pharmacological profile of competition with [3H]-DHT binding by nicardipine, in the presence or in the absence of guanosine triphosphate and NaCl, is consistent with antagonist activity of the dihydropyridine derivative at the alpha-adrenoceptor. This property may account for the lower sympathetic stimulatory activity elicited by nicardipine, in comparison with other Ca2+ channel blockers used in cardiovascular therapy. PMID:8051200

Bronzetti, E; Felici, L; Polidori, C; Amenta, F

1994-04-01

162

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

Microsoft Academic Search

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

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

2009-01-01

163

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

Microsoft Academic Search

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

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

2001-01-01

164

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

Microsoft Academic Search

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

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

2009-01-01

165

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

Microsoft Academic Search

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

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

2008-01-01

166

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

Microsoft Academic Search

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

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

1999-01-01

167

Effects of minimal-dose aprotinin on coronary artery bypass grafting  

Microsoft Academic Search

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

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

1997-01-01

168

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

Microsoft Academic Search

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

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

2001-01-01

169

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

PubMed Central

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

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

2013-01-01

170

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

Microsoft Academic Search

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

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

2008-01-01

171

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

SciTech Connect

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

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

2008-01-15

172

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

SciTech Connect

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.

Sakai, Hidetsugu; Urasawa, Kazushi; Oyama, Naotsugu; Kitabatake, Akira [Hokkaido University Graduate School of Medicine, Department of Cardiovascular Medicine (Japan)

2004-09-15

173

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

SciTech Connect

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

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

2006-10-15

174

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

PubMed Central

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

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

2014-01-01

175

Expanded polytetrafluoroethylene arterial prostheses in humans: histopathological study of 298 surgically excised grafts.  

PubMed

The expanded polytetrafluoroethylene vascular prosthesis is considered to be the best synthetic alternative for peripheral arterial reconstruction. Most studies on the healing characteristics of expanded polytetrafluoroethylene prostheses have been carried out on animals, and very few data are available on prosthesis implanted in humans long term. We implanted 298 expanded polytetrafluoroethylene grafts as arterial substitutes in humans. The mean duration of implantation was 523 d and the grafts were implanted mainly for infrainguinal or axillofemoral bypass. The cellular and collagen infiltration of the microporous expanded polytetrafluoroethylene structure was generally poor. Infiltration occurred mainly in the external region of the prosthetic wall and increased with the duration of implantation. The external reinforcement was not a major factor in limiting tissue infiltration. The luminal surfaces were covered with a thin, irregular layer of organized fibrin, interspersed with exposed expanded polytetrafluoroethylene areas. Mineral deposits were observed in five cases. Despite poor healing, the clinical performance of expanded polytetrafluoroethylene vascular prostheses is relatively good. Since the chief advantage of this material is good mechanical stability in vivo, any modifications of the graft to improve healing characteristics or thrombogenic properties should not be made at the expense of stability in vivo. PMID:8399965

Guidoin, R; Chakfé, N; Maurel, S; How, T; Batt, M; Marois, M; Gosselin, C

1993-07-01

176

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

PubMed

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

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

2014-06-27

177

Milk production, plasma metabolite profiles and mammary arterial-venous differences of milk precursors in early lactation cows milked at different frequencies by an automatic milking system.  

PubMed

The objective of this study was to clarify the effect of different milking frequencies under an automatic milking system (AMS) on milk yield, plasma metabolite profiles and mammary arterial-venous (A-V) differences of milk precursors by mammary tissues in early lactation cows. Twelve Holstein cows were divided into two and four times milking frequency treatments by AMS after calving to 50 days postpartum. Cows were given a partial mixed ration ad libitum and a concentrate diet at every milking. Dry matter intake increased similarly in both treatments with advancing postpartum days. Milk yield was greater (P?Arterial concentrations of glucose and glutamate were lower (P?arterial concentration of nonesterified fatty acids did not differ between treatments. Although mammary A-V differences of plasma concentration for most milk precursors did not differ between treatments, estimated plasma flow was higher (P?mammary uptake of milk precursors, whereas may not affect the extent of fat mobilization of early lactating cows from day 20 postpartum onward. PMID:25474097

Astuti, Andriyani; Obitsu, Taketo; Sugino, Toshihisa; Taniguchi, Kohzo; Okita, Miki; Kurokawa, Yuzo

2014-12-01

178

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

Microsoft Academic Search

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

Stephen G. Pauker; Deeb N. Salem

2003-01-01

179

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

SciTech Connect

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

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

1981-04-01

180

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

NASA Astrophysics Data System (ADS)

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

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

2011-11-01

181

Less-invasive management of left subclavian artery in stent-grafting for distal aortic arch disease.  

PubMed

Simple coverage of the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR) is still a controversial procedure. We present our modified strategy dealing with LSA in TEVAR. Hand-made stent grafts were placed more proximal beyond the LSA for 104 patients. In elective 76, preoperative LSA occlusion test was performed on 31 patients, and preoperative computed tomographic angiography (CTA) of the vertebro-basilar artery was performed on the remaining 45. Head vessels were planned to be kept patent using fenestrated stent grafts, if possible. Stent grafts were placed from zone 0 in 23, zone 1 in 39, and zone 2 in 42. The LSA occlusion tests revealed harmful effects, such as loss of consciousness and vertigo in two out of 31 patients (6.5%). Vertebro-basilar arterial CTA revealed possible risks, if LSA covered, in three out of 45 patients (6.7%). Fenestrated stent grafts could successfully preserve 131 head vessels, except for one unintentional occlusion of the left carotid artery (0.75%). There was no LSA-related complication in any of the cases. A combination of preoperative vertebro-basilar arterial CTA and fenestrated stent grafts is useful to avoid possible LSA-related complications in TEVAR. PMID:19240060

Kurimoto, Yoshihiko; Kawaharada, Nobuyoshi; Ito, Toshiro; Baba, Toshio; Ohori, Syunsuke; Watanabe, Atsushi; Asai, Yasufumi; Higami, Tetsuya

2009-05-01

182

Implantation of balloon-expandable intravascular grafts by catheterization in pulmonary arteries and systemic veins.  

PubMed

The purpose of this investigation was to evaluate the efficacy and safety of implanting expandable intravascular stents in pulmonary arteries and systemic veins. Twenty-seven balloon-expandable grafts were placed in 13 mongrel dogs under anesthesia. A long sheath was introduced over a wire and catheter or dilator into the pulmonary artery or target vein. A collapsed stainless steel expandable mesh stent was placed over the balloon of an angioplasty catheter. The catheter with the mounted stent was advanced through the sheath. The stent expanded to the diameter of the balloon as the balloon was inflated, and remained expanded as the balloon was deflated. The stent was expanded further with a larger balloon in 11 instances. Eleven stents were placed successfully in pulmonary arteries (out of thirteen attempted), and 11 of 14 were installed in tributaries of the precava or postcava. Three inadvertent embolizations of the devices occurred. All three devices that embolized lodged in the pulmonary arteries and did not obstruct flow. Seven dogs were recatheterized at intervals ranging from 56 to 278 days. Twelve stents were patent and nonobstructive, and two were malpositioned, one of which was obstructed. Three animals were killed 2 months (two dogs) and 9 months (one dog) after the implantations. The stents (four in the pulmonary arteries and two in veins) were completely covered with neointima and were patent, without thrombosis. These stents hold promise for definitive dilation of congenital or postoperative vessel stenoses. PMID:3335067

Mullins, C E; O'Laughlin, M P; Vick, G W; Mayer, D C; Myers, T J; Kearney, D L; Schatz, R A; Palmaz, J C

1988-01-01

183

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

PubMed Central

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

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

2015-01-01

184

Analysis of transit time flow of the right internal thoracic artery anastomosed to the left anterior descending artery compared to the left internal thoracic artery  

PubMed Central

Introduction We evaluated with transit time flow the performance of the right and left thoracic arteries when used as a graft for the left anterior descending artery. Methods Fifty patients undergoing surgery for myocardial revascularization without cardiopulmonary bypass were divided into two groups. In group A patients received graft of right internal mammary artery to the anterior interventricular branch. In group B patients received graft of left internal mammary artery to the same branch. At the end of the operation the flow was assessed by measuring transit time. Results In group A, mean age was 60.6±9.49 years. The average height and weight of the group was 80.4±10.32 kg and 169.2±6.86 cm. The average number of grafts per patient in this group was 3.28±1.49. The mean flow and distal resistance obtained in right internal thoracic artery was 42.1±23.4 ml/min and 2.8±0.9 respectively. In group B, the mean age was 59.8±9.7 years. The average height and weight of this group was 77.7±14.22 kg and 166.0±8.2 cm. The average number of grafts per patient in this group was 3.08 ±0.82. The mean flow and distal resistance observed in this group was 34.2±19.1 ml/min and 2.0±0.7. There were no deaths in this series. Conclusion Right internal mammary artery presented a similar behavior to left internal mammary artery when anastomosed to the anterior interventricular branch of the left coronary artery. There was no statistical difference between the measured flow obtained between both arteries. PMID:25140463

Milani, Rodrigo; de Moraes, Daniela; Sanches, Aline; Jardim, Rodrigo; Lumikoski, Thais; Miotto, Gabriela; Santana, Vitor Hugo; Brofman, Paulo Roberto

2014-01-01

185

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

PubMed

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

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

2015-04-01

186

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

PubMed

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

Shah, Shitalkumar; Hrabovsky, Derek

2014-09-01

187

Internal Iliac Artery Aneurysmo–Colonic Fistula after Endovascular Stent-Graft Repair: A Case Report  

PubMed Central

We describe rare ilio-enteric fistula that developed after endovascular repair of a left internal iliac artery aneurysm (IIAA). An 83-year-old man with a history of previous surgeries via laparotomies suddenly developed a high fever 3 years after undergoing endovascular abdominal aortic repair (EVAR) with a stent-graft to treat a left isolated IIAA. Computed tomography imaging revealed a fistula between the IIAA and the sigmoid colon. A colostomy was created because severe intraperitoneal adhesions prevented resection of the IIAA. The postoperative course was uneventful and the patient remained free of infection without antibiotics. Residual aneurysms can cause complications after EVAR. PMID:25848433

Fukada, Johji; Tamiya, Yukihiko

2015-01-01

188

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

Microsoft Academic Search

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

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

2006-01-01

189

Intra-arterial methylprednisolone for severe steroid refractory gastrointestinal graft-versus-host disease.  

PubMed

Acute graft versus host disease (GVHD) is a significant complication of bone marrow transplantation with approximately half of patients being refractory to steroids. There are numerous second-line systemic immunosuppressive treatments but the overall prognosis is poor and these therapies are associated with high mortality due to infection. An alternative approach to systemic treatment for GVHD is targeted delivery of immunosuppression. We present two pediatric cases with steroid-refractory gastrointestinal GVHD who clinically responded to intra-arterial steroid administration. We also review the literature regarding this treatment modality with a particular emphasis in children. PMID:25053422

Bhuller, Kaljit S; Heran, Manraj K S; Wu, John K M; Rassekh, S Rod

2014-12-01

190

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

PubMed Central

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

Chedrawy, Edgar G.

2014-01-01

191

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

PubMed

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

Tsygan, I V

2013-11-01

192

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

Microsoft Academic Search

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

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

2007-01-01

193

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

PubMed

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

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

2015-01-01

194

Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms  

SciTech Connect

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

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

2012-02-15

195

Clinical significance, angiographic characteristics, and short-term outcomes in 30 patients with early coronary artery graft failure  

Microsoft Academic Search

BackgroundDespite technical advances in coronary artery bypass grafting (CABG), early postoperative myocardial ischaemia still remains\\u000a a challenging problem. The aim of this study was to determine the incidence, clinical features, angiographic characteristics,\\u000a and management of early graft failure in the present CABG era.\\u000a \\u000a \\u000a MethodsBetween January 1997 and December 2002, 1731 patients underwent CABG at our institution. Coronary angiography was performed

S. S. Virani; M. Alam; C. E. Mendoza; H. Arora; A. C. Ferreira; E. de Marchena

2009-01-01

196

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

SciTech Connect

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

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

1997-03-15

197

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

Microsoft Academic Search

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

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

2003-01-01

198

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

PubMed Central

We have previously reported initial clinical feasibility with our small diameter tissue engineered blood vessel (TEBV). Here we present in vitro results of the mechanical properties of the TEBVs of the first 25 patients enrolled in an arterio-venous (A-V) shunt safety trial, and compare these properties with those of risk-matched human vein and artery. TEBV average burst pressures (3,490 +/? 892 mmHg, n=230) were higher than native saphenous vein (SV) (1,599 +/? 877 mmHg, n=7), and not significantly different than native internal mammary artery (IMA) (3,196 +/? 1,264 mmHg, n=16). Suture retention strength for the TEBVs (152 +/? 50 gmf) was also not significantly different than IMA (138 +/? 50 gmf). Compliance for the TEBVs prior to implantation (3.4 +/? 1.6 %/100 mmHg) was lower than IMA (11.5 +/? 3.9 %/100 mmHg). By 6 months post-implant, the TEBV compliance (8.8 +/? 4.2 %/100 mmHg, n=5) had increased to values comparable to IMA, and showed no evidence of dilation or aneurysm formation. With clinical time points beyond 21 months as an A-V shunt without intervention, the mechanical tests and subsequent lot release criteria reported here would seem appropriate minimum standards for clinical use of tissue engineered vessels. PMID:19111338

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

2009-01-01

199

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

SciTech Connect

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

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

2010-06-15

200

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

SciTech Connect

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

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

1989-10-15

201

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

PubMed Central

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

2013-01-01

202

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

PubMed Central

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

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

2014-01-01

203

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

SciTech Connect

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

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

2006-12-15

204

Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft.  

PubMed

Coronary artery perforation is a rare, but dreaded, complication of percutaneous coronary intervention. Conventional treatment, including reversal of anticoagulation and prolonged balloon inflation, is associated with a high incidence of death, Q-wave myocardial infarction, and emergency coronary bypass surgery. Although a number of case reports have demonstrated the feasibility of sealing coronary perforations with synthetic material-covered stent grafts, the efficacy of this treatment has not been reported in a large, multicenter series. We used a retrospective international registry to examine the outcomes of the polytetrafluoroethylene-coated JOSTENT coronary stent graft (CSG) in 41 cases of coronary perforations. Perforations were relatively severe: 16.7% Ellis grade 1, 54.2% grade 2, and 29.1% grade 3. Of the 41 patients, > 1/3 (n = 14) experienced life-threatening complications before stent graft implantation, including pericardial tamponade (12.2%), cardiogenic shock (9.8%), and cardiac arrest (2.4%). A total of 52 CSGs were used to treat the 41 perforations (mean 1.3 per lesion). All CSGs were placed successfully, with 92.9% of the perforations sealed completely and 7.1% partially. One patient developed abrupt vessel closure after CSG deployment, resulting in an overall procedure success rate of 96.4%. No in-hospital Q-wave myocardial infarctions, emergency coronary bypass surgeries, or deaths resulted. The CSG may be a reliable and highly effective treatment option for sealing coronary perforations complicating percutaneous coronary interventions. PMID:16860026

Lansky, Alexandra J; Yang, Yi-ming; Khan, Yosef; Costa, Ricardo A; Pietras, Cody; Tsuchiya, Yoshihiro; Cristea, Ecaterina; Collins, Michael; Mehran, Roxana; Dangas, George D; Moses, Jeffrey W; Leon, Martin B; Stone, Gregg W

2006-08-01

205

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

Microsoft Academic Search

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

Doron Aronson; Elazer R. Edelman

2010-01-01

206

Long-term outcome of femoral above-knee popliteal artery bypass using autologous saphenous vein versus expanded polytetrafluoroethylene grafts.  

PubMed

Despite a recent flurry of publications on preferred techniques for femoral above-knee popliteal artery bypass, controversy persists over the use of autologous saphenous vein and expanded polytetrafluoroethylene (ePTFE) grafts. The purpose of this study was to compare our long-term results using these two bypass materials. In a series of 474 infrainguinal bypasses performed between January 1993 and December 1998, we performed a total of 75 femoral above-knee popliteal artery bypass using an autologous saphenous vein graft in 48 cases (64%) and an ePTFE graft in 27 cases (36%). Prosthetic grafts were used by choice in 17 cases and by necessity due to the absence of useable vein in 10 cases. There were 55 men and 18 women with a mean age of 70 years. The indication for bypass was lower extremity arterial occlusive disease at stage II in 17 cases (22.7%), stage III in 9 cases (12%), and stage IV in 36 cases (48%); subacute ischemia in 8 cases (10.7%); and femoropopliteal aneurysm in 5 cases (6.7%). Preoperative arteriography demonstrated three patent leg arteries in 15.5% of cases, two patent leg arteries in 43.5%, and one patent leg artery in 41%. There was no significance difference between the vein graft and ePTFE graft groups with regard to indications and arteriographic findings. No patient died during the immediate postoperative period. The mean duration of follow-up was 25.5 months (range, 3 to 108 months). The primary patency rate at 4 years was 82.2 +/- 8% for venous bypass vs. 80.6 +/- 11.8% for ePTFE bypass (p = 0.42). The secondary patency rate at 4 years was 84.7 +/- 7.4% for vein bypasses and 79.5 +/- 12% for ePTFE bypasses (p = 0.26). In our experience, there was no statistically significant difference in long-term outcome of femoral above-knee popliteal artery bypass using autologous vein grafts or prosthetic ePTFE grafts. PMID:14670018

Sala, Florent; Hassen-Khodja, Reda; Lecis, Alexandre; Bouillanne, Pierre-Jean; Declemy, Serge; Batt, Michel

2003-07-01

207

Sternal Healing after Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Arteries: Assessment by Computed Tomography Scan  

PubMed Central

Background This study aimed to investigate sternal healing over time and the incidence of poor sternal healing in patients undergoing coronary artery bypass graft (CABG) surgery using bilateral internal thoracic arteries. Methods This study enrolled 197 patients who underwent isolated CABG using skeletonized bilateral internal thoracic arteries (sBITA) from 2006 through 2009. Postoperative computed tomography (CT) angiography was performed on all patients at monthly intervals for three to six months after surgery. In 108 patients, an additional CT study was performed 24 to 48 months after surgery. The axial CT images were used to score sternal fusion at the manubrium, the upper sternum, and the lower sternum. These scores were added to evaluate overall healing: a score of 0 to 1 reflected poor healing, a score of 2 to 4 was defined as fair healing, and a score of 5 to 6 indicated complete healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results Three to six months after surgery, the average total score of sternal healing was 2.07±1.52 and 68 patients (34.5%) showed poor healing. Poor healing was most frequently found in the manubrium, which was scored as zero in 72.6% of patients. In multivariate analysis, the factors associated with poor early healing were shorter post-surgery time, older age, diabetes mellitus, and postoperative renal dysfunction. In later CT images, the average sternal healing score improved to 5.88±0.38 and complete healing was observed in 98.2% of patients. Conclusion Complete sternal healing takes more than three months after a median sternotomy for CABG using sBITA. Healing is most delayed in the manubrium. PMID:25705595

Shin, Yoon Cheol; Kim, Sue Hyun; Kim, Dong Jung; Kim, Dong Jin; Kim, Jun Sung; Lim, Cheong; Park, Kay-Hyun

2015-01-01

208

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

PubMed Central

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

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

2015-01-01

209

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

SciTech Connect

Arterial rupture subsequent to angioplasty occurs in about 5% of cases. Thrombolysis with re-establishment of flow without resolving underlying anatomic defects such as hepatic arterial stenosis leads to re-thrombosis. We present a case of arterial anastomotic rupture after thrombolysis and angioplasty of an underlying anastomotic hepatic arterial stenosis. Both the underlying anatomic defect and the rupture were resolved successfully with placement of a stent-graft, with a resultant patent artery for 1 year after the procedure.

Yamakado, Koichiro, E-mail: yama@clin.medic.mie-u.ac.jp; Nakatsuka, Atsuhiro; Takaki, Haruyuki [Mie University School of Medicine, Department of Radiology (Japan); Usui, Masanobu; Sakurai, Hiroyuki; Isaji, Shuji [Mie University School of Medicine, First Department of Surgery (Japan); Uemoto, Shinji [Kyoto University, Department of Surgery (Japan); Takeda, Kan [Mie University School of Medicine, Department of Radiology (Japan)

2008-07-15

210

Warm Carolina rinse solution prevents graft failure from storage injury after orthotopic rat liver transplantation with arterialization  

Microsoft Academic Search

An injury to nonparenchymal cells, characterized by loss of viability of sinusoidal endothelial cells and activation of Kupffer cells, occurs after reperfusion of livers stored for transplantation. Recently, a new solution, Carolina rinse solution, was shown to prevent reperfusion injury to endothelial cells in vitro almost completely and to improve graft survival after orthotopic rat liver transplantation (ORLT) without arterialization.

Sigrid Bachmann; Jane C. Caldwell-Kenkel; Inga Oleksy; Rudolf Steffen; Ronald G. Thurman; John J. Lemasters

1992-01-01

211

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

Microsoft Academic Search

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

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

2005-01-01

212

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

Microsoft Academic Search

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

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

2001-01-01

213

Outcome of common iliac arteries after aortoaortic graft placement during elective repair of infrarenal abdominal aortic aneurysms  

Microsoft Academic Search

Purpose: The purpose of this study was determination of the expansion rates relative to the size of the common iliac artery (CIA) after elective placement of a straight aortic tube graft for an infrarenal abdominal aortic aneurysm (AAA). Methods: Between January 1993 and December 1997, 74 men (mean age, 69 years) with AAA underwent surgical repair with a straight tube

Florent Sala; Reda Hassen-khodja; Pascal Branchereau; Jean-Philippe Berthet; Michel Batt; Henry Mary; Charles Marty-Ane; Pierre Alric

2002-01-01

214

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

Microsoft Academic Search

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

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

2007-01-01

215

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

Microsoft Academic Search

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

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

2003-01-01

216

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

Microsoft Academic Search

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

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

1998-01-01

217

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

SciTech Connect

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.

Carrafiello, Giampaolo [University of Insubria, Department of Radiology, Interventional Radiology, Varese University Hospital (Italy); Rivolta, Nicola [University of Insubria, Department of Surgical Sciences, Vascular Surgery, Varese University Hospital (Italy); Fontana, Federico [University of Insubria, Department of Radiology, Interventional Radiology, Varese University Hospital (Italy); Piffaretti, Gabriele, E-mail: gabriele.piffaretti@uninsubria.i [University of Insubria, Department of Surgical Sciences, Vascular Surgery, Varese University Hospital (Italy); Mariscalco, Giovanni [University of Insubria, Department of Surgical Sciences, Cardiac Surgery, Varese University Hospital (Italy); Bracchi, Elena [University of Insubria, Department of Radiology, Interventional Radiology, Varese University Hospital (Italy); Ferrario, Massimo [University of Insubria, General Surgery II, Varese University Hospital (Italy)

2010-04-15

218

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

Microsoft Academic Search

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

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

1996-01-01

219

Ruptured Mycotic Common Femoral Artery Pseudoaneurysm: Fatal Pulmonary Embolism after Emergency Stent-Grafting in a Drug Abuser  

PubMed Central

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

Kalogirou, Thomas E.; Giagtzidis, Ioakeim T.; Papazoglou, Konstantinos O.

2014-01-01

220

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

NASA Astrophysics Data System (ADS)

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

Sankaran, Sethuraman; Marsden, Alison

2010-11-01

221

Nifedipine for postoperative blood pressure control following coronary artery vein grafts.  

PubMed Central

The drug control of raised blood pressure following coronary artery bypass grafting was studied in 20 patients during the early postoperative period. On a random basis, 10 patients were given intranasal nifedipine and 10 other patients received intranasal saline. If the systolic pressure was raised, it was treated by an infusion of sodium nitroprusside. The systolic pressure abated in those treated with nifedipine so that 7 of the 10 did not require any other treatment in the first hour. The reduction in pressure was accomplished without an increase in heart rate. The requirement for sodium nitroprusside to control the pressure was much less in the first hour postoperatively in the nifedipine treated group and at 4 hours, the effect of nifedipine was still apparent. This study demonstrates that intranasal nifedipine is an effective adjunct for controlling raised blood pressure in the early postoperative period. PMID:3485398

Iyer, V. S.; Russell, W. J.

1986-01-01

222

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

PubMed

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

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

2014-01-01

223

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

PubMed Central

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

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

2013-01-01

224

Numerical simulation of compliant artery bypass grafts using fluid-structure interaction framework.  

PubMed

Early researches on the artery bypass graft (ABG) generally took the assumption of rigid vessel wall that ignored the wall compliancy. To obtain more realistic and physiological hemodynamic parameters, a fluid structure interaction study on a complete ABG was carried out. It was concluded: (1) a compliant vessel is able to expand its vessel diameter and decrease its anastomosis angle to achieve a buffer for the blood, thereby helping to reduce endothelial cell injury. (2) The vessel walls experienced their maximum deformation at the time of peak pressure while the deformation could be ignored during diastole. However, the consideration of wall compliance did not quantitatively change the flow characters compared to those of rigid walls. (3) Generally, the hemodynamic priority of helical-type ABG over a conventional one was further strengthened by adopting compliant vessel wall. (4) The consideration of the wall deformation revealed a hidden fact by the rigid wall assumption: Helical ABG aggravated the risk of intimal hyperplasia at its toe region due to its geometry and flow asymmetry. The present study may be useful for surgeons and graft designers to optimize the current and future ABG configurations and selection of materials. PMID:24814837

Wen, Jun; Ding, Guanqiao; Jiang, Wentao; Wang, Qingyuan; Zheng, Tinghui

2014-01-01

225

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

PubMed Central

Background: To describe the use of a short segment cortical intracranial–intracranial (IC–IC) bypass for the treatment of a distal middle cerebral artery (MCA) aneurysm. Case Description: A 54-year-old woman presented with a loss of consciousness followed by multiple seizures and was found to have a partially thrombosed distal MCA aneurysm. This possibly mycotic aneurysm was treated by creating a short segment jump graft between a normal cortical artery and a nearby cortical branch arising from the aneurysmal M3 arterial segment. The bypass allowed for subsequent occlusion of the aneurysmal vessel without ischemic consequence. At surgery, the anterior division of the superficial temporal artery (STA) was exposed and dissected. Intraoperative angiography was utilized to localize a cortical artery arising from the involved segment as well as a nearby cortical artery arising from a distinct, uninvolved MCA branch. A segment of the STA was harvested, and then 10-0 suture was utilized to anastomose this short segment, to both the involved and normal cortical arteries. This created a short jump graft allowing for subsequent sacrifice of the diseased artery. Following surgery, the patient immediately underwent coil embolization of the aneurysm back into the parent artery resulting in local vascular sacrifice. The remainder of the patient's hospital course was uneventful. She was discharged home in good condition. Conclusions: We suggest that cortical IC–IC bypass followed by endovascular arterial sacrifice as performed in our case represents a simple and safe option for treating unclippable distal MCA aneurysms including mycotic lesions. PMID:21811704

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

2011-01-01

226

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

SciTech Connect

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

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

1983-05-01

227

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

PubMed Central

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

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

2014-01-01

228

Percutaneous Stent-Graft Repair of a Mycotic Pulmonary Artery Pseudoaneurysm  

SciTech Connect

Ruptured mycotic pulmonary pseudoaneurysm is a lethal complication. Emergent surgical repair is usually recommended, but still associated with a high mortality rate. We present a patient in whom mycotic pulmonary pseudoaneurysm was a complication after surgical lobectomy 2 weeks earlier. This patient had suffered from repeated massive hemoptysis. After emergent surgical repair of the ruptured pulmonary artery stump, another episode of massive hemorrhage occurred. The pulmonary arteriogram revealed a segmental stenosis and a large, wide-necked, lobulated pseudoaneurysm at the left proximal pulmonary artery. We deployed a balloon-expandable stent-graft (48 mm in length mounted on a 12 mm x 40 mm angioplasty balloon) across the stenotic segment and the neck of the pulmonary pseudoaneurysm. Hemostasis was achieved immediately and, under a 4-week antibiotic treatment, patient was transferred to a local hospital for medical care. This case report demonstrates the benefit of minimally invasive endovascular therapy in a critically ill patient. A literature review of the etiology and management of mycotic pulmonary pseudoaneurysm is included.

Chou Meichun; Liang Hueilung, E-mail: hlliang@isca.vghks.gov.tw; Pan Huayban; Yang Chienfang [Kaohsiung Veterans General Hospital, Department of Radiology (China)

2006-10-15

229

CASE REPORT Sternal Chondrosarcoma After Sternotomy for Coronary Artery Bypass Grafting  

PubMed Central

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

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

2013-01-01

230

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

PubMed

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

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

2000-03-01

231

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

PubMed

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

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

1994-03-01

232

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

PubMed Central

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

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

2013-01-01

233

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

SciTech Connect

Serial platelet deposition, surface topography, and patency were evaluated in control (N . 28) and endothelial cell-seeded (N . 28) small-diameter (4 mm inner diameter) USCI Dacron grafts implanted in the carotid and femoral arteries of dogs. All dogs received aspirin (325 mg) daily for 2 weeks starting 24 hours prior to graft implantation. Endothelial cell seeding was performed by mixing suspensions of autologous endothelial cells that had been enzymatically harvested from segments of external jugular vein with blood that was used to preclot the prostheses. The platelet deposition on each graft was quantitated by means of indium 111-labeled platelets and technetium 99m-labeled red cells in a dual-isotope platelet-imaging technique. Platelet deposition on seeded grafts 24 hours after implantation was significantly higher than on the controls (p less than 0.05). Two weeks after implantation platelet deposition on seeded prostheses had decreased to a level significantly lower than that on the controls and continued to decline on serial studies up to 7 months. In contrast to seeded grafts, platelet accumulation on control grafts dramatically increased after the withdrawal of aspirin therapy and was associated with a sharp rise in control graft thromboses. Cumulative 7-month patency for seeded prostheses was significantly higher than for the controls (96% and 29%, respectively; p less than 0.001). We conclude that endothelial cell seeding in combination with short-term aspirin therapy is a simple, reliable diameter Dacron prostheses. Abrupt withdrawal of aspirin therapy may be contraindicated in nonseeded control grafts because it results in increased platelet deposition and thrombosis.

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

1984-01-01

234

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

SciTech Connect

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

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

2009-03-15

235

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

PubMed Central

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

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

2015-01-01

236

Extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients  

Microsoft Academic Search

Objectives  Squamous cell carcinoma (SCC) of the penis with inguinal lymph node involvement aggravates prognosis and can cause femoral\\u000a artery bleeding, hemorrhagic shock and even death. The objective of this study is to describe the use of extra-anatomical\\u000a transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis.\\u000a \\u000a \\u000a \\u000a Casuistic and method  Five patients with SCC and inguinal lymphatic metastasis

Ubirajara Ferreira; Leonardo Oliveira Reis; Lia Yumi Ikari; Walter da Silva Jr; Wagner Eduardo Matheus; Fernandes Denardi; Rafael Mamprim Stopiglia; Fábio Husseman Menezes

2008-01-01

237

In vivo quantitation of platelet deposition on human peripheral arterial bypass grafts using indium-111-labeled platelets. Effect of dipyridamole and aspirin  

SciTech Connect

Indium-111-labeled autologous platelets, injected 48 hours after operation, were used to evaluate the thrombogenicity of prosthetic material and the effect of platelet inhibitor therapy in vivo. Dacron double-velour (Microvel) aortofemoral artery bifurcation grafts were placed in 16 patients and unilateral polytetrafluoroethylene femoropopliteal grafts were placed in 10 patients. Half the patients in each group received platelet inhibitors before operation (dipyridamole, 100 mg 4 times a day) and after operation (dipyridamole, 75 mg, and acetylsalicylic acid, 325 mg 3 times a day); the rest of the patients served as control subjects. Five-minute scintigrams of the graft region were taken with a gamma camera interfaced with a computer 48, 72, and 96 hours after injection of the labeled platelets. Platelet deposition was estimated from the radioactivities of the grafts and expressed as counts per 100 pixels per microcurie injected. Dipyridamole and aspirin therapy significantly reduced the number of platelets deposited on Dacron grafts and prevented platelet accumulation over 3 days. With the small amount of platelet deposition on polytetrafluoroethylene femoropopliteal artery grafts even in control patients, platelet inhibitor therapy had no demonstrable effect on platelet deposition on these grafts. It is concluded that (1) platelet deposition on vascular grafts in vivo can be quantitated by noninvasive methods, and (2) dipyridamole and aspirin therapy reduced platelet deposition on Dacron aortofemoral artery grafts.

Pumphrey, C.W.; Chesebro, J.H.; Dewanjee, M.K.; Wahner, H.W.; Hollier, L.H.; Pairolero, P.C.; Fuster, V.

1983-03-01

238

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

Microsoft Academic Search

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

N Caine; L D Sharples; J Wallwork

1999-01-01

239

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

Microsoft Academic Search

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

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

2005-01-01

240

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

Microsoft Academic Search

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

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

2010-01-01

241

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

Microsoft Academic Search

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

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

1999-01-01

242

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

Microsoft Academic Search

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

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

2008-01-01

243

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

Microsoft Academic Search

Neuropsychologic impairment in patients undergoing cardiopulmonary bypass may be associated with cerebral blood flow changes arising from different management protocols for carbon dioxide tension during bypass. Seventy patients having coronary artery bypass grafting were randomized to either pH-stat or alpha-stat acid-base management during cardiopulmonary bypass with a membrane oxygenator. In each patient, cerebral blood flow (xenon 133 clearance), middle cerebral

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

1996-01-01

244

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

Microsoft Academic Search

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

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

2005-01-01

245

Numerical investigation of oxygen mass transfer in a helical-type artery bypass graft.  

PubMed

Local oxygen lack in arterial walls (hypoxia) plays a very important role in the initiation, progression and development of intimal hyperplasia (IH) and thrombosis. Aiming to find out whether a helical-type artery bypass graft (ABG) is hypoxia beneficial, a numerical study was carried out to compare oxygen transport between a helical-type ABG and a conventional-type ABG. The dimensionless mass transfer coefficient (Sherwood number) was introduced to evaluate the oxygen mass transfer distribution and detailed oxygen wall flux was computed. The results show that the intrinsic geometry of a helical-type ABG resulted in improved hypoxia and the oxygen-depleted fluid located proximally to the occluded section as compared with that of a conventional-type ABG. However, benefits aside, distinct double low regions (low wall shear stress (WSS) and hypoxia) which might be most prone to IH and more localised and thicker boundary layer of oxygen-depleted fluid were observed at the helical-type ABG. This may explain why the helical flow plays a detrimental role at some locations in the human body. In addition, it was observed that although low WSS region was always accompanied with low oxygen supply, the oxygen transport rate did not adjust simultaneously with flow. The change in oxygen distribution usually lagged behind the flow change. A physiological WSS region may be associated with hypoxia condition. This study captured the qualitative trend of oxygen distribution in ABGs and the effect of helical geometry on reducing hypoxia, which is useful in the structural design of swirling flow vascular devices. PMID:22794110

Zheng, Tinghui; Wen, Jun; Jiang, Wentao; Deng, Xiaoyan; Fan, Yubo

2014-04-01

246

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

SciTech Connect

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

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

1985-05-01

247

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

PubMed Central

We report a study of the role of hemodynamic shear stress in the remodeling and failure of a peripheral artery bypass graft. Three separate scans of a femoral to popliteal above-knee bypass graft were taken over the course of a 16 month period following a revision of the graft. The morphology of the lumen is reconstructed from data obtained by a custom 3D ultrasound system. Numerical simulations are performed with the patient-specific geometries and physiologically realistic flow rates. The ultrasound reconstructions reveal two significant areas of remodeling: a stenosis with over 85% reduction in area, which ultimately caused graft failure, and a poststenotic dilatation or widening of the lumen. Likewise, the simulations reveal a complicated hemodynamic environment within the graft. Preliminary comparisons with in vivo velocimetry also showed qualitative agreement with the flow dynamics observed in the simulations. Two distinct flow features are discerned and are hypothesized to directly initiate the observed in vivo remodeling. First, a flow separation occurs at the stenosis. A low shear recirculation region subsequently develops distal to the stenosis. The low shear region is thought to be conducive to smooth muscle cell proliferation and intimal growth. A poststenotic jet issues from the stenosis and subsequently impinges onto the lumen wall. The lumen dilation is thought to be a direct result of the high shear stress and high frequency pressure fluctuations associated with the jet impingement. PMID:21428682

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

2011-01-01

248

Evaluation of arterial prostheses in a baboon ex vivo shunt: the effect of graft material and flow on platelet deposition.  

PubMed

Surface thrombogenicity is recognized as an important factor in the failure of small caliber vascular prostheses. The baboon ex vivo shunt was developed to study small caliber grafts under controlled conditions at different flow rates. The shunt was created by percutaneous insertion of catheters into the baboon femoral artery and vein. Platelet-graft interactions were studied using autogenous indium 111 labeled platelets. Two graft materials were placed in series and exposed to blood flow for 2 1/2 hours at flow rates of 25 and 200 ml/min. At the end of this period, the grafts were removed for morphologic examination. Platelet adhesion to the grafts, especially with the less thrombogenic materials (PTFE and HUV), was found to be independent of flow rate. PTFE was found to be the least platelet-reactive material, HUV was intermediate, and knitted Dacron was the most thrombogenic surface. Platelet deposition on the flow surface was confirmed by light microscopy and scanning electron microscopy. PMID:3161349

Eldrup-Jorgensen, J; Mackey, W C; Connolly, R J; McCullough, J L; Ramberg, K; Gavris, V; O'Donnell, T F; Callow, A D

1985-08-01

249

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

PubMed Central

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

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

2015-01-01

250

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

PubMed Central

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

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

2014-01-01

251

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

SciTech Connect

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

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

1990-11-15

252

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

PubMed

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

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

2015-03-01

253

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

PubMed Central

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

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

2013-01-01

254

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

NASA Astrophysics Data System (ADS)

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

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

2008-01-01

255

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

PubMed

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

Yang, Mei; Zhao, Yanyong

2015-03-01

256

'Cold hand, ischemic heart': treatment by stenting of the left subclavian artery.  

PubMed

A 59-year-old man presented with worsening angina and a cold, painful left hand, eight years after coronary artery bypass surgery. Coronary angiography showed extensive coronary atherosclerosis with blocked vein grafts to his left circumflex and right coronary arteries. There was a severe narrowing in the left subclavian artery before the origin of the left internal mammary artery (LIMA) which appeared patent. PTCA and stent implantation to the left subclavian artery stenosis restored normal flow to the left hand and the LIMA with abolition of his ischemic hand symptoms and marked improvement of his angina. PMID:11060571

Osula, S; Gandhi, N M; Chester, M; Ramsdale, D R

2000-11-01

257

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

SciTech Connect

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

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

1988-06-01

258

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

PubMed Central

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

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

2014-01-01

259

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

PubMed Central

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

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

2015-01-01

260

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

PubMed Central

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

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

2005-01-01

261

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

PubMed Central

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

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

2015-01-01

262

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

PubMed Central

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

2010-01-01

263

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

PubMed Central

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

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

2014-01-01

264

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

PubMed Central

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

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

2012-01-01

265

Cytomegalovirus Infection and Atherosclerosis in Candidate of Coronary Artery Bypass Graft  

PubMed Central

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

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

2015-01-01

266

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

PubMed

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

Canale, Leonardo Secchin; Bonatti, Johannes

2014-01-01

267

The midterm experience of tapered stent grafts in the endovascular management of iliac artery aneurysms with unfavorable anatomy.  

PubMed

We report our experience and the midterm results of a modern technique for endovascular management of isolated iliac artery aneurysms (IAAs) with unfavorable neck anatomy, which involves the inversion of an iliac leg of a Zenith stent graft. Patients who underwent endovascular IAA repair from 2002 to 2010 were reviewed. A total of 12 patients, with a mean age of 77.6 years, underwent endovascular repair of 13 IAAs. Mean size of the aneurysms was 54.6 mm (range 34-133 mm). Mean proximal neck diameter was 18 mm (range 15-22 mm). In 7 patients, the length of the proximal neck was <15 mm (10-14 mm). Only 1 patient developed thrombosis of the stent graft immediately after the operation. Patients were followed up for a mean of 31.5 months (range 18-72 months). Our midterm results demonstrate the durability of this technique in the management of iliac aneurysms with unfavorable anatomy. PMID:22344985

Aldin, Zaid; Kashef, Elika; Jenkins, Michael; Gibbs, Richard; Wolfe, John; Hamady, Mohamad

2012-02-01

268

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

PubMed

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

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

2010-01-15

269

Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft  

PubMed Central

Introduction Transfusions of one or more packed red blood cells is a widely strategy used in cardiac surgery, even after several evidences of increased morbidity and mortality. The world's blood shortage is also already evident. Objective To assess whether the risk of mortality is dose-de>pendent on the number of packed red blood cells transfused after coronary artery bypass graft. Methods Between June 2009 and July 2010, were analyzed 3010 patients: transfused and non-transfused. Transfused patients were divided into six groups according to the number of packed red blood cells received: one, two, three, four, five, six or more units, then we assess the mortality risk in each group after a year of coronary artery bypass graft. To calculate the odds ratio was used the multivariate logistic regression model. Results The increasing number of allogeneic packed red blood cells transfused results in an increasing risk of mortality, highlighting a dose-dependent relation. The odds ratio values increase with the increased number of packed red blood cells transfused. The death's gross odds ratio was 1.42 (P=0.165), 1.94 (P=0.005), 4.17; 4.22, 8.70, 33.33 (P<0.001) and the adjusted death's odds ratio was 1.22 (P=0.43), 1.52 (P=0.08); 2.85; 2.86; 4.91 and 17.61 (P<0.001), as they received one, two, three, four, five, six or more packed red blood cells, respectively. Conclusion The mortality risk is directly proportional to the number of packed red blood cells transfused in coronary artery bypass graft. The greater the amount of allogeneic blood transfused the greater the risk of mortality. The current transfusion practice needs to be reevaluated. PMID:24598957

dos Santos, Antônio Alceu; Sousa, Alexandre Gonçalves; Piotto, Raquel Ferrari; Pedroso, Juan Carlos Montano

2013-01-01

270

Effects of dual arterial blood supply on liver regeneration in the graft and the host following heterotopic auxiliary liver transplantation  

PubMed Central

This study aimed to investigate the effect of the dual arterial blood supply method used in auxiliary liver transplantation on the regeneration of grafted and host liver. A total of 72 male Sprague-Dawley rats were randomly assigned to three experimental groups, namely the 68% hepatectomy group (group A), the 68% hepatectomy with dual arterial blood supply group (group B) and the auxiliary liver transplantation with dual arterial blood supply group (group C). Group C was further divided into the host liver subgroup (group Ca) and the transplanted liver subgroup (group Cb). Six animals from each group were sacrificed at 1, 2 and 7 days after surgery. The calculation of the liver regeneration rate (LRR) was based on measuring liver weight. Liver function was assessed by measuring serum alanine aminotransferase (ALT) levels. Immunohistochemistry was employed to detect the expression of proliferating cell nuclear antigen (PCNA). Apoptotic changes in the grafts and host livers were evaluated using TUNEL staining. The LRR in each group exhibited a tendency to increase over time. At each time point, the LRR of transplanted livers in group C exhibited no significant difference from that of host livers in group C (P>0.05). The ALT levels for each group exhibited a time-dependent decreasing tendency. The ALT level in group C was significantly higher compared to that in groups A and B at each time point (P<0.05). The expression of PCNA in transplanted and host livers in group C was significantly lower compared to that in groups A and B at the same time point (P<0.001). Although the number of apoptotic cells in each group varied at different time points, there was no statistically significant difference (P>0.05). In auxiliary liver transplantation with the dual arterial blood supply method, the capacity of the liver regeneration in the grafts was similar to that of the host livers. Therefore, this technique may reduce the potential risk of graft liver atrophy caused by functional competition. PMID:25289034

ZHANG, JUNJING; XI, JUNQING; DONG, CHAOXUAN; MENG, XINGKAI

2014-01-01

271

Blockade of the Interaction Between PD1 and PDL1 Accelerates Graft Arterial Disease in Cardiac Allografts  

Microsoft Academic Search

Background—Programmed death 1 (PD-1), a member of the CD28 family, has been identified. PD-1 is involved in the negative regulation of some immune responses. We evaluated the role of PD-ligand 1 (PD-L1) in graft arterial disease (GAD) of cardiac allografts and in smooth muscle cells (SMCs). Methods and Results—C57BL\\/6 murine hearts were transplanted into B6.C-H2bm12KhEg mice for examination of GAD.

Noritaka Koga; Jun-ichi Suzuki; Hisanori Kosuge; Go Haraguchi; Yasuyuki Onai; Hideki Futamatsu; Yasuhiro Maejima; Ryo Gotoh; Hitoshi Saiki; Fumihiko Tsushima; Miyuki Azuma; Mitsuaki Isobe

2009-01-01

272

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

Microsoft Academic Search

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

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

2010-01-01

273

Renal artery rupture secondary to pretransplantation Candida contamination of the graft in two different recipients  

Microsoft Academic Search

Infected graft transplantation is an unwelcome complication that may lead to serious consequences in the immunosuppressed host. It can be caused by infection of the donor or by contamination of the organ during harvest, preservation and handling, or at transplantation. With current donor evaluation protocols, the risk of transmitting infections by exogenous contaminated grafts seems to be more frequent than

Jesus Calviño; Rafael Romero; Elena Pintos; Daniel Novoa; Javier Mardaras; Victor Arcocha; Xose M. Lens; Domingo Sanchez-Guisande

1999-01-01

274

Endovascular repair of abdominal aortic aneurysm using bifurcated stent-graft in a patient with complete occlusion from the common to the external iliac artery.  

PubMed

Extensive iliofemoral occlusive disease can limit the use of endovascular aortic aneurysm repair (EVAR), and the treatment strategy varies depending on severity of the lesion. In cases of mild iliac artery (IA) stenosis, predilation using a balloon catheter before EVAR is relatively common, and for severe IA stenosis, the technique of internal endoconduits has been reported with good results. In contrast, EVAR using an aortouni-iliac stent graft with femorofemoral crossover bypass has traditionally been used for abdominal aortic aneurysm with IA occlusion. However, EVAR using a bifurcated stent graft has some clear advantages over aortouni-iliac stent grafts. In this report, we describe and discuss technical aspects and feasibility of chronically occluded iliac artery recanalization before EVAR to facilitate the use of bifurcated stent grafts in a patient with concomitant complete common to external IA occlusion. PMID:24360941

Fujimura, Naoki; Harada, Hirohisa; Yashiro, Hideki; Akiyoshi, Takurin; Nakagawa, Motohito; Kanai, Toshio; Obara, Hideaki; Kitagawa, Yuko

2014-04-01

275

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

PubMed Central

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

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

2013-01-01

276

Impact of statins and beta-blocker therapy on mortality after coronary artery bypass graft surgery  

PubMed Central

Background We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE). Methods We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad. Results We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period. Conclusions A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines. PMID:25774344

Blackstone, Eugene; Kapadia, Samir R.

2015-01-01

277

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

PubMed

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

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

2015-03-20

278

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

PubMed

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

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

2014-11-01

279

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

SciTech Connect

This study describes the efficacy of the right gastroepiploic artery (GEA) as graft material for coronary artery bypass grafting (CABG) as assessed by exercise thallium 201 myocardial scintigraphy in eight patients (age, 59.4 {plus minus} 9.35 years (mean {plus minus} SD)) who underwent CABG with the GEA graft in the past 2 years. Planar and single-photon-emission computed tomographic (SPECT) images were obtained during and 3 hours after exercise. Planar images were evaluated quantitatively with the percentile-washout method, and SPECT images were evaluated qualitatively with a bull's-eye, polar-coordinate map. All patients had triple-vessel disease, and in situ GEAs were anastomosed to the right coronary artery in seven patients and to the left anterior descending coronary artery in one. The internal mammary artery graft was concomitantly used in all patients. The mean number of grafts per patient was 3.0 (range, 2-4). Preoperative exercise testing could not be performed in two patients because of emergency operation. By qualitative assessment with the polar-coordinate map, four patients showed improvement, one did not show any change, and one became worse due to perioperative myocardial infarction.

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

1989-09-01

280

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

SciTech Connect

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.

Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it; Cannavale, Alessandro [University of Rome 'Sapienza,', Department of Radiological Sciences, Vascular and Interventional Radiology Unit (Italy)] [University of Rome 'Sapienza,', Department of Radiological Sciences, Vascular and Interventional Radiology Unit (Italy); Gazzetti, Marianna [Sapienza University of Rome 'Sapienza,', Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy)] [Sapienza University of Rome 'Sapienza,', Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy); Fantozzi, Cristiano; Taurino, Maurizio [University of Rome 'Sapienza,', Department of Vascular Surgery (Italy)] [University of Rome 'Sapienza,', Department of Vascular Surgery (Italy); Speziale, Francesco [Sapienza University of Rome 'Sapienza,', Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy)] [Sapienza University of Rome 'Sapienza,', Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy)

2013-02-15

281

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

PubMed Central

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

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

2013-01-01

282

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

SciTech Connect

The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters <18 mm and 30 (26%) patients had one or more CIA diameters >18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs {>=}18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs {>=}18 mm (p = 0.232). One-year freedom from IRSI was 92% {+-} 3% and 84% {+-} 9% for the <18-mm and {>=}18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

England, Andrew, E-mail: a.england@liv.ac.u [University of Liverpool, Department of Medical Imaging and Radiotherapy (United Kingdom); Butterfield, John S. [University Hospitals of South Manchester NHS Foundation Trust, Department of Radiology (United Kingdom); McCollum, Charles N. [University Hospitals of South Manchester NHS Foundation Trust, Department of Vascular Surgery (United Kingdom); Ashleigh, Raymond J. [University Hospitals of South Manchester NHS Foundation Trust, Department of Radiology (United Kingdom)

2008-07-15

283

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

Microsoft Academic Search

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

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

2010-01-01

284

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

Microsoft Academic Search

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

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

2000-01-01

285

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

Microsoft Academic Search

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

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

1997-01-01

286

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

Microsoft Academic Search

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

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

1996-01-01

287

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

PubMed

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

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

2014-09-15

288

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

Microsoft Academic Search

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

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

1996-01-01

289

Visualization of vortex shedding at the proximal side-to-end artery-graft anastomosis.  

PubMed

The motion of guanine particles was recorded by video to visualize transitional flow phenomena in models of a proximal side-to-end anastomosis. Close examination of successive video fields revealed that above a critical Reynolds number, particles were periodically shed into the graft from a vortex situated near the anastomosis heel, and this disturbed the flow patterns in the graft causing vortex shedding to occur near to the toe of the anastomosis. The images clearly demonstrated that periodic flow structures propagated distally along the graft for over 15 tube diameters from the proximal anastomosis. The frequency of the vortex shedding was found to increase with Reynolds number. Under pulsatile conditions, the primary vortex at the heel of the anastomosis became unstable during the deceleration phase of the flow cycle and particles were shed downstream into the graft. Although it was possible briefly to observe the characteristic banded structure in the bypass graft, the flow patterns were highly three-dimensional and were quickly broken up by the accelerating flow. Dynamic flow visualization using guanine particles was found to be a complementary technique to particle tracer flow visualization and was highly effective in identifying transitional flow phenomena and the mass transport mechanisms associated with them. PMID:8977657

Hughes, P E; Shortland, A P; How, T V

1996-01-01

290

Enzymatic differentiation of arterial and venous segments of the capillary bed during the development of free muscle grafts in the rat.  

PubMed

The revascularization of freely grafted muscles in the rat was studied by histochemical reactions that on frozen sections stain the arterial part of the capillary bed blue (alkaline phosphatase [AP] reaction) and the venous part of the capillary bed red (dipeptidyl peptidase IV [DPP IV] reaction). In 112 rats the extensor digitorum longus or soleus muscles were freely grafted and removed at various times up to 93 days following the surgery. In cross section, the capillaries of a normal muscle show a mosaic pattern of staining for the activity of the two enzymes. After grafting, DPP IV activity of capillaries is lost throughout the entire graft within a day or two; but within ischemic muscle, weak and diffuse AP staining persists in capillary remnants for up to 6 days. In the very periphery of the graft AP staining is also preserved in partially damaged capillaries. By 4 days, new AP-positive capillaries can be identified at the periphery of the graft, and in succeeding days AP-positive capillaries are found progressively nearer the center of the graft. At 7 days, the capillary/muscle-fiber ratios are 66% of normal in the periphery of the graft and 44% in the intermediate zone. DPP IV-stained capillaries are not seen until 7 days after grafting. By 60 days, when the grafts have become stabilized, the mosaic pattern of capillary staining has become reestablished. In mature grafts, the number of capillaries per unit area was slightly higher than that in control muscles, but the capillary/muscle-fiber ratio was slightly lower, owing to the smaller than normal cross-sectional areas of the regenerated muscle fibers. PMID:3788818

Grim, M; Mrázková, O; Carlson, B M

1986-10-01

291

Elevated Pulmonary Artery Pressure Is a Risk Factor for Primary Graft Dysfunction Following Lung Transplantation for Idiopathic Pulmonary Fibrosis  

PubMed Central

Background: Idiopathic pulmonary fibrosis (IPF) is often associated with elevations in pulmonary artery pressures. Although primary pulmonary arterial hypertension (PAH) has been associated with primary graft dysfunction (PGD), the role of secondary PAH in mediating PGD risk in patients with IPF is incompletely understood. The purpose of this study was to evaluate the relationship between mean pulmonary artery pressure (mPAP) and PGD among patients with IPF. Methods: We performed a multicenter prospective cohort study of 126 lung transplant procedures performed for IPF between March 2002 and August 2007. The primary outcome was grade 3 PGD at 72 h after lung transplant. The mPAP was measured as the initial reading following insertion of the right-sided heart catheter during lung transplant. Multivariable logistic regression was used to adjust for confounding variables. Results: The mPAP for patients with PGD was 38.5 ± 16.3 mm Hg vs 29.6 ± 11.5 mm Hg for patients without PGD (mean difference, 8.9 mm Hg [95% CI, 3.6-14.2]; P = .001). The increase in odds of PGD associated with each 10-mm Hg increase in mPAP was 1.64 (95% CI, 1.18-2.26; P = .003). In multivariable models, this relationship was independent of confounding by other clinical variables, although the use of cardiopulmonary bypass partially attenuated the relationship. Conclusions: Higher mPAP in patients with IPF is associated with the development of PGD. PMID:20864607

Fang, Adam; Studer, Sean; Kawut, Steven M.; Ahya, Vivek N.; Lee, James; Wille, Keith; Lama, Vibha; Ware, Lorraine; Orens, Jonathan; Weinacker, Ann; Palmer, Scott M.; Crespo, Maria; Lederer, David J.; Deutschman, Clifford S.; Kohl, Benjamin A.; Bellamy, Scarlett; Demissie, Ejigayehu

2011-01-01

292

Comparison between Drug-Eluting Stents and Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease: A Meta-Analysis of Two Randomized Trials and Thirteen Observational Studies  

Microsoft Academic Search

Objective: The clinical outcomes for unprotected left main coronary artery (LMCA) between coronary artery bypass grafting (CABG) and drug-eluting stents (DES) are still controversial. The objective was to compare safety and efficacy between DES and CABG for unprotected LMCA. Methods: Electronic databases and article references were systematically searched (2000–2010) to access relevant studies. Results: Fifteen studies with 5,479 patients were

Shuai Zheng; Zhe Zheng; Jianfeng Hou; Shengshou Hu

2011-01-01

293

Choice of material for internal carotid artery bypass grafting: vein or prosthetic? Analysis of 44 procedures  

Microsoft Academic Search

Purpose: Although infrequent, reconstruction of the internal carotid artery due to recurrent or extensive disease, tumor, or difficulty in completing the endarterectomy, may be necessary. Few studies evaluate the type of material used as conduit in regard to outcome. In this report we detail our results using both prosthetic and vein bypass of the internal carotid artery for atherosclerotic bifurcation

Sean P Roddy; R. Clement Darling III; Kathleen J Ozsvath; Manish Mehta; Benjamin B Chang; Philip S. K Paty; Paul B Kreienberg; Dhiraj M Shah

2002-01-01

294

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

SciTech Connect

Pelvic fractures secondary to blunt trauma are associated with a significant mortality rate due to uncontrolled bleeding. Interventional radiology (IR) can play an important and central role in the management of such patients, offering definitive minimally invasive therapy and avoiding the need for high-risk surgery. Rapid access to whole-body computed tomography has been shown to improve survival in polytrauma patients and allows rapid diagnosis of vascular injury and assessment of suitability for endovascular therapy. IR can then target and treat the specific area of bleeding. Embolisation of bleeding pelvic arteries has been shown to be highly effective and should be the treatment of choice in this situation. The branches of the internal iliac artery (IIA) are usually involved, and these arteries are accessed by way of IIA catheterisation after abdominal aortography. Occasionally these arteries cannot be accessed by way of this conventional route because of recent IIA ligation carried out surgically in an attempt to stop the bleeding or because (in the rare situation we describe here) these vessels are excluded secondary to previous aortoiliac repair. In this situation, knowledge of pelvic arterial collateral artery pathways is important because these will continue to supply pelvic structures whilst making access to deep pelvic branches challenging. We describe a rare case, which has not been previously reported in the literature, in which successful embolisation of a bleeding pelvic artery was carried out by way of the collateral artery pathways.

Abulaban, Osama; Hopkins, Jonathan; Willis, Andrew P.; Jones, Robert G., E-mail: robert.jones@uhb.nhs.uk [Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust (United Kingdom)

2011-02-15

295

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

Microsoft Academic Search

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

Leif Dibbelt; Peter Schmucker

2000-01-01

296

Fisioterapia convencional versus terapia EPAP no pós-operatório de cirurgia de revascularização do miocárdio Conventional physical therapy versus EPAP therapy in postoperative coronary artery bypass grafting  

Microsoft Academic Search

Introduction: Pulmonary complications in the immediate postoperative period of co- ronary artery bypass grafting (CABG) increase the morbidity and mortality risk. Respira- tory physical therapy with its techniques and resources, such as application of positive pressure, have been tested with the aim of diminishing the complications. Objective: To compare the effects of conventional chest physical therapy (PT) with the EPAP+PT

Daniela Bertol

297

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

Microsoft Academic Search

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

Y Ben-Shlomo; N Chaturvedi

1995-01-01

298

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

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.…

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

2012-01-01

299

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

Microsoft Academic Search

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

William Whang; J. Thomas Bigger

2000-01-01

300

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

Microsoft Academic Search

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

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

2000-01-01

301

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

Microsoft Academic Search

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

Winnie C. Yip

1998-01-01

302

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

Microsoft Academic Search

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

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

1999-01-01

303

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

Microsoft Academic Search

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

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

2010-01-01

304

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

Microsoft Academic Search

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

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

2006-01-01

305

Assessment of Decline in Health-Related Quality of Life among Angina-Free Patients Undergoing Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

Purpose: Coronary artery bypass graft (CABG) surgery generally decreases symptoms and improves quality of life, but for those patients without angina, prolongation of life takes precedence. We used the SF-36 to assess changes in health-related quality of life (HRQOL) among patients who were angina free prior to CABG compared to those reporting angina. Methods: We combined data from two randomized

Paul A. Pirraglia; Janey C. Peterson; Pamela Williams-Russo; Mary E. Charlson

2003-01-01

306

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

Microsoft Academic Search

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

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

1998-01-01

307

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

PubMed Central

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

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

2015-01-01

308

Arterial Grafting through the Obturator Foramen in Secondary Hemorrhage from the Femoral Vessels  

Microsoft Academic Search

Secondary hemorrhage from the groin is a life-threatening situation with a high risk of amputation if the limb is not revascularized after controlling the bleeding. Three cases are described in which grafting via the obturator foramen was used to achieve iliofemoral bypass in patients with secondary hemorrhage from the femoral vessels. Obturator bypass has previously mainly been used in the

R. F. M. Wood

1982-01-01

309

Risk factors for stroke in patients undergoing coronary artery bypass grafting  

Microsoft Academic Search

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

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

1996-01-01

310

Noninvasive evaluation of arterial grafts with newly released multidetector computed tomography  

Microsoft Academic Search

BackgroundHigh-quality postoperative imaging of bypass conduits is essential when evaluating different types of conduits, anastomoses, and surgical techniques. We investigated the potential value of the newest generation of multidetector-row computer tomographic scanners in assessing bypass grafts.

Jacob Gurevitch; Tamar Gaspar; Boris Orlov; Ron Amar; Dan Dvir; Nathan Peled; Dan J Aravot

2003-01-01

311

Use of the Sundt Clip Graft in a Previously Coiled Internal Carotid Artery Blister-Like Aneurysm  

PubMed Central

Owing to the focal wall defect covered with thin fibrous tissues, an aneurysm arising from the dorsal wall of the internal carotid artery (ICA) is difficult to manage either surgically or endovascularly and is often associated with high morbidity and mortality. Unfortunately, the definitive treatment modality of such highly risky aneurysm has not yet been demonstrated. Upon encountering the complex intracranial pathophysiology of such a highly precarious aneurysm, a neurosurgeon would be faced with a challenge to decide on an optimal approach. This is a case of multiple paraclinoid aneurysms including the ICA dorsal wall aneurysm, presented with spontaneous subarachnoid hemorrhage. With respect to treatment, direct clipping with a Sundt graft clip was performed after multiple endovascular interventions had failed. This surgical approach can be a treatment modality for a blood blister-like aneurysm after failed endovascular intervention(s). PMID:25628810

Cho, Jae Ik

2014-01-01

312

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

NASA Astrophysics Data System (ADS)

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.

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

313

Safety and efficacy of off-pump coronary artery bypass grafting  

Microsoft Academic Search

Background. We evaluated the application of the off-pump coronary artery bypass (OPCAB) procedure relative to safety and efficiency as measured by operative mortality postoperative complications and longitudinal outcome.Methods. Three hundred and fifty OPCAB patients were compared to 3,171 on-pump or conventional coronary artery bypass (CCAB) patients between January 1, 1997 and December 31, 1998. The groups were divided into three

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

2000-01-01

314

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

PubMed

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

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

1991-06-01

315

Changes in the Distribution of Hepatic Arterial Blood Flow Following TIPS with Uncovered Stent and Stent-Graft: An Experimental Study  

SciTech Connect

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.

Keussen, Inger [Center for Medical Imaging and Physiology, Lund University Hospital, SE-221 85 Lund (Sweden); Song, Ho-Young [Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of); Bajc, Marika; Cwikiel, Wojciech [Center for Medical Imaging and Physiology, Lund University Hospital, SE-221 85 Lund (Sweden)

2002-08-15

316

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

SciTech Connect

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

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

1983-05-01

317

Transvenous Embolization of a Spontaneous Femoral AVF 5 Years After an Incomplete Treatment with Arterial Stent-Grafts  

SciTech Connect

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.

Peynircioglu, Bora [Hacettepe University School of Medicine, Department of Radiology (Turkey)], E-mail: borapeynir@gmail.com; Ozkan, Murat; Dogan, Omer Faruk [Hacettepe University School of Medicine, Department of Vascular Surgery (Turkey); Cil, Barbaros E. [Hacettepe University School of Medicine, Department of Radiology (Turkey); Dogan, Riza [Hacettepe University School of Medicine, Department of Vascular Surgery (Turkey)

2008-03-15

318

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

PubMed Central

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

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

2008-01-01

319

Customized Tapered Stent-Grafts in the Endovascular Management of Internal Iliac Artery Aneurysms: A Useful Adjunct to Conventional Endovascular Options  

SciTech Connect

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.

Haslam, J. Elizabeth, E-mail: lizjohnson@doctors.org.uk; Hardman, John, E-mail: John.Hardman@ruh-bath.swest.nhs.u [Royal United Hospital, Department of Radiology (United Kingdom); Horrocks, Michael [Royal United Hospital, Department of Vascular Surgery (United Kingdom); Fay, Dominic [Royal United Hospital, Department of Radiology (United Kingdom)

2009-01-15

320

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)

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.

Toth, Csaba; Kiss, Ferenc; Klarik, Zoltan; Gergely, Eszter; Toth, Eniko; Peto, Katalin; Vanyolos, Erzsebet; Miko, Iren; Nemeth, Norbert

2014-05-01

321

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

PubMed

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

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

2013-09-15

322

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

Microsoft Academic Search

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

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

2002-01-01

323

Calcific aorta and coronary artery: two cases of calcific ascending aorta and descending aorta  

PubMed Central

Calcific aorta is a disease of old age and is an independent risk factor for morbidity and mortality. Here, we present two patients with calcific aorta at different levels. One with a descending porcelain aorta, and modified Bentall's procedure was done. Second is a patient who is having a calcific ascending aorta and coronary artery. Coronary artery bypass grafting from left internal mammary artery to left anterior descending was done for the patient. The calcification and its morbidity had been discussed briefly. PMID:25678909

Idhrees, A Mohammed; Radhakrishnan, Bineesh K; Panicker, Vargheese T; Pillai, Vivek; Karunakaran, Jayakumar

2015-01-01

324

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

PubMed Central

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

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

2014-01-01

325

Coronary Artery Disease Performance Measures and Statin Use in Patients With Recent Percutaneous Coronary Intervention or Recent Coronary Artery Bypass Grafting (from the NCDR PINNACLE Registry).  

PubMed

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

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

2015-04-15

326

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

Saphenous vein graft disease is a timely problem in coronary artery bypass grafting. Indeed, after exposure of the vein to arterial blood flow, a progressive modification in the wall begins, due to proliferation of smooth muscle cells in the intima. As a consequence, the graft progressively occludes and this leads to recurrent ischemia. In the present study we employed a novel ex vivo culture system to assess the biological effects of arterial-like pressure on the human saphenous vein structure and physiology, and to compare the results to those achieved in the presence of a constant low pressure and flow mimicking the physiologic vein perfusion. While under both conditions we found an activation of Matrix Metallo-Proteases 2/9 and of microRNAs-21/146a/221, a specific effect of the arterial-like pressure was observed. This consisted in a marked geometrical remodeling, in the suppression of Tissue Inhibitor of Metallo-Protease-1, in the enhanced expression of TGF-?1 and BMP-2 mRNAs and, finally, in the upregulation of microRNAs-138/200b/200c. In addition, the veins exposed to arterial-like pressure showed an increase in the density of the adventitial vasa vasorum and of cells co-expressing NG2, CD44 and SM22? markers in the adventitia. Cells with nuclear expression of Sox-10, a transcription factor characterizing multipotent vascular stem cells, were finally found in adventitial vessels. Our findings suggest, for the first time, a role of arterial-like wall strain in the activation of pro-pathologic pathways resulting in adventitial vessels growth, activation of vasa vasorum cells, and upregulation of specific gene products associated to vascular remodeling and inflammation. PMID:25689822

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

327

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

Saphenous vein graft disease is a timely problem in coronary artery bypass grafting. Indeed, after exposure of the vein to arterial blood flow, a progressive modification in the wall begins, due to proliferation of smooth muscle cells in the intima. As a consequence, the graft progressively occludes and this leads to recurrent ischemia. In the present study we employed a novel ex vivo culture system to assess the biological effects of arterial-like pressure on the human saphenous vein structure and physiology, and to compare the results to those achieved in the presence of a constant low pressure and flow mimicking the physiologic vein perfusion. While under both conditions we found an activation of Matrix Metallo-Proteases 2/9 and of microRNAs-21/146a/221, a specific effect of the arterial-like pressure was observed. This consisted in a marked geometrical remodeling, in the suppression of Tissue Inhibitor of Metallo-Protease-1, in the enhanced expression of TGF-?1 and BMP-2 mRNAs and, finally, in the upregulation of microRNAs-138/200b/200c. In addition, the veins exposed to arterial-like pressure showed an increase in the density of the adventitial vasa vasorum and of cells co-expressing NG2, CD44 and SM22? markers in the adventitia. Cells with nuclear expression of Sox-10, a transcription factor characterizing multipotent vascular stem cells, were finally found in adventitial vessels. Our findings suggest, for the first time, a role of arterial-like wall strain in the activation of pro-pathologic pathways resulting in adventitial vessels growth, activation of vasa vasorum cells, and upregulation of specific gene products associated to vascular remodeling and inflammation. PMID:25689822

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

328

Endovascular Treatment of a Giant Superior Mesenteric Artery Pseudoaneurysm Using a Nitinol Stent-Graft  

SciTech Connect

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.

Gandini, Roberto; Pipitone, Vincenzo; Konda, Daniel, E-mail: danielkonda@yahoo.com; Pendenza, Gianluca; Spinelli, Alessio; Stefanini, Matteo; Simonetti, Giovanni [University of Tor Vergata, Diagnostic Imaging and Interventional Radiology (Italy)

2005-01-15

329

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

Microsoft Academic Search

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

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

2009-01-01

330

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

Microsoft Academic Search

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

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

1997-01-01

331

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

Microsoft Academic Search

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

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

332

Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting  

PubMed Central

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

Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

2014-01-01

333

Management of carotid Dacron patch infection: a case report using median sternotomy for proximal common carotid artery control and in situ polytetrafluoroethylene grafting.  

PubMed

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

Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Ceccanei, Gianluca; Pacilè, Maria Antonietta

2009-01-01

334

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

Microsoft Academic Search

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

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

2005-01-01

335

Abdominal Aortic Aneurysm with a Dilated Common Iliac Artery: Treatment Using a Handmade Bifurcated Stent-Graft with a Wide Iliac Limb End  

SciTech Connect

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.

Miyayama, Shiro [Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Departments of Diagnostic Radiology and Vascular Surgery (Japan); Matsui, Osamu [Kanazawa University, School of Medicine, 13-1, Takara-machi, Kanazawa920-8640, Department of Radiology (Japan); Akakura, Yukari; Yamamoto, Toru; Nishida, Hiroto; Yoneda, Kenji; Kawai, Keiichi [Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Departments of Diagnostic Radiology andVascular Surgery (Japan); Murakami, Shinya [Kanazawa University, School of Medicine, 13-1, Takara-machi, Kanazawa 920-8640, Department of Radiology (Japan)

2003-11-15

336

Influence of Bilateral Skeletonized Harvesting on Occurrence of Deep Sternal Wound Infection in 1,000 Consecutive Patients Undergoing Bilateral Internal Thoracic Artery Grafting  

PubMed Central

Objective To evaluate the risk of deep sternal infection in a large patient cohort following bilateral internal thoracic artery (BITA) grafting using skeletonized BITA dissection. Summary Background Data Complete myocardial revascularization using BITAs improves long-term survival and lowers the rate of repeat operations. Harvesting of ITAs as skeletonized vessels preserves sternal collateral blood supply, thus enabling rapid sternal healing with less risk of deep sternal infection. Methods One thousand consecutive patients (763 men, 340 patients >70 years old, 304 diabetics) underwent skeletonized BITA grafting from April 1996 to July 1999. Results The 30-day mortality rate was 3.4%. There were 10 perioperative infarcts, 16 strokes, and 22 deep sternal infections. There was an increased risk of deep sternal infection in repeat coronary artery bypass grafting (CABG) operations (15%), chronic obstructive pulmonary disease (COPD) (6.2%), congestive heart failure (4.7%), left ventricular dysfunction (ejection fraction < 35%, 4.5%), and longer aortic cross-clamping time. After adjustment for other demographic, clinical, and surgical predictors, the only independent predictors of deep sternal infection were repeat operations, COPD, and duration of aortic cross-clamping. No patients in the reoperation subgroup died, but three of six COPD patients with deep sternal infection died, and COPD was an independent predictor of overall (early + late) mortality. Conclusions Skeletonized BITA grafting carries an acceptable risk of deep sternal infection but is not recommended for repeat CABG or for patients with COPD. PMID:12560787

Pevni, Dmitry; Mohr, Rephael; Lev-Run, Oren; Locer, Chaim; Paz, Yosef; Kramer, Amir; Shapira, Itzhak

2003-01-01

337

Uncultured undifferentiated adipose-derived nucleated cell fractions combined with inside-out artery graft accelerate sciatic nerve regeneration and functional recovery.  

PubMed

Effects of transplantation of adipose-derived nucleated cell fractions (ADNCs) on sciatic nerve regeneration were studied. A 10-mm sciatic nerve defect was bridged using artery graft filled with ADNCs. In control group, artery graft was filled with saline alone. Regenerated nerve fibres were studied for 12 weeks. In sham-operated group, sciatic nerve was only exposed and manipulated. Behavioural and functional studies confirmed faster recovery of regenerated axons in ADNCs transplanted animals than in control group (P<0.05). At the end of study period, animals in ADNCs transplanted group achieved a sciatic functional index (SFI) value of -31.6 ± -3.14, whereas in control group a value of -42.5 ± -3.7 was found. Gastrocnemius muscle mass in ADNCs transplanted animals was found to be significantly higher than that in control group (P=0.001). Morphometric indices of regenerated fibres showed the number and diameter of myelinated fibres to be significantly higher in ADNCs transplanted animals than in control group (P=0.001). On immunohistochemistry, there was more positive staining of S100 in the ADNCs transplanted animals than in control group. ADNCs transplantation into an artery graft could be considered a readily accessible technique that improves functional recovery of sciatic nerve. PMID:24951175

Mohammadi, R; Asadollahi, A; Amini, K

2014-09-01

338

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

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

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

2010-01-01

339

Noninvasive testing of cerebral perfusion reserve prior to coronary artery bypass graft surgery  

SciTech Connect

Cerebral perfusion reserve testing using fluorine-18-fluoromethane and positron emission tomographic brain scanning to define cerebral blood flow abnormalities was performed in 5 patients being considered for combined coronary and carotid reconstructive surgery. Blood flow testing during normocapnia and following hypercapnia was utilized in these patients to determine the hemodynamic significance of known extracranial carotid artery occlusive lesions. Reserve diminution in 2 of these patients prompted combined surgery, whereas normal reserve values in the other 3 prompted coronary surgery alone. Results obtained in this preliminary series show how preoperative noninvasive testing of cerebral perfusion reserve adds to the diagnostic evaluation of patients with widespread vascular disease.

Levine, R.L.; Lagreze, H.L.; Berkoff, H.A.; Turnipseed, W.D.; Hanson, J.M.; Sunderland, J.J.; Nickles, R.J.; Rowe, B.R.

1988-05-01

340

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

Microsoft Academic Search

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

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

2010-01-01

341

Incidental moderate mitral regurgitation in patients undergoing coronary artery bypass grafting: update on guidelines and key randomized trials.  

PubMed

Incidental moderate mitral regurgitation (MR) in patients presenting for coronary artery bypass grafting (CABG) is not only common but also probably adversely affects clinical outcome. The echocardiographic evaluation of incidental MR must be comprehensive and integrated, as it remains a cornerstone in management decisions. Current guidelines support surgical mitral intervention in this setting as a reasonable option, reflecting clinical equipoise towards moderate MR in the setting of planned CABG. There are currently 2 major randomized trials in progress that will test whether surgical correction of moderate MR combined with CABG improves major clinical outcomes as compared to CABG alone. These landmark trials will be completed in the near future. In the interim, significant progress in the fields of cardiac resynchronization therapy, transcatheter mitral valve intervention, and minimally invasive mitral valve surgery promise to affect the management alternatives for moderate MR in patients undergoing CABG regardless of operative risk. It is likely that in the coming decade there will be less tolerance for incidental moderate MR given its already known outcome effects and the multimodal interventions that continue to mature with better safety profiles. PMID:24440010

Ramakrishna, Harish; Ghadimi, Kamrouz; Augoustides, John G T

2014-02-01

342

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

PubMed Central

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

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

2014-01-01

343

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

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

Dalaklioglu, Selvinaz; Golbasi, Ilhan; Ogutman, Caglar

2013-01-01

344

The management of concomitant renal oncocytoma and giant coronary and bilateral common iliac artery aneurysms.  

PubMed

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

Clarke, Jonathan; Choong, Andrew; Raja, Shahzad; Amrani, Mohamed; Hellawell, Giles; Hussain, Tahir

2014-05-01

345

First implantation of Gore Hybrid Vascular Graft in the right vertebral artery for cerebral debranching in a patient with Loeys-Dietz syndrome.  

PubMed

A 53-year-old woman with Loeys-Dietz syndrome developed progressive subclavian artery aneurysm and common carotid artery dissection. She was treated successfully by plugging and coiling of the subclavian aneurysm and its side branches after combined cervical debranching using standard carotid-axillary bypass and Gore Hybrid Vascular Graft for vertebral revascularization. Follow-up control (4 weeks) documented patent debranching, and only minimal residual flow in the subclavian aneurysm. The described off-label use for sutureless cerebral revascularisation of the vertebral artery might be a fast, simple, and reliable solution for cervical debranching in selective challenging patients. Further studies are necessary to evaluate side effects and durability. PMID:24239520

Wipper, Sabine; Ahlbrecht, Oliver; Kölbel, Tito; Pflugradt, Axel; von Kodolitsch, Yskert; Debus, E Sebastian

2015-03-01

346

[Anesthetic management for robot assisted off-pump construction of composite graft using the da Vinci surgical system].  

PubMed

Robot-assisted minimally invasive surgery has become common in recent years. We used the da Vinci surgical system and managed anesthesia in 6 cases of bilateral internal mammary artery dissection and construction of a composite graft using the radial artery. To ensure vision inside the thoracic cavity, endoscopic robotic surgery employs the inflation of the thoracic cavity with carbon dioxide, producing a pneumothorax and turning the thoracic cavity into a positive pressure chamber. Thus, marked acidosis and circulatory changes manifest during anesthetic management. Although robotic surgery is considered "minimally invasive, such surgery involves a number of problems in terms of anesthetic management, and these problems must be examined. PMID:20169956

Takanashi, Yoko; Hamano, Hiroko; Miyata, Kazuto; Matsumoto, Shouhei; Isshiki, Atushi

2010-02-01

347

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

PubMed Central

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

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

1997-01-01

348

Investigation of the Hemodynamic Effect of Stent Wires on Renal Arteries in Patients with Abdominal Aortic Aneurysms Treated with Suprarenal Stent-Grafts  

SciTech Connect

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.

Sun Zhonghua, E-mail: z.sun@curtin.edu.a [Curtin University of Technology, Discipline of Medical Imaging, Department of Imaging and Applied Physics (Australia); Chaichana, Thanapong [King Mongkut's Institute of Technology Ladkrabang, Department of Electronic Engineering (Thailand)

2009-07-15

349

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

PubMed Central

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

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

2008-01-01

350

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

PubMed

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

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

2014-03-15

351

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

PubMed Central

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

2012-01-01

352

Comparing the Effects of Morphine Sulfate and Diclofenac Suppositories on Postoperative Pain in Coronary Artery Bypass Graft Patients  

PubMed Central

Background: Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care. Objectives: This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management. Patients and Methods: In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 ?g/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 ?g/kg/min, fentanyl 1-2 ?g/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients. Results: No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ? 0.05). Total dosage of used morphine was 22 ± 8.3 mg in each patient and total dosage of used diclofenac was 94 ± 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ? 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023). Conclusions: Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery. PMID:25346897

Imantalab, Vali; Mirmansouri, Ali; Sedighinejad, Abbas; Naderi Nabi, Bahram; Farzi, Farnoush; Atamanesh, Hadi; Nassiri, Nassir

2014-01-01

353

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

PubMed

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

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

2015-02-01

354

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

SciTech Connect

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

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

1990-08-15

355

Numerical investigation of haemodynamics in a helical-type artery bypass graft using non-Newtonian multiphase model.  

PubMed

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

Wen, Jun; Liu, Kai; Khoshmanesh, Khashayar; Jiang, Wentao; Zheng, Tinghui

2015-01-01

356

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

SciTech Connect

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)

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

357

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

PubMed Central

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

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

2014-01-01

358

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

SciTech Connect

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.

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

2012-03-15

359

Coronary Artery Bypass Grafting  

MedlinePLUS

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

360

Graft material and results of platelet inhibitor trials in peripheral arterial reconstructions: reappraisal of results from a meta-analysis  

PubMed Central

Aims To investigate the characteristics of published trials in order to establish the origin of the differing results obtained in trials of platelet inhibitors after peripheral bypass procedures. Methods Analysis of the information from 11 randomised, controlled trials of platelet inhibitors after peripheral bypass procedures published up until 1999 and involving 2302 patients undergoing peripheral bypass operations, 1250 of whom were treated with platelet inhibitors. Results There is a significant treatment benefit of platelet inhibitors on meta-analysis of the trials, but a significant heterogeneity amongst the individual trial results. The proportion of patients in a trial with prosthetic grafts was a significant factor in explaining the heterogeneity. Proportion of prosthetic grafts was associated with sample size and with the proportion of grafts above the knee, but these were not found to make an independent contribution to the heterogeneity observed. The platelet inhibitor regimen used, the severity of ischaemic symptoms and the proportion of smokers included were also not found to be important. Conclusions The improvement of graft patency by aspirin and related platelet inhibitors in clinical trials in peripheral bypass procedures can be attributed to an effect on patients with prosthetic grafts. There is little evidence that these agents prevent occlusion of vein grafts. The conclusion of an earlier meta-analysis that antiplatelet agents should be used for all bypasses is not supported. PMID:10792206

Watson, Hugh R; Skene, Allan M; Belcher, Glyn

2000-01-01

361

Short term outcomes of total arterial coronary revascularization in patients above 65 years: a propensity score analysis  

PubMed Central

Background Despite the advantages of bilateral mammary coronary revascularization, many surgeons are still restricting this technique to the young patients. The objective of this study is to demonstrate the safety and potential advantages of bilateral mammary coronary revascularization in patients older than 65 years. Methods Group I included 415 patients older than 65 years with exclusively bilateral mammary revascularization. Using a propensity score we selected 389 patients (group II) in whom coronary bypass operations were performed using the left internal mammary artery and the great saphenous vein. Results The incidence of postoperative stroke was higher in group II (1.5% vs. 0%, P = 0.0111). The amount of postoperative blood loss was higher in group I (908 ± 757 ml vs. 800 ± 713 ml, P = 0.0405). There were no other postoperative differences between both groups. Conclusion Bilateral internal mammary artery revascularization can be safely performed in patients older than 65 years. T-graft configuration without aortic anastomosis is particularly beneficial in this age group since it avoids aortic manipulation, which is an important risk factor for postoperative stroke. PMID:20398421

2010-01-01

362

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

PubMed

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

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

1993-09-15

363

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

PubMed

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

Agarwal, R; Kaul, U; Jain, P

1996-01-01

364

Peripheral artery bypass - leg  

MedlinePLUS

... of the artery that is blocked. After moving skin and tissue out of the way, the surgeron will place clamps at each end of the blocked section of artery. The graft is then sewn in place. The surgeon will ...

365

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

PubMed

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

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

2015-04-01

366

Successful use of the Impella Recover LP 5.0 device for circulatory support during off-pump coronary artery bypass grafting  

PubMed Central

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

Pepino, Paolo; Coronella, Germano; Oliviero, Piermario; Monaco, Mario; Schiavone, Vincenzo; Finizio, Filippo; Biondi-Zoccai, Giuseppe; Frati, Giacomo; Giordano, Arturo

2014-01-01

367

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

PubMed

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

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

1993-01-01

368

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

PubMed

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

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

2014-12-01

369

Doppler derived quantitative flow estimate in coronary artery bypass graft: a computational multiscale model for the evaluation of the current clinical procedure.  

PubMed

In order to investigate the reliability of the so called mean velocity/vessel area formula adopted in clinical practice for the estimation of the flow rate using an intravascular Doppler guide wire instrumentation, a multiscale computational model was used to give detailed predictions on flow profiles within Y-shaped coronary artery bypass graft (CABG) models. At this purpose three CABG models were built from clinical patient's data and used to evaluate and compare, in each model, the computed flow rate and the flow rate estimated according to the assumption of parabolic velocity profile. A consistent difference between the exact and the estimated value of the flow rate was found in every branch of all the graft models. In this study we showed that this discrepancy in the flow rate estimation is coherent to the theory of Womersley regarding spatial velocity profiles in unsteady flow conditions. In particular this work put in evidence that the error in flow rate estimation can be reduced by using the estimation formula recently proposed by Ponzini et al. [Ponzini R, Vergara C, Redaelli A, Veneziani A. Reliable CFD-based estimation of flow rate in haemodynamics measures. Ultrasound Med Biol 2006;32(10):1545-55], accounting for the unsteady nature of blood, applicable in the clinical practice without resorting to further measurements. PMID:17980641

Ponzini, Raffaele; Lemma, Massimo; Morbiducci, Umberto; Montevecchi, Franco M; Redaelli, Alberto

2008-09-01

370

Alterations in plasma soluble vascular endothelial growth factor receptor-1 (sFlt-1) concentrations during coronary artery bypass graft surgery: relationships with post-operative complications  

PubMed Central

Background Plasma concentrations of sFlt-1, the soluble form of the vascular endothelial growth factor receptor (VEGF), markedly increase during coronary artery bypass graft (CABG) surgery with extracorporeal circulation (ECC). We investigated if plasma sFlt-1 values might be related to the occurrence of surgical complications after CABG. Methods Plasma samples were collected from the radial artery catheter before vascular cannulation and after opening the chest, at the end of ECC just before clamp release, after cross release, after weaning from ECC, at the 6th and 24th post-operative hour. Thirty one patients were investigated. The presence of cardiovascular, haematological and respiratory dysfunctions was prospectively assessed. Plasma sFlt-1 levels were measured with commercially ELISA kits. Results Among the 31 investigated patients, 15 had uneventful surgery. Patients with and without complications had similar pre-operative plasma sFlt-1 levels. Lowered plasma sFlt-1 levels were observed at the end of ECC in patients with haematological (p = 0.001, ANOVA) or cardiovascular (p = 0.006) impairments, but not with respiratory ones (p = 0.053), as compared to patients with uneventful surgery. Conclusion These results identify an association between specific post-CABG complication and the lower release of sFlt-1 during ECC. sFlt-1-induced VEGF neutralisation might, thus, be beneficial to reduce the development of post-operative adverse effects after CABG. PMID:18423019

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

2008-01-01

371

Serum Lactate Is not Correlated with Mixed or Central Venous Oxygen Saturation for Detecting Tissue Hypo Perfusion During Coronary Artery Bypass Graft Surgery: A Prospective Observational Study  

PubMed Central

Objectives: Effective assessment of tissue perfusion is highly important during Coronary Artery Bypass Graft (CABG). Mixed venous O2 saturation (Svo2) is one of the best and routinely used markers of tissue perfusion. However, this method is costly and leads to considerable complications. Thus, the present study aimed to determine whether the Svo2 can be substituted with central venous saturation (Scvo2) and if there is any correlation between lactate level and Svo2. Methods: This prospective observational study was conducted on 62 patients scheduled for CABG. After induction and maintenance of anesthesia, blood samples drawn from central venous, pulmonary artery, and radial artery were used to measure Scvo2, Svo2 and serum lactate level respectively before and after Cardio Pulmonary Bypass (CPB). Pearson’s correlation test was used to determine the correlation between Svo2 and Scvo2 as well as between Svo2 and serum lactate level. Besides, P < 0.05 was considered as statistically significant. Results: Overall, 62 Patients, 33 males (53.2%) and 29 females (46.8%) were enrolled into the present study. The most common coexisting illness was hypertension detected in 33 patients (53.2%) followed by hypercholesterolemia in 28 ones (44.4%). In this study, Svo2 was positively correlated with Scvo2 (r = 0.63, P < 0.001). However, no correlation was found between Svo2 and lactate (r = 0.124, P = 0.348). Conclusions: In summary, Scvo2 is considered as the best substitute of Svo2 for detecting tissue hypo perfusion during CPB. Although the lactate level had been considered as an appropriate marker of tissue perfusion and ischemia, it was not correlated to Svo2 during CABG. PMID:24757637

Shahbazi, Shahrbano; Khademi, Saeed; Shafa, Masih; Joybar, Reza; Hadibarhaghtalab, Maryam; Sahmeddini, Mohammad Ali

2013-01-01

372

Treatment of Iatrogenic Internal Carotid Artery Laceration and Carotid Cavernous Fistula with Endovascular Stent-Graft Placement  

Microsoft Academic Search

Summary: The risk of fatal injury of the internal carotid artery (ICA) and surrounding anatomy during transsphe- noidal surgery for pituitary adenoma is the most severe potential complication associated with this particular ap- proach. We present a case in which iatrogenic injury to a patient's ICA and resultant carotid cavernous fistula and massive hemorrhage was successfully managed with the emergency

Naci Kocer; Osman Kizilkilic; Sait Albayram; Ibrahim Adaletli; Fatih Kantarci; Civan Islak

373

Comparing mortality and myocardial infarction between coronary artery bypass grafting and drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis  

PubMed Central

Introduction We aim to compare the midterm outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients who had multivessel coronary artery diseases (CAD). Material and methods A comprehensive literature search was conducted to identify the related clinical studies with a follow-up for 1 year at least. The endpoints were death, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE). Results Finally, the analysis of ten studies involving 5,264 patients showed that patients with CABG had worse baseline characteristics, a higher rate of stable angina pectoris, a higher percentage of triple-vessel disease, higher incidence of chronic total occlusion and a higher SYNTAX score. However, there was no significant difference in mortality between the two groups. Additionally, the rates of myocardial infarction and MACCE were markedly decreased in the CABG group. Conclusions The strategy of CABG is better than PCI for diabetic patients with multivessel CAD. The CABG can significantly reduce the rates of myocardial infarction and MACCE and is comparable in mortality despite the worse baseline characteristics. PMID:25097568

Qi, Xiaolong; Xu, Mingxin; Yang, Haitao; Zhou, Lin; Mao, Yu; Song, Haoming; Li, Quan

2014-01-01

374

Skin graft  

MedlinePLUS

Skin transplant; Skin autografting; FTSG; STSG; Split thickness skin graft; Full thickness skin graft ... donor site. Most people who are having a skin graft have a split-thickness skin graft. This takes ...

375

Comparison of the Effectiveness of Continuous versus Intermittent Cefazolin for the Prevention of Infection after Off-Pump Coronary Artery Bypass Graft  

PubMed Central

Abstract Background: Surgical site infection is known as a common complication after cardiac surgery, and Cefazolin is the best prophylactic antibiotic to prevent this complication. The goal of this study was to evaluate the effect of continuous and intermittent Cefazolin for the prevention of superficial surgical site infection following off-pump coronary artery bypass (OPCAB). Methods: This prospective randomized clinical trial study was conducted on 141 patients candidated for OPCAB and divided into two groups. This study was performed between February 2011 and February 2012 in the Iranian city of Yazd. Patients in both groups received 2 g of Cefazolin as a starting dose and at 30 minutes before incision. Definition of surgical site infections was according to the Centers for Disease Control and Prevention Criteria (CDC-criteria). In the continuous infusion group (n = 74), 3 g of Cefazolin was infused over a 24-hour period after surgery. In the intermittent group (n = 67), 1 g of Cefazolin was administered at 3, 11, and 19 hours after the starting dose. Hyperlipidemia, diabetes, hypertension, smoking, history of heart disease, and incidences of superficial infection were compared between the two groups. Duration of follow- up was 4 weeks. Results: The mean age of the patients was 60.49 ± 10.63 years. The patients were 30.5% female and 69.5% male. There were no significant differences in age, body surface area, duration of operation, number of distal grafts, number of proximal grafts, and duration of hospital stay before heart surgery between two groups. The incidence of infection in intermittent group was (7.5%) and in continuous groups was (2.7%). There was no significant difference in the incidence of infection between the two groups (p value = 0.26). Conclusion: Our findings in this study showed no significant differences between continuous and intermittent Cefazolin for the prevention of superficial surgical site infections after OPCAB.

Forouzannia, Seyed Khalil; Karimi-Bondarabadi, Ali Akbar; Bagherinasab, Mostafa; Sarebanhassanabadi, Mohammadtaghi

2014-01-01

376

Collaborative overview of randomised trials of antiplatelet therapy--II: Maintenance of vascular graft or arterial patency by antiplatelet therapy. Antiplatelet Trialists' Collaboration.  

PubMed Central

OBJECTIVE--To determine the efficacy of antiplatelet therapy in maintaining vascular patency in various categories of patients. DESIGN--Overviews of 46 randomised trials of antiplatelet therapy versus control and 14 randomised trials comparing one antiplatelet regimen with another. SETTING--Randomised trials that could have been available by March 1990 and in which vascular graft or arterial patency was to be studied systematically. SUBJECTS--About 8000 patients at varying degrees of risk of vascular occlusion (by virtue of disease or of having some vascular procedure) were in trials of antiplatelet therapy versus control and 4000 such patients were in trials directly comparing different antiplatelet regimens. RESULTS--Overall, antiplatelet therapy produced a highly significant (2P < 0.0001) reduction in vascular occlusion, with similar proportional reductions in several different types of patients. Hence the absolute reductions tended to be largest among patients at highest risk of occlusion, with smaller but still significant absolute reductions among lower risk patients. The proportions of patients with confirmed occlusion among those allocated antiplatelet therapy versus appropriately adjusted control proportions (and mean scheduled treatment durations and net absolute benefits) were: (a) among about 4000 patients with coronary artery grafts, 21% antiplatelet therapy v 30% control (seven month benefit about 90 patients protected per 1000 allocated antiplatelet therapy (2P < 0.00001)); (b) among about 800 patients after coronary angioplasty, 4% antiplatelet therapy v 8% control (six month benefit about 40/1000 (2P = 0.02)); (c) among about 3000 patients with peripheral artery procedures or disease, 16% antiplatelet therapy v 25% control (19 month benefit about 90/1000 (2P < 0.00001)); (d) among about 400 renal patients with a shunt or fistula placed for haemodialysis access, 17% antiplatelet therapy v 39% control (two month benefit about 200/1000 (2P < 0.00001)). Indirect comparisons between the effects of starting treatment before these vascular procedures and starting soon after them indicated similar sized benefits. As well as preventing subclinical occlusion, antiplatelet therapy produced a significant (2P = 0.002) reduction of about one quarter in the odds of suffering a "vascular event" (non-fatal myocardial infarction, non-fatal stroke, or vascular death). Various antiplatelet regimens (chiefly aspirin alone or aspirin plus dipyridamole) were studied but there was no significant evidence of differences between their effects on arterial occlusion or vascular events. Data on bleeding were incomplete but no large excess with antiplatelet therapy was apparent. CONCLUSION--Antiplatelet therapy (chiefly aspirin alone or aspirin plus dipyridamole) greatly reduces the risk of vascular occlusion in a wide range of patients at high risk of this complication. Further studies are required to determine exactly when treatment should start (to limit any perioperative bleeding while still preventing most early occlusion) and for how long it should be continued. PMID:8312766

1994-01-01

377

Calcific stenotic jump graft.  

PubMed Central

A young lady with post-subclavian coarctation and cranial hypertension is discussed. She had a jump graft from left subclavian artery to descending aorta, and presented 18 years later with hypertension, calcification of the graft with a gradient of 40 mmHg across it. In the meantime, she also developed moderate aortic regurgitation on a bicuspid aortic valve. Management strategies including trans-catheter options are discussed. We present our reservations on trans-catheter options in an occluded dacron graft. PMID:16749963

Padmakumar, R.; Krishnamoorthy, K. M.; Tharakan, J. A.

2004-01-01

378

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

PubMed

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

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

2013-12-01

379

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

PubMed Central

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

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

2014-01-01

380

Predictors of packed red cell transfusion after isolated primary coronary artery bypass grafting – The experience of a single cardiac center: A prospective observational study  

PubMed Central

Background Preoperative patients' characteristics can predict the need for perioperative blood component transfusion in cardiac surgical operations. The aim of this prospective observational study is to identify perioperative patient characteristics predicting the need for allogeneic packed red blood cell (PRBC) transfusion in isolated primary coronary artery bypass grafting (CABG) operations. Patients and Methods 105 patients undergoing isolated, first-time CABG were reviewed for their preoperative variables and followed for intraoperative and postoperative data. Patients were 97 males and 8 females, with mean age 58.28 ± 10.97 years. Regression logistic analysis was used for identifying the strongest perioperative predictors of PRBC transfusion. Results PRBC transfusion was used in 71 patients (67.6%); 35 patients (33.3%) needed > 2 units and 14 (13.3%) of these needed > 4 units. Univariate analysis identified female gender, age > 65 years, body weight ? 70 Kg, BSA ? 1.75 m2, BMI ? 25, preoperative hemoglobin ? 13 gm/dL, preoperative hematocrit ? 40%, serum creatinine > 100 ?mol/L, Euro SCORE (standard/logistic) > 2, use of CPB, radial artery use, higher number of distal anastomoses, and postoperative chest tube drainage > 1000 mL as significant predictors. The strongest predictors using multivariate analysis were CPB use, hematocrit, body weight, and serum creatinine. Conclusion The predictors of PRBC transfusion after primary isolated CABG are use of CPB, hematocrit ? 40%, weight ? 70 Kg, and serum creatinine > 100 ?mol/L. This leads to better utilization of blood bank resources and cost-efficient targeted use of expensive blood conservation modalities. PMID:19422707

Elmistekawy, Elsayed M; Errett, Lee; Fawzy, Hosam F

2009-01-01

381

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

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

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

2014-01-01

382

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

PubMed Central

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

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

2014-01-01

383

Neurological Complications Comparing Endoscopically vs. Open Harvest of the Radial Artery  

ClinicalTrials.gov

Complications Due to Coronary Artery Bypass Graft; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Heart Diseases; Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases

2015-02-28

384

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

PubMed Central

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

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

2013-01-01

385

Interrelationship between prolactin and progesterone in normal mammary gland growth in SHN virgin mice.  

PubMed

In order to clarify the interrelationship between prolactin and progesterone on normal mammary gland growth, SHN strain of virgin mice were given the pituitary grafting under the kidney capsule, the subcutaneous implantation of progesterone pellet or the bilateral ovariectomy singly or in combination at 40 days of age. All mice were killed 60 days after treatments and mammary end-bud formation, mammary DNA content and plasma prolactin level were examined. The single pituitary grafting elevated plasma prolactin levels in both the intact and the ovariectomized animals, however, mammary gland growth was enhanced only in the former. Progesterone pellet implantation also stimulated mammary gland growth in the intact mice, while prolactin changed little. Progesterone effect was nullified by ovariectomy associated with the decline in plasma prolactin level. The simultaneous single pituitary grafting and progesterone pellet implantation in combination or the grafting with three pituitaries restored mammary gland regression by ovariectomy. All findings have demonstrated that the manifestation of progesterone effect on mammary glands is dependent upon prolactin and that the role of prolactin is both direct on the glands and indirect through its luteotropic effect - through its stimulation of ovarian progesterone secretion. PMID:4092747

Nagasawa, H; Miura, K; Niki, K; Namiki, H

1985-12-01

386

Comparison of the Length of Hospital Stay between the Patients with Atrial Fibrillation Treated with Amiodarone and Patients with Normal Sinus Rhythm after Coronary Artery Bypass Graft  

PubMed Central

Introduction Postoperative atrial fibrillation occurs in 20 % to 40 % of patients undergoing coronary artery bypass grafting ( CABG ) and contributes to increasing length of stay and hospital cost . The purpose of our study was to compare the length of hospital stay between patients of postoperative atrial fibrillation treated with amiodarone (experimental) and those with normal sinus rhythm ( NSR ) (Control ) after CABG. Methods From October of 2008 to October 2010, our experimental group including 26 patients was treated with amiodarone in Tabriz Madani Heart Center. The background variables, length of atrial fibrillation, and length of hospital stay were recorded. The experimental group was compared with a control group of 50 patients. The two groups were the same in terms of age, gender, ejection fraction, vascular diseases and risk factors. Results The hospital stay duration was 8.0 ±1.6 and 7.4 ±1.4 days (p = 0.08) for experimental, and control groups respectively. Atrial fibrillation occurred mainly (60%) on the second postoperative day. Conclusion 25 patients out of 26 patients (96 %) returned to NSR after starting the amiodarone protocol and the length of hospital stay in the experimental group was not significantly different from that of the control group. Thus, treating with Amiodarone in postoperative atrial fibrillation can reduce hospital stay duration compared to that of normal sinus patients. PMID:24250975

Shams Vahdati, Samad; Samadikhah, Jahanbakhsh; Hakim, Seied Hadi; Azarfarin, Rasoul; Ansarin, Mahsa

2012-01-01

387

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

PubMed

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

Dooley, Andrew; Asimakopoulos, George

2013-06-01

388

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

PubMed

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

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

2015-01-21

389

A Model of Vein Graft Intimal Hyperplasia  

Microsoft Academic Search

When vein graft is implanted in the arterial system, the vein graft wall becomes thicker as an adaptive process. We have developed a model of early adaptive vein graft intimal thickening induced by shear stress. Intimal thickness and the rate of intimal thickening are expressed as functions of shear stress and time based on experimental data. The model describes the

Roger Tran-Son-Tay; Minki Hwang; Scott A. Berceli; C. Keith Ozaki; Marc Garbey

2007-01-01

390

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

SciTech Connect

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.

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

391

Effects of lying or standing on mammary blood flow and heart rate of dairy cows  

E-print Network

Effects of lying or standing on mammary blood flow and heart rate of dairy cows H Rulquin, JP of standing or lying on the mammary blood flow and heart rate in dairy cows. To widen the range of blood flow on the left common ex- ternal pudic artery by a transit-time blood flowmeter. Heart rate was determined

Paris-Sud XI, Université de

392

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

PubMed

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

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

2000-09-01

393

Emotional Processes in Patients Undergoing Coronary Artery Bypass Graft Surgeries with Extracorporeal Circulation in View of Selected Indicators of the Inflammatory Condition  

PubMed Central

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

P?otek, W?odzimierz; Pielok, Joanna; Cybulski, Marcin; Samborska, Regina

2015-01-01

394

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

PubMed Central

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

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

2014-01-01

395

Effects of Metabolic Syndrome with or without Obesity on Outcomes after Coronary Artery Bypass Graft. A Cohort and 5-Year Study  

PubMed Central

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

Ao, Hushan; Xu, Fei; Wang, Xianqiang; Tang, Xinran; Zheng, Zhe; Hu, Shengshou

2015-01-01

396

Impact of aspirin resistance on outcomes among patients following coronary artery bypass grafting: exploratory analysis from randomized controlled trial (NCT01159639).  

PubMed

Individual variability in the response to aspirin, has been established by various platelet function assays, however, the clinical relevance of aspirin resistance (AR) in patients undergoing coronary artery bypass grafting (CABG) has to be evaluated. Our working group conducted a randomized controlled trial (NCT01159639) with the aim to assess impact of dual antiplatelet therapy (APT) on outcomes among patients with AR following CABG. Patients that were aspirin resistant on fourth postoperative day (POD 4) were randomly assigned to receive either dual APT with clopidogrel (75 mg) plus aspirin (300 mg)-intervention arm or monotherapy with aspirin (300 mg)-control arm. This exploratory analysis compares clinical outcomes between aspirin resistant patients allocated to control arm and patients that have had adequate platelet inhibitory response to aspirin at POD 4. Both groups were treated with 300 mg of aspirin per day following surgery. We sought to evaluate the impact of early postoperative AR on outcomes among patients following CABG. Exploratory analysis included a total number of 325 patients. Of those, 215 patients with adequate response to aspirin and 110 patients with AR allocated to aspirin monotherapy following randomization protocol. The primary efficacy end point (MACCEs-major adverse cardiac and cardiovascular events) occurred in 10 and 6 % of patients with AR and with adequate aspirin response, respectively (p = 0.27). Non-significant differences were observed in bleeding events occurrence. Subgroup analysis of the primary end point revealed that aspirin resistant patients with BMI > 30 kg/m(2) tend to have a higher occurrence of MACCEs 18 versus 5 % (relative risk 0.44 [95 % CI 0.16-1.16]; p = 0.05). This exploratory analysis did not reveal significant impact of aspirin resistance on outcomes among patients undergoing CABG. Further, sufficiently powered studies are needed in order to evaluate clinical relevance of AR in patients undergoing CABG. PMID:25095738

Petricevic, Mate; Kopjar, Tomislav; Gasparovic, Hrvoje; Milicic, Davor; Svetina, Lucija; Zdilar, Boris; Boban, Marko; Mihaljevic, Martina Zrno; Biocina, Bojan

2015-05-01

397

Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial†  

PubMed Central

OBJECTIVES The incidence of surgical site infection (SSI) after open vein harvesting in coronary artery bypass grafting (CABG) patients ranges in different studies between 2 and 20%. Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis. We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting. METHODS An investigator-initiated prospective randomized double-blind single-centre study was performed with 374 patients, randomized to subcutaneous and intracutaneous leg-wound closure with either triclosan-coated sutures (Vicryl Plus® and Monocryl Plus®, Ethicon, Somerville, NJ, USA) (n = 184) or identical sutures without triclosan (n = 190) from the same manufacturer. All patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). Primary endpoint was SSI within 60 days after surgery according to the definition of Center for Disease Control. Predefined secondary endpoints included culture-proven and antibiotic-treated SSI. RESULTS The primary endpoint occurred in 23 patients (12.5%) with triclosan-coated sutures and in 38 patients (20.0%) in the group without triclosan (P = 0.0497, risk ratio 0.63, (95% confidence interval 0.39–1.00). Corresponding figures for culture-proven infections were 7.6 vs 12.1%, (P = 0.15), and for antibiotic-treated infections, 10.9 vs 18.4%, (P = 0.039). Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens in both groups. Insulin-treated diabetes and vein-harvesting time were associated with SSI after vein harvesting. CONCLUSIONS Leg-wound closure with triclosan-coated sutures in CABG patients reduces SSIs after open vein harvesting. (ClinicalTrials.gov number NCT01212315). PMID:23435526

Thimour-Bergström, Linda; Roman-Emanuel, Christine; Scherstén, Henrik; Friberg, Örjan; Gudbjartsson, Tomas; Jeppsson, Anders

2013-01-01

398

Preventive Use of Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Coronary Artery Bypass Grafting: A Retrospective Study  

PubMed Central

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

Zhang, Jingchao; Lang, Yan; Guo, Longhui; Song, Xiaodong; Shu, Liliang; Su, Gang; Liu, Hai; Xu, Jing

2015-01-01

399

Hospital-Acquired Pneumonia in Patients Undergoing Coronary Artery Bypass Graft; Comparison of the Center for Disease Control Clinical Criteria With Physicians’ Judgment  

PubMed Central

Background: Following coronary artery bypass graft (CABG), patients are at high risk (3.2%-8.3%) for developing hospital-acquired pneumonia (HAP) with mortality rate of 24% to 50%. Some of routine features in patients undergoing CABG are similar to clinical criteria of Center of Disease Control (CDC) for diagnosis of pneumonia. This may lead to over-diagnosis of pneumonia in these patients. Objectives: This study aimed to assess the frequency of CDC criteria for diagnosis of pneumonia in patients undergoing CABG. Patients and Methods: This study was performed on CABG candidates admitted to post cardiac surgery Intensive Care Unit (ICU) in a six-month period. Patient’s records, Chest-X-Ray, and Laboratory tests were assessed for PNU1-CDC criteria for HAP diagnosis. At the same time, a physician who was unaware of the study protocol assessed the clinical diagnosis. Then the results were compared with CDC criteria-based diagnosis. Results: Of total 300 patients, 9 (3%) met CDC criteria for diagnosis of pneumonia while none of the cases were diagnosed as HAP according to the physicians’ clinical diagnosis. All nine patients were discharged with proper general condition and no need of antibiotic therapy. This study showed that loss of consciousness, tachypnea, dyspnea, PaO2 < 60 mm Hg, PaO2/FiO2 < 240, and local infiltration in 24 hours of operation were misleading features of CDC criteria, which were not considered in physicians’ clinical judgment to establish the diagnosis. Conclusions: Our findings suggest that in Post-CABG patients, physicians could judge the occurrence of HAP more accurately in comparison to making the diagnosis based on CDC criteria alone. Expert physician may intentionally do not take some of these criteria into account according the patients’ course of disease. Therefore, it is suggested that the value of these criteria in special group of patients like those undergoing CABG should be re-evaluated. PMID:25289379

Baghban, Mahboubeh; Paknejad, Omalbanin; Yousefshahi, Fardin; Gohari Moghadam, Keivan; Bina, Payvand; Samimi Sadeh, Saghar

2014-01-01

400

Temporal Trends in the Incidence of Surgical Site Infections in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Population-Based Cohort Study, 1993 to 2008  

PubMed Central

Objective To determine the incidence of and temporal trends in surgical site infections (SSIs) in patients underoing coronary artery bypass graft (CABG) surgery. Methods A population-based cohort study was conducted to describe the epidemiologic features of SSI in Olmsted County, Minnesota, between January 1, 1993, and December 31, 2008, using the Rochester Epidemiology Project. Period-specific incidence rates (in-hospital or within 30 days outside the hospital) were calculated. Logistic regression analysis was used to adjust for potential confounders that could affect temporal trends in SSI incidence rates. Results During the 16-year study, of 1424 residents of Olmsted County who underwent CABG surgery, 1189 (83%) had isolated CABG and 235 (17%) had combined CABG and valve surgery. The overall SSI incidence rate was 7.0% (95% confidence interval [CI], 5.7%-8.4%). The incidence rate of superficial sternal SSI was 2.0% (95% CI, 1.2%-2.7%) and of deep sternal SSI was 1.5% (95% CI, 0.9%-2.2%). The leg harvest site infection rate was 3.6% (95% CI, 2.6 %-4.5%). The incidence rate decreased over time with a statistically significant linear trend. The adjusted odds ratio (95% CI) of SSI showed a decreasing linear trend: 0.39 (0.19-0.81) vs 0.50 (0.27-0.93) vs 0.83 (0.48-1.42) vs reference for 2005-2008 vs 2001-2004 vs 1997-2000 vs 1993-1996. Conclusion In this population-based surveillance study of patients undergoing CABG surgery, the incidence of SSI decreased markedly between 1993 and 2008 in patients in Olmsted County. The factors responsible for this decrease are the focus of ongoing investigations. PMID:23127732

Alasmari, Faisal A.; Tleyjeh, Imad M.; Riaz, Muhammad; Greason, Kevin L.; Berbari, Elie F.; Virk, Abinash; Baddour, Larry M.

2012-01-01

401

Preventive use of intra-aortic balloon pump in patients undergoing high-risk coronary artery bypass grafting: a retrospective study.  

PubMed

Background Coronary artery bypass grafting (CABG) is an important therapeutic measure for CHD patients. The patients who score more than 12 EuroSCORE points cannot achieve good results because of their low cardiac output and delicate left ventricular function. Therefore, use of an intra-aortic balloon pump (IABP) is essential for coronary surgical patients in the peri-operative period. At present, there is no unified standard about when to insert an IABP. This study aimed to compare the short-term clinical outcomes of the IABP inserted in the preoperative condition with its use in the emergency condition for extremely high-risk patients. Material and Methods IABP support time, respirator support time, and ICU stay time were significantly shorter (all p<0.05) in the preoperative IABP group compared to the emergency IABP group, and the rates of low cardiac output syndrome (LCOS), acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower in the preoperative IABP group (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between two groups. Results Compared to the emergency IABP group, the IABP support time, respirator support time and ICU stay time were significantly lower in the preoperative IABP group (all p<0.05), and the rates of LCOS, acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between the 2 groups. Conclusions For high-risk patients with CABG, preoperative IABP insertion is a safe and effective measure. PMID:25797193

Zhang, Jingchao; Lang, Yan; Guo, Longhui; Song, Xiaodong; Shu, Liliang; Su, Gang; Liu, Hai; Xu, Jing

2015-01-01

402

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

PubMed

The prognostic significance of previous percutaneous coronary intervention (PCI) in patients undergoing coronary artery bypass grafting (CABG) is still unclear. Although many studies have reported adverse effects of previous PCI on postoperative mortality in CABG, as yet no meta-analysis has been carried out. We conducted this first meta-analysis to assess whether previous PCI increases postoperative mortality in CABG. MEDLINE and EMBASE were searched for relevant articles up to and including April 2014. Studies published in English satisfying the following criteria were included in the meta-analysis: (i) comparing CABG patients with previous PCI versus without previous PCI; and (ii) reporting hospital mortality. Our search identified 23 comparative studies, including 174 777 patients: 19 179 with previous PCI and 155 598 without pre