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Sample records for 15-month cabg sxscore

  1. 12-15 Months: Your Child's Development

    MedlinePlus

    ... Member Home Resources & Services Parenting Resource 12–15 Months: Your Child’s Development Download Files Feb 9, 2016 ... play. Spotlight on Temperament Between 12 and 15 Months Every child is born with his own individual ...

  2. Do 15-Month-Old Infants Understand False Beliefs?

    PubMed Central

    Onishi, Kristine H.; Baillargeon, Renée

    2012-01-01

    For more than two decades, researchers have argued that young children do not understand mental states such as beliefs. Part of the evidence for this claim comes from preschoolers’ failure at verbal tasks that require the understanding that others may hold false beliefs. Here, we used a novel nonverbal task to examine 15-month-old infants’ ability to predict an actor’s behavior on the basis of her true or false belief about a toy’s hiding place. Results were positive, supporting the view that, from a young age, children appeal to mental states—goals, perceptions, and beliefs—to explain the behavior of others. PMID:15821091

  3. Potential biomarkers for predicting outcomes in CABG cardiothoracic surgeries

    PubMed Central

    2013-01-01

    The variations in recovery time, complications, and survival among cardiac patients who have undergone coronary artery bypass graft (CABG) procedures are vast. Many formulas and theories are used to predict clinical outcome and recovery time, and current prognostic predictions are based on medical and family history, lifestyle, co-morbidities, and performance status. The identification of biomarkers that provide concrete evidence supporting clinical outcome has greatly affected the field of medicine, helping clinicians in many medicine sub-specialties to forecast clinical course. Recent studies have discovered biomarkers that may be used as predictors of cardiac patients’ status post-cardiothoracic surgery, and the applications are numerous. In this review, we assess currently available cardiac biomarkers as predictors of clinical outcome for post-operative CABG patients. Data were collected from various studies in which cardiac biomarkers were measured in pre-operative and post-operative CABG patients. PMID:23866777

  4. Correlation of occipitofrontal circumference and crown-rump length from birth to 15 months.

    PubMed

    Martins, A M; Lyons Jones, K

    1994-04-01

    This study examines the relationship between the occipito-frontal circumference (OFC) and crown-rump length (CRL) from birth to 15 months. Data where obtained from 100 male and 100 female white infants at term, 2, 4, 6, 10 and 15 months of age. The data indicate that documentation of the OFC/CRL ratio is an effective way to determine if head circumference is in the normal range for a particular child's body size. PMID:8055136

  5. 15-Month-Old Infants Fast Map Words but Not Representational Gestures of Multimodal Labels

    PubMed Central

    Puccini, Daniel; Liszkowski, Ulf

    2012-01-01

    This study investigated whether 15-month-old infants fast map multimodal labels, and, when given the choice of two modalities, whether they preferentially fast map one better than the other. Sixty 15-month-old infants watched films where an actress repeatedly and ostensively labeled two novel objects using a spoken word along with a representational gesture. In the test phase, infants were assigned to one of three conditions: Word, Word + Gesture, or Gesture. The objects appeared in a shelf next to the experimenter and, depending on the condition, infants were prompted with either a word, a gesture, or a multimodal word–gesture combination. Using an infant eye tracker, we determined whether infants made the correct mappings. Results revealed that only infants in the Word condition had learned the novel object labels. When the representational gesture was presented alone or when the verbal label was accompanied by a representational gesture, infants did not succeed in making the correct mappings. Results reveal that 15-month-old infants do not benefit from multimodal labeling and that they prefer words over representational gestures as object labels in multimodal utterances. Findings put into question the role of multimodal labeling in early language development. PMID:22493588

  6. Hyponatraemic-hypertensive syndrome in a 15-month-old child with renal artery stenosis.

    PubMed

    Seracini, Daniela; Pela, Ivana; Favilli, Silvia; Bini, Roberta M

    2006-07-01

    In this report we present the case of a 15-month-old girl with hyponatraemic-hypertensive syndrome (HHS) caused by stenosis of the left renal artery. On sonographic examination the contralateral non-stenotic kidney appeared enlarged and with cortical hyperechogenicity mimicking a parenchymal lesion. After successful percutaneous transluminal angioplasty, when the girl became normotensive, her serum electrolyte and acid-base balance became normal within a few days. The contralateral non-stenotic kidney hyperechogenicity also disappeared, but only after a period of 6 months, suggesting parenchymal damage due to tubulointerstitial injury, even though reversible. Our case confirms that renovascular hypertension may rarely also be present with HHS in children and that metabolic and morphological alterations are reversible after the resolution of arterial stenosis. PMID:16773417

  7. Apical Closure of Nonvital Permanent Teeth: 15 Months Follow-up Study of Four Cases

    PubMed Central

    Umashetty, Girish; Patil, Basanagouda; Rao, Nandan; Ajgaonkar, Nishant

    2015-01-01

    Obtaining a complete seal of the root canal system is a major problem in performing root canal treatment in nonvital teeth with incomplete root development and wide open apices. The aim was to study apexification using mineral trioxide aggregate (MTA), clinically and radiographically over a period of 15 months. MTA was used in four cases of teeth with incomplete root development in order to achieve an apical seal and the remaining canal was obturated with gutta-percha. Clinical and radiographic assessments of teeth were done. The clinical and radiographic results indicated that apexification procedure was predictable by using MTA. The total number of patients’ visits and the total time duration required to obtain an apical barrier using MTA was markedly less than that of conventional techniques using calcium hydroxide. PMID:26028910

  8. Impact of a health promotion intervention on maternal depressive symptoms at 15 months postpartum.

    PubMed

    Surkan, Pamela J; Gottlieb, Barbara R; McCormick, Marie C; Hunt, Anne; Peterson, Karen E

    2012-01-01

    Given that diet, physical activity, and social support are associated with depression, we examined whether a health promotion intervention designed to modify these factors in low-income, postpartum women would reduce depressive symptoms. This study used a randomized, controlled design to examine the effect of the Just for You (JFY) Program, an educational intervention promoting healthy lifestyles through home visits by nutrition paraprofessionals and motivational telephone counseling, on postpartum depressive symptoms. A total of 679 women income-eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were recruited at 6-20 weeks post delivery and randomized to Usual WIC Care or JFY. Using an intention-to-treat analysis, the authors modeled depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D) among 403 women (59%) completing follow-up at a mean of 15 months infant age, adjusting for baseline CES-D, age, household income and randomization strata (body mass index (BMI), race/region). As a secondary analysis, the authors evaluated potential mediators related to social support and self-efficacy to change one or more health behaviors targeted by the intervention. Women randomized to JFY reported 2.5 units lower CES-D score (P = 0.046) compared with those receiving Usual WIC Care alone. This relationship was attenuated by change in self-efficacy (β = -2.3; P = 0.065), suggesting this construct may partially have mediated the effect of JFY on maternal depressive symptoms. A health promotion intervention delivered through home visits and telephone calls can reduce depressive symptoms at 15 months postpartum among low-income, ethnically diverse women. PMID:21153759

  9. Fairness expectations and altruistic sharing in 15-month-old human infants.

    PubMed

    Schmidt, Marco F H; Sommerville, Jessica A

    2011-01-01

    Human cooperation is a key driving force behind the evolutionary success of our hominin lineage. At the proximate level, biologists and social scientists have identified other-regarding preferences--such as fairness based on egalitarian motives, and altruism--as likely candidates for fostering large-scale cooperation. A critical question concerns the ontogenetic origins of these constituents of cooperative behavior, as well as whether they emerge independently or in an interrelated fashion. The answer to this question will shed light on the interdisciplinary debate regarding the significance of such preferences for explaining how humans become such cooperative beings. We investigated 15-month-old infants' sensitivity to fairness, and their altruistic behavior, assessed via infants' reactions to a third-party resource distribution task, and via a sharing task. Our results challenge current models of the development of fairness and altruism in two ways. First, in contrast to past work suggesting that fairness and altruism may not emerge until early to mid-childhood, 15-month-old infants are sensitive to fairness and can engage in altruistic sharing. Second, infants' degree of sensitivity to fairness as a third-party observer was related to whether they shared toys altruistically or selfishly, indicating that moral evaluations and prosocial behavior are heavily interconnected from early in development. Our results present the first evidence that the roots of a basic sense of fairness and altruism can be found in infancy, and that these other-regarding preferences develop in a parallel and interwoven fashion. These findings support arguments for an evolutionary basis--most likely in dialectical manner including both biological and cultural mechanisms--of human egalitarianism given the rapidly developing nature of other-regarding preferences and their role in the evolution of human-specific forms of cooperation. Future work of this kind will help determine to what

  10. Fairness Expectations and Altruistic Sharing in 15-Month-Old Human Infants

    PubMed Central

    Schmidt, Marco F. H.; Sommerville, Jessica A.

    2011-01-01

    Human cooperation is a key driving force behind the evolutionary success of our hominin lineage. At the proximate level, biologists and social scientists have identified other-regarding preferences – such as fairness based on egalitarian motives, and altruism – as likely candidates for fostering large-scale cooperation. A critical question concerns the ontogenetic origins of these constituents of cooperative behavior, as well as whether they emerge independently or in an interrelated fashion. The answer to this question will shed light on the interdisciplinary debate regarding the significance of such preferences for explaining how humans become such cooperative beings. We investigated 15-month-old infants' sensitivity to fairness, and their altruistic behavior, assessed via infants' reactions to a third-party resource distribution task, and via a sharing task. Our results challenge current models of the development of fairness and altruism in two ways. First, in contrast to past work suggesting that fairness and altruism may not emerge until early to mid-childhood, 15-month-old infants are sensitive to fairness and can engage in altruistic sharing. Second, infants' degree of sensitivity to fairness as a third-party observer was related to whether they shared toys altruistically or selfishly, indicating that moral evaluations and prosocial behavior are heavily interconnected from early in development. Our results present the first evidence that the roots of a basic sense of fairness and altruism can be found in infancy, and that these other-regarding preferences develop in a parallel and interwoven fashion. These findings support arguments for an evolutionary basis – most likely in dialectical manner including both biological and cultural mechanisms – of human egalitarianism given the rapidly developing nature of other-regarding preferences and their role in the evolution of human-specific forms of cooperation. Future work of this kind will help determine

  11. Comparative analysis of hospital and forensic laboratory ethanol concentrations: A 15 month investigation of antemortem specimens.

    PubMed

    Saitman, Alec; Estrada, Julio; Fitzgerald, Robert L; McIntyre, Iain M

    2015-07-01

    Quantitative serum alcohol concentrations from regional hospitals (from specimens collected at time of hospital admission) were compared to results from whole blood (from specimens collected at the time of hospital admission) concentrations measured at the San Diego County Medical Examiner's Office (SDCMEO). Over a 15 month period (January 2012 to March 2013), the postmortem forensic toxicology laboratory analyzed a total of 2,321 cases. Of these, 280 were hospital cases (antemortem) representing 12% of the overall Medical Examiner toxicology casework. 59 of the 280 hospital cases (or 21%) screened positive for alcohol (ethanol). 39 of these 59 cases were included in the study based on available specimens for quantitative analyses. This investigation indicated that serum hospital ethanol concentrations correlated well (R(2) = 0.942) with ethanol values determined at SDCMEO (generally measured in whole blood). There was an observed negative bias with an average of -14.1%. A paired t-test was applied to the data and it was shown that this observed bias is statistically significant. These differences in ethanol concentrations could result from differences in specimen, analytical techniques, and/or calibration. The potential for specimen contamination is also discussed.

  12. Effects of beach replenishment on intertidal invertebrates: A 15-month, eight beach study.

    NASA Astrophysics Data System (ADS)

    Wooldridge, Tyler; Henter, Heather J.; Kohn, Joshua R.

    2016-06-01

    Beach replenishment is an increasingly popular means to remediate coastal erosion, but no consensus exists regarding how long replenishment affects sandy beach intertidal invertebrates, key components of beach ecosystems. We monitored the intertidal invertebrate community for fifteen months following a replenishment project at eight beaches, each with replenished and control sections, across San Diego County. Nearly all taxa showed major declines in abundance immediately following replenishment. Populations of talitrid amphipods and the bean clam Donax gouldii recovered within one year, sooner than in previous studies. On some beaches, populations of the mole crab Emerita analoga bloomed four months after replenishment and were more numerous on replenished portions of beaches at that time. Mole crab populations subsequently declined and no longer differed by treatment. The polychaete community, composed of Scolelepis sp. and several other numerically important taxa, showed a strong replenishment-induced reduction in abundance that persisted through the end of the study. The large negative effect of replenishment on polychaetes, coupled with their overall importance to the invertebrate community, resulted in a more than twofold reduction in overall invertebrate abundance on replenished beaches at 15 months. Such reductions may have far reaching consequences for sandy beach ecosystems, as community declines can reduce prey availability for shorebirds and fish. As this and other recent studies have revealed longer times for the recovery of intertidal invertebrates than previously observed, longer study periods and more cautious estimates regarding the magnitude, variability, and duration of impacts of beach replenishment for management decision-making are warranted.

  13. Sex effect on meat quality and carcass traits of foals slaughtered at 15 months of age.

    PubMed

    Lorenzo, J M; Sarriés, M V; Franco, D

    2013-07-01

    The effect of sex on carcass measurement, physico-chemical properties, nutritional value and sensory characteristics of foal meat slaughtered at 15 months was investigated. Twelve foals (six females and six males) from an extensive production system in freedom regimen were used for this study. Sex had no statistical influence on carcass measurements, chemical composition, colour parameters, textural properties, amino acid content and sensory characteristics. In contrast, there was a clear effect on the fatty acid profile of longissimus dorsi. Slaughter weight was not significantly (P > 0.05) different between sexes, although higher values were observed in male group compared with female group (194 v. 184 kg). As a consequence, this trend affected carcass weight being slightly (P > 0.05) heavier in the male group than in the female group. On the other hand, cooking loss samples from males showed significantly higher values than those from females (21.50% v. 14.96%, P < 0.05). From a nutritional point of view, the n-6/n-3 ratio in both sexes was within the recommended range for the human diet and this ratio was ostensibly different between the sexes (1.83 v. 1.36, P < 0.05, for male and female, respectively) and it showed a strong correlation (r = -0.91, P < 0.01) with C18:3n-3 content.

  14. Physicochemical changes in pyrogenic organic matter (biochar) after 15 months field-aging

    NASA Astrophysics Data System (ADS)

    Mukherjee, A.; Zimmerman, A. R.; Hamdan, R.; Cooper, W. T.

    2014-03-01

    Predicting the effects of pyrogenic organic matter (OM) addition (either natural or intentional as in the case of biochar amendment) on soil chemistry and crop yields has been hampered by a lack of understanding of how pyrogenic OM evolves in the environment over time. This work compared the physicochemical characteristics of newly-made and 15 month field-aged biochars and biochar-soil mixtures. After aging, biochars made by pyrolysis of wood and grass at 250, 400 and 650 °C exhibited 5-fold increases in cation exchange capacity (CEC), on average, appearance of anion exchange capacity (AEC) and significant decreases in pH, ash content and nanopore surface area. Cross polarization 13C-NMR analyses indicated relative increases in O-containing functional groups including substituted aryl, carboxyl and carbonyl C, likely via abiotic and microbial oxidation and losses of O-alkyl groups, likely via leaching. Similar chemical trends were observed for soil-biochar mixtures suggesting the same biochar aging processes occurred in the soil environment. However, there was evidence for a major role of soil OM-microbe-biochar interaction during aging. Field-aging of soil with biochar resulted in large increases in C and N content (up to 124 and 143%, respectively) and exchange capacity (up to 43%) beyond that calculated by the weighted addition of the properties of biochar and soil aged separately. These beneficial interactive effects varied greatly with soil and biochar type. Scanning electronic microscopy (SEM) images of biochar particles, both aged alone and with soil, showed colonization by microbes and widespread surficial deposits that were likely OM. Thus, sorption of both microbially-produced and soil OM are likely processes that enhanced biochar aging. Among the important implications of these findings are that biochar's full beneficial effects on soil properties only occur over time and proper assignment of C sequestration credits to biochar users will require

  15. Physicochemical changes in pyrogenic organic matter (biochar) after 15 months of field aging

    NASA Astrophysics Data System (ADS)

    Mukherjee, A.; Zimmerman, A. R.; Hamdan, R.; Cooper, W. T.

    2014-07-01

    Predicting the effects of pyrogenic organic matter (OM) addition (either natural or intentional as in the case of biochar amendment) on soil chemistry and crop yields has been hampered by a lack of understanding of how pyrogenic OM evolves in the environment over time. This work compared the physicochemical characteristics of newly made and 15-month-field-aged biochars and biochar-soil mixtures. After aging, biochars made by pyrolysis of wood and grass at 250, 400 and 650 °C exhibited 5-fold increases in cation exchange capacity (CEC), on average; appearance of anion exchange capacity (AEC); and significant decreases in pH, ash content and nanopore surface area. Cross polarization 13C nuclear magnetic resonance (NMR) analyses indicated relative increases in O-containing functional groups, including substituted aryl, carboxyl and carbonyl C, and losses of O-alkyl groups. Similar chemical trends were observed for soil-biochar mixtures, suggesting the same biochar aging processes occurred in the soil environment. However, there was evidence for a role of soil OM-microbe-biochar interaction during aging. Field aging of soil with biochar resulted in large increases in C and N content (up to 124 and 143%, respectively) and exchange capacity (up to 43%) beyond that calculated by the weighted addition of the properties of biochar and soil aged separately. These beneficial interactive effects varied with soil and biochar type. Scanning electronic microscopy (SEM) images of biochar particles aged with soil showed colonization by microbes and widespread OM coatings. Thus, sorption of both microbially produced and soil OM are likely processes that enhanced biochar aging. Thus, biochar's full beneficial effects on soil properties likely increase over time, and proper assignment of C sequestration credits to biochar users will require consideration of soil-biochar interactions.

  16. Relationship between plasma level of vitamin D and post operative atrial fibrillation in patients undergoing CABG

    PubMed Central

    Shadvar, Kamran; Ramezani, Fariba; Sanaie, Sarvin; Maleki, Taher Entezari; Arbat, Babak Kazemi; Nagipour, Bahman

    2016-01-01

    Objective: Atrial fibrillation is the most common arrhythmia after cardiac surgery. Several studies have shown the impact of vitamin D on heart disease; however, there have been few studies for the incidence of AF and its relationship with vitamin D levels. According to the different results of these studies, we decided to evaluate the relation of plasma levels of vitamin D and postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery (CABG). Methods: This cross-sectional study was performed on 50 patients after CABG surgery. Simple random sampling was done. Twenty five patients who developed AF within 48 hours after CABG with Cardiopulmonary bypass (CPB) were enrolled in the case group and 25 patients who did not develop AF within 48 hours after CABG with CPB were enrolled in the control group. Plasma levels of vitamin D in both groups of patients were recorded. Collected data were analyzed by the SPSS software version 17. Results: There was no significant difference in terms of demographic characteristics, comorbidities, lipid profile and kidney function between two groups. The mean plasma level of vitamin D was 27.4 ± 2.22 ng/ml in the case group and was 28.2 ± 1.18 ng/ml in the control group it (p= 0.803). Conclusions: Plasma levels of vitamin D were almost the same in both groups and there was no statistically significant difference between the groups with and without atrial fibrillation following CABG.

  17. Relationship between plasma level of vitamin D and post operative atrial fibrillation in patients undergoing CABG

    PubMed Central

    Shadvar, Kamran; Ramezani, Fariba; Sanaie, Sarvin; Maleki, Taher Entezari; Arbat, Babak Kazemi; Nagipour, Bahman

    2016-01-01

    Objective: Atrial fibrillation is the most common arrhythmia after cardiac surgery. Several studies have shown the impact of vitamin D on heart disease; however, there have been few studies for the incidence of AF and its relationship with vitamin D levels. According to the different results of these studies, we decided to evaluate the relation of plasma levels of vitamin D and postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery (CABG). Methods: This cross-sectional study was performed on 50 patients after CABG surgery. Simple random sampling was done. Twenty five patients who developed AF within 48 hours after CABG with Cardiopulmonary bypass (CPB) were enrolled in the case group and 25 patients who did not develop AF within 48 hours after CABG with CPB were enrolled in the control group. Plasma levels of vitamin D in both groups of patients were recorded. Collected data were analyzed by the SPSS software version 17. Results: There was no significant difference in terms of demographic characteristics, comorbidities, lipid profile and kidney function between two groups. The mean plasma level of vitamin D was 27.4 ± 2.22 ng/ml in the case group and was 28.2 ± 1.18 ng/ml in the control group it (p= 0.803). Conclusions: Plasma levels of vitamin D were almost the same in both groups and there was no statistically significant difference between the groups with and without atrial fibrillation following CABG. PMID:27648036

  18. Indian Ocean tsunami: relationships among posttraumatic stress, posttraumatic growth, resource loss, and coping at 3 and 15 months.

    PubMed

    Sattler, David N; Assanangkornchai, Sawitri; Moller, Adam M; Kesavatana-Dohrs, Wiworn; Graham, James M

    2014-01-01

    This study examines variables associated with posttraumatic stress symptoms (PTS) and posttraumatic growth among 2 independent samples of survivors following the Indian Ocean tsunami in Khao Lak, Thailand. Participants were exposed to unprecedented horror and loss of life and property. At 3 months participants (N = 248) were living in temporary shelters, and at 15 months a second sample (N = 255) was living in homes built after the tsunami. Prior traumatic experiences, life threat, loss of personal characteristic resources and condition resources, somatic problems, and social support accounted for close to half of the variance in PTS in each sample. At 3 months, emotion-focused coping and concerns about government favoritism also contributed to PTS. At 15 months, lack of prior disaster experience and loss of energy resources also contributed to PTS. Distress was higher among participants surveyed at 3 months than among those surveyed at 15 months. Posttraumatic growth was positively associated with social support and problem-focused coping in both samples. The findings support conservation of resources stress theory ( Hobfoll, 2012 ) and underscore how systemic issues affect mental health. The implications of the findings are discussed, as is the educational International Tsunami Museum designed by the first author to address systemic stressors.

  19. The proportion of beef bulls in western Canada with mature spermiograms at 11 to 15 months of age.

    PubMed Central

    Arteaga, A; Baracaldo, M; Barth, A D

    2001-01-01

    A study was conducted to determine the proportion of yearling beef bulls that have mature spermiograms at 11 to 15 months of age, and to evaluate the relationship between semen quality traits, age, and scrotal circumference. Semen samples and data on sperm motility and scrotal circumference measurements were obtained from 1641 bulls of 14 breeds. Criteria for a satisfactory spermiogram included sperm concentration > or = 400 x 10(6)/mL, > or = 60% progressively motile sperm, and > or = 70% morphologically normal sperm. The mean scrotal circumference measurements for all bulls combined were 33.4, 34.4, 35.2, 35.8, and 35.3 cm at 11, 12, 13, 14, and 15 months of age, respectively. The percentage of bulls with matures spermiograms at 11, 12, 13, 14, and 15 months of age were 20%, 30%, 51%, 52%, and 61%, respectively. There was a high positive correlation (r = 0.9) between the number of bulls with > or = 70% normal sperm and scrotal circumference measurement. The main types of morphologic defects observed in immature bulls were proximal droplets and midpiece defects. PMID:11665426

  20. Indian Ocean tsunami: relationships among posttraumatic stress, posttraumatic growth, resource loss, and coping at 3 and 15 months.

    PubMed

    Sattler, David N; Assanangkornchai, Sawitri; Moller, Adam M; Kesavatana-Dohrs, Wiworn; Graham, James M

    2014-01-01

    This study examines variables associated with posttraumatic stress symptoms (PTS) and posttraumatic growth among 2 independent samples of survivors following the Indian Ocean tsunami in Khao Lak, Thailand. Participants were exposed to unprecedented horror and loss of life and property. At 3 months participants (N = 248) were living in temporary shelters, and at 15 months a second sample (N = 255) was living in homes built after the tsunami. Prior traumatic experiences, life threat, loss of personal characteristic resources and condition resources, somatic problems, and social support accounted for close to half of the variance in PTS in each sample. At 3 months, emotion-focused coping and concerns about government favoritism also contributed to PTS. At 15 months, lack of prior disaster experience and loss of energy resources also contributed to PTS. Distress was higher among participants surveyed at 3 months than among those surveyed at 15 months. Posttraumatic growth was positively associated with social support and problem-focused coping in both samples. The findings support conservation of resources stress theory ( Hobfoll, 2012 ) and underscore how systemic issues affect mental health. The implications of the findings are discussed, as is the educational International Tsunami Museum designed by the first author to address systemic stressors. PMID:24410331

  1. Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents

    PubMed Central

    Efird, Jimmy T.; Griffin, William F.; Sarpong, Daniel F.; Davies, Stephen W.; Vann, Iulia; Koutlas, Nathaniel T.; Anderson, Ethan J.; Crane, Patricia B.; Landrine, Hope; Kindell, Linda; Iqbal, Zahra J.; Ferguson, T. Bruce; Chitwood, W. Randolph; Kypson, Alan P.

    2015-01-01

    The aim of this study was to examine racial differences in long-term mortality after coronary artery bypass grafting (CABG), stratified by preoperative use of inotropic agents. Black and white patients who required preoperative inotropic support prior to undergoing CABG procedures between 1992 and 2011 were compared. Mortality probabilities were computed using the Kaplan-Meier product-limit method. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. A total of 15,765 patients underwent CABG, of whom 211 received preoperative inotropic agents within 48 hours of surgery. Long-term mortality differed by race (black versus white) among preoperative inotropic category (inotropes: adjusted HR = 1.6, 95% CI = 1.009–2.4; no inotropes: adjusted HR = 1.15, 95% CI = 1.08–1.2; Pinteraction < 0.0001). Our study identified an independent preoperative risk-factor for long-term mortality among blacks receiving CABG. This outcome provides information that may be useful for surgeons, primary care providers, and their patients. PMID:26154656

  2. Reduction in pulmonary function after CABG surgery is related to postoperative inflammation and hypercortisolemia

    PubMed Central

    Roncada, Gert; Dendale, Paul; Linsen, Loes; Hendrikx, Marc; Hansen, Dominique

    2015-01-01

    Pulmonary function is significantly reduced in the acute phase after coronary artery bypass graft (CABG) surgery. Because pulmonary function partly depends on respiratory muscle strength, we studied whether reductions in pulmonary function are related to postoperative alterations in circulatory factors that affect muscle protein synthesis. Methods: Slow vital capacity (SVC) was assessed in 22 subjects before and 9 ± 3 days after CABG surgery. Blood testosterone, cortisol, insulin-like growth factor-1 (IGF-1), growth hormone, sex-hormone binding globulin (SHBG), glucose, insulin, c-peptide, c-reactive protein (CRP) content, and free androgen index, cortisol/testosterone ratio, HOMA-IR index were assessed before surgery and during the first three days after surgery. Intubation, surgery time and cumulative chest tube drainage were measured. Correlations between changes in SVC and blood parameters after surgery or subject characteristics were studied. This was a prospective observational study. Results: After CABG surgery SVC decreased by 37 ± 18% (P < 0.01). Free androgen index, blood SHBG, testosterone and IGF-1 content decreased, while HOMA-IR index, cortisol/testosterone ratio, blood growth hormone, insulin and CRP content increased (P < 0.0025) in the first three days after surgery. Decrease in SVC was independently (P < 0.05) related to higher preoperative SVC (SC β = 0.66), and greater increase in blood cortisol (SC β = 0.54) and CRP (SC β = 0.37) content after surgery. Conclusions: Larger reductions in pulmonary function after CABG surgery are present in patients experiencing greater postoperative increases in blood CRP and cortisol levels. Decrements in pulmonary function after CABG surgery are, at least in part, thus related to alterations in circulatory factors that affect muscle protein synthesis. PMID:26379888

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

    PubMed Central

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

    2014-01-01

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

  4. Analysis and Characterization of Herpes Simplex Virus After Its Persistance in a Lymphoblastoid Cell Line for 15 Months

    PubMed Central

    Roumillat, L. F.; Feorino, P. M.; Caplan, D. D.; Lukert, P. D.

    1980-01-01

    Infection of a human lymphoblastoid cell line (F-365 line containing Epstein-Barr viral capsid antigen, derived from an individual without overt signs of lymphoma, infectious mononucleosis, or leukemia) with herpes simplex virus (HSV), maintained and observed for 15 months, was characterized by the continuous production of infectious extracellular virus. By the 5th day postinfection 75% of the cells produced HSV antigen as detected by fluorescent antibody, and by the 10th day 90% did so; production continued through the 15th month. Only 11% of single isolated cells produced detectable infectious virus. HSV produced after the 3rd month formed smaller plaque in monolayer cell culture than did the parental virus. No antigenic or polypeptide change in the HSV was detected by crossed immunoelectrophoresis and sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis over the 15-month cultivation in F-365 cells. Cell susceptibility and HSV virulence did not appear to change. The HSV-lymphoblastoid cell culture provided a useful model in which to study long-term virus-cell interactions. ImagesFig. 3Fig. 4 PMID:6260656

  5. Dual left anterior descending coronary artery from right aortic sinus: report of a case of recurrent unstable angina after CABG.

    PubMed

    Formica, Francesco; Corti, Fabrizio; Colombo, Virgilio; Monica, Gionali; Paolini, Giovanni

    2005-01-01

    Anomalies of the left coronary artery are very rare, with an incidence range between .3% and 1.64%. The diagnosis is generally incidental during coronary angiogram, coronary artery bypass operation, or autopsy. However, sometimes this anomaly is not recognized during CABG operation and can be responsible for the recurrence of angina after CABG operation and even compromise the outcome. We presented a case in which the dual left anterior coronary artery from the right aortic sinus occasionally was shown in a coronary angiogram after CABG operation; the angiogram was performed because of the recurrence of angina.

  6. Single incision Laparoscopic repair of post CABG sternotomy sub xiphoid hernia

    PubMed Central

    Shah, Haresh K; Chaudhari, Namita; Khopade, Suman; Thombare, Bhushan; Chavan, Shirish G

    2013-01-01

    The current decade has witnessed the evolution of Minimal Access Surgery (MAS) from Multi port Laparoscopy to Single Port Laparoscopy. The reduction of ports, subsequent scars and pain makes MAS more patients friendly. Symptomatic Subxiphoid Incisional hernias in patients having post CABG Sternotomy are surgically challenging. This is because of the difficult anatomical position i.e. sternum and the ribs superiorly and the diaphragm posteriorly. Another reason is high intra-abdominal pressure with the shearing forces of the musculature in the upper abdomen. Consequently the conventional open primary anatomical or mesh repairs are difficult to perform and have a high recurrence rate. Laparoscopy promises to be an effective technique to treat this condition. In this case report we describe the use of Laparoscopy in particular: Single Incision for the repair of CABG Sternotomy Subxiphoid Hernia along with relevant literature. This is the first report in English Language Literature. PMID:24250068

  7. 15-month-olds' transfer of learning between touch screen and real-world displays: language cues and cognitive loads.

    PubMed

    Zack, Elizabeth; Gerhardstein, Peter; Meltzoff, Andrew N; Barr, Rachel

    2013-02-01

    Infants have difficulty transferring information between 2D and 3D sources. The current study extends Zack, Barr, Gerhardstein, Dickerson & Meltzoff's (2009) touch screen imitation task to examine whether the addition of specific language cues significantly facilitates 15-month-olds' transfer of learning between touch screens and real-world 3D objects. The addition of two kinds of linguistic cues (object label plus verb or nonsense name) did not elevate action imitation significantly above levels observed when such language cues were not used. Language cues hindered infants' performance in the 3D→2D direction of transfer, but only for the object label plus verb condition. The lack of a facilitative effect of language is discussed in terms of competing cognitive loads imposed by conjointly transferring information across dimensions and processing linguistic cues in an action imitation task at this age.

  8. TELEPHONE-DELIVERED COLLABORATIVE-CARE FOR TREATING POST-CABG DEPRESSION: A RANDOMIZED CONTROLLED TRIAL

    PubMed Central

    Rollman, Bruce L.; Belnap, Bea Herbeck; LeMenager, Michelle S.; Mazumdar, Sati; Houck, Patricia R.; Counihan, Peter J.; Kapoor, Wishwa N.; Schulberg, Herbert C.; Reynolds, Charles F.

    2010-01-01

    Context Depressive symptoms commonly follow coronary artery bypass (CABG) surgery and are associated with worse clinical outcomes. Objective To test the effectiveness of telephone-delivered collaborative care for post-CABG depression versus doctors’ usual care. Design Single-blind effectiveness trial. Setting Seven Pittsburgh-area university-based and community hospitals. Participants 302 depressed post-CABG patients and a non-depressed comparison group of 151 randomly sampled post-CABG patients recruited between 3/2004 and 9/2007 and followed as outpatients. Intervention 8-Months of telephone-delivered collaborative care provided by nurses working with patients’ primary care physicians and supervised by a study psychiatrist and study primary care physician. Main Outcome Measures Mental health-related quality of life (HRQoL) as measured by the SF-36 MCS at 8-months follow-up; secondary outcome measures included mood symptoms (Hamilton Rating Scale for Depression (HRS-D)), physical HRQoL (SF-36 PCS) and functioning (Duke Activity Status Index (DASI)); and hospital readmissions. Results Depressed intervention patients (N=150) reported greater improvements (all P ≤ 0.02) in mental HRQoL (SF-36 MCS: Δ 3.2 points; 95% CI: 0.5–6.0), physical functioning (DASI: Δ 4.6 points; 1.9–7.3), and mood symptoms (HRS-D: Δ3.1 points (1.3–4.9); and were more likely to report a ≥ 50% decline in HRS-D score from baseline (50.0% vs. 29.6%; NNT 4.9 (3.2–10.4)) than depressed patients randomized to their physicians’ usual care (N=152) (P<0.001). Depressed men were particularly likely to benefit from the intervention (SF-36 MCS: Δ 5.7 points (2.2–9.2); P=0.001) and tended to have a lower incidence of rehospitalization for cardiovascular causes than depressed men receiving usual care (13% vs. 23%; P=0.07) or depressed women (19% vs. 11%; P=0.22). However, the mean HRQoL and physical functioning of depressed intervention patients did not reach that of our non

  9. Comparison of immunogenicity of simultaneous and nonsimultaneous vaccination with MMR and JE vaccine among 15-month-old children.

    PubMed

    Tseng, C Y; Hwang, K P; Lin, K H; Chen, H Y; Lu, C C; Chiang, C H

    1999-01-01

    To evaluate the immunogenicity of measles- mumps- rubella (MMR) vaccination with Japanese encephalitis (JE) vaccine nonsimultaneously and simultaneously, 145 babies, aged 15 months were enrolled into two groups. Group A received MMR and JE vaccines nonsimultaneously at an interval of 6 weeks; group B received the vaccinations simultaneously. Antibody titers of MMR and JE were detected before and 8 weeks after vaccination. A total of 118 babies (61 in group A; 57 in group B) completed the study. In group A, mean increments of logarithmic geometric mean titers (GMTs) of MMR and JE were 4.51, 5.93, 4.07 and 1.99; seroresponse rates were 100% (61/61), 77.05% (47/61), 96.72% (59/61) and 59.02% (36/61) respectively. In group B, mean increments of logarithmic GMTs of MMR and JE were 4.35, 5.37, 4.44 and 1.93; seroresponse rates were 98.25% (56/57), 77.19% (44/57), 98.25% (56/57) and 57.89% (33/57) respectively. There were no significant differences between these two groups. These results suggest that simultaneous and nonsimultaneous vaccination with MMR and JE vaccines were similar in immunogenicity.

  10. Relative kinematics of the rib cage and abdomen during speech and nonspeech behaviors of 15-month-old children.

    PubMed

    Moore, C A; Caulfield, T J; Green, J R

    2001-02-01

    Speech motor control emerges in the neurophysiologic context of widely distributed, powerful coordinative mechanisms, including those mediating respiratory function. It is unknown, however, whether developing children are able to exploit the capabilities of neural circuits controlling homeostasis for the production of speech and voice. Speech and rest breathing were investigated in eleven 15-month-old children using inductance plethysmography (Respitrace). Rib cage and abdominal kinematics were studied using a time-varying correlational index of thoracoabdominal coupling (i.e., reflecting the synchrony of movement of the rib cage and abdomen) as well as simple classification of the moment-to-moment kinematic relationship of these two functional components (i.e., concurrent expansion or compression, or oppositional movement). Results revealed markedly different patterns of movement for rest breathing and speech breathing, although within types of vocalization (nonspeech vocalization, babbling, true word production) no differences were apparent. Whereas rest breathing was characterized by tight coupling of rib cage and abdominal movement (average correlation coefficients usually exceeded .90), speech breathing exhibited weak coupling (the correlation coefficient ranged widely, but averaged about .60). Furthermore, speech production by these toddlers included the occurrence of both rib cage and abdominal paradoxing, which are observed infrequently in adult speakers. These results fail to support the suggestion that speech emerges from the extant coordinative organization of rest breathing. Rather, even in its earliest stages breathing for speech and voice exhibits kinematic properties distinct from those of other observed behaviors.

  11. Sequence and priming in 15 month-olds' reactions to brief arm restraint: evidence for a hierarchy of anger responses.

    PubMed

    Potegal, Michael; Robison, Sarah; Anderson, Fiona; Jordan, Catherine; Shapiro, Elsa

    2007-01-01

    Brief, gentle arm restraint is widely used in experimental studies of children's anger, but the pattern of responses generated by such restraint has been incompletely described. We now describe a hierarchy of responses within trials as well as an escalation across trials that have both methodological and theoretical significance. Mothers of 87 15-month olds prevented them from playing with a toy by restraining their arms on two consecutive 30 sec trials. Physical struggling was the first and most frequent response; children who struggled were significantly more likely to vocalize, and those who vocalized were significantly more likely to show facial expressions of anger. The children's responses became more probable, rapid, and intense during Trial 2 restraint. Overall, the hierarchy was orderly enough to meet criteria for Guttman scalability. The particular sequence observed suggests situational, as opposed to bio-energetic, ordering of responses. Methodologically, the two trial paradigm is a simple, ecologically valid model for studying anger escalation that parallels the "attack priming" of aggression in other species. The magnitude and persistence of anger priming may provide novel measures of anger regulation. Theoretically, the existence of an orderly response hierarchy is consistent with previous observations suggesting that, within a situational context, the sequential appearance of specific behaviors may indicate progressive increases in anger intensity. PMID:17918278

  12. Long‐Term Post‐CABG Survival: Performance of Clinical Risk Models Versus Actuarial Predictions

    PubMed Central

    Carr, Brendan M.; Romeiser, Jamie; Ruan, Joyce; Gupta, Sandeep; Seifert, Frank C.; Zhu, Wei

    2015-01-01

    Abstract Background/aim Clinical risk models are commonly used to predict short‐term coronary artery bypass grafting (CABG) mortality but are less commonly used to predict long‐term mortality. The added value of long‐term mortality clinical risk models over traditional actuarial models has not been evaluated. To address this, the predictive performance of a long‐term clinical risk model was compared with that of an actuarial model to identify the clinical variable(s) most responsible for any differences observed. Methods Long‐term mortality for 1028 CABG patients was estimated using the Hannan New York State clinical risk model and an actuarial model (based on age, gender, and race/ethnicity). Vital status was assessed using the Social Security Death Index. Observed/expected (O/E) ratios were calculated, and the models' predictive performances were compared using a nested c‐index approach. Linear regression analyses identified the subgroup of risk factors driving the differences observed. Results Mortality rates were 3%, 9%, and 17% at one‐, three‐, and five years, respectively (median follow‐up: five years). The clinical risk model provided more accurate predictions. Greater divergence between model estimates occurred with increasing long‐term mortality risk, with baseline renal dysfunction identified as a particularly important driver of these differences. Conclusions Long‐term mortality clinical risk models provide enhanced predictive power compared to actuarial models. Using the Hannan risk model, a patient's long‐term mortality risk can be accurately assessed and subgroups of higher‐risk patients can be identified for enhanced follow‐up care. More research appears warranted to refine long‐term CABG clinical risk models. doi: 10.1111/jocs.12665 (J Card Surg 2016;31:23–30) PMID:26543019

  13. A comparison of several regression models for analysing cost of CABG surgery.

    PubMed

    Austin, Peter C; Ghali, William A; Tu, Jack V

    2003-09-15

    Investigators in clinical research are often interested in determining the association between patient characteristics and cost of medical or surgical treatment. However, there is no uniformly agreed upon regression model with which to analyse cost data. The objective of the current study was to compare the performance of linear regression, linear regression with log-transformed cost, generalized linear models with Poisson, negative binomial and gamma distributions, median regression, and proportional hazards models for analysing costs in a cohort of patients undergoing CABG surgery. The study was performed on data comprising 1959 patients who underwent CABG surgery in Calgary, Alberta, between June 1994 and March 1998. Ten of 21 patient characteristics were significantly associated with cost of surgery in all seven models. Eight variables were not significantly associated with cost of surgery in all seven models. Using mean squared prediction error as a loss function, proportional hazards regression and the three generalized linear models were best able to predict cost in independent validation data. Using mean absolute error, linear regression with log-transformed cost, proportional hazards regression, and median regression to predict median cost, were best able to predict cost in independent validation data. Since the models demonstrated good consistency in identifying factors associated with increased cost of CABG surgery, any of the seven models can be used for identifying factors associated with increased cost of surgery. However, the magnitude of, and the interpretation of, the coefficients vary across models. Researchers are encouraged to consider a variety of candidate models, including those better known in the econometrics literature, rather than begin data analysis with one regression model selected a priori. The final choice of regression model should be made after a careful assessment of how best to assess predictive ability and should be tailored to

  14. A comparison of several regression models for analysing cost of CABG surgery.

    PubMed

    Austin, Peter C; Ghali, William A; Tu, Jack V

    2003-09-15

    Investigators in clinical research are often interested in determining the association between patient characteristics and cost of medical or surgical treatment. However, there is no uniformly agreed upon regression model with which to analyse cost data. The objective of the current study was to compare the performance of linear regression, linear regression with log-transformed cost, generalized linear models with Poisson, negative binomial and gamma distributions, median regression, and proportional hazards models for analysing costs in a cohort of patients undergoing CABG surgery. The study was performed on data comprising 1959 patients who underwent CABG surgery in Calgary, Alberta, between June 1994 and March 1998. Ten of 21 patient characteristics were significantly associated with cost of surgery in all seven models. Eight variables were not significantly associated with cost of surgery in all seven models. Using mean squared prediction error as a loss function, proportional hazards regression and the three generalized linear models were best able to predict cost in independent validation data. Using mean absolute error, linear regression with log-transformed cost, proportional hazards regression, and median regression to predict median cost, were best able to predict cost in independent validation data. Since the models demonstrated good consistency in identifying factors associated with increased cost of CABG surgery, any of the seven models can be used for identifying factors associated with increased cost of surgery. However, the magnitude of, and the interpretation of, the coefficients vary across models. Researchers are encouraged to consider a variety of candidate models, including those better known in the econometrics literature, rather than begin data analysis with one regression model selected a priori. The final choice of regression model should be made after a careful assessment of how best to assess predictive ability and should be tailored to

  15. Safety and Immunogenicity of Human Serum Albumin-Free MMR Vaccine in US Children Aged 12–15 Months

    PubMed Central

    Mufson, Maurice A.; Diaz, Clemente; Leonardi, Michael; Harrison, Christopher J.; Grogg, Stanley; Carbayo, Antonio; Carlo-Torres, Simon; JeanFreau, Robert; Quintero-Del-Rio, Ana; Bautista, Gisele; Povey, Michael; Da Costa, Christopher; Nicholson, Ouzama; Innis, Bruce L.

    2015-01-01

    Background M-M-RTMII (MMRII; Merck & Co) is currently the only measles-mumps-rubella (MMR) vaccine licensed in the United States. Another licensed vaccine would reinforce MMR supply. This study assessed the immunogenicity of a candidate vaccine (PriorixTM, GlaxoSmithKline Vaccines [MMR-RIT]) when used as a first dose among eligible children in the United States. Methods In this exploratory Phase-2, multicenter, observer-blind study, 1220 healthy subjects aged 12–15 months were randomized (3:3:3:3) and received 1 dose of 1 of 3 MMR-RIT lots with differing mumps virus titers (MMR-RIT-1 [4.8 log10]; MMR-RIT-2 [4.1 log10]; MMR-RIT-3 [3.7 log10] CCID50) or MMRII co-administered with hepatitis A vaccine (HAV), varicella vaccine (VAR) and 7-valent pneumococcal conjugate vaccine (PCV7). Immune response to measles, mumps, and rubella viruses was evaluated at Day 42 post-vaccination. Incidence of solicited injection site, general, and serious adverse events was assessed. Results Seroresponse rates for MMR vaccine viral components in MMR-RIT lots were 98.3–99.2% (measles), 89.7–90.7% (mumps), and 97.5–98.8% (rubella), and for MMRII were 99.6%, 91.1%, and 100%, respectively. Immune responses to HAV, VAR, and PCV7 were similar when co-administered with any of the 3 MMR-RIT lots or MMRII. There were no apparent differences in solicited or serious adverse events among the 4 groups. Conclusions Immune responses were above threshold levels for projected protection against the 3 viruses from MMR-RIT lots with differing mumps virus titers. MMR-RIT had an acceptable safety profile when co-administered with HAV, VAR, and PCV7. Clinical Trials Registration NCT00861744; etrack; 111870 PMID:26582873

  16. Intramyocardial transfer of hepatocyte growth factor as an adjunct to CABG: phase I clinical study.

    PubMed

    Kim, J S; Hwang, H Y; Cho, K R; Park, E-A; Lee, W; Paeng, J C; Lee, D S; Kim, H-K; Sohn, D-W; Kim, K-B

    2013-07-01

    The purpose of this phase I clinical trial was to evaluate the safety, tolerability and potential efficacy of VM202, naked DNA expressing two isoforms of hepatocyte growth factor, as an adjunct therapy to coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD). Nine patients were assigned to receive increasing doses (0.5 to 2.0 mg) of VM202 injected into the right coronary artery (RCA) territory following completion of CABG for the left coronary artery territory. Patients were evaluated for safety and tolerability, and changes in myocardial functions were monitored via echocardiography, cardiac magnetic resonance imaging and myocardial single photon emission computed tomography throughout 6-month follow-up period. No serious complication related to VM202 was observed throughout the 6-month follow-up period. Global myocardial functions (wall motion score index, P=0.0084; stress perfusion, P=0.0002) improved during the follow-up period. In the RCA region, there was an increase in the stress perfusion (baseline vs 3-month, P=0.024; baseline vs 6-month, P=0.024) and also in the wall thickness of the diastolic and systolic phases. Intramyocardial injection of VM202 can be safely used in IHD patients with the tolerable dose of 2.0 mg. In addition, VM202 might appear to have improved regional myocardial perfusion and wall thickness in the injected region. PMID:23151518

  17. Ultra-minimally invasive cardiac surgery: robotic surgery and awake CABG.

    PubMed

    Ishikawa, Norihiko; Watanabe, Go

    2015-01-01

    The recognition of the significant advantages of minimizing surgical trauma has resulted in the development of minimally invasive surgical procedures. Endoscopic surgery confers the benefits of minimally invasive surgery upon patients, and surgical robots have enhanced the ability and precision of surgeons. Consequently, technological advances have facilitated totally endoscopic robotic cardiac surgery, which has allowed surgeons to operate endoscopically, rather than through a median sternotomy, during cardiac surgery. Thus, repairs for structural heart conditions, including mitral valve plasty, atrial septal defect closure, multivessel minimally invasive direct coronary artery bypass grafting and totally endoscopic coronary artery bypass graft surgery (CABG), can be totally endoscopic. On the other hand, general anesthesia remains a risk in patients who have severe carotid artery stenosis before surgery, as well as in those with a history of severe cerebral infarction or respiratory failure. In this study, the potential of a new awake CABG protocol using only epidural anesthesia was investigated for realizing day surgery and was found to be a promising modality for ultra-minimally invasive cardiac surgery. We herein review robot-assisted cardiac surgery and awake off-pump coronary artery bypass grafting as ultra-minimally invasive cardiac surgeries. PMID:25274467

  18. Effect of muscle and intensity of finishing diet on meat quality of foals slaughtered at 15 months.

    PubMed

    Franco, Daniel; Lorenzo, José M

    2014-01-01

    The effect of muscle and intensity of finishing diet on meat quality of foals slaughtered at 15 months was study. For this work, a total of twenty one foals and six muscles: longissimus dorsi (LD), semimembranosus (SM), semitendinosus (ST), biceps femoris (BF), triceps brachii (TB) and Psoas major & minor (PM) from two different intensities of finishing diet (1.5 vs. 3 kg/day) were analysed. Meat quality (chemical composition, colour characteristics, and textural traits), fatty and amino acid profile and mineral composition were studied. In general the factor muscle had more effect on all traits measured in this study than finishing effect, especially in the fatty acids and mineral composition. SM muscle showed the highest percentage of protein in both finishing groups (22.34 and 21.74% for 3 and 1.5 kg of commercial feeding, respectively). The intramuscular fat content in the analysed muscles ranged between 0.15% (LD in 1.5 group) and 1.83% (PM in 3.0 group). The highest values of iron heme that were obtained in TB muscle (2.46 mg/100 g meat) are a considerable source of bioavailable iron content. The three most abundant fatty acids in both groups and for all muscles studied were oleic acid, palmitoleic acid and linoleic acid. From a healthy point of view, muscles from foals finishing with a minor amount of commercial fodder were the best. The best nutritional value was reached for PM and ST with 14.73% of total omega 3 and the highest polyunsaturated/saturated ratio (1.10), respectively. Concerning amino acid profile, values of essential/non-essential ratio were significantly higher (P<0.001) in muscles of 1.5 diet group foals (0.856) than the other group (0.833). Finally, potassium (243 mg/100 g) and phosphorous (202 mg/100 g) were the two main minerals, followed by sodium (54 mg/100 g) and magnesium (26 mg/100 g).

  19. Development of Phonological Constancy: 19-Month-Olds, but Not 15-Month-Olds, Identify Words in a Non-Native Regional Accent

    ERIC Educational Resources Information Center

    Mulak, Karen E.; Best, Catherine T.; Tyler, Michael D.; Kitamura, Christine; Irwin, Julia R.

    2013-01-01

    By 12 months, children grasp that a phonetic change to a word can change its identity ("phonological distinctiveness"). However, they must also grasp that some phonetic changes do "not" ("phonological constancy"). To test development of phonological constancy, sixteen 15-month-olds and sixteen 19-month-olds completed…

  20. Peer Contacts of 15-Month-Olds in Childcare: Links with Child Temperament, Parent-Child Interaction and Quality of Childcare

    ERIC Educational Resources Information Center

    Deynoot-Schaub, Mirjam J. Gevers; Riksen-Walraven, J. Marianne

    2006-01-01

    Seventy 15-month-old children were observed during 90 minutes of free play with their peers in childcare centers. The study aimed to describe individual differences in the children's contacts with peers and to explain the individual differences in relation to: (1) child temperament, (2) the quality of parental behavior toward the child and (3) the…

  1. Child Care Effects in Context: Quality, Stability, and Multiplicity in Nonmaternal Child Care Arrangements during the First 15 Months of Life

    ERIC Educational Resources Information Center

    Tran, Henry; Weinraub, Marsha

    2006-01-01

    Main and interactive effects of child care quality, stability, and multiplicity on infants' attachment security, language comprehension, language production, and cognitive development at 15 months were examined using data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care. Thirty-nine percent of the…

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  3. Mild Anastomotic Stenosis in Patient-Specific CABG Model May Enhance Graft Patency: A New Hypothesis

    PubMed Central

    Huo, Yunlong; Luo, Tong; Guccione, Julius M.; Teague, Shawn D.; Tan, Wenchang; Navia, José A.; Kassab, Ghassan S.

    2013-01-01

    It is well known that flow patterns at the anastomosis of coronary artery bypass graft (CABG) are complex and may affect the long-term patency. Various attempts at optimal designs of anastomosis have not improved long-term patency. Here, we hypothesize that mild anastomotic stenosis (area stenosis of about 40–60%) may be adaptive to enhance the hemodynamic conditions, which may contribute to slower progression of atherosclerosis. We further hypothesize that proximal/distal sites to the stenosis have converse changes that may be a risk factor for the diffuse expansion of atherosclerosis from the site of stenosis. Twelve (12) patient-specific models with various stenotic degrees were extracted from computed tomography images using a validated segmentation software package. A 3-D finite element model was used to compute flow patterns including wall shear stress (WSS) and its spatial and temporal gradients (WSS gradient, WSSG, and oscillatory shear index, OSI). The flow simulations showed that mild anastomotic stenosis significantly increased WSS (>15 dynes⋅cm−2) and decreased OSI (<0.02) to result in a more uniform distribution of hemodynamic parameters inside anastomosis albeit proximal/distal sites to the stenosis have a decrease of WSS (<4 dynes⋅cm−2). These findings have significant implications for graft adaptation and long-term patency. PMID:24058488

  4. Mild anastomotic stenosis in patient-specific CABG model may enhance graft patency: a new hypothesis.

    PubMed

    Huo, Yunlong; Luo, Tong; Guccione, Julius M; Teague, Shawn D; Tan, Wenchang; Navia, José A; Kassab, Ghassan S

    2013-01-01

    It is well known that flow patterns at the anastomosis of coronary artery bypass graft (CABG) are complex and may affect the long-term patency. Various attempts at optimal designs of anastomosis have not improved long-term patency. Here, we hypothesize that mild anastomotic stenosis (area stenosis of about 40-60%) may be adaptive to enhance the hemodynamic conditions, which may contribute to slower progression of atherosclerosis. We further hypothesize that proximal/distal sites to the stenosis have converse changes that may be a risk factor for the diffuse expansion of atherosclerosis from the site of stenosis. Twelve (12) patient-specific models with various stenotic degrees were extracted from computed tomography images using a validated segmentation software package. A 3-D finite element model was used to compute flow patterns including wall shear stress (WSS) and its spatial and temporal gradients (WSS gradient, WSSG, and oscillatory shear index, OSI). The flow simulations showed that mild anastomotic stenosis significantly increased WSS (>15 dynes · cm(-2)) and decreased OSI (<0.02) to result in a more uniform distribution of hemodynamic parameters inside anastomosis albeit proximal/distal sites to the stenosis have a decrease of WSS (<4 dynes · cm(-2)). These findings have significant implications for graft adaptation and long-term patency. PMID:24058488

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

    NASA Astrophysics Data System (ADS)

    Sankaran, Sethuraman; Marsden, Alison

    2010-11-01

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

  6. Effect of LIMA Harvesting Technique on Postoperative Drainage in Off-Pump CABG

    PubMed Central

    Özülkü, Mehmet; Aygün, Fatih

    2016-01-01

    Objective We investigated the effects of pedicled and semiskeletonized left internal mammary artery (LIMA) harvesting techniques on postoperative drainage in patients subjected to off-pump CABG, ignoring other advantages or disadvantages of those techniques. Methods The present study comprises a total of 160 subjects that underwent coronary artery bypass surgery in our clinic. Data were collected consecutively and retrospectively. An attempt was made to have similar groups in terms of demographic characteristics. Patients that underwent off-pump coronary artery bypass surgery by two surgical teams which differed only in LIMA harvesting technique were dichotomized and compared according to these techniques. The first group (Group 1) consisted of patients in whom LIMA was harvested with surrounding tissues using the pedicled technique. The second group (Group 2) consisted of patients in whom LIMA was harvested using the semiskeletonized technique, with the veins separated from surrounding connective tissues. Results The mean amount of drainage in the first 24 hours was 706.1±234.2 ml vs. 591±258.8 ml (Group 1 vs. Group 2; P=0.005), the mean amount of drainage in the second 24 hours was 270±133.6 ml vs. 189.4±140.4 ml (Group 1 vs. Group 2; P<0.001), and the mean amount of total drainage was determined to be 976.1±306.9 ml vs. 781.2±335.5 ml (Group 1 vs. Group 2; P<0.001). Conclusion It was observed that semiskeletonized LIMA presents reduced amount of postoperative drainage in the first and second 24-hour periods and total amount of drainage than pedicled LIMA, independent of pleural integrity. PMID:27556310

  7. Effects of feeding different dietary protein and energy levels on the performance of 12-15-month-old buffalo calves.

    PubMed

    Shahzad, Muhammad Aasif; Tauqir, Nasir A; Ahmad, Fayyaz; Nisa, Mahr U; Sarwar, Muhammad; Tipu, Murtaza A; Tipu, Muhammad A

    2011-03-01

    The study investigated the performance response of different dietary protein and energy levels of Nili-Ravi buffalo calves. Sixty buffalo calves of 12-15 months of age and similar body weight (140 ± 14 kg) were divided in to 12 groups, five animals in each group, according to 4 × 3 factorial arrangements. Twelve rations were formulated containing four levels of crude protein (CP; 10.5%, 12.20%, 13.80%, and 15.55%) each with three levels (1.72, 2.11, and 2.5 Mcal/Kg) of metabolizable energy (ME). Experiment lasted for 100 days; first 10 days were given for dietary adaptation. Daily feed consumption in calves fed all experimental diets were statistically significant (p<0.05) across all treatments. Higher feed intake was observed in buffalo calves fed diets containing 12.20% and 13.85% CP with 2.11 Mcal/kg ME. Results of dry matter (DM) digestion were significantly different (p<0.05) across all treatments. There was a quadratic (p<0.05) response of DM digestibility for levels of dietary protein while, curvilinear (p<0.05) trend with respect to dietary energy levels. Daily weight gain of buffalo calves did not show any treatment effect. The outcome of the present study indicate that 12-15-month-old buffalo calves perform adequately well when fed on diets containing 12.2% CP and 2.10 ME Mcal/Kg. PMID:21107907

  8. False-negative HIV-1 polymerase chain reaction in a 15-month-old boy with HIV-1 subtype C infection.

    PubMed

    Oladokun, R; Korsman, S; Ndabambi, N; Hsiao, N; Hans, L; Williamson, C; Abrahams, M-R; Eley, B

    2015-10-01

    Polymerase chain reaction (PCR) testing is the gold standard for determining the HIV status in children <18 months of age. However, when clinical manifestations are not consistent with laboratory results, additional investigation is required. We report a 15-month-old HIV-exposed boy referred to our hospital after he had been admitted several times for infectious diseases. A rapid antibody test on the child was positive, while routine diagnostic HIV PCRs using the Roche COBAS Ampliprep/COBAS TaqMan HIV Qual Test were negative at 6 weeks, 6 months, 7 months and 15 months. In addition, the same PCR test performed on the HIV-infected mother was also negative. Alternative PCR and viral load assays using different primer sets detected HIV RNA or proviral DNA in both child and mother. Gag sequences from the child and his mother classified both infections as HIV-1 subtype C, with very rare mutations that may have resulted in PCR assay primer/probe mismatch. Consequently, the child was commenced on antiretroviral therapy and made a remarkable recovery. These findings indicate that more reliable PCR assays capable of detecting a wide range of HIV subtypes are desirable to circumvent the clinical problems created by false-negative PCR results. PMID:26636158

  9. Lifestyle changes in free-living patients with peripheral vascular disease (Fontaine stage II) related to plasma and LDL lipid composition: a 15 month follow-up study.

    PubMed

    Ramírez-Tortosa, M C; Urbano, G; López-Jurado, M; Nestares, T; Gomez, M C; González, J; Mir, A; Ros, E; Mataix, J; Gil, A

    1999-10-01

    Peripheral vascular disease (PVD) is characterized by arteriosclerosis and lower extremity ischemia which cause intermittent claudication. Patients grouped in the Fontaine stage II have more than 75% organic stenosis in their large coronary arteries and exhibit a number of alterations in blood coagulation and plasma lipids. The aim of this study was to evaluate an intervention program of lifestyle habits including dietary recommendations, moderate exercise and decreased smoking in a population of patients with PVD for a period of 15 months, with respect to plasma-lipid and lipoprotein composition as well as LDL susceptibility to peroxidation. These parameters are well known risk indicators of arteriosclerosis and coronary heart disease. A total 13 subjects diagnosed with PVD (Fontaine stage II) were selected, while a healthy age-matched group (n=20) was used as a reference. This study design was an uncontrolled trial of lifestyle interventions. The group of patients was examined at 0, 3, 6, 9, 12 and 15 months. Patients smoking one or more packets of cigarettes per day at the beginning of the study (54.2%) decreased smoking by as much as 7.7% 15 months later. In addition, physical activity intensified significantly (walking > 1 km: 13.1-77%) and treadmill running increased over the study period while the energy intake decreased by 10%. The percentage of saturated fat in the diet decreased by 10% while the intake of polyunsaturated fat rose, and monounsaturated-fat intake showed a parallel trend to increase; the average intake of cholesterol also fell by 10% and plasma triglycerides and HDL-cholesterol showed a trend to decrease and increase, respectively. No permanent changes in LDL lipid fractions for patients were detected during the follow-up period and no differences between patients and the age-matched reference group were found. The macrophage uptake of plasma-oxidized LDL was significantly higher in patients than in the reference group and no differences due

  10. Similar and functionally typical kinematic reaching parameters in 7- and 15-month-old in utero cocaine-exposed and unexposed infants.

    PubMed

    Tronick, E Z; Fetters, Linda; Olson, Karen L; Chen, Yuping

    2004-04-01

    This study examined the effects of intrauterine cocaine exposure on the reaches of 19 exposed and 15 unexposed infants at 7 and 15 months using kinematic measures. Infants sat at a table and reached for a rattle, a toy doll, and a chair. Videotaped reaches were digitized using the Peak Performance system. Kinematic movement variables were extracted (e.g., reach duration, peak velocity, movement units, path length) and ratios computed (e.g., path length divided by number of movement units). Regardless of exposure status, reaches of older infants were faster, more direct, had fewer movement units, and covered more distance with the first movement unit. Exposed infants covered more distance per movement unit than unexposed infants, but there were no other significant differences. Reaches of exposed and unexposed infants were essentially similar. Importantly, reach parameters for these high-risk infants were similar to reach parameters for infants at lower social and biological risk. PMID:15054885

  11. Influence of packaging conditions on biogenic amines and fatty acids evolution during 15months storage of a typical spreadable salami ('Nduja).

    PubMed

    Loizzo, Monica Rosa; Spizzirri, U Gianfranco; Bonesi, Marco; Tundis, Rosa; Picci, Nevio; Restuccia, Donatella

    2016-12-15

    The study evaluated the fatty acids and the biogenic amines (BAs) in 'Nduja of Spilinga stored in different packaging materials (i.e. natural casing under vacuum, glass jar, aluminum tube and OVTENE®) during 15months of shelf-life. Raw materials and pepper mixture were analysed as well. BAs concentrations increased with time, tyramine (TYR), putrescine (PUT) and cadaverine (CAD) were the most abundant. BAs in natural casing were always higher than those found in glass jar, aluminum tube and OVTENE®. Total fatty acids were characterized by higher level of unsaturated fatty acid that decreased with time (glass jar>natural casing under vacuum>aluminum tube>OVTENE®). The reduction of PUFA is the consequence of the increase of peroxides and carbonyls reacting with amino acids to form BAs. This was confirmed by Pearson's correlation matrices implying that lipid oxidation processes were in some way linked to the chemical production of BAs. PMID:27451162

  12. Pertussis vaccination during pregnancy in Belgium: Follow-up of infants until 1 month after the fourth infant pertussis vaccination at 15 months of age.

    PubMed

    Maertens, Kirsten; Caboré, Raïssa Nadège; Huygen, Kris; Vermeiren, Sandra; Hens, Niel; Van Damme, Pierre; Leuridan, Elke

    2016-06-30

    Vaccination of pregnant women with a pertussis containing vaccine is a recommended strategy in some industrialized countries, to protect young infants from severe disease. One of the effects of the presence of high titers of passively acquired maternal antibodies in young infants is blunting of immune responses to infant vaccination. We present infant immune responses to a fourth pertussis containing vaccine dose at 15 months of age, as a follow-up of previously presented data. In a prospective cohort study, women were either vaccinated with an acellular pertussis vaccine (Boostrix(®)) during pregnancy (vaccine group) or received no vaccine (control group). All infants were vaccinated with Infanrix Hexa(®) according to the standard Belgian vaccination schedule (8/12/16 weeks, 15 months). We report results from blood samples collected before and 1 month after the fourth vaccine dose. Immunoglobulin G (IgG) antibodies against pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin (Prn), tetanus toxoid (TT) and diphtheria toxoid (DT) were measured using commercially available ELISA tests. Antibody levels were expressed in International Units per milliliter. Demographic characteristics were similar in the vaccine and control group. Before the fourth vaccine dose, significantly lower antibody titers were measured in the vaccine group compared to the control group for anti-Prn IgG (p=0.003) and anti-DT IgG (p=0.023), with a steep decay of antibody titers since post-primary vaccination. One month after the fourth dose, antibody titers were only significantly lower in the vaccine group for anti-PT IgG (p=0.006). For all antigens, there was a rise in antibody titer after the fourth vaccine dose. The present results indicate still a minor blunting effect 1 month after a fourth vaccine dose for anti-PT antibodies. However, a good humoral immune response on all measured antigens was elicited in both groups of children. The clinical significance of such blunting

  13. Immunogenicity and safety of a monovalent, multicomponent acellular pertussis vaccine in 15 month-6-year-old German children. Monovalent Acellular Pertussis Vaccine Study Group.

    PubMed

    Stehr, K; Heininger, U; Uhlenbusch, R; Angersbach, P; Hackell, J; Eckhardt, T

    1995-03-01

    Immunization against pertussis has been re-recommended for healthy children in Germany in 1991. In addition the former restriction of immunizing only in the first 2 years of life was abolished. In children born before 1991 immunization rates against pertussis were 15% or less. With the new recommendations physicians are now faced with an increasing demand of parents for catch-up vaccinations in these children. Since they were immunized against diphtheria and tetanus previously monovalent pertussis vaccines are needed for this indication. Therefore a monovalent, multicomponent acellular pertussis vaccine was studied in 249 German children 15 months to 6 years of age. Three doses were administered at 6-10 week intervals. Reactogenicity and antibody responses against the vaccine antigens pertussis toxin (PT), filamentous haemagglutinin (FHA), 69-kd antigen (pertactin) and fimbriae-2 (agglutinogen) were investigated. Local and systemic reactions were minimal in frequency and severity. Antibody responses against all vaccine antigens were pronounced with 93%-100% of vaccinees demonstrating at least four fold titre rises above pre-immunization after the third dose. These findings indicate that this monovalent, multicomponent acellular pertussis vaccine with excellent immunogenicity and low reactogenicity is an appropriate candidate for closing immunization gaps in older children in countries with previously low vaccination rates against pertussis. Based on the results of this study the monovalent acellular pertussis vaccine was licensed in Germany in January 1994. PMID:7758519

  14. Household and personal factors are sources of heterogenity in intestinal parasite clearance among Mexican children 6-15 months of age supplemented with vitamin A and zinc.

    PubMed

    Srinivasan, Punitha; Lawa, Ha'i Raga; Rosado, Jorge L; Al Mamun, Abdullah; Khatun, Mohsina; Santos, José I; Utzinger, Jürg; Long, Kurt Z

    2016-04-01

    A randomised, double-blind, placebo-controlled trial was carried out among Mexico children aged 6-15 months to determine how household characteristics modify vitamin A and zinc supplementation efficacy on Ascaris lumbricoides, Giardia intestinalis and Entamoeba histolytica/E. dispar infection durations. Children assigned to receive vitamin A every 2 months, a daily zinc supplement, a combined vitamin A-zinc supplement or a placebo were followed for 1 year. Parametric hazard models were fit to infection durations stratified by personal and household factors. Children supplemented with vitamin A and zinc combined from households lacking piped water and children in all three treatment arms from households with dirt floors had longer G. intestinalis and A. lumbricoides infection durations than their counterparts, respectively. Shorter E. histolytica/E.dispar durations were found among zinc-supplemented children of mothers who had <6 years of education and no indoor bathrooms. Heterogeneity in supplementation efficacy among children may reflect differences in exposure risk and baseline immune responses.

  15. Household and personal factors are sources of heterogenity in intestinal parasite clearance among Mexican children 6-15 months of age supplemented with vitamin A and zinc.

    PubMed

    Srinivasan, Punitha; Lawa, Ha'i Raga; Rosado, Jorge L; Al Mamun, Abdullah; Khatun, Mohsina; Santos, José I; Utzinger, Jürg; Long, Kurt Z

    2016-04-01

    A randomised, double-blind, placebo-controlled trial was carried out among Mexico children aged 6-15 months to determine how household characteristics modify vitamin A and zinc supplementation efficacy on Ascaris lumbricoides, Giardia intestinalis and Entamoeba histolytica/E. dispar infection durations. Children assigned to receive vitamin A every 2 months, a daily zinc supplement, a combined vitamin A-zinc supplement or a placebo were followed for 1 year. Parametric hazard models were fit to infection durations stratified by personal and household factors. Children supplemented with vitamin A and zinc combined from households lacking piped water and children in all three treatment arms from households with dirt floors had longer G. intestinalis and A. lumbricoides infection durations than their counterparts, respectively. Shorter E. histolytica/E.dispar durations were found among zinc-supplemented children of mothers who had <6 years of education and no indoor bathrooms. Heterogeneity in supplementation efficacy among children may reflect differences in exposure risk and baseline immune responses. PMID:26772449

  16. Effect of cross breeding and amount of finishing diet on growth parameters, carcass and meat composition of foals slaughtered at 15 months of age.

    PubMed

    Franco, Daniel; Crecente, Santiago; Vázquez, José Antonio; Gómez, María; Lorenzo, José M

    2013-03-01

    This trial was conducted to study the effects of cross breeding (GM: Galician Mountain; HB×GM: Hispano-Breton×Galician Mountain crossing) and finishing feed (1.5 kg vs. 3.0 kg of commercial feed in the finishing period) on growth, performance, carcass characteristics and meat quality of foals slaughtered at 15 months of age. For this study, twenty one foals of GM and HB×GM crossbred were used. Results obtained for the current study suggest an interesting potential for meat production, because the introduction of HB×GM stallions allows an advantage compared with the Galician breed, because they had better carcass weight, better conformation and the best carcass ratios. Other morphometric measurements related to the leg were also higher in HB×GM crossbred. On the other hand, the finishing diet had also significant influence in commercial cuts both in the front and hind quarter. A finishing diet with 3 kg of commercial feed increased carcass fat level. Regarding meat quality, genotype did not affect any physical-chemical trait, while finishing foals with 3 kg of fodder quadrupled intramuscular fat value and provided meat with a higher luminosity (35.9 vs. 38.2, P<0.05, for 1.5 and 3 kg concentrate/day, respectively). However, this increase in intramuscular fat was not correlated with improvements in meat textural parameters because they were not influenced (P>0.05) by either of the two effects studied. Nutritive profiles (both fatty and amino acids composition) were not influenced by genotype (P>0.05) whereas finishing effect modified almost all fatty acid finding.

  17. Measuring spatial effects in time to event data: a case study using months from angiography to coronary artery bypass graft (CABG).

    PubMed

    Crook, Angela M; Knorr-Held, Leonhard; Hemingway, Harry

    2003-09-30

    The application of Bayesian hierarchical models to measure spatial effects in time to event data has not been widely reported. This case study aims to estimate the effect of area of residence on waiting times to coronary artery bypass graft (CABG) and to assess the role of important individual specific covariates (age, sex and disease severity). The data involved all patients with definite coronary artery disease who were referred to one cardiothoracic unit from five contiguous health authorities covering 488 electoral wards (areas). Time to event was the waiting time in months from angiography (diagnosis) to CABG (event). A number of discrete time survival models were fitted to the data. A discrete baseline hazard was estimated by fitting waiting time non-parametrically into the models. Ward was fitted as a spatial effect using a Gaussian Markov random field prior. Individual specific covariates considered were age, sex and number of diseased vessels. The recently proposed DIC criteria was used for comparing models. Results showed a marked spatial effect on time to bypass surgery after including age, sex and disease severity in the model. Notably this spatial effect was not apparent when these covariates were not included in the model. The observed small area spatial variation in time to CABG warrants further investigation. PMID:12953290

  18. Measuring spatial effects in time to event data: a case study using months from angiography to coronary artery bypass graft (CABG).

    PubMed

    Crook, Angela M; Knorr-Held, Leonhard; Hemingway, Harry

    2003-09-30

    The application of Bayesian hierarchical models to measure spatial effects in time to event data has not been widely reported. This case study aims to estimate the effect of area of residence on waiting times to coronary artery bypass graft (CABG) and to assess the role of important individual specific covariates (age, sex and disease severity). The data involved all patients with definite coronary artery disease who were referred to one cardiothoracic unit from five contiguous health authorities covering 488 electoral wards (areas). Time to event was the waiting time in months from angiography (diagnosis) to CABG (event). A number of discrete time survival models were fitted to the data. A discrete baseline hazard was estimated by fitting waiting time non-parametrically into the models. Ward was fitted as a spatial effect using a Gaussian Markov random field prior. Individual specific covariates considered were age, sex and number of diseased vessels. The recently proposed DIC criteria was used for comparing models. Results showed a marked spatial effect on time to bypass surgery after including age, sex and disease severity in the model. Notably this spatial effect was not apparent when these covariates were not included in the model. The observed small area spatial variation in time to CABG warrants further investigation.

  19. 12-MONTH COST-EFFECTIVENESS OF TELEPHONE-DELIVERED COLLABORATIVE CARE FOR TREATING DEPRESSION FOLLOWING CABG SURGERY: A RANDOMIZED CONTROLLED TRIAL

    PubMed Central

    Donohue, Julie M.; Belnap, Bea Herbeck; Men, Aiju; He, Fanyin; Roberts, Mark S.; Schulberg, Herbert C.; Reynolds, Charles F.; Rollman, Bruce L.

    2014-01-01

    Objective To determine the 12-month cost-effectiveness of a collaborative care (CC) program for treating depression following coronary artery bypass graft (CABG) surgery versus physicians’ usual care (UC). Methods We obtained 12 continuous months of Medicare and private medical insurance claims data on 189 patients who screened positive for depression following CABG surgery, met criteria for depression when reassessed by telephone two-weeks following hospitalization (9-item Patient Health Questionnaire ≥10), and were randomized to either an 8-month centralized, nurse-provided, and telephone-delivered collaborative care (CC) intervention for depression or to their physicians’ usual care (UC). Results At 12-months following randomization, CC patients had $2,068 lower but statistically similar estimated median costs compared to UC (P=0.30) and a variety of sensitivity analyses produced no significant changes. The incremental cost effectiveness ratio of CC was −$9,889 (−$11,940 to −$7,838) per additional quality-adjusted life-year (QALY), and there was 90% probability it would be cost-effective at the willingness to pay threshold of $20,000 per additional QALY. A bootstrapped cost-effectiveness plane also demonstrated a 68% probability of CC “dominating” UC (more QALYs at lower cost). Conclusions Centralized, nurse-provided, and telephone-delivered CC for post-CABG depression is a quality-improving and cost-effective treatment that meets generally accepted criteria for high-value care. PMID:24973911

  20. [Evaluation test of cadmium concentration influence on selected lipid metabolism parameters in smokers with stable coronary artery disease scheduled for coronary artery bypass grafting (CABG)].

    PubMed

    Kleszczewska, Ewa; Lisowski, Piotr; Kleszczewski, Tomasz; Adamczuk, Anna; Trzciński, Robert

    2005-01-01

    The influence of cadium from cigarette intoxication on selected lipid metabolism parameters in smokers with stable coronary artery disease scheduled for coronary artery bypass grafting (CABG) was studied. It has been shown that concentration of cadmium leads to an increase in the lipid peroxidation and changes in the lipid metabolism. In our study, there was a significant higher cadmium concentration in smokers with stable angina pectoris (20.90+/-0.18) compared to stable angina pectoris non-smokers (7.71 +/-0,45), p<0.0001. We have not found correlations between cadmium concentration in smokers and non-smokers with stable angina pectoris patients and total cholesterol, LDL, HDL, and triglicerydes concentrations. Total cholesterol, LDL, HDL and TG concentrations in smokers scheduled for CABG were respectively: 221.60+/-10.26 mg/dl; 148.40+/-8.71 mg/dl; 41.16+/-2.12 mg/dl, 159.10+/-14.49 mg/dl. All of these lipid parameters in stable angina pectoris smokers did not differ significantly from non-smokers.

  1. N-acetylcysteine instead of theophylline in patients with COPD who are candidates for elective off-pump CABG surgery: Is it possible in cardiovascular surgery unit?

    PubMed Central

    Mirhosseini, Seyed Jalil; Forouzannia, Seyed Khalil; Nasirian, Marjan; Ali-Hassan-Sayegh, Sadegh

    2013-01-01

    Background: Forced expiratory volume in one second (FEV1) is a good predictor of chronic obstructive pulmonary disease (COPD). COPD is characterized by a chronic limitation of airflow. This study was designed to compare the effects and complications of theophylline alone, N-acetylcysteine (NAC) alone, and a combination of the two drugs on the rates of FEV1 in patients with COPD who were candidates for off-pump coronary artery bypass graft (CABG) surgery. Methods: This clinical trial was performed on 100 patients who had a smoking history of 27 pack years with a range of 20 to 40 pack years but were not heavy smokers and were candidates for elective off-pump CABG surgery in Afshar Cardiovascular Hospital, Yazd, Iran. The patients with a history of asthma and bronchospasm and non-COPD respiratory disorders were excluded. There were three groups, that is, the theophylline group (n=33) that received theophylline 10 mg/kg TDS after consumption of food, NAC group (n=33) who received NAC 10-15 mg/kg BD after consumption of food, and the combined group (n=32) who received theophylline and NAC together. Data were analyzed by analysis of variance (ANOVA), Chi-square, and exact test for quantitative and qualitative variables. Results: One hundred patients with COPD enrolled in this study as possible candidates for CABG surgery. Average age of the patients was 60.36±10.21 years. Of the participants, 83 (83.3%) were male and 17 (17%) were female. Rate of postoperative FEV1 to basal FEV1 was 0.76±0.32, 0.66±0.22, and 0.69±0.24 in the treatments with theophylline, NAC, and the combination, respectively. Theophylline, NAC, and a combination of these drugs can decrease the rate of postoperative FEV1 compared to basal FEV1 significantly. (P=0.0001) Conclusion: Theophylline alone, NAC alone, and a combination of these drugs improve pulmonary function, and there are no significant differences between these protocols. Stomach discomfort and cardiac complications in treatment with

  2. The role of adherence in the relationship between self-efficacy and self-management in diabetic patients undergoing CABG in Taiwan

    PubMed Central

    Tung, Heng-Hsin; Lien, Ru-Yu; Wei, Jeng; Clinciu, Daniel L; Lee, Jyun-Yi; Huang, Hui-Chuan

    2012-01-01

    Objectives To determine the role of adherence and its significance in the relationship between self-efficacy and self-management of diabetic patients undergoing coronary artery bypass graft (CABG) in Taiwan. Design Descriptive and correlational survey design. Setting Three outpatient clinics in Taiwan. Participants Patients diagnosed with diabetes undergoing CABG at least 6 months before the study, 18 years of age or older, able to communicate verbally without any psychiatric problems, and with a life expectancy longer than 1 year. Main outcome measures Self-management assessment (self-efficacy for managing disease and adherence to guidelines and medication measured on a scale of 0–8), the higher aspects of self-management (keeping appointments, taking medication properly and keeping follow-up appointments) and the lower aspects of self-management (inability to share decisions with primary physician, inability to take correct actions when symptoms worsen and inability to adapt habits to improve health). Results The mean score obtained for self-management among the 166 participants was 6.48, with 57 (34.3%) of them showing non-adherent behaviour. Self-efficacy accounts for 38% (R2=0.380, F(1,103)=63.124, p < 0.001), and 54% of good self-management was explained by self-efficacy and adherence in managing disease (R2=0.540, F(2,102)=56.937, p<0.001). Adherence accounts for 16% of better self-management, age and education combined account for 4.9% (R2=0.589, F(6.98)=23.399, p<0.001), and lifestyle items account for 5.2% (R2=0.641, F(14,90)=11.457, p<0.001). Disease-related variables contribute 3.4% (R2=0.674, F(17,87)=10.599, p<0.001). Thus self-efficacy, adherence, age, education, primary care provider and systolic pressure are considered significant predictors of self-management. With the exception of adherence, none of the variables had a statistically significant mediating effect. Conclusions The results confirm strong relationships between self

  3. The effects of tranexamic acid and 6% hydroxyethyl starch (HES) solution (130/0.4) on postoperative bleeding in coronary artery bypass graft (CABG) surgery

    PubMed Central

    Yanartas, M; Baysal, A; Aydın, C; Ay, Y; Kara, İ; Aydın, E; Cevirme, D; Köksal, C; Sunar, H

    2015-01-01

    Background: The addition of 6% hydroxyethyl starch (HES) into Ringer lactate priming solution may have adverse effects on hemostasis in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) with or without the use of tranexamic acid. Methods: In a prospective, randomized clinical trial, 132 patients were assigned to receive 20 ml/kg of Ringer priming solution with or without tranexamic acid (TA) (Group RS-TA, n=34 and Group RS-noTA, n=32) or 10 ml/kg of 6% HES plus 10 ml/kg of RS priming solution with or without intravenous tranexamic acid (Group HES-TA, n=35 and Group HES-noTA, n=31). Estimated blood loss, chest tube drainage, amount of blood products, hemoglobin, hematocrit, platelet and coagulation parameters were examined before and 24 hour after surgery. Results: For Group HES with tranexamic acid, when compared to other groups, estimated blood loss, postoperative 24 hour drainage loss and blood product transfusions were less (P=0.023; P=0.003; P=0.001; respectively) and hemoglobin, hematocrit values at 12 and 24 hours after surgery increased in comparison to other groups (P=0.041, P=0.034, P=0.004, P=0.001; respectively). Platelet concentrations were similar between groups (P>0.05). Conclusions: In CABG, the administration of tranexamic acid in HES 130/0.4 prime solution study group decreased estimated blood loss and chest tube drainage in comparison to patients receving Ringer prime solution with or without tranexamic acid postoperatively however, no effects on renal functions or postoperative complications were shown. PMID:26131192

  4. Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial

    PubMed Central

    Cardona, Saumeth; Pasquel, Francisco; Jacobs, Sol; Peng, Limin; Unigwe, Michael; Newton, Christopher A.; Smiley-Byrd, Dawn; Vellanki, Priyathama; Halkos, Michael; Puskas, John D.; Guyton, Robert A.; Thourani, Vinod H.

    2015-01-01

    OBJECTIVE The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial. RESEARCH DESIGN AND METHODS We randomized patients with diabetes (n = 152) and without diabetes (n = 150) with hyperglycemia to an intensive glucose target of 100–140 mg/dL (n = 151) or to a conservative target of 141–180 mg/dL (n = 151) after coronary artery bypass surgery (CABG) surgery. After the intensive care unit (ICU), patients received a single treatment regimen in the hospital and 90 days postdischarge. Primary outcome was differences in a composite of complications, including mortality, wound infection, pneumonia, bacteremia, respiratory failure, acute kidney injury, and major cardiovascular events. RESULTS Mean glucose in the ICU was 132 ± 14 mg/dL (interquartile range [IQR] 124–139) in the intensive and 154 ± 17 mg/dL (IQR 142–164) in the conservative group (P < 0.001). There were no significant differences in the composite of complications between intensive and conservative groups (42 vs. 52%, P = 0.08). We observed heterogeneity in treatment effect according to diabetes status, with no differences in complications among patients with diabetes treated with intensive or conservative regimens (49 vs. 48%, P = 0.87), but a significant lower rate of complications in patients without diabetes treated with intensive compared with conservative treatment regimen (34 vs. 55%, P = 0.008). CONCLUSIONS Intensive insulin therapy to target glucose of 100 and 140 mg/dL in the ICU did not significantly reduce perioperative complications compared with target glucose of 141 and 180 mg/dL after CABG surgery. Subgroup analysis showed a lower number of complications in patients without diabetes, but not in patients with diabetes treated with the intensive regimen. Large prospective randomized studies are needed to confirm these findings. PMID:26180108

  5. [THE USE OF 20% LIPOFUNDIN INFUSIONS AT THE APPEARANCE OF TOXIC PROPERTIES OF ROPIVACAINE 2 MG/ML IN CHILD 1.5 MONTHS AT THE POSTOPERATIVE PERIOD WITH EPIDURAL ANALGESIA].

    PubMed

    Sichkar, S Yu; Afukov, I I; Koshko, O V; Yeliseeva, N V

    2016-01-01

    Introduction of local anesthetic proved application of epidural (EP) as an effective and safe way of an analgesia in intra- and the post-operational period and now it is widely applied at children of all age groups (1). However there is a number of contraindications for application of this type of an analgesia. At children till 6 months lower dosages of a ropivacain of 2 mg/kg are applied, considering their age features. At the phenomena of system toxicity infusion of 20% lipofundin is applied. The child has an age 1.5 months, weight 5230 g, with the diagnosis a cystous dysplasia of both kidneys, a megaureter at the left and on the right, lack offunction of the left kidney operation a laparoscopic nefrureterektomia is executed at the left. In the postoperative period at application of EP of an analgesia ofropivacain 2 mg/ml by a drop way introduction in a standard dosage of 0.2 mg/kg of body weight an hour the repeating episodes of convulsions which were regarded as manifestation of toxic properties of local anesthetic were noted. Infusion of 20% lipofundin of 15 ml (2.8 ml/kg of body weight) within 30 minutes with a positive effect was applied. EP an analgesia was recoloured. PMID:27192857

  6. Immunogenicity and safety of measles-mumps-rubella-varicella (MMRV) vaccine followed by one dose of varicella vaccine in children aged 15 months-2 years or 2-6 years primed with measles-mumps-rubella (MMR) vaccine.

    PubMed

    Gillet, Y; Steri, G C; Behre, U; Arsène, J P; Lanse, X; Helm, K; Esposito, S; Meister, N; Desole, M G; Douha, M; Willems, P

    2009-01-14

    In this open, randomized, comparative study (105908/NCT00353288), 458 age-stratified children (15 months-2 years and 2-6 years) previously primed with MMR received one dose of either a combined MMRV vaccine (Priorix-Tetra, MMRV group) or concomitant MMR and varicella vaccines (Priorix and Varilrix, MMR+V group), followed 42-56 days later by another dose of varicella vaccine (Varilrix) in both groups. Post-vaccination measles, mumps and rubella seropositivity rates and antibody geometric mean titers (GMTs) were high (99.5% for anti-measles and 100% for anti-mumps and anti-rubella) in both vaccine groups. In the two age strata, varicella seroconversion rates were, post-dose 1: > or =97.6% (MMRV), > or =96.6% (MMR+V) and, post-dose 2: 100% in both groups. Post-dose 2, anti-varicella GMTs increased respectively 14.1- and 12.6-fold (MMRV), and 9.8- and 13.1-fold (MMR+V). Both vaccine regimens were well-tolerated. Post-dose 1, the incidence of any solicited local symptom during the 4-days follow-up was < or =28.2% (MMRV) and < or =19.8% (MMR+V) and the incidence of fever >39.5 degrees C (rectal temperature) within 15 days was < or =2.8% (MMRV) and < or =2.6% (MMR+V). This MMRV vaccine appears an immunogenic and safe substitute for a second dose of MMR vaccine in young children. The increase in anti-varicella antibodies observed after a second dose of varicella vaccine supports a two-dose schedule for varicella-containing vaccine.

  7. Allogeneic Blood Product Usage in Coronary Artery Bypass Grafting (CABG) with minimalized Extracorporeal Circulation System (MECC) Versus Standard On-Pump Coronary Artery Bypass Grafting

    PubMed Central

    Lisy, M.; Schmid, E.; Kozok, J.; Rosenberger, P.; Stock, U.A.; Kalender, G.

    2016-01-01

    Aim: Intraoperative allogeneic blood product transfusion (ABPT) in cardiac surgery is associated with worse overall outcome, including mortality. The objective of this study was to evaluate the ABPTs in minimalized extracorporeal cardiopulmonary (MECCTM) compared with standard open system on-pump coronary revascularization. Methods: Data of 156 patients undergoing myocardial revascularization between September 2008 and September 2010 were reviewed. 83 patients were operated by the MECC technique and 73 were treated by standard extracorporeal circulation (sECC). ABPT and overall early postoperative complications were analyzed. Results: Operative mortality and morbidity were similar in both groups. ABPT in the MECC group was significantly lower than in the sECC group both intraoperatively (7.2 vs. 60.3% of patients p<0.001) and during the first five postoperative days (19.3 vs. 57.5%; p<0.001). “Skin to skin”- (214 ± 45 vs. 232 ± 45 min; p=0.012), cardiopulmonary bypass (CPB) - (82 ± 25 vs. 95 ± 26 min; p=0.014), and X-clamp- times (50 ± 16 vs. 56 ± 17 min; p=0.024) were significantly lower in the MECC group than in the sECC group. Length of ICU (intensive care unit) - and hospital stay were also significantly lower in the MECC group vs. the sECC group (26.7 ± 20.2 vs. 54.5 ± 68.9 h; p<0.001, and 12.0 ± 4.1 vs. 14.5 ± 4.6 days; p<0.001). Conclusion: Application of MECC as on-pump coronary artery bypass graft (CABG) results in significantly lower ABPT as well as shorter ICU and in-hospital stay. In order to achieve these benefits of MECC autologous retrograde priming, Bispectral index (BIS) monitoring, intraoperative cell salvage, meticulous hemostasis and strict peri- and postoperative volume management are crucial. PMID:27499818

  8. Non-invasive versus invasive management in patients with prior coronary artery bypass surgery with a non-ST segment elevation acute coronary syndrome: study design of the pilot randomised controlled trial and registry (CABG-ACS)

    PubMed Central

    Lee, Matthew M Y; Petrie, Mark C; Rocchiccioli, Paul; Simpson, Joanne; Jackson, Colette; Brown, Ammani; Corcoran, David; Mangion, Kenneth; McEntegart, Margaret; Shaukat, Aadil; Rae, Alan; Hood, Stuart; Peat, Eileen; Findlay, Iain; Murphy, Clare; Cormack, Alistair; Bukov, Nikolay; Balachandran, Kanarath; Papworth, Richard; Ford, Ian; Briggs, Andrew; Berry, Colin

    2016-01-01

    Introduction There is an evidence gap about how to best treat patients with prior coronary artery bypass grafts (CABGs) presenting with non-ST segment elevation acute coronary syndromes (NSTE-ACS) because historically, these patients were excluded from pivotal randomised trials. We aim to undertake a pilot trial of routine non-invasive management versus routine invasive management in patients with NSTE-ACS with prior CABG and optimal medical therapy during routine clinical care. Our trial is a proof-of-concept study for feasibility, safety, potential efficacy and health economic modelling. We hypothesise that a routine invasive approach in patients with NSTE-ACS with prior CABG is not superior to a non-invasive approach with optimal medical therapy. Methods and analysis 60 patients will be enrolled in a randomised clinical trial in 4 hospitals. A screening log will be prospectively completed. Patients not randomised due to lack of eligibility criteria and/or patient or physician preference and who give consent will be included in a registry. We will gather information about screening, enrolment, eligibility, randomisation, patient characteristics and adverse events (including post-discharge). The primary efficacy outcome is the composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction and hospitalisation for heart failure. The primary safety outcome is the composite of bleeding, stroke, procedure-related myocardial infarction and worsening renal function. Health status will be assessed using EuroQol 5 Dimensions (EQ-5D) assessed at baseline and 6 monthly intervals, for at least 18 months. Trial registration number NCT01895751 (ClinicalTrials.gov). PMID:27110377

  9. Highlights of the First 15 Months of Aquarius Salinity Measurements

    NASA Technical Reports Server (NTRS)

    Lagerloef, Gary S. E.; Kao, Hsun-Ying; Wentz, Frank; LeVine, David M.; Yueh, Simon H.; Feldman, Gene C.

    2012-01-01

    Aquarius satellite salinity measurements are resolving the major global and regional spatial patterns, and temporal variations, since the start of routine data collection on 25 August 2011. This description includes the principal seasonal variations over the first annual cycle as observed by the mission. In particular, we identify the evolution of low salinity anomalies associated with the Atlantic and Pacific intertropical convergence zones (ITCZ), major river outflows such as the Amazon, a seasonal low salinity anomaly in the Panama bight, and other features. We also explore the links that the salinity variations have with precipitation and surface currents. We then will describe the variations related to the presently evolving 2012 El Nino, now evident, as it progresses through the summer and fall 2012. We conclude with a brief summary of the Aquarius data products and validation

  10. Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up.

    PubMed

    Kröger, Christoph; Schweiger, Ulrich; Sipos, Valerija; Kliem, Sören; Arnold, Ruediger; Schunert, Tanja; Reinecker, Hans

    2010-12-01

    There is evidence from case studies suggesting that adapted dialectical behavior therapy (DBT) for borderline personality disorder (BPD) and eating disorders (ED) might improve disorder related complaints. Twenty-four women with BPD (9 with comorbid anorexia nervosa [AN] and 15 with bulimia nervosa [BN]), who already had failed to respond to previous eating-disorder related inpatient treatments were consecutively admitted to an adapted inpatient DBT program. Assessment points were at pre-treatment, post-treatment, and 15-month follow-up. At follow-up, the remission rate was 54% for BN, and 33% for AN. Yet 44% of women with AN crossed over to BN and one woman additionally met the criteria of AN. For women with AN, the mean weight was not significantly increased at post-treatment, but had improved at follow-up. For women with BN, the frequency of binge-eating episodes was reduced at post-treatment as well as at follow-up. Self-rated eating-related complaints and general psychopathology, as well as ratings on global psychosocial functioning, were significantly improved at post-treatment and at follow-up. Although these findings support the assumption that the adapted DBT inpatient program is a potentially efficacious treatment for those who failed to respond to previous eating-disorder related inpatient treatments, remission rates and maintained eating-related psychopathology also suggest that this treatment needs further improvement.

  11. Depression after CABG: a prospective study

    PubMed Central

    Nunes, Joana Kátya Veras Rodrigues Sampaio; de Figueiredo Neto, José Albuquerque; de Sousa, Rosângela Maria Lopes; Costa, Vera Lívia Xavier de Castro; Silva, Flor de Maria Araújo Mendonça; da Hora, Ana Flávia Lima Teles; da Silva, Edna Lúcia Coutinho; Reis, Lívia Mariane Castelo Branco

    2013-01-01

    Introduction Depression during or shortly after hospitalization elevated two to three times the risk of mortality or nonfatal cardiac events, significantly increasing the morbidity and mortality of these patients. Objective To assess the impact of revascularization on symptoms of depression in patients with coronary artery disease. Methods A prospective cohort study of 57 patients of both sexes undergoing coronary artery bypass grafting between June 2010 and June 2011. We used the SF-36 to assess quality of life, and the Beck Depression Inventory to detect depressive symptoms, applied preoperatively and six months. Results The prevalence of patients aged 60-69 years was 22 patients (38.60%), 39 men (68.42%), 26 described themselves as mixed race (45.61%), 16 literate (28.07 %) and 30 married (52.63%). The beck depression inventory score demonstrated increased after revascularization: 15 patients mild (26.32%) at time zero to 17 (29.82%) after. And with moderate, seven patients (12.28%) before and 10 (17.54%) after. In the categories of individuals with decreased minimum degree of 32 (56.14%) to 28 (49.12%), and severe of three (5.26%) for two (3.51%) patients. Association was observed between beck depression inventory, gender, age, lifestyle, comorbidities and quality of life. Conclusion There was a high prevalence of elevated beck depression inventory scores, lowest scores of depressive symptoms among men and association between the improvement of quality of life scores and beck depression inventory. PMID:24598954

  12. Pneumococcal Sepsis Complicated by Splenic Abscesses and Purpura Fulminans in a 15-Month-Old Child

    PubMed Central

    Pangonis, Scott; Patamasucon, Pisespong; Fitzpatrick, Ellen

    2016-01-01

    Streptococcus pneumoniae is an invasive organism that causes a wide range of common diseases, including sinusitis, acute otitis media, and pneumonia. Splenic abscesses and purpura fulminans (PF) are rare complications of pneumococcal disease. Splenic abscesses caused by S pneumoniae have only been reported in the adult literature. PF has been described in the pediatric population as a rare complication in patients with invasive pneumococcal disease (IPD) with and without underlying immunological disorders such as asplenia. Here, we report a patient with IPD complicated by splenic abscesses and PF. Our patient initially presented with bacteremia, septic shock, and disseminated intravascular coagulation. She subsequently developed PF and splenic abscesses. She survived her illness after receiving a total of 8 weeks of antibiotic therapy. This case highlights 2 rare complications of IPD and demonstrates the need to keep pneumococcal disease in the differential diagnosis even in children whose vaccination status is up to date. PMID:27006958

  13. A 15-Month MS Chemical Engineering Degree Program for BS Chemists.

    ERIC Educational Resources Information Center

    Hanks, Richard W.; Oscarson, John L.

    1979-01-01

    The key to shortening the time-frame for this program is a special summer course in unit operations, and the replacement of the usual nine credits of minor courses with undergraduate chemical engineering courses. (BB)

  14. Factors Associated with Intubation Time and ICU Stay After CABG

    PubMed Central

    Flegler, Suzanny; Paro, Flavia Marini

    2015-01-01

    OBJECTIVE The aim of this study was to identify factors associated with intubation time and intensive care unit stay after coronary artery bypass grafting with cardiopulmonary bypass. METHODS This was a retrospective study, whose data collection was performed in the hospital charts of 160 patients over 18 years, who underwent surgery from September 2009 to July of 2013 in a hospital in the state of Espirito Santo, Brazil. RESULTS The mean age of the subjects was 61.44±8.93 years old and 68.8% were male. Subjects had a mean of 5.17±8.42 days of intensive care unit stay and mean intubation time of 10.99±8.41 hours. We observed statistically significant positive correlation between the following variables: patients' age and intubation time; patients' age and intensive care unit stay; intubation time and intensive care unit stay. CONCLUSION In conclusion, the study showed that older patients had longer intubation time and increased intensive care unit stay. Furthermore, patients with longer intubation time had increased intensive care unit stay. PMID:26934403

  15. CABG in a patient recovering from dengue fever.

    PubMed

    Rawat, S K S; Mehta, Yatin; Yaseen, Taha; Sharma, Jeetender; Kohli, Vijay; Trehan, Naresh

    2009-01-01

    Dengue fever (DF) is the most common and widespread arbovirus infection worldwide. It is endemic in the tropical and sub-tropical areas of the world especially in Southeast Asia, the Pacific, East and West Africa, the Caribbean and South America with cyclical epidemics. Major epidemics of DF have occurred in India and Southeast Asia in the last two decades. We have outlined the anaesthetic management of a 64-year-old man with DF who needed urgent Coronary artery Bypass graft surgery.

  16. Evidence for a postnatal doubling of neuron number in the developing human cerebral cortex between 15 months and 6 years.

    PubMed

    Shankle, W R; Landing, B H; Rafii, M S; Schiano, A; Chen, J M; Hara, J

    1998-03-21

    The generalization of the finding of no postnatal neurogenesis in non-human primates to humans may be incorrect because: (1) rhesus macaques belong to a superfamily that diverged more than 25 million years ago from the superfamily including the genus Homo; (2) the pulse thymidine labeling method, which demonstrates DNA synthesis rather than mitosis per se, is less reliable than some have assumed. This study examines changes in the number of neurons in a column underneath a cortical surface area of 1 mm2, extending through all cortical layers (mm2-column) for 35 gyri (representing about 73% of the human cerebral cortex) based on the data of J.L. Conel (1939 to 1967). We corrected these data, derived from his measures of cortical neuronal packing density, somal breadth and height, and cortical layer thickness at postnatal ages 0, 1, 3, 6, 15, 24, 48, and 72 months, for shrinkage and stereological errors. In all 35 gyri, neuron number/mm2-column: (1) initially declines (mu = 46% decline, sigma = 8%), 95% of which is due to surface area expansion (mean age of nadir value = 15.8 months); (2) then increases to age 72 months by 70% (mu = 1.7-fold increase, (mu rate = 1.1% per month). Because of a a concomitant 1.3-fold increase in cortical surface from 15 to 72 months, total cortical neuron number increases 2.2-fold. The close agreement between neuron number/mm2-column for Conel's age 72-month data to the corresponding values reported by others for adult human and primate cortex using more modern methods suggests the finding is not an artifact. Neuronal proliferative fate-determining factors provide at least four mechanisms for increasing cortical neuron number postnatally, with or without DNA synthesis. PMID:9631564

  17. Syntax Score and Major Adverse Cardiac Events in Patients with Suspected Coronary Artery Disease: Results from a Cohort Study in a University-Affiliated Hospital in Southern Brazil

    PubMed Central

    Fuchs, Felipe C.; Ribeiro, Jorge P.; Fuchs, Flávio D.; Wainstein, Marco V.; Bergoli, Luis C.; Wainstein, Rodrigo V.; Zen, Vanessa; Kerkhoff, Alessandra C.; Moreira, Leila B.; Fuchs, Sandra C.

    2016-01-01

    Background: The importance of coronary anatomy in predicting cardiovascular events is well known. The use of traditional anatomical scores in routine angiography, however, has not been incorporated to clinical practice. SYNTAX score (SXscore) is a scoring system that estimates the anatomical extent of coronary artery disease (CAD). Its ability to predict outcomes based on a baseline diagnostic angiography has not been tested to date. Objective: To evaluate the performance of the SXscore in predicting major adverse cardiac events (MACE) in patients referred for diagnostic angiography. Methods: Prospective cohort of 895 patients with suspected CAD referred for elective diagnostic coronary angiography from 2008 to 2011, at a university-affiliated hospital in Brazil. They had their SXscores calculated and were stratified in three categories: no significant CAD (n = 495), SXscoreLOW-INTERMEDIATE: < 23 (n = 346), and SXscoreHIGH: ≥ 23 (n = 54). Primary outcome was a composite of cardiac death, myocardial infarction, and late revascularization. Secondary endpoints were the components of MACE and death from any cause. Results: On average, patients were followed up for 1.8 ± 1.4 years. The primary outcome occurred in 2.2%, 15.3%, and 20.4% in groups with no significant CAD, SXscoreLOW-INTERMEDIATE, and SXscoreHIGH, respectively (p < 0.001). All-cause death was significantly higher in the SXscoreHIGH compared with the 'no significant CAD' group, 16.7% and 3.8% (p < 0.001), respectively. After adjustment for confounding factors, all outcomes remained associated with the SXscore. Conclusions: SXscore independently predicts MACE in patients submitted to diagnostic coronary angiography. Its routine use in this setting could identify patients with worse prognosis. PMID:27509092

  18. Off-Pump CABG in a Patient with Dextrocardia Totalis: a Case Report.

    PubMed

    Dabbagh, Ali; Bolourian, Ali Asghar

    2011-01-01

    Coronary revascularization in patients with dextrocardia is not a common clinical condition. There are very few cases of off-pump coronary artery bypass. A 64-year-old woman was admitted to a university hospital due to exertional chest pain. Her primary diagnosis was coronary artery disease superimposed on dextrocardia, which was first suspected on physical examination, with the patient having right-sided heart sounds on auscultation. It was corroborated by chest X-ray. After diagnostic evaluations, including coronary angiography, she underwent off-pump coronary artery bypass grafting due to a significant left main coronary artery stenosis associated with dextrocardia. Two years later, multi-slice CT angiography revealed patent grafts, demonstrating good clinical results.

  19. Towards Projector-Based Visualization for Computer-Assisted CABG at the Open Heart

    NASA Astrophysics Data System (ADS)

    Hartung, Christine; Gnahm, Claudia; Sailer, Stefan; Schenderlein, Marcel; Friedl, Reinhard; Hoffmann, Martin; Dietmayer, Klaus

    Computer-assistance in coronary artery bypass grafting at the open heart with intraoperative navigation enables accurate placement of a bypass graft to a preoperatively planned anastomosis site. So far, navigation information were displayed on a monitor, requiring the operating surgeon to change focus from the monitor to the surgical site and vice versa during the navigation process. In this work, a mechanism is presented which is intended to enable the projection of registered preprocedural information directly onto the surface of the open heart. The method was tested on a heart phantom yielding good results.

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

    PubMed Central

    Piwkowski, Cezary; Zieliński, Paweł; Dyszkiewicz, Wojciech

    2016-01-01

    Video-assisted thoracic surgery (VATS) lobectomy has been proven to be a safe operation associated with a low complication rate and good long-term results comparable to those obtained by the thoracotomy approach. During the development of thoracoscopic anatomical lung cancer resections, eligibility criteria for the operation have been gradually extended. Currently, even as complicated cases as bronchial and vascular sleeve resections or pneumonectomies are being performed by VATS. However, minimally invasive surgery after previous coronary artery bypass graft surgery merits special consideration due to the consequences of potential injury to the bypass graft. This is particularly important in the case of VATS left upper lobectomy after left internal mammary artery grafting to the left anterior descending artery bypass. PMID:27212981

  1. NICE guidance for off-pump CABG: keep the pump primed.

    PubMed

    Pepper, John R

    2011-11-01

    Because of a desire to reduce the morbidity of a well-established and effective procedure for coronary artery disease, up to 30% of coronary bypass operations are being performed without the use of a heart-lung pump. Concerns remain about the quality of the coronary anastomoses and the completeness of revascularisation. Randomised trials have not disclosed the significant reduction in morbidity or mortality that the early enthusiasts had hoped for. Yet a number of non-randomised studies have shown clinical benefit with the avoidance of an extracorporeal circulation, but these studies have been criticised for potential bias in patient selection and management. Most surgeons have not yet adopted this technique and are waiting for more evidence.

  2. CT-Guided Thrombin Injection to Control Rapid Expansion of Ascending Aortic False Aneurysm 15 Months After Bentall-Bono Operation

    SciTech Connect

    Perek, Bartlomiej Urbanowicz, Tomasz; Zabicki, Bartosz; Puslecki, Mateusz; Juszkat, Robert; Jemielity, Marek

    2011-02-15

    We report a case of 57-year-old man treated emergently with CT-guided local thrombin injection as the first, life-saving step for control rapid expansion of the aortic pseudoaneurysm. Fifteen months earlier, he was operated on for ascending aortic true aneurysm and coronary artery disease. Upon admission, he had an anterior thoracic wall pulsatile tumor. Due to critical status, definite surgery was postponed and thrombin was injected close to the origin of pseudoaneurysm. It controlled successfully, bleeding from the ascending aorta and enabled the patient to survive the acute phase.

  3. Concentration of radiocesium in the wild Japanese monkey (Macaca fuscata) over the first 15 months after the Fukushima Daiichi nuclear disaster.

    PubMed

    Hayama, Shin-ichi; Nakiri, Sachie; Nakanishi, Setsuko; Ishii, Naomi; Uno, Taiki; Kato, Takuya; Konno, Fumiharu; Kawamoto, Yoshi; Tsuchida, Shuichi; Ochiai, Kazuhiko; Omi, Toshinori

    2013-01-01

    Following the massive earthquake that struck eastern Japan on March 11, 2011, a nuclear reactor core meltdown occurred at the Fukushima Daiichi Nuclear Power Plant, operated by Tokyo Electric Power Company, and was followed by the release of large amounts of radioactive materials. The objective of this study was to measure the concentration of radiocesium (134)Cs and (137)Cs in the muscle of Japanese monkeys (Macaca fuscata) inhabiting the forest area of Fukushima City and to determine the change in concentration over time as well as the relationship with the level of soil contamination. Cesium concentrations in the muscle of monkeys captured at locations with 100,000-300,000 Bq/m(2) were 6,000-25,000 Bq/kg in April 2011 and decreased over 3 months to around 1,000 Bq/kg. However, the concentration increased again to 2,000-3,000 Bq/kg in some animals during and after December 2011 before returning to 1,000 Bq/kg in April 2012, after which it remained relatively constant. This pattern of change in muscle radiocesium concentration was similar to that of the change in radiocesium concentration in atmospheric fallout. Moreover, the monkeys feed on winter buds and the cambium layer of tree bark potentially containing higher concentrations of radiocesium than that in the diet during the rest of the year. The muscle radiocesium concentration in the monkeys related significantly with the level of soil contamination at the capture locations.

  4. Quality of Interaction between At-Risk Infants and Caregiver at 12-15 Months is Associated with 3-Year Autism Outcome

    ERIC Educational Resources Information Center

    Wan, Ming Wai; Green, Jonathan; Elsabbagh, Mayada; Johnson, Mark; Charman, Tony; Plummer, Faye

    2013-01-01

    Background: Recent models of the early emergence of autism spectrum disorder (ASD) propose that infant intrinsic risk susceptibilities in behaviour may be amplified by interaction within the early social environment into an increasingly atypical developmental trajectory. This study examines whether 6- and 12-month parent-infant interactions in…

  5. A case report of emergency off-pump CABG in an aged patient with ACS renewing ventricular fibrillation.

    PubMed

    Masuhara, Hiroshi; Watanabe, Yoshinori; Shiono, Noritsugu; Kawasaki, Muneyasu; Yokomuro, Hiroki; Fujii, Takeshiro; Koyama, Nobuya

    2006-06-01

    An emergency off-pump coronary artery bypass (OPCAB) was performed successfully in an aged patient with acute coronary syndrome (ACS). The patient, an 80-year-old woman residing in a nursing home, suddenly lost consciousness during lunch. The electrocardiogram (ECG) showed ventricular fibrillation (Vf) but defibrillation successfully recovered the sinus rhythm. The patient was brought to our hospital as an emergency. She underwent emergency cardiac catheterization. Coronary angiography demonstrated severe three vessel disease with left main coronary trunk (LMT) stenosis. Even during intra-aortic balloon pumping (IABP), the hemodynamic state was unstable, with repeated development of ventricular tachycardia and fibrillation. An emergency coronary artery bypass without a cardiopulmonary bypass was performed. Saving her life was of primary importance and revascularization of the left anterior descending artery (LAD) branch, was performed. Thanks to the advances made in various devices, safe and reliable anastomoses have become possible in OPCAB applied to ACS. OPCAB for ACS have become safe and reliable anastomoses following development of various devices. We think that OPCAB is an effective surgical technique for coronary revascularization for emergency or serious cases involving elderly patients. PMID:16823341

  6. Heart bypass surgery

    MedlinePlus

    Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

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

    PubMed Central

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

    2014-01-01

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

  8. Diagnosis & Treatment | Coronary Artery Disease | NIH MedlinePlus the Magazine

    MedlinePlus

    ... to keep it open after angioplasty. Coronary artery bypass grafting (CABG) is a type of surgery that ... veins from other areas in your body to bypass your narrowed coronary arteries. CABG can improve blood ...

  9. A lethal tension pneumothorax during minimally invasive coronary artery bypass surgery: Can transesophageal echocardiography pick it?

    PubMed Central

    Agrawal, Dharmesh Radheshyam; Nambala, Sathyaki Purushottam

    2016-01-01

    Minimally invasive cardiac surgery is establishing itself as the standard of care across the world. MICS CABG is currently performed in only a few centers. Hemodynamics disturbances are peculiar during MICS CABG due to space constraints. We report a 70-year-old man who underwent MICS CABG who developed tension pneumothorax during revascularization that was diagnosed in a novel way. PMID:27716712

  10. Metastatic renal cell carcinoma-associated pleural effusion after coronary artery bypass grafting.

    PubMed

    Rowlands, Deborah M; Zasik, Joseph M; Reed, James F

    2004-05-01

    Pleural effusions after coronary artery bypass grafting (CABG) occur in up to 89% of patients undergoing the procedure. Effusions present days to months after surgery, and fluid characteristics relate to timing factors. Most of the effusions are left-sided and resolve spontaneously. Pleural effusions requiring treatment occur in a small percentage of patients who have undergone CABG. Post-CABG pleural effusions in temporal relation to malignant effusions are not widely reported. This report describes a 50-year-old man presenting with a malignant left-sided pleural effusion 3 months after CABG, with characteristics resembling a late post-CABG effusion.

  11. Mitral valve repair for ischemic moderate mitral regurgitation in patients undergoing coronary artery bypass grafting

    PubMed Central

    Toktas, Faruk; Yavuz, Senol; Ozsin, Kadir K.; Sanri, Umut S.

    2016-01-01

    Objectives: To investigate whether mitral valve repair (MVR) at the time of coronary artery bypass grafting (CABG) in patients with ischemic moderate mitral regurgitation (MR) and coronary artery disease could improve short- and mid-term postoperative outcomes. Methods: Between March 2013 and December 2015, 90 patients with moderate ischemic MR underwent first-time CABG in Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey. Out of 90 patients, 44 (48.9%) underwent combined CABG+MVR. The remaining 46 (51.1%) underwent CABG alone. Ventricular functions and effort capacities of patients in both groups were evaluated echocardiographically and clinically in the preoperative period, and in the first postoperative year. Results: Postoperative regurgitant volume changes according to preoperative values were -24.76±19 ml/beat in the combined CABG+MVR group, and -8.70±7.2 ml/beat in the CABG alone group (p=0.001). The change of vena contracta width was -3.40±0.2 mm in the combined CABG+MVR group whereas in the CABG alone -1.45±0.7 mm (p=0.019). The changes of left ventricular end-systolic volume index were -30.77±25.9 ml/m2 in the combined CABG+MVR group and -15.6±9.4 ml/m2 in the CABG alone group (p=0.096). Ejection fraction changes in the combined CABG+MVR group was +1.51±5.3% and in the CABG alone group was +1.15±4.3%. No statistically significant difference was found between both groups (p=0.604). Preoperative New York Heart Association class values in the combined CABG+MVR group was 2.18±0.45, and in the CABG alone group was 2.13±0.54. Conclusions: Moderate MR in patients undergoing CABG affects the outcome adversely and it does not reliably improve after CABG alone. Therefore, patients with ischemic moderate MR should undergo simultaneous MVR at the time of CABG. PMID:27464861

  12. Recovery of Left Ventricular Function After Percutaneous Coronary Intervention Compared to Coronary Artery Bypass Grafting in Patients with Multi-Vessel Coronary Disease and Left Ventricular Dysfunction

    PubMed Central

    Siu, Andrea M; Davis, James; Kao, John

    2016-01-01

    Recovery of left ventricular (LV) function after revascularization has been described for coronary artery bypass grafting (CABG); however, LV recovery after percutaneous coronary intervention (PCI), and how it compares to CABG has not been well described in the literature. The aim of this single center retrospective study was to evaluate LV recovery in patients with severely reduced LV function undergoing PCI compared to those undergoing CABG. Patients with LV ejection fraction (LVEF) < 40% and multivessel coronary artery disease (CAD) undergoing revascularization with either CABG (n=16) or PCI (n=176), and with 12 months of follow up data were included in the study. LVEF at baseline exhibited significant differences between PCI (28.5 ± 8.0) and CABG (24.2 ± 6.8) groups (P=.05). LVEF recovery at 6-month follow up showed no difference between PCI and CABG groups. LVEF recovery differences at one-year follow-up was significantly different between PCI (4.82) and CABG (15.25) groups (P=.005). Patients with severely reduced LV function undergoing multivessel PCI had a statistically significant increase in LVEF over time; however patients undergoing CABG demonstrated greater gains in LVEF over the same time period. Surgical revascularization with CABG may be a procedure of choice in patients with depressed LV function and multivessel CAD. PMID:27688953

  13. Recovery of Left Ventricular Function After Percutaneous Coronary Intervention Compared to Coronary Artery Bypass Grafting in Patients with Multi-Vessel Coronary Disease and Left Ventricular Dysfunction

    PubMed Central

    Siu, Andrea M; Davis, James; Kao, John

    2016-01-01

    Recovery of left ventricular (LV) function after revascularization has been described for coronary artery bypass grafting (CABG); however, LV recovery after percutaneous coronary intervention (PCI), and how it compares to CABG has not been well described in the literature. The aim of this single center retrospective study was to evaluate LV recovery in patients with severely reduced LV function undergoing PCI compared to those undergoing CABG. Patients with LV ejection fraction (LVEF) < 40% and multivessel coronary artery disease (CAD) undergoing revascularization with either CABG (n=16) or PCI (n=176), and with 12 months of follow up data were included in the study. LVEF at baseline exhibited significant differences between PCI (28.5 ± 8.0) and CABG (24.2 ± 6.8) groups (P=.05). LVEF recovery at 6-month follow up showed no difference between PCI and CABG groups. LVEF recovery differences at one-year follow-up was significantly different between PCI (4.82) and CABG (15.25) groups (P=.005). Patients with severely reduced LV function undergoing multivessel PCI had a statistically significant increase in LVEF over time; however patients undergoing CABG demonstrated greater gains in LVEF over the same time period. Surgical revascularization with CABG may be a procedure of choice in patients with depressed LV function and multivessel CAD.

  14. Surgical ventricular reconstruction has a role in surgical remodeling in patients with LV systolic dysfunction even post-STICH?

    PubMed

    Balsam, Leora B; Grossi, Eugene A

    2013-01-01

    The Hypothesis 2 arm of the STICH trial compared outcomes in ischemic cardiomyopathy patients undergoing CABG plus SVR vs. CABG alone. Although the trial results suggest equivalency of these therapies, important trial flaws have been identified which cast critical doubt regarding the generalizability of the trial findings.

  15. Depression and Geographic Status as Predictors for Coronary Artery Bypass Surgery Outcomes

    ERIC Educational Resources Information Center

    Dao, Tam K.; Chu, Danny; Springer, Justin; Hiatt, Emily; Nguyen, Quang

    2010-01-01

    Purpose: To examine the relationships between depression, geographic status, and clinical outcomes following a coronary artery bypass grafting (CABG) surgery. Methods: Using the 2004 Nationwide Inpatient Sample database, we identified 63,061 discharge records of patients who underwent a primary CABG surgery (urban 57,247 and rural 5,814). We…

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

    ClinicalTrials.gov

    2016-09-08

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

  17. Lower Extremity Compartment Syndrome After Coronary Artery Bypass: Easy to Miss Unless Suspected.

    PubMed

    Etra, Joanna W; Metkus, Thomas S; Whitman, Glenn J; Mandal, Kaushik

    2016-01-01

    Acute compartment syndrome after coronary artery bypass grafting (CABG) is a rare adverse event, and the diagnosis is challenging unless this condition is actively considered. We report a case from our institution of a patient with confounding presentation leading to a delayed diagnosis of compartment syndrome after CABG.

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

    PubMed

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

    2016-04-01

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

  19. Quality of Life in Patients of Different Age Groups before and after Coronary Artery By-Pass Surgery

    PubMed Central

    Jovanovic-Markovic, Snežana; Peric, Dejan; Rasic, Dragisa; Novakovic, Tatjana; Dejanovic, Bogdan; Borzanovic, Milorad

    2015-01-01

    Purpose: The study evaluates the changes in quality of life (QOL) six months after coronary artery bypass grafting (CABG) related to the patients’ age. Methods: The total of 243 consecutive patients completed the Nottingham Health Profile Questionnaire part 1 before and six months after CABG. Postoperative questionnaire was completed by 226 patients. Patients were divided into four examined groups (<50, 50–59, 60–69 and ≥70 years), according to their age. Results: Six months after CABG, the quality of life in different sections has been significantly improved in most patients.The analysis of the relation between the age and the changes in QOL of patients six months after CABG showed a significant correlation among the patients’ age and the improvement of QOL in the sections of physical mobility (r = 0.18, p = 0.008), social isolation (r = 0.17, p = 0.01) and energy ( r = 0.21, p = 0.002). The most prominent improvement was found in older patients. The age was not an independent predictor of QOL deterioration after CABG. Conclusions: The most noticeable improvement of QOL six months after CABG was found in older patients. Age is not the independent predictor of deterioration of QOL after CABG. PMID:26328597

  20. Cardiac rehabilitation and survival of dialysis patients after coronary bypass.

    PubMed

    Kutner, Nancy G; Zhang, Rebecca; Huang, Yijian; Herzog, Charles A

    2006-04-01

    Patients who are on renal dialysis are at high risk for cardiac death and have a large burden of cardiovascular disease and cardiovascular disease risk factors. Cardiac rehabilitation can promote improved survival of nondialysis patients after coronary artery bypass grafting (CABG) surgery and is covered by Medicare, but no previous studies have investigated whether dialysis patients' survival after CABG may be improved as a function of cardiac rehabilitation. A prospective cohort study was conducted using Medicare claims (1998 to 2002) for CABG and cardiac rehabilitation and patient information from the United States Renal Data System database for 6215 renal patients who initiated hemodialysis and underwent CABG between January 1, 1998, and December 31, 2002, with mortality follow-up to December 31, 2003. Cardiac rehabilitation was defined by Current Procedural Terminology codes for monitored and nonmonitored exercise in Medicare claims data. Dialysis patients who received cardiac rehabilitation after CABG had a 35% reduced risk for all-cause mortality and a 36% reduced risk for cardiac death compared with dialysis patients who did not receive cardiac rehabilitation, independent of sociodemographic and clinical risk factors, including recent hospitalization. Only 10% of patients received cardiac rehabilitation after CABG, compared with an estimated 23.4% of patients in the general population, and lower income patients of all ages as well as women and black patients who were aged 65+ were significantly less likely to receive cardiac rehabilitation services. This observational study suggests a survival benefit of cardiac rehabilitation for dialysis patients after CABG.

  1. Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate

    PubMed Central

    Prates, Paulo Roberto L.; Williams, Judson B.; Mehta, Rajendra H.; Stevens, Susanna R.; Thomas, Laine; Smith, Peter K.; Newby, L. Kristin; Kalil, Renato A. K.; Alexander, John H.; Lopes, Renato D.

    2016-01-01

    Introduction Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario. Objective Identify predictors of clopidogrel following CABG. Methods We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG. Results At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032). Conclusion Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG. PMID:27556308

  2. Impact of surgical ventricular reconstruction on sphericity index in patients with ischemic cardiomyopathy: follow-up from the STICH trial

    PubMed Central

    Choi, Jin-Oh; Daly, Richard C.; Lin, Grace; Lahr, Brian D.; Wiste, Heather J.; Beaver, Thomas M.; Iacovoni, Attilio; Malinowski, Marcin; Friedrich, Ivar; Rouleau, Jean L.; Favaloro, Roberto R.; Sopko, George; Lang, Irene M.; White, Harvey D.; Milano, Carmelo A.; Jones, Robert H.; Lee, Kerry L.; Velazquez, Eric J.; Oh, Jae K.

    2015-01-01

    Aims We sought to evaluate associations between baseline sphericity index (SI) and clinical outcome, and changes in SI after coronary artery bypass graft surgery (CABG) with or without surgical ventricular reconstruction (SVR) in ischemic cardiomyopathy patients enrolled in the SVR study (Hypothesis 2) of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Methods and results Among 1,000 patients in the STICH SVR study, we evaluated 546 patients (255 randomized to CABG alone and 291 to CABG+SVR) whose baseline SI values were available. SI was not significantly different between treatment groups at baseline. After 4 months, SI had increased in the CABG+SVR group, but was unchanged in the CABG alone group (0.69 ± 0.10 to 0.77 ± 0.12 versus 0.67 ± 0.07 to 0.66 ± 0.09, respectively; P < 0.001). SI did not significantly change from 4 months to 2 years in either group. Although LV end-systolic volume and ejection fraction improved significantly more in the CABG+SVR group compared to CABG alone, the severity of mitral regurgitation significantly improved only in the CABG alone group and estimated LV filling pressure (E/A ratio) increased only in the CABG+SVR group. Higher baseline SI was associated with worse survival after surgery (hazard ratio = 1.21, 95% confidence interval = 1.02−1.43; P = 0.026). Survival was not significantly different by treatment strategy. Conclusion Although SVR was designed to improve LV geometry, SI worsened after SVR despite improved LV ejection fraction and smaller LV volume. Survival was significantly better in patients with lower SI regardless of treatment strategy. (THE STICH TRIAL: Surgical Treatment for Ischemic Heart Failure trial; NCT00023595) PMID:25779355

  3. Time-driven activity-based costing of multivessel coronary artery bypass grafting across national boundaries to identify improvement opportunities: study protocol

    PubMed Central

    Erhun, F; Mistry, B; Platchek, T; Milstein, A; Narayanan, V G; Kaplan, R S

    2015-01-01

    Introduction Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease—a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32 201±$23 059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery. Methods and analysis We use time-driven activity-based costing (TDABC) to quantify the hospitals’ costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labour and non-labour resources utilised to perform each activity) with the unit cost of each resource used to provide the care. Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews. Unit costs were calculated as a capacity cost rate, measured as a $/min, for each resource consumed in CABG production. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost of CABG production at each site. We will conclude by conducting a variance analysis of labour costs to reveal opportunities to bend the cost curve for CABG production in the USA. Ethics and dissemination All our methods were exempted from review by the Stanford Institutional Review Board. Results will be published in peer-reviewed journals and presented at scientific meetings. PMID:26307621

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

    PubMed

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

    2016-04-01

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

  5. Revascularization in stable coronary artery disease: a combined perspective from an interventional cardiologist and a cardiac surgeon.

    PubMed

    Holmes, David R; Taggart, David P

    2016-06-21

    It is now half a century since the start of coronary bypass graft surgery (CABG) with the first percutaneous coronary intervention (PCI) following just over a decade later. The relative merits of PCI vs. CABG for stable coronary artery disease (stable-CAD) have continued to be debated ever since and have been the focus of around 20 randomized trials and numerous registry studies, systematic reviews, and meta-analyses. The aim of this review is to identify areas of agreement, disagreement, and uncertainties in the role of PCI and CABG in patients with stable-CAD. PMID:26994152

  6. The history of arterial revascularization: from Kolesov to Tector and beyond

    PubMed Central

    Galvin, Sean D.

    2013-01-01

    Coronary artery bypass grafting (CABG) is the one of the most effective revascularization strategies for patients with obstructive coronary artery disease. Total arterial revascularization using one or both internal thoracic and radial arteries has been shown to improve early outcomes and reduce long-term cardiovascular morbidity. Although CABG has evolved from an experimental procedure in the early 1900’s to become one of the most commonly performed surgical procedures, there is still significant variation in grafting strategies amongst surgeons. We review the history and development of CABG with a particular emphasis on the early pioneers and the evolution of arterial grafting. PMID:23977617

  7. Current State of Surgical Myocardial Revascularization

    PubMed Central

    Sellke, Frank W.; Chu, Louis M.; Cohn, William E.

    2016-01-01

    Despite increasing competition from percutaneous interventions and other novel methods of non-surgical coronary revascularization, coronary artery bypass grafting (CABG) remains one of the most definitive and durable treatments for coronary artery disease, especially for those patients with extensive and diffuse disease. In recent years the CABG procedure itself has undergone innovation and evolution. This review article provides a brief historical perspective on the procedure, and examines the current state of modern variations including off-pump, limited-access, and robotic-assisted CABG. PMID:20467145

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

    PubMed Central

    Chedrawy, Edgar G.

    2014-01-01

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

  9. Short- and Long-Term Patient Outcomes From Combined Coronary Endarterectomy and Coronary Artery Bypass Grafting

    PubMed Central

    Wang, Jiayang; Gu, Chengxiong; Yu, Wenyuan; Gao, Mingxin; Yu, Yang

    2015-01-01

    Abstract This meta-analysis aimed to compare the short- and long-term outcomes in patients undergoing combined coronary endarterectomy and coronary artery bypass grafting (CE + CABG) versus isolated CABG, and particularly to examine subgroup patients with high-risk profile and patients with diffuse disease in the left anterior descending artery (LAD). Studies published between January 1, 1970 and May 31, 2015 were searched in the literature databases, including Ovid Medline, Embase, PubMed, and ISI Web of Science. A total of 30 eligible studies including 63,730 patients were analyzed. Five authors extracted data from the included studies independently. Meta-analysis on the total patients revealed that CE + CABG was associated with significantly increased 30-day postoperative all-cause mortality compared with isolated CABG (OR = 1.86, 95% CI: 1.66–2.08, z = 10.99, P < 0.0001). Subgroup analysis on patients with high-risk profile and patients with diffuse disease in the LAD showed that 30-day mortality after CE + CABG was 2.6 folds (OR = 2.60, 95% CI: 1.39–4.86, z = 2.99, P = 0.003) and 3.93 folds (OR = 3.93, 95% CI: 1.40–11.0, z = 2.60, P = 0.009) of that after isolated CABG in the respective subgroup. In contrast, the mortality was comparable in CE + off-pump CABG and CE + on-pump CABG groups (OR = 0.53, 95% CI: 0.18–1.55, z = 1.16, P = 0.248). In addition, the incidences of perioperative myocardial infarction (MI) and 30-day postoperative complications, including low output syndrome (LOS), MI, ventricular tachycardia (VT), and renal dysfunction after CE + CABG were significantly higher than those after isolated CABG (all P < 0.05). In high-risk patient subgroup, CE + CABG significantly increased the incidences of postoperative LOS, MI, and renal function compared with isolated CABG (all P < 0.05). The incidence of perioperative myocardial after CE + CABG was 2.86 and 2.92 times of that after isolated

  10. Dual Antiplatelet Therapy after Coronary Artery Bypass Graft Surgery: A Review.

    PubMed

    Soomro, Hala; Aleem, Salik; Alam, Ali; Qadeer, Mohammad Ali; Essam, Nabeeha; Siddiqui, Anas Ahmed; Mansuri, Muhammad Fasih; Fatima, Huda; Raza, Ali; Sultan, Ayyaz Alam; Jameel, Rohail; Begg, Maha; Khan, Maaz Hasan; Musharraf, Muhammad Bazil; Burhan, Arbab; Lashari, Muhammad Nawaz

    2016-01-01

    Coronary artery bypass graft surgery (CABG) is the gold standard treatment for relieving angina symptoms and reducing mortality among ischemic heart disease patients. As post-operative thrombosis of the grafts has been a frequent complication of CABG, antiplatelet therapy remains essential to maintain graft patency. Since a long time, aspirin has been used as a single anti-platelet agent post CABG. However, in some high risk patients aspirin alone is insufficient in preventing graft occlusion. Therefore, dual antiplatelet therapy involving aspirin plus clopidogrel is becoming increasingly popular. Aspirin plus clopidogrel therapy has proved to be highly efficacious in patients with acute coronary syndrome; however, its role in patients after CABG has remained unclear. In this review, we outline the effects of dual antiplatelet therapy involving aspirin plus clopidogrel with respect to graft patency, post-operative angina/myocardial infarction, major bleeding event and mortality. PMID:27530557

  11. Depression following coronary artery bypass grafting surgery revisited.

    PubMed

    Pourafkari, Nosratollah; Pourafkari, Leili; Nader, Nader D

    2016-09-01

    Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure. Depression is a frequent comorbidity in patients with ischemic heart disease that can affect the course of the disease and the process of recovery after CABG. Depression after CABG is more common in women and is an independent predictor of mortality in long-term. However, fewer than half of cardiologists ask about depression symptoms in their patients, and with screening measures not being routinely utilized, depression remains under-recognized in this patient population. Treatment of depression in patients with ischemic heart disease can be challenging, considering unwanted medication side effects and interactions. The present report is a review of risk factors, prognosis, prevention, and treatment of depression in patients following CABG. PMID:27665338

  12. Bypass graft imaging and coronary anomalies in MDCT.

    PubMed

    Fernandez, Gabriel C

    2005-02-01

    Coronary artery bypass graft (CABG) is used to restore the blood flow in an ischemic area of myocardium using conduits bypassing a diseased coronary artery. Until now, conventional angiography has been the recognized technique to study patients with bypass grafts. Nowadays, non-invasive methods such as multi-detector CT (MDCT) emerge as reliable imaging methods in the study of CABG. Thus, radiologists play an important role in this field, not only to define if the bypass graft is occluded or stenosed but also to report further information such as CABG technique performed, type of conduit used or pre-operative findings. This paper analyzes the most practical information that the radiologist must know in a study of CABG. Another theme which will be briefly described is the use of MDCT in coronary anomalies studies, with particular emphasis on the course of the abnormal vessel and its relation to great vessels. PMID:15801059

  13. Emergency coronary artery bypass grafting for cardiogenic shock due to left main coronary artery obstruction caused by Kawasaki disease in a 4-year-old boy.

    PubMed

    Tamaki, Wataru; Tsuda, Etsuko; Nakajima, Hiroyuki; Kobayashi, Junjiro; Shiono, Junko

    2014-04-01

    We describe the case of a 4-year-old boy whose clinical course after Kawasaki disease resulted in coronary artery bypass grafting (CABG) due to acute myocardial infarction (AMI) causing cardiogenic shock. He had developed an ischemic cardiomyopathy due to severe localized stenosis of the left main coronary artery (LCA) and went into cardiogenic shock due to AMI on the day before a scheduled operation. He underwent successful emergency CABG within 4 h of MI. Postoperatively his neurological status was intact. This is the first report of a successful emergency CABG in a small child with cardiogenic shock due to LCA occlusion. CABG should be undertaken in small patients when appropriate indications exist, if bodyweight is >10 kg.

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

    PubMed

    Yuan, Xin; Sun, Hansong; Wang, Xianqiang

    2015-08-01

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

  15. Does coronary artery bypass grafting improve quality of life in elderly patients?

    PubMed

    Baig, Kamran; Harling, Leanne; Papanikitas, Joseph; Attaran, Saina; Ashrafian, Hutan; Casula, Roberto; Athanasiou, Thanos

    2013-09-01

    Traditional outcome measures such as long-term mortality may be of less value than symptomatic improvement in elderly patients undergoing coronary artery bypass grafting (CABG). In this systematic review, we analyse health-related quality of life (HRQOL) as a marker of outcome after CABG. We aimed to assess the role of HRQOL tools in making recommendations for elderly patients undergoing surgery, where symptomatic and quality-of-life improvement may often be the key indications for intervention. Twenty-three studies, encompassing 4793 patients were included. Overall, elderly patients underwent CABG at reasonably low risk. Our findings, therefore, support the conclusion that performing CABG in the elderly may be associated with significant improvements in HRQOL. In order to overcome previous methodological limitations, future work must clearly define and stringently follow-up this elderly population, to develop a more robust, sensitive and specialty-specific HRQOL tool.

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

    NASA Astrophysics Data System (ADS)

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

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

  17. Individual Differences in Infants' Joint Attention Behaviors with Mother and a New Social Partner

    ERIC Educational Resources Information Center

    Meins, Elizabeth; Fernyhough, Charles; Arnott, Bronia; Vittorini, Lucia; Turner, Michelle; Leekam, Susan R.; Parkinson, Kathryn

    2011-01-01

    Relations between infant-mother attachment security at 15 months and infants' (N = 206) joint attention behaviors (a) with an experimenter at 8 and 15 months, and (b) with their mothers at 15 months were investigated. No concurrent or longitudinal relations were observed between attachment security and infants' tendency to respond to an…

  18. Challenges in predicting the need for coronary artery bypass grafting at presentation in patients with non-ST-segment elevation acute coronary syndromes.

    PubMed

    Mehta, Rajendra H; Chen, Anita Y; Pollack, Charles V; Roe, Matthew T; Zalenski, Robert J; Clements, Elizabeth A; Gibler, W Brian; Ohman, E Magnus; Harrington, Robert A; Peterson, Eric D

    2006-09-01

    In the case of non-ST-segment elevation acute coronary syndromes (NSTE-ACSs), the acute use of certain antiplatelet agents is complicated by concerns about perioperative bleeding risks in patients requiring coronary artery bypass grafting (CABG) during the index hospitalization. As a result, clinicians often withhold potentially useful agents, such as clopidogrel, before determining patients' coronary anatomy. An accurate predictive model could allow for a better balance of this safety concern with the demonstrated benefits of agents such as clopidogrel. To create an accurate decision-making tool that would assess, at hospital presentation, the need for CABG in patients with NSTE-ACSs, we studied 61,974 high-risk patients with NSTE-ACS admitted to 311 CABG-capable hospitals participating in Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) from 2001 to 2003. A total of 8,395 patients (14%) underwent CABG during their initial hospital stay. A multivariate model was developed and identified 13 presenting clinical characteristics significantly associated with the likelihood of CABG (previous CABG, male gender, previous heart failure, diabetes, hyperlipidemia, renal insufficiency, ST depression and transient ST elevation, age > or = 75 years, previous percutaneous coronary intervention, family history of coronary artery disease, hypertension, trends in CABG rates, and previous stroke). This model had only modest predictive accuracy and calibration (c-index = 0.67). In conclusion, although certain presenting clinical features are associated with an increased likelihood of CABG in patients with NSTE-ACSs during the index hospitalization, it remains difficult to reliably identify, before diagnostic angiography, those who will subsequently undergo surgical revascularization. PMID:16923449

  19. Bleeding Outcomes in Patients Given Clopidogrel Within 5 Days of Robotic Coronary Artery Bypass Graft Procedure

    PubMed Central

    Vainrub, Sophia; Patanwala, Asad E.; Cosgrove, Richard; Poston, Robert; Nolan, Paul E.

    2014-01-01

    Background Current guidelines recommend that clopidogrel should be held for 5 days prior to coronary artery bypass graft (CABG) procedure. However, it is unknown if this recommendation should apply to robotic-assisted (rCABG), which is less invasive because it does not involve sternotomy and thus reduces the risk of bleeding. Objective To compare postoperative bleeding for rCABG patients who were taking clopidogrel within 5 days of the procedure with those who were not taking clopidogrel. Methods This was a retrospective cohort study conducted between January 1, 2012 and December 31, 2012 of consecutive patients undergoing rCABG. Patients were categorized into 2 groups based on whether or not clopidogrel was administered within 5 days prior to the date of surgery. The primary outcome measure was the occurrence of the Bleeding Academic Research Consortium (BARC) definition for CABG-related bleeding. The secondary outcome measure was a comparison of chest tube output during the first 24-hour postoperative period. Results A total of 136 rCABG patients were included in the final analyses. Of these, 39 (29%) received clopidogrel within 5 days of surgery. CABG-related bleeding using the BARC definition occurred in 26% of patients who received clopidogrel and 8% of patients who did not (P = .011). Median chest tube output during the first 24-hour postoperative period was also greater in patients who received clopidogrel (900 vs 735 mL, P = .002). Conclusions The use of clopidogrel within 5 days of rCABG is associated with greater postoperative bleeding and chest tube output, as defined by the BARC criteria. PMID:24259636

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

    SciTech Connect

    Takeishi, Y.; Tono-oka, I.; Kubota, I.; Ikeda, K.; Masakane, I.; Chiba, J.; Abe, S.; Tsuiki, K.; Komatani, A.; Yamaguchi, I. )

    1991-09-01

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

  1. Knowledge Management in Cardiac Surgery: The Second Tehran Heart Center Adult Cardiac Surgery Database Report

    PubMed Central

    Abbasi, Kyomars; Karimi, Abbasali; Abbasi, Seyed Hesameddin; Ahmadi, Seyed Hossein; Davoodi, Saeed; Babamahmoodi, Abdolreza; Movahedi, Namdar; Salehiomran, Abbas; Shirzad, Mahmood; Bina, Peyvand

    2012-01-01

    Background: The Adult Cardiac Surgery Databank (ACSD) of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data. Methods: All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period. Results: There were 24959 procedures performed: 19663 (78.8%) isolated coronary artery bypass grafting surgeries (CABGs); 1492 (6.0%) isolated valve surgeries; 1437 (5.8%) CABGs concomitant with other procedures; 832 (3.3%) CABGs combined with valve surgeries; 722 (2.9%) valve surgeries concomitant with other procedures; 545 (2.2%) surgeries other than CABG or valve surgery; and 267 (1.1%) CABGs concomitant with valve and other types of surgery. The overall mortality was 205 (1.04%), with the lowest mortality rate (0.47%) in the isolated CABGs and the highest (4.49%) in the CABGs concomitant with valve surgeries and other types of surgery. Meanwhile, the overall mortality rate was higher in the female patients than in the males (1.90% vs. 0.74%, respectively). Conclusion: Isolated CABG was the most prevalent procedure at our center with the lowest mortality rate. However, the overall mortality was more prevalent in our female patients. This database can serve as a platform for the participation of the other countries in the region in the creation of a regional ACSD. PMID:23304179

  2. The Right Gastroepiploic Artery Graft for Coronary Artery Bypass Grafting: A 30-Year Experience

    PubMed Central

    Suma, Hisayoshi

    2016-01-01

    Throughout its 30-year history, the right gastroepiploic artery (GEA) has been useful for in situ grafts in coronary artery bypass grafting (CABG). The early graft patency rate is high, and the late patency rate has improved by using the skeletonized GEA graft and proper target selection, which involves having a target coronary artery with a tight >90% stenosis. Total arterial revascularization with the internal thoracic artery and GEA grafts is an option for achieving better outcomes from CABG procedures. PMID:27525230

  3. Cost-Effectiveness of Percutaneous Coronary Intervention with Drug Eluting Stents versus Bypass Surgery for Patients with Diabetes and Multivessel Coronary Artery Disease: Results from the FREEDOM Trial

    PubMed Central

    Magnuson, Elizabeth A.; Farkouh, Michael E.; Fuster, Valentin; Wang, Kaijun; Vilain, Katherine; Li, Haiyan; Appelwick, Jaime; Muratov, Victoria; Sleeper, Lynn A.; Boineau, Robin; Abdallah, Mouin; Cohen, David J.

    2013-01-01

    Background Studies from the balloon angioplasty and bare metal stent eras have demonstrated that CABG is cost-effective compared with PCI for patients undergoing multivessel coronary revascularization—particularly among patients with complex CAD or diabetes. Whether these results apply in the drug-eluting stent (DES) era is unknown. Methods and Results Between 2005 and 2010, 1900 patients with diabetes and multivessel CAD were randomized to PCI with DES (DES-PCI; n=953) or CABG (n=947). Costs were assessed from the perspective of the U.S. health care system. Health state utilities were assessed using the EuroQOL. A patient-level microsimulation model based on U.S. life-tables and in-trial results was used to estimate lifetime cost-effectiveness. Although initial procedural costs were lower for CABG, total costs for the index hospitalization were $8,622/patient higher. Over the next 5 years, follow-up costs were higher with PCI, owing to more frequent repeat revascularization and higher outpatient medication costs. Nonetheless, cumulative 5-year costs remained $3,641/patient higher with CABG. Although there were only modest gains in survival with CABG during the trial period, when the in-trial results were extended to a lifetime horizon, CABG was projected to be economically attractive relative to DES-PCI, with substantial gains in both life expectancy and quality-adjusted life expectancy and incremental cost-effectiveness ratios <$10,000 per life-year or quality-adjusted life-year gained across a broad range of assumptions regarding the effect of CABG on post-trial survival and costs. Conclusions Despite higher initial costs, CABG is a highly cost-effective revascularization strategy compared with DES-PCI for patients with diabetes and multivessel CAD. PMID:23277307

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

    PubMed Central

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

    2016-01-01

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

  5. Exercise Capacity and Mortality in Patients with Ischemic Left Ventricular Dysfunction Randomized to Coronary Artery Bypass Surgery or Medical Therapy: An Analysis From the Surgical Treatment for Ischemic Heart Failure (STICH) Trial

    PubMed Central

    Stewart, Ralph; Szalewska, Dominika; She, Lilin; Lee, Kerry L.; Drazner, Mark H.; Lubiszewska, Barbara; Kosevic, Dragana; Ruengsakulrach, Permyos; Nicolau, José C.; Coutu, Benoit; Choudhary, Shiv K.; Mark, Daniel B.; Cleland, John G.F.; Piña, Ileana L.; Velazquez, Eric J.; Rynkiewicz, Andrzej; White, Harvey

    2014-01-01

    Objective To assess the prognostic significance of exercise capacity in patients with ischemic left ventricular (LV) dysfunction eligible for coronary artery bypass surgery (CABG). Background Poor exercise capacity is associated with mortality, but it is not known how this influences the benefits and risks of CABG compared to medical therapy. Methods In an exploratory analysis physical activity was assessed by questionnaire and 6-minute walk test in 1,212 patients before randomization to CABG (n=610) or medical management (n=602) in the STICH trial. Mortality (n=462) was compared by treatment allocation during 56 (IQR 48 to 68) months follow-up for subjects able (n=682) and unable (n=530) to walk 300m in 6 minutes and with less (Physical Ability Score >55, n= 749) and more (PAS ≤55, n=433) limitation by dyspnea or fatigue. Results Compared to medical therapy mortality was lower for patients randomized to CABG who walked ≥300m (HR 0.77, 95% CI 0.59 to 0.99, p=0.038) and those with a PAS >55 (HR 0.79, 95% CI 0.62 to 1.01, p=0.061). Patients unable to walk 300m or with a PAS ≤55 had higher mortality during the first 60 days with CABG (HR 3.24, 95% CI 1.64 to 6.83, p=0.002) and no significant benefit from CABG during total follow-up (HR 0.95, 95% CI 0.75 to 1.19, p=0.626, interaction p=0.167). Conclusion These observations suggest that patients with ischemic LV dysfunction and poor exercise capacity have increased early risk, and similar 5 year mortality with CABG compared to medical therapy, while those with better exercise capacity have improved survival with CABG. PMID:25023813

  6. Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting.

    PubMed

    Tanaka, Akihito; Ishii, Hideki; Oshima, Hideki; Shibata, Yohei; Tatami, Yosuke; Osugi, Naohiro; Ota, Tomoyuki; Kawamura, Yoshihiro; Suzuki, Susumu; Usui, Akihiko; Murohara, Toyoaki

    2016-07-01

    Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts.

  7. Combining carotid endarterectomy with off-pump coronary artery bypass graft surgery is safe and effective

    PubMed Central

    Garg, Arun; Bansal, Atma Ram; Singh, Dilip; Mishra, Manisha; Sharma, Pooja; Kasliwal, Ravi Ratan; Trehan, Naresh

    2015-01-01

    Background: We, as neurologists, are frequently consulted to give neurological clearance for surgery in patients who are undergoing coronary artery bypass graft (CABG) surgery and have suffered from stroke or transient ischemic attack (TIA) in past. Similarly clearance is also sought in another group of patients who, though have not suffered from stroke or TIA, but found to have significant carotid stenosis on routine screening prior to surgery. Cardiac surgeons and anesthetists want to know the risk of perioperative stroke in such patients and should carotid endarterectomy (CEA) be done along with CABG. In absence of any clear-cut guideline, neurologists often fail to give any specific recommendation. Aim: To find out safety and efficacy of synchronous CEA in patients undergoing CABG. Design: Retrospective study. Materials and Methods: Out of 3,700 patients who underwent CABG, 150 were found to have severe carotid stenosis of >70%. Out of this, 46 patients with >80% stenosis (three symptomatic and 43 asymptomatic) and one patient with >70% symptomatic carotid stenosis (TIA within last 2 weeks) were taken for simultaneous CEA along with CABG. These three symptomatic carotid patients had suffered from stroke within last 6 months. Results: One patient with asymptomatic near total occlusion of carotid artery suffered from hyperperfusion syndrome. None suffered from ischemic stroke, myocardial infarction (MI), or death during perioperative period. Conclusion: Combining CEA along with CABG is a safe and effective procedure. PMID:26713014

  8. Adverse Cardiovascular Outcomes associated with Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention with Everolimus Eluting Stents: A Meta-Analysis

    PubMed Central

    Bundhun, Pravesh Kumar; Pursun, Manish; Teeluck, Abhishek Rishikesh; Bhurtu, Akash; Soogund, Mohammad Zafooruddin Sani; Huang, Wei-Qiang

    2016-01-01

    This study aimed to compare the mid-term adverse cardiovascular outcomes associated with Coronary Artery Bypass Surgery (CABG) and Percutaneous Coronary Intervention (PCI) with Everolimus Eluting Stents (EES). Electronic databases were searched for studies comparing the mid-term (>1 year) adverse cardiovascular outcomes between CABG and PCI with EES. Odd Ratios (OR) with 95% Confidence Intervals (CIs) were calculated and the pooled analyses were performed with RevMan 5.3 software. A total number of 5207 patients were involved in this analysis. No significant difference was observed in mortality between CABG and EES with OR: 0.90, 95% CI: 0.73–1.10; P = 0.30. Moreover, CABG was associated with a high stroke rate, with OR: 0.73, 95% CI: 0.45–1.17; P = 0.19, without any statistical significant. CABG was associated with significantly lower Major Adverse Cardiac Events and Myocardial Infarction with OR: 1.46, 95% CI: 1.05–2.04; P = 0.03 and OR: 1.46, 95% CI: 1.01–2.12; P = 0.05 respectively whereas PCI was associated with a significantly higher repeated revascularization with OR: 2.21; 95% CI: 1.76–2.77; P = 0.00001. In conclusion, significant differences were noted in several subgroups analyzing the mid-term cardiovascular outcomes between CABG and EES. PMID:27775055

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

    PubMed Central

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

    2014-01-01

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

  10. Widening clinical applications of the SYNTAX Score.

    PubMed

    Farooq, Vasim; Head, Stuart J; Kappetein, Arie Pieter; Serruys, Patrick W

    2014-02-01

    The SYNTAX Score (http://www.syntaxscore.com) has established itself as an anatomical based tool for objectively determining the complexity of coronary artery disease and guiding decision-making between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Since the landmark SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) Trial comparing CABG with PCI in patients with complex coronary artery disease (unprotected left main or de novo three vessel disease), numerous validation studies have confirmed the clinical validity of the SYNTAX Score for identifying higher-risk subjects and aiding decision-making between CABG and PCI in a broad range of patient types. The SYNTAX Score is now advocated in both the European and US revascularisation guidelines for decision-making between CABG and PCI as part of a SYNTAX-pioneered heart team approach. Since establishment of the SYNTAX Score, widening clinical applications of this clinical tool have emerged. The purpose of this review is to systematically examine the widening applications of tools based on the SYNTAX Score: (1) by improving the diagnostic accuracy of the SYNTAX Score by adding a functional assessment of lesions; (2) through amalgamation of the anatomical SYNTAX Score with clinical variables to enhance decision-making between CABG and PCI, culminating in the development and validation of the SYNTAX Score II, in which objective and tailored decisions can be made for the individual patient; (3) through assessment of completeness of revascularisation using the residual and post-CABG SYNTAX Scores for PCI and CABG patients, respectively. Finally, the future direction of the SYNTAX Score is covered through discussion of the ongoing development of a non-invasive, functional SYNTAX Score and review of current and planned clinical trials.

  11. Time trends in coronary revascularization procedures among people with COPD: analysis of the Spanish national hospital discharge data (2001–2011)

    PubMed Central

    de Miguel-Díez, Javier; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; Carrasco-Garrido, Pilar; Bueno, Héctor; Puente-Maestu, Luis; Jimenez-Trujillo, Isabel; Alvaro-Meca, Alejandro; Esteban-Hernandez, Jesús; de Andrés, Ana López

    2015-01-01

    Background People with COPD suffering from coronary artery disease are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of these procedures in COPD and non-COPD patients in Spain between 2001 and 2011. Methods We identified all patients who had undergone percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped into: COPD and no COPD. Results From 2001 to 2011, 428,516 PCIs and 79,619 CABGs were performed. The sex and age-adjusted use of PCI increased by 21.27% per year from 2001 to 2004 and by 5.47% per year from 2004 to 2011 in patients with COPD. In-hospital mortality (IHM) among patients with COPD who underwent a PCI increased significantly from 2001 to 2011 (odds ratio 1.11; 95% confidence interval 1.03–1.20). Among patients with COPD who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 9.77% per year from 2001 to 2003, and then decreased by 3.15% through 2011. The probability of dying during hospitalization in patients who underwent a CABG did not change significantly in patients with and without COPD (odds ratio, 1.06; 95% confidence interval 0.96–1.17). Conclusion The annual percent change in PCI procedures increased in COPD and non-COPD patients. We found a decrease in the use of CABG procedures in both groups. IHM was higher in patients with COPD who underwent a PCI than in those without COPD. However, COPD did not increase the probability of dying during hospitalization in patients who underwent a CABG. PMID:26543361

  12. Abnormal Motion of the Interventricular Septum after Coronary Artery Bypass Graft Surgery: Comprehensive Evaluation with MR Imaging

    PubMed Central

    Choi, Seong Hoon; Chun, Eun Ju; Chang, Huk-Jae; Park, Kay-Hyun; Lim, Cheong; Kim, Shin-Jae; Kang, Joon-Won; Lim, Tae-Hwan

    2010-01-01

    Objective To define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques. Materials and Methods Eighteen patients (mean age, 58 ± 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group. Results All patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non-ASM group (2.1±5.3 mm vs. 14.9±4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8±4.5 mm vs. 2.1±5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89±5.41 vs. -15.41±3.7, p < 0.05) Conclusion Abnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium. PMID:21076588

  13. Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy

    PubMed Central

    Velazquez, Eric J.; Lee, Kerry L.; Jones, Robert H.; Al-Khalidi, Hussein R.; Hill, James A.; Panza, Julio A.; Michler, Robert E.; Bonow, Robert O.; Doenst, Torsten; Petrie, Mark C.; Oh, Jae K.; She, Lilin; Moore, Vanessa L.; Desvigne-Nickens, Patrice; Sopko, George; Rouleau, Jean L.

    2016-01-01

    BACKGROUND The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear. METHODS From July 2002 to May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to undergo CABG plus medical therapy (CABG group, 610 patients) or medical therapy alone (medical-therapy group, 602 patients). The primary outcome was death from any cause. Major secondary outcomes included death from cardiovascular causes and death from any cause or hospitalization for cardiovascular causes. The median duration of follow-up, including the current extended-follow-up study, was 9.8 years. RESULTS A primary outcome event occurred in 359 patients (58.9%) in the CABG group and in 398 patients (66.1%) in the medical-therapy group (hazard ratio with CABG vs. medical therapy, 0.84; 95% confidence interval [CI], 0.73 to 0.97; P = 0.02 by log-rank test). A total of 247 patients (40.5%) in the CABG group and 297 patients (49.3%) in the medical-therapy group died from cardiovascular causes (hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P = 0.006 by log-rank test). Death from any cause or hospitalization for cardiovascular causes occurred in 467 patients (76.6%) in the CABG group and in 524 patients (87.0%) in the medical-therapy group (hazard ratio, 0.72; 95% CI, 0.64 to 0.82; P<0.001 by log-rank test). CONCLUSIONS In a cohort of patients with ischemic cardiomyopathy, the rates of death from any cause, death from cardiovascular causes, and death from any cause or hospitalization for cardiovascular causes were significantly lower over 10 years among patients who underwent CABG in addition to receiving medical therapy than among those who received medical therapy alone. (Funded by the National Institutes of

  14. Optimism measured pre-operatively is associated with reduced pain intensity and physical symptom reporting after coronary artery bypass graft surgery

    PubMed Central

    Ronaldson, Amy; Poole, Lydia; Kidd, Tara; Leigh, Elizabeth; Jahangiri, Marjan; Steptoe, Andrew

    2014-01-01

    Objective Optimism is thought to be associated with long-term favourable outcomes for patients undergoing coronary artery bypass graft (CABG) surgery. Our objective was to examine the association between optimism and post-operative pain and physical symptoms in CABG patients. Methods We assessed optimism pre-operatively in 197 adults undergoing CABG surgery, and then followed them up 6–8 weeks after the procedure to measure affective pain, pain intensity, and physical symptom reporting directly pertaining to CABG surgery. Results Greater optimism measured pre-operatively was significantly associated with lower pain intensity (β = − 0.150, CI = − 0.196 to − 0.004, p = .042) and fewer physical symptoms following surgery (β = − 0.287, CI = − 0.537 to − 0.036, p = .025), but not with affective pain, after controlling for demographic, clinical and behavioural covariates, including negative affectivity. Conclusions Optimism is a modest, yet significant, predictor of pain intensity and physical symptom reporting after CABG surgery. Having positive expectations may promote better recovery. PMID:25129850

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

    PubMed

    Ghista, Dhanjoo N; Kabinejadian, Foad

    2013-01-01

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

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

    PubMed Central

    2013-01-01

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

  17. Hemodynamic Responses to Etomidate Versus Ketamine-Thiopental Sodium Combination for Anesthetic Induction in Coronary Artery Bypass Graft Surgery Patients with Low Ejection Fraction: A Double-Blind, Randomized, Clinical Trial

    PubMed Central

    Habibi, Mohammad Reza; Soleimani, Aria; Zeydi, Amir Emami; Nia, Hamid Sharif; Habibi, Ali; Onagh, Naser

    2014-01-01

    Background: During induction of anesthesia and intubation, hemodynamic changes are very important; especially in patients with coronary artery disease (CAD) and left ventricular dysfunction. A little information is available on the hemodynamic effects of a combination of ketamine-thiopental for induction of anesthesia in patients undergoing coronary artery bypass graft (CABG) surgery, with impaired ventricular function. Aim: The aim of this study was to compare the hemodynamic responses to etomidate versus ketamine-thiopental sodium combination for anesthetic induction in CABG surgery patients with low ejection fraction (EF<45%). Materials and Methods: In a double blind randomized clinical trial, a total of 100 patients, scheduled for elective CABG surgery were randomly assigned into two groups. These patients received either etomidate or ketamine-thiopental sodium combination at induction of anesthesia. Hemodynamics variable were measured and recorded at baseline, immediately before and after laryngoscopy and intubation, one, two and three minutes after intubation. Also, muscle twitching incidence among patients in two groups was evaluated. Results: No significant differences between the two groups regarding the changes of hemodynamic variables including systolic and diastolic arterial blood pressure, mean arterial pressure and heart rate, were notice (p>0.05). Muscle twitching was not observed in the two groups. Conclusion: Hemodynamic stability after administration of ketamine-thiopental sodium combination for induction of anesthesia in patients undergoing CABG surgery, with impaired ventricular function, supports the clinical impression that this combination is safe in CABG surgery patients with low EF. PMID:25478364

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

    PubMed Central

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

    2015-01-01

    Background: For coronary artery bypass grafting (CABG) sternotomy should be performed. The pain after surgery is severe and requires medical intervention. Use of the analgesics is limited by their side effects and studies suggest that prevention with some medications before surgery is effective in controlling the postoperative pain. Objectives: We investigated the efficacy of pregabalin administration before surgery in the treatment of acute postoperative pain after CABG surgery. Patients and Methods: Sixty patients indicated for elective CABG surgery were randomly allocated to two groups. One group received placebo and the other received 150 mg of oral pregabalin before surgery. Heart rates, blood pressure, respiratory rate, intensive care unit (ICU) stay duration, morphine consumption, and pain score according to the visual analog scale (VAS) were measured and recorded at 4, 12, and 24 hours of surgery. Results: Pregabalin consumption did not alter hemodynamic parameters and was safe in patients after CABG. Its consumption was associated with significant reduction in the pain score (P values were 0.035, 0.026, and 0.047 respectively at 4, 12, and 24 hours of surgery). Its use was not associated with changes in the morphine consumption at 4, 12, and 24 hours of surgery (P > 0.05). Conclusions: Premedication with studied dose of pregabalin is effective for the prevention of postoperative pain in patients after CABG and has no adverse effects. Trials with other treating schedule and doses of the drug should be performed to determine the best treatment plan. PMID:25830118

  19. Minimally Invasive Multivessel Coronary Surgery and Hybrid Coronary Revascularization: Can We Routinely Achieve Less Invasive Coronary Surgery?

    PubMed Central

    Rodriguez, Maria; Ruel, Marc

    2016-01-01

    Coronary artery bypass grafting (CABG) is the gold standard in managing severe coronary artery disease. However, it is associated with prolonged recovery and potential complications, in part due to the invasiveness of the procedure. Less invasive CABG techniques attempt to improve the quality and quantity of life in the same way as surgical revascularization but with fewer complications. Minimally invasive coronary surgery (MICS) through a small thoracotomy allows for complete revascularization with good results in graft patency. Perioperative mortality is low, and there is decreased need for blood transfusion, lower surgical site infection rates, and an earlier return to full physical function. Hybrid coronary revascularization (HCR) attempts to combine the advantages of coronary artery bypass grafting with those of percutaneous coronary intervention. Several studies have shown that HCR provides better short-term outcomes with regard to decreased ventilation and ICU time, reduced need for blood transfusion, and shortened hospital stay. However, the rates for major adverse cardiovascular events and mortality are comparable to conventional CABG, except for patients with a high SYNTAX score who displayed increased mortality rates. There is also strong evidence of a higher need for repeat revascularization with HCR compared to CABG. Overall, MICS and HCR appear to be viable alternatives to conventional CABG, offering a less invasive approach to coronary revascularization, which may be especially beneficial to high-risk patients. This article discusses approaches that deliver the advantages of minimally invasive surgical revascularization that can be adapted by surgeons with minimal investment with regards to training and infrastructure. PMID:27127557

  20. Friable but treatable: coronary artery dissections in Ehlers-Danlos syndrome.

    PubMed

    Zago, Alexandre C; Matte, Bruno S

    2013-01-01

    Vascular Ehlers-Danlos syndrome is a rare connective tissue disorder associated with arterial dissection or rupture. Percutaneous coronary intervention (PCI) is often critical in patients with this syndrome because their coronary arteries are prone to dissection, enhancing the risk of stent borders dissection when conventional stent deployment pressures are used. Coronary artery bypass graft (CABG) treatment for these patients may also raise concerns because the left internal mammary artery is probably friable. Therefore, coronary artery revascularization in vascular Ehlers-Danlos syndrome either using PCI or CABG is challenging due to the arteries friability. A small number of cases have been published describing the friability of the vessels and associated complications; nevertheless, the optimum treatment remains unclear. We report the case of a 54-year-old woman treated successfully with PCI and CABG in two different acute coronary syndrome episodes, in which specific technical issues related to both procedures were decisive. PMID:22422654

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

    PubMed Central

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

    2016-01-01

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

  2. Distal coronary perforation in patients with prior coronary artery bypass graft surgery: The importance of early treatment.

    PubMed

    Karatasakis, Aris; Akhtar, Yasir N; Brilakis, Emmanouil S

    2016-09-01

    In patients with prior coronary artery bypass graft (CABG) surgery, distal coronary perforations are commonly considered to be at low risk for causing cardiac tamponade due to a potential protective role of pericardial adhesions, which obliterate the pericardial space. Loculated effusions can however form in such patients, compressing various cardiac structures and causing hemodynamic compromise. We present two cases of distal coronary perforation in prior CABG patients undergoing chronic total occlusion percutaneous coronary intervention. In the first case a distal coronary perforation was initially observed, resulting in a loculated pericardial effusion that caused ST-segment elevation and death, despite successful sealing of the perforation. In the second case a similar perforation was immediately sealed with a covered stent, followed by uneventful patient recovery. A literature review of coronary perforation leading to hemodynamic compromise in patients with prior CABG surgery revealed high mortality (22%), suggesting that prompt sealing of the perforation is critical in these patients. PMID:27465517

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

    PubMed Central

    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

    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

  4. Influence of inspired nitrogen concentration during anaesthesia for coronary artery bypass grafting on postoperative atelectasis.

    PubMed

    Joyce, C J; Baker, A B; Chartres, S

    1995-10-01

    Pulmonary collapse is a common problem after coronary artery bypass graft surgery (CABG). If absorption atelectasis during anaesthesia is an important mechanism in the genesis of pulmonary collapse after CABG, the addition of nitrogen to the inspired gas during anaesthesia should reduce the amount of postoperative collapse. We studied 30 patients who were allocated randomly and prospectively to receive either 100% oxygen or an oxygen-air mixture as the inspired gas during anaesthesia for CABG. Lung volumes, PaO2, and an x-ray atelectasis score were measured before and after surgery to assess the degree of atelectasis. There were no significant differences between the two treatment groups in any of these measurements. PMID:7488481

  5. Therapeutic options in coronary artery disease: Focusing on the guidelines

    PubMed Central

    Schwartz, Leonard

    2009-01-01

    There are three options for the treatment of patients with coronary artery disease: coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI) and optimal medical treatment alone. While there has been an active interface between CABG and PCI, medical treatment has not been as vociferously advocated. However, it performs well in randomized trials and is still a treatment arm in studies such as the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. The present review compares these options in acute and chronic coronary syndromes, including the indications for each as summarized by recent American College of Cardiology and American Heart Association guidelines. While the landscape in Canada is changing for CABG and PCI, with an increase in the latter procedure for patients with multivessel disease, optimal medical treatment alone is very effective. There are few subsets, particularly in chronic syndromes, in which revascularization is indicated for prognosis alone. PMID:19148338

  6. When we should say no to TAVR-Defining the line between utility and futility.

    PubMed

    Khan, Zubair A; Aji, Janah; Soomro, Armaghan; Malik, Sara; Saeed, Wajeeha; Sardar, M Rizwan

    2016-09-01

    History of prior coronary artery bypass surgery (CABG) is a frequent scenario encountered in patients with severe symptomatic aortic stenosis deemed inoperable and referred for transcatheter aortic valve replacement (TAVR). Aside from indices of frailty and other comorbidities, these patients remain at higher risk for peri-operative mortality and morbidity compared to their counterparts without prior CABG. Presence of concomitant peripheral arterial disease and patent left internal mammary artery (LIMA) graft pose further access related challenges. We present a case of an 84-year-old female with prior CABG and severe PAD who underwent transapical TAVR for severe symptomatic AS sustaining an acute myocardial injury from damage to her apical epicardial collateral circulation. The case entails the importance of recognition of epicardial coronary collateralization where a transapical approach is best avoided or further aided by utilization of peri-procedural angiographic/fluoroscopy guidance to avoid epicardial vascular injury.

  7. [Intraoperative graft assessment using fluorescent imaging system (SPY)].

    PubMed

    Kawashima, T; Naraoka, S; Kakizaki, T

    2009-07-01

    We investigated the efficacy of intraoperative fluorescent imaging system for the assessment of coronary artery bypass grafting (CABG). We used SPY imaging system in 100 CABG (57 off-pump and 43 on-pump CABG), totalling 287 distal anastomoses. The total graft patency rate on postoperative angiography in this series was 96.2% (276/287). Graft revision was done in 10 cases (10.0%) and 13 anastomoses (4.5%) by SPY imaging, which all resulted in good patency at postoperative angiography. On the other hand, 7 distal anastomoses and 1 mammary graft (2.8%) appeared to be successful on intraoperative SPY imaging, but were revealed to be occluded by postoperative angiography. SPY imaging system is useful for graft validation, and may contribute to improvement of coronary bypass graft patency.

  8. Atrial fibrillation and coronary bypass surgery - what can be risk factors for its' appearance?

    PubMed

    Straus, Slavenka; Kacila, Mirsad; Omerbasic, Edin; Mujicic, Ermina

    2010-02-01

    The main goal of our study was to evaluate possible perioperative risk factors for occurrence of atrial fibrillation in the postoperative period in patients after CABG operations. The study included 140 patients after CABG, divided into two groups - Group I - 64 patients with new onset of POAF and Group II - 76 patients without postoperative atrial fibrillation occurrence. In both groups possible risk factors for atrial fibrillation onset (preoperative and postoperative) were analyzed.Results showed that we can predict new onset of atrial fibrillation after CABG if the following preoperative factors are present - low ejection fraction (less than 40%), LAd > 40mm, higher body mass index (BMI over 30), presence of COPD and older age. Important perioperative factors for onset of atrial fibrillation in our study were longer extracorporeal circulation, increased dose/number of inotropic drugs, blood transfusion and elevated WBC count postoperatively.

  9. Effect of Preoperative Aspirin Replacement With Enoxaparin in Patients Undergoing Primary Isolated On-Pump Coronary Artery Bypass Grafting.

    PubMed

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

    2016-02-15

    Management of preoperative antiplatelet therapy in coronary artery bypass grafting (CABG) is variable among surgeons: guidelines collide with prejudices because replacement of aspirin with low-molecular-weight heparin is still performed because of a presumed minor bleeding risk. This study aims to analyze postoperative bleedings and complications in patients scheduled for elective primary isolated on-pump CABG, depending on preoperative aspirin treatment or its replacement with enoxaparin. In this cohort study, we propensity score matched 200 patients in whom aspirin was stopped at least 5 days before CABG and replaced with enoxaparin and 200 patients who continued aspirin therapy until the day before surgery. Postoperative bleedings and complications were monitored during hospitalization. Among patients who continued aspirin treatment, mean overall bleeding was 701.0 ± 334.6 ml, whereas in the matched enoxaparin group, it was significantly greater (882.6 ± 64.6 ml, p value <0.001); this was associated with reduced postoperative complications, lower values of postoperative C-reactive protein in aspirin takers, and a presumed protective effect for statins. After propensity score adjustment, aspirin treatment carried a protective effect against major postoperative bleeding (odds ratio 0.312, p = 0.001). In conclusion, postoperative bleeding is reduced in patients who continued aspirin, likely due to a reduction in postoperative inflammation. The practice of empirically discontinuing aspirin and replacing it with enoxaparin before CABG should be abandoned. Patients with coronary artery disease referred to CABG should continue antiplatelet medications until the surgical procedure. Those results might be extended to patients under oral anticoagulant therapy requiring CABG. PMID:26721653

  10. Outcomes following percutaneous coronary intervention and coronary artery bypass grafting surgery in Chinese, South Asian and white patients with acute myocardial infarction: administrative data analysis

    PubMed Central

    2013-01-01

    Background Little is known on whether there are ethnic differences in outcomes following percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) after acute myocardial infarction (AMI). We compared 30-day and long-term mortality, recurrent AMI, and congestive heart failure in South Asian, Chinese and White patients with AMI who underwent PCI and CABG. Methods Hospital administrative data in British Columbia (BC), Canada were linked to the BC Cardiac Registry to identify all patients with AMI who underwent PCI (n = 4729) or CABG (n = 1687) (1999–2003). Ethnicity was determined from validated surname algorithms. Logistic regression for 30-day mortality and Cox proportional-hazards models were adjusted for age, sex, socio-economic status, severity of coronary disease, comorbid conditions, time from AMI to a revascularization procedure and distance to the nearest hospital. Results Following PCI, Chinese had higher short-term mortality (Odds Ratio (OR): 2.36, 95% CI: 1.12-5.00; p = 0.02), and South Asians had a higher risk for recurrent AMI (OR: 1.34, 95% CI: 1.08-1.67, p = 0.007) and heart failure (OR 1.81, 95% CI: 1.00-3.29, p = 0.05) compared to White patients. Risk of heart failure was higher in South Asian patients who underwent CABG compared to White patients (OR (95% CI) = 2.06 (0.92-4.61), p = 0.08). There were no significant differences in mortality following CABG between groups. Conclusions Chinese and South Asian patients with AMI and PCI or CABG had worse outcomes compared to their White counterparts. Further studies are needed to confirm these findings and investigate potential underlying causes. PMID:24369071

  11. Is Canadian cardiac surgeons’ management of asymptomatic carotid artery stenosis at coronary artery bypass supported by the literature? A survey and a critical appraisal of the literature

    PubMed Central

    Palerme, Louis P.; Hill, Andrew B.; Obrand, Daniel; Steinmetz, Oren K.

    2000-01-01

    Objective To document and compare the management of asymptomatic carotid stenosis (ACS) by Canadian cardiac surgeons at coronary artery bypass grafting (CABG) against a critical literature analysis. Design A multiple choice survey and a structured literature review. Data sources Seventy-seven surgeons and 272 publications selected from the English literature between 1980 and 1997. Search terms used were “carotid,” “coronary bypass,” and “cardiac surgery.” Study selection Five natural history studies were identified, and 58 studies were found that had objective documentation of ACS of 50% or more before cardiac surgery, and both operative stroke and mortality data reported for CABG with and without carotid endarterectomy (CEA). Data extraction Natural history and outcome studies were independently rated against published guidelines. Outcome data were independently pooled and compared. Data discrepancy was resolved by consensus. Survey results were tabulated for simple descriptive statistics. Data synthesis No methodologically sound natural history studies were found to document an increased risk of stroke from ACS after CABG. There were no randomized controlled studies to guide treatment recommendations. Pooled data for stroke or death did not support CEA for risk reduction from ACS at CABG (relative risk 0.9, p = 0.5). Ninety-four percent of surgeons believed that the literature is insufficient to support the routine use of CEA to reduce the risk of stroke from ACS after CABG. Despite this, 20% of surgeons advocated CEA for this purpose. Conclusion The management of ACS at CABG by the majority of Canadian cardiac surgeons is consistent with the results of the literature review; however, significant management variation exists. PMID:10812343

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

    PubMed Central

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

    2014-01-01

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

  13. A Randomized, Placebo-Controlled Trial of Omega-3 Fatty Acids for Inhibition of Supraventricular Arrhythmias After Cardiac Surgery: The FISH Trial

    PubMed Central

    Sandesara, Chirag M.; Chung, Mina K.; Van Wagoner, David R.; Barringer, Thomas A.; Allen, Keith; Ismail, Hassan M.; Zimmerman, Bridget; Olshansky, Brian

    2012-01-01

    Background Omega-3 polyunsaturated fatty acids (n3-PUFAs) might have antiarrhythmic properties, but data conflict on whether n3-PUFAs reduce rates of atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG). We hypothesized that n3-PUFAs would reduce post-CABG AF, and we tested this hypothesis in a well-powered, randomized, double-blind, placebo-controlled, multicenter clinical trial. Methods and Results Patients undergoing CABG were randomized to pharmaceutical-grade n3-PUFAs 2 g orally twice daily (minimum of 6 g) or a matched placebo ≥24 hours before surgery. Gas chromatography was used to assess plasma fatty acid composition of samples collected on the day of screening, day of surgery, and postoperative day 4. Treatment continued either until the primary end point, clinically significant AF requiring treatment, occurred or for a maximum of 2 weeks after surgery. Two hundred sixty patients were enrolled and randomized. Before surgery, n3-PUFA dosing increased plasma n3-PUFA levels from 2.9% to 4% and reduced the n6:n3-PUFA ratio from 9.1 to 6.4 (both P<0.001). Similar changes were noted on postoperative day 4. There were no lipid changes in the placebo group. The rate of post-CABG AF was similar in both groups (30% n3-PUFAs versus 33% placebo, P=0.67). The post-CABG AF odds ratio for n3-PUFAs relative to placebo was 0.89 (95% confidence interval 0.52–1.53). There were no differences in any secondary end points. Conclusions Oral n3-PUFA supplementation begun 2 days before CABG did not reduce AF or other complications after surgery. Clinical Trial Registration url: http://www.clinicaltrials.gov Unique identifier: NCT00446966. (J Am Heart Assoc. 2012;1:e000547 doi: 10.1161/JAHA.111.000547.) PMID:23130134

  14. Does the use of a stentless bioprosthesis increase surgical risk?

    PubMed

    Westaby, S; Jönson, A; Payne, N; Saito, S; Jin, X Y; Del Rizzo, D F; Grunkemeier, G

    2001-10-01

    Stentless aortic bioprostheses (SBPs) convey hemodynamic and perhaps survival benefit over stented counterparts. The aim of this study was to determine whether the more taxing operation increases surgical risk. We studied contemporary multicenter (USA) data submitted to the Food and Drug Administration (FDA) for Freestyle stentless (group I, n = 583) and Mosaic stented xenograft approval (group II, n = 1260). The study compared 30-day mortality for the two groups overall, then for isolated aortic valve replacement (AVR) and for AVR and coronary bypass (CABG). Because the USA Freestyle valves were used in selected patients (pts) we included SBP data (group III) from Oxford, where Freestyle valves were used consecutively within the same time frame. We also reviewed hospital mortality in the stentless bioprosthesis literature and compared this with the Society of Thoracic Surgery Database. There were no differences in age, NYHA, or incidence of CABG between the groups. There was no significant difference in operative mortality between stented (group II) and exclusive (group III) SBP patient groups (P =.233 for AVR and P =.478 for AVR + CABG), or between selective (group I) and exclusive (P =.929 for AVR and P =.390 for AVR + CABG) groups, after adjustment for risk factors. However, there was a significantly higher mortality both for isolated AVR (P =.026) and AVR + CABG (P =.001) in the selected stentless group compared with stented. This was partly attributed to greater mortality when the Freestyle was used in elderly patients by the full root replacement method, and to the higher proportion of females, and subjects with intra-aortic balloon pump insertion in this group. A meta-analysis of published stentless valve series, showed mortality rates to be lower than those of the STS National Database average. During the learning curve selective use of SBPs increased hospital mortality for AVR +/- CABG. Consecutive use dispelled the difference and the literature now

  15. Hematological Changes in Patients Undergoing Coronary Artery Bypass Surgery: a Prospective Study

    PubMed Central

    Lako, Sotir; Dedej, Teuta; Nurka, Tatjana; Ostreni, Vera; Demiraj, Aurel; Xhaxho, Roland; Prifti, Edvin

    2015-01-01

    Objectives: Removal of pro inflammatory stimuli after CABG, wound closure and the regenerative ability of the bone marrow will ensure a gradual recovery of hematological parameters. The aim of this study was to assess the hematological changes after CABG. Materials and Methods: A prospective cohort study included 164 consecutive patients undergoing on pump CABG surgery between January 2012 and January 2013. Patients with primary hematologic disease, emergent or urgent CABG and off-pump CABG were not included. A time line protocol was employed. Results: All patients survived surgery. Average values of erythrocytes, hemoglobin and hematocrit declined, to reach lower values on day 3 after surgery (-33.6 %, -33.1 %, -32.6 % versus preoperative value, p<0.001) and then gradually increased to reach normal values after one month and the preoperative values after three months. The average values of leukocytes and neutrophils increased rapidly to achieve the highest value on day 2, while the average value of lymphocytes decreased quickly to achieve lower value on day 1 after surgery (+74.7 %, +127.1 %, -52.4 % respectively from the preoperative value, p<0.001). The average platelet count decreased to the lowest value on day 2 after surgery (-26.4 % from the preoperative value, p<0.001), after which gradually increased up to +100.8 % of preoperative value on day 14 (p<0.001) and then gradually decreased to reach normal values on day 21 and preoperative values after three months. Conclusions: Average values of the three peripheral blood cells parameters undergo important changes after CABG, but not life threatening, and regain normal and preoperative values after 1-3 months after surgery. PMID:26261388

  16. Optimal revascularization in diabetes after the FREEDOM trial: were the controversies finally settled?

    PubMed

    Tenenbaum, Alexander; Fisman, Enrique Z

    2013-01-01

    The prevalence of diabetes mellitus (DM) is growing worldwide. Prothrombotic and proinflammatory states, in adjunct to endothelial dysfunction and metabolic disorders, such as hyperglycemia, dyslipidemia, obesity, insulin resistance, and oxidative stress, are key features of the accelerated atherosclerotic progression observed in patients with DM. Moreover, drug-eluting stents (DES) thrombosis rate was higher in DM than in non-DM patients and DM itself was identifi ed as an independent predictor of stent thrombosis, particularly due to the impaired response to dual antiplatelet therapy. The accumulating data even before the FREEDOM trial provided strong evidence that in patients with DM and complex coronary artery disease, coronary artery bypass grafting (CABG) was superior to percutaneous coronary intervention (PCI) which was based on the first-generation DES. The FREEDOM trial enrolled 1900 patients with DM and multivessel coronary artery disease treated with CABG surgery or PCI with the first-generation DES. The patients were followed for a median 3.8 years; CABG was superior to PCI as it significantly reduced rates of death and myocardial infarction (MI), with a higher rate of stroke. The benefit of CABG was driven by differences in rates of both MI (p < 0.001) and death from any cause (p = 0.049). Following the FREEDOM results, patients with DM ought to be informed before coronary angiography about the potential survival benefit from CABG for the treatment of a complex disease. However, it should be noticed that the second generation DES were associated with better outcomes compared to the first-generation DES. New stent designs are continually being developed, with the aim of further improving the clinical effi cacy and the safety profile of these devices. Therefore, although the results of the FREEDOM trial clearly demonstrated that CABG was superior to PCI in DM, a comparative analysis of the new incoming stents warrants further investigation. PMID:23913450

  17. Effect of Preoperative Aspirin Replacement With Enoxaparin in Patients Undergoing Primary Isolated On-Pump Coronary Artery Bypass Grafting.

    PubMed

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

    2016-02-15

    Management of preoperative antiplatelet therapy in coronary artery bypass grafting (CABG) is variable among surgeons: guidelines collide with prejudices because replacement of aspirin with low-molecular-weight heparin is still performed because of a presumed minor bleeding risk. This study aims to analyze postoperative bleedings and complications in patients scheduled for elective primary isolated on-pump CABG, depending on preoperative aspirin treatment or its replacement with enoxaparin. In this cohort study, we propensity score matched 200 patients in whom aspirin was stopped at least 5 days before CABG and replaced with enoxaparin and 200 patients who continued aspirin therapy until the day before surgery. Postoperative bleedings and complications were monitored during hospitalization. Among patients who continued aspirin treatment, mean overall bleeding was 701.0 ± 334.6 ml, whereas in the matched enoxaparin group, it was significantly greater (882.6 ± 64.6 ml, p value <0.001); this was associated with reduced postoperative complications, lower values of postoperative C-reactive protein in aspirin takers, and a presumed protective effect for statins. After propensity score adjustment, aspirin treatment carried a protective effect against major postoperative bleeding (odds ratio 0.312, p = 0.001). In conclusion, postoperative bleeding is reduced in patients who continued aspirin, likely due to a reduction in postoperative inflammation. The practice of empirically discontinuing aspirin and replacing it with enoxaparin before CABG should be abandoned. Patients with coronary artery disease referred to CABG should continue antiplatelet medications until the surgical procedure. Those results might be extended to patients under oral anticoagulant therapy requiring CABG.

  18. Revascularisation of patients with end-stage renal disease on chronic haemodialysis: bypass surgery versus PCI—analysis of routine statutory health insurance data

    PubMed Central

    Möckel, Martin; Searle, Julia; Baberg, Henning Thomas; Dirschedl, Peter; Levenson, Benny; Malzahn, Jürgen; Mansky, Thomas; Günster, Christian; Jeschke, Elke

    2016-01-01

    Objectives We aimed to analyse the short-term and long-term outcome of patients with end-stage renal disease (ESRD) undergoing percutaneous intervention (PCI) as compared to coronary artery bypass surgery (CABG) to evaluate the optimal coronary revascularisation strategy. Design Retrospective analysis of routine statutory health insurance data between 2010 and 2012. Main outcome measures Primary outcome was adjusted all-cause mortality after 30 days and major adverse cardiovascular and cerebrovascular events at 1 year. Secondary outcomes were repeat revascularisation at 30 days and 1 year and bleeding events within 7 days. Results The total number of cases was n=4123 (PCI; n=3417), median age was 71 (IQR 62–77), 30.4% were women. The adjusted OR for death within 30 days was 0.59 (95% CI 0.43 to 0.81) for patients undergoing PCI versus CABG. At 1 year, the adjusted OR for major adverse cardiac and cerebrovascular events (MACCE) was 1.58 (1.32 to 1.89) for PCI versus CABG and 1.47 (1.23 to 1.75) for all-cause death. In the subgroup of patients with acute myocardial infarction (AMI), adjusted all-cause mortality at 30 days did not differ significantly between both groups (OR 0.75 (0.47 to 1.20)), whereas in patients without AMI the OR for 30-day mortality was 0.44 (0.28 to 0.68) for PCI versus CABG. At 1 year, the adjusted OR for MACCE in patients with AMI was 1.40 (1.06 to 1.85) for PCI versus CABG and 1.47 (1.08 to 1.99) for mortality. Conclusions In this cohort of unselected patients with ESRD undergoing revascularisation, the 1-year outcome was better for CABG in patients with and without AMI. The 30-day mortality was higher in non-AMI patients with CABG reflecting an early hazard with surgery. In cases where the patient's characteristics and risk profile make it difficult to decide on a revascularisation strategy, CABG could be the preferred option. PMID:27752331

  19. Coronary artery bypass surgery in diabetic patients – risk factors for sternal wound infections

    PubMed Central

    Lenz, Kristina; Brandt, Michael; Fraund-Cremer, Sandra; Cremer, Jochen

    2016-01-01

    The incidence of sternal wound infections (SWI) after coronary artery bypass surgery (CABG) as reported worldwide is low. However, it is associated with significant increase of postoperative mortality and treatment costs. The major risk factors discussed are diabetes mellitus and bilateral IMA harvesting of the internal mammary artery. This study analyses data of 590 patients receiving CABG concerning the risk factors for SWI. Sternal wound infections occur significantly more often in diabetic patients, one crucial and significant additional risk factor is obesity. PMID:27547690

  20. Outcomes and costs of coronary artery bypass grafting: comparison between octogenarians and septuagenarians at a tertiary care centre

    PubMed Central

    Smith, Kelly M.; Lamy, André; Arthur, Heather M.; Gafni, Amiram; Kent, Rosanne

    2001-01-01

    Background Decision-making related to coronary artery bypass grafting (CABG) in elderly patients is hampered by inadequate outcome data. We compared the clinical outcomes of octogenarians with those of septuagenarians who underwent CABG. Our secondary objective was to compare the costs associated with CABG in these groups. Methods We conducted a retrospective database review of patients 70 years of age and older who had undergone CABG at a regional cardiac surgical centre in Hamilton, Ont., between July 1, 1997, and Apr. 30, 2000. A total of 1034 patients were divided into 3 age groups: young septuagenarians (aged 70–74 years), old septuagenarians (aged 75–79) and those 80 and older. Costs were determined in a subset of 773 patients with the use of a case-costing system for cardiac surgery developed at our institution. Results The 3 groups were similar with respect to sex distribution and preoperative risk factors. Urgency scores at referral differed significantly between the groups, with the young septuagenarians demonstrating the lowest risk (mean score [and standard deviation] 4.48 [1.3] in that group, 4.28 [1.4] in the old septuagenarian group and 4.11 [1.2] in the octogenarian group). The rates of all complications combined were similar between the 3 groups (27.1%, 28.1% and 29.6% in the young and old septuagenarian groups and the octogenarian group respectively). There were no significant differences between the 3 groups in the mean number of grafts per patient (3.0, 3.1 and 3.0 respectively), the rate of postoperative death (3.3%, 5.7% and 4.2%), the mean length of stay (11.7, 13.4 and 12.6 days) or the incidence of postoperative myocardial infarction (4.5%, 3.4% and 4.2%). The total cost of CABG per patient did not differ significantly between the 3 groups. Interpretation Given that patients who are accepted for CABG represent a selected population, our findings suggest that, with careful triage, CABG in octogenarians is as safe as, and no more costly

  1. When is an invasive palliative intervention in an acute internal medical patient worth it? A structured palliative approach.

    PubMed

    Weber, Thomas; Strasser, Florian

    2015-12-01

    A 67-year-old patient with coronary artery disease (CAD), diabetes, and chronic obstructive pulmonary disease (COPD) was scheduled for coronary artery bypass graft (CABG) surgery after a recent myocardial infarction despite a high perioperative risk of death. While waiting, acute renal failure developed, and the patient was admitted to the intensive care unit (ICU). After the patient and his wife were informed that CABG surgery was no longer possible, he declined further intensive care treatment and subsequently died peacefully.We show that a structured palliative approach which has been proposed for cancer patients may also be feasible in palliative situations concerning nononcologic patients. PMID:26620468

  2. “DK Crush” Technique for a Tightly Stenosed Conjoined SVG Lesion in a Patient with Acute Coronary Syndrome and Cardiogenic Shock

    PubMed Central

    Chen, Kuan-Ju; Lee, Wen-Lieng; Liu, Tsun-Jui; Chang, Wei-Chun; Wang, Kuo-Yang; Su, Chieh-Shou

    2015-01-01

    Coronary artery bifurcation disease of saphenous venous graft (SVG) is extremely rare. SVG disease remains a challenging lesion to treat because of increased morbidity and mortality with repeated coronary artery bypass graft surgery (CABG), high rates of periprocedural complications, and in-stent restenosis or occlusion requiring repeat revascularization with percutaneous coronary intervention. Herein, we present the first reported case of using the “DK crush” technique to treat an inverted Y-shaped SVG bifurcation disease in a patient with a prior CABG and new-onset acute coronary syndrome. Arising from our treatment, favorable immediate and mid-term angiographic and clinical outcomes were obtained. PMID:27122880

  3. Percutaneous revascularization in acute myocardial infarction due to left main stem occlusion.

    PubMed

    Valeur, Nana; Gaster, Anne Louise; Saunamäki, Kari

    2005-04-01

    Following the encouraging results of trials testing the effect of primary percutaneous coronary intervention (PCI) more cases of left main arterial stenosis (LMS) as culprit lesions in acute myocardial infarction (AMI) are being handled. Not many cases of primary PCI on LMS have been published. We present 12 cases of primary PCI on LMS. Eighty-three percent of the patients presented with cardiogenic shock and only 42% were discharged alive. Due to the high rate of cardiogenic shock at presentation, PCI seems to be the treatment of choice, over coronary artery bypass grafting (CABG), although one might consider using PCI as a bridge over to CABG.

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

    PubMed

    Liliav, Benjamin; Yakoub, Danny; Kasabian, Armen

    2011-01-01

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

  5. Maternal Talk about Mental States and the Emergence of Joint Visual Attention

    ERIC Educational Resources Information Center

    Slaughter, Virginia; Peterson, Candida C.; Carpenter, Malinda

    2008-01-01

    Twenty-four infants were tested monthly for gaze and point following between 9 and 15 months of age and mother-infant free play sessions were also conducted at 9, 12, and 15 months (Carpenter, Nagell, & Tomasello, 1998). Using this data set, this study explored relations between maternal talk about mental states during mothers' free play with…

  6. Early Maternal Language Use during Book Sharing in Families from Low-Income Environments

    ERIC Educational Resources Information Center

    Abraham, Linzy M.; Crais, Elizabeth; Vernon-Feagans, Lynne; Cox, Martha; Blair, Clancy; Burchinal, Peg; Crnic, Keith; Crouter, Ann; Garrett-Peters, Patricia; Greenberg, Mark; Lanza, Stephanie; Mills-Koonce, Roger; Werner, Emily; Willoughby, Michael

    2013-01-01

    Purpose: The authors examined the language used by mothers from low-income and rural environments with their infants at ages 6 and 15 months to identify predictors of maternal language use at the 15-month time point. Method: Maternal language use by 82 mothers with their children was documented during book-sharing interactions within the home in a…

  7. 78 FR 26372 - Proposed Information Collection Activity; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-06

    ... treatment group that is offered participation in HPOG and a control group that is not permitted to enroll in... basic and an enhanced version of the intervention) and a control group. Data collected from the HPOG...-Impact 15-month control group member follow-up survey; and (13) The HPOG-NIE 15-month participant...

  8. Longitudinal Modeling of Adolescents' Activity Involvement, Problem Peer Associations, and Youth Smoking

    PubMed Central

    Metzger, Aaron; Dawes, Nickki; Mermelstein, Robin; Wakschlag, Lauren

    2010-01-01

    Longitudinal associations among different types of organized activity involvement, problem peer associations, and cigarette smoking were examined in a sample of 1,040 adolescents (mean age = 15.62 at baseline, 16.89 at 15-month assessment, 17.59 at 24 months) enriched for smoking experimentation (83% had tried smoking). A structural equation model tested longitudinal paths between three categories of involvement (team sports, school clubs and activities, and religious activities, measured at baseline and 15 months), problem peer associations (baseline and 15 months), and cigarette smoking behavior (baseline and 24 months). Multi-group analyses indicated pathways differed by type of activity and adolescent gender. Boys’ baseline team sports and religious involvement predicted lower levels of smoking at 24 months via continued activity involvement at 15 months. Girls’ involvement in school clubs and activities and religious activities indirectly predicted lower levels of smoking at 24 months via reduced exposure to problem peers at 15 months. PMID:21603061

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

    PubMed

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

    2005-07-01

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

  10. Left Main Coronary Artery Disease: Secular Trends in Patient Characteristics, Treatments, and Outcomes.

    PubMed

    Lee, Pil Hyung; Ahn, Jung-Min; Chang, Mineok; Baek, Seunghee; Yoon, Sung-Han; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Lee, Cheol Whan; Park, Seong-Wook; Park, Duk-Woo; Park, Seung-Jung

    2016-09-13

    Left main coronary artery (LMCA) disease is the highest-risk lesion subset of ischemic heart disease, and has traditionally been an indication for coronary artery bypass grafting (CABG). Recent evidence suggests comparable clinical outcomes between percutaneous coronary intervention (PCI) and CABG for LMCA disease, with similar rates of mortality and serious composite outcomes, a higher rate of stroke with CABG, and a higher rate of repeat revascularization with PCI. These results have been translated to the current guideline recommendation that PCI is a reasonable alternative to CABG in patients with low to intermediate anatomic complexity. However, how the characteristics, treatment, and clinical outcomes of patients with unprotected LMCA disease have evolved over time has not yet been fully evaluated. We therefore described secular trends in the characteristics and long-term outcomes of unprotected LMCA disease using "real-world" clinical experience from the IRIS-MAIN (Interventional Research Incorporation Society-Left MAIN Revascularization) registry together with a broad review of this topic. PMID:27609687

  11. Bilateral Internal Thoracic Artery Grafting: Is It Reasonable in Octogenarians?

    PubMed Central

    Fukui, Toshihiro; Takanashi, Shuichiro

    2015-01-01

    Purpose: The feasibility of using bilateral internal thoracic artery (BITA) grafts for coronary artery bypass grafting (CABG) in octogenarians is not clear. This study aimed to compare outcomes between use of BITA and single internal thoracic artery (SITA) grafts in octogenarians undergoing isolated CABG. Methods: Isolated CABG was performed in 1,566 patients at the Sakakibara Heart Institute between September 2004 and December 2012. Of these, 125 consecutive octogenarians were included and divided into two groups, according to the use of BITA grafts (101 subjects) or SITA grafts (24 subjects). Early and late outcomes were compared between groups. Results: The preoperative patient characteristics were similar between the two groups. Early outcomes were similar, including hospital death or deep sternal infection. The estimated 5-year survival rate was similar in the BITA and SITA groups (78% vs 62%, p = 0.269). Freedom from major adverse cardiac or cerebrovascular events was significantly higher in the BITA group than in the SITA group after 5 years (90% vs 75%, p = 0.032). Conclusions: Our results suggest that use of BITA grafts for CABG is feasible and beneficial in octogenarians, resulting in improved late outcomes without increased operative risk. PMID:26004110

  12. Concanavalin A binding glycoproteins in subcellular fractions from the developing rat cerebral cortex.

    PubMed

    Rudge, J S; Murphy, S

    1984-09-01

    Synaptic plasma membrane (SPM) and mitochondrial fractions were prepared from 3-50-day rat cerebral cortex and their purity assessed. The fractions were subjected to electrophoresis on slab gels, stained for protein, and overlaid with 125I-concanavalin A (ConA). ConA binding glycoproteins (CABGs) were revealed by autoradiography. In the SPM fraction CABGs of MW 25,000, 63,000, 80,000, 115,000, 174,000, and 239,000 increased while those of MW 47,000, 75,000, and 190,000 decreased developmentally. In the mitochondrial fraction, CABGs of MW 25,000, 44,000, 115,000 and 174,000 increased while those of 34,000, 43,000, 47,000, 51,000, 80,000, 107,000, and 195,000 decreased developmentally. CABGs of MW 32,000, 63,000, 88,000, 153,000, 190,000, and 239,000 appear to be unique to the SPM fraction and those of MW 34,000, 107,000, and 195,000 are unique to the mitochondrial fraction. PMID:6747641

  13. Minimally Invasive Direct Coronary Artery Bypass Surgery with Right Gastroepiploic Artery for Redo Patients

    PubMed Central

    Nabuchi, Akihiro; Terada, Hirohito; Hiranuma, Susumu; Miyazaki, Takuya; Okuyama, Hiroshi; Endo, Masahiro

    2015-01-01

    Coronary artery bypass grafting (CABG) has been widely performed for coronary artery disease. Therefore, cases requiring reoperative CABG are increasing. We performed a minimally invasive direct coronary artery bypass (MIDCAB) procedure on four patients, as reoperative CABG surgery for the right coronary artery (RCA), employing the right gastroepiploic artery (RGEA). The target sites were the distal RCA in two patients and the posterior descending (PD) branch in the other two. Complete revascularization was accomplished in all patients without sternotomy, cardiopulmonary bypass (CPB), or blood transfusion. The mean operative time was 3.0 h (range: 2.4–3.7 h). Postoperative coronary angiography showed all grafts to be patent. All patients were discharged without postoperative complications and remained free from cardiac events during a mean follow-up period of 1.5 years (range: 0.5–3.0 years). MIDCAB for the RCA, employing the RGEA via a subxiphoid incision showed, excellent revascularization in redo CABG cases. This technique is a safe and effective method for redo cases. PMID:25912220

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

    SciTech Connect

    van Vlies, B.; van Royen, E.A.; Visser, C.A.; Meyne, N.G.; van Buul, M.M.; Peters, R.J.; Dunning, A.J. )

    1990-11-15

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

  15. Unusual suspect-coronary subclavian steal syndrome caused severe myocardial ischemia

    PubMed Central

    Srećković, Miodrag; Jagić, Nikola; Miloradović, Vladimir; Nikolić, Dušan; Pavlović, Milica; Srećković, Ana Maksimović

    2014-01-01

    Coronary-subclavian steal syndrome represents a reversal of blood flow in left internal mammary artery. The most common cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. We present a case of 72 years old male, who developed severe anginal and neurological complaints three years after coronary artery bypass graft surgery(CABG). PMID:24579971

  16. Cardiac Strain in a Swine Model of Regional Hibernating Myocardium: Effects of CoQ10 on Contractile Reserve Following Bypass Surgery.

    PubMed

    Hocum Stone, Laura; Butterick, Tammy A; Duffy, Cayla; Swingen, Corey; Ward, Herbert B; Kelly, Rosemary F; McFalls, Edward O

    2016-08-01

    There is conflicting clinical evidence whether administration of coenzyme Q10 (CoQ10) improves function following coronary artery bypass graft surgery (CABG). Using a swine model of hibernating myocardium, we tested whether daily CoQ10 would improve contractile function by MRI at 4-week post-CABG. Twelve pigs underwent a thoracotomy and had a constrictor placed on the left anterior descending (LAD). At 12 weeks, they underwent off-pump bypass and received daily dietary supplements of either CoQ10 (10 mg/kg/day) or placebo. At 4-week post-CABG, circumferential strain measurements in the hibernating LAD region from placebo and CoQ10 groups were not different and increased to a similar extent with dobutamine (-14.7 ± 0.6 versus -14.8 ± 0.1, respectively (NS)). Post-sacrifice, oxidant stress markers were obtained in the mitochondrial isolates and protein carbonyl in the placebo, and CoQ10 groups were 6.14 ± 0.36 and 5.05 ± 0.32 nmol/mg, respectively (NS). In summary, CoQ10 did not improve contractile reserve or reduce oxidant stress at 4-week post-CABG.

  17. Cardiac Strain in a Swine Model of Regional Hibernating Myocardium: Effects of CoQ10 on Contractile Reserve Following Bypass Surgery.

    PubMed

    Hocum Stone, Laura; Butterick, Tammy A; Duffy, Cayla; Swingen, Corey; Ward, Herbert B; Kelly, Rosemary F; McFalls, Edward O

    2016-08-01

    There is conflicting clinical evidence whether administration of coenzyme Q10 (CoQ10) improves function following coronary artery bypass graft surgery (CABG). Using a swine model of hibernating myocardium, we tested whether daily CoQ10 would improve contractile function by MRI at 4-week post-CABG. Twelve pigs underwent a thoracotomy and had a constrictor placed on the left anterior descending (LAD). At 12 weeks, they underwent off-pump bypass and received daily dietary supplements of either CoQ10 (10 mg/kg/day) or placebo. At 4-week post-CABG, circumferential strain measurements in the hibernating LAD region from placebo and CoQ10 groups were not different and increased to a similar extent with dobutamine (-14.7 ± 0.6 versus -14.8 ± 0.1, respectively (NS)). Post-sacrifice, oxidant stress markers were obtained in the mitochondrial isolates and protein carbonyl in the placebo, and CoQ10 groups were 6.14 ± 0.36 and 5.05 ± 0.32 nmol/mg, respectively (NS). In summary, CoQ10 did not improve contractile reserve or reduce oxidant stress at 4-week post-CABG. PMID:27184805

  18. The Effect of Music on Anxiety and Cardiovascular Indices in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Controlled Trial

    PubMed Central

    Heidari, Saeide; Babaii, Atye; Abbasinia, Mohammad; Shamali, Mahdi; Abbasi, Mohammad; Rezaei, Mahboobe

    2015-01-01

    Background: The instability of cardiovascular indices and anxiety disorders are common among patients undergoing coronary artery bypass graft (CABG) and could interfere with their recovery. Therefore, improving the cardiovascular indices and anxiety is essential. Objectives: This study aimed to investigate the effect of music therapy on anxiety and cardiovascular indices in patients undergoing CABG. Patients and Methods: In this randomized controlled trial, 60 patients hospitalized in the cardiovascular surgical intensive care unit of Shahid Beheshti Hospital in Qom city, Iran, in 2013 were selected using a consecutive sampling method and randomly allocated into the experimental and control groups. In the experimental group, patients received 30 minutes of light music, whereas in the control group, patients had 30 minutes of rest in bed. The cardiovascular indices and anxiety were measured immediately before, immediately after and half an hour after the study. Data were analyzed using the chi-square test and repeated measures analysis of variance. Results: Compared to the immediately before intervention, the mean anxiety scores immediately after and 30 minutes after the intervention were significantly lower in the experimental group (P < 0.037) while it did not significantly change in the control group. However, there were no significant differences regarding the cardiovascular indices in the three consecutive measurements (P > 0.05). Conclusions: Music therapy is effective in decreasing anxiety among patients undergoing CABG. However, the intervention was not effective on cardiovascular indices. Music can effectively be used as a non-pharmacological method to manage anxiety after CABG. PMID:26835471

  19. Cost and effectiveness assessment of cardiac rehabilitation for dialysis patients following coronary bypass

    PubMed Central

    Huang, Yijian; Zhang, Rebecca; Culler, Steven; Kutner, Nancy

    2009-01-01

    Dialysis patients have a high risk of cardiovascular disease. In the general population, cardiac rehabilitation is recommended as a standard component of care and is covered by Medicare for patients who have undergone coronary artery bypass grafting (CABG). Previous investigation demonstrated survival benefit of cardiac rehabilitation in dialysis patients. This study investigated its impact on Medicare expenditure and its cost effectiveness. A cohort of 4,324 end-stage renal disease (ESRD) patients who initiated chronic hemodialysis and underwent CABG between 1998 and 2004 was selected from the United States Renal Data System. Cardiac rehabilitation was defined by Current Procedural Terminology codes for monitored and nonmonitored exercise in Medicare claims data. Medicare expenditure included inpatient and outpatient claims with cost adjusted to 1998 dollars. At 42 months of follow-up after a 6-month entry period following CABG hospitalization discharge, cardiac rehabilitation at baseline was associated with higher cumulative Medicare expenditure, incurring a statistically nonsignificant increment of $2,904 (95% CI: −7,028, 11,940). During the same period, cardiac rehabilitation was significantly associated with longer cumulative lifetime, having an incremental benefit of 76 days (95% CI: 22, 129). The incremental cost-effectiveness ratio was $13,887 per year of life saved, suggesting that cardiac rehabilitation is highly cost-effective in ESRD patients following CABG. PMID:18650790

  20. Effect of dipyridamole on myocardial reperfusion injury: A double-blind randomized controlled trial in patients undergoing elective coronary artery bypass surgery.

    PubMed

    El Messaoudi, S; Wouters, C W; van Swieten, H A; Pickkers, P; Noyez, L; Kievit, P C; Abbink, E J; Rasing-Hoogveld, A; Bouw, T P; Peters, J G; Coenen, M J H; Donders, A R T; Riksen, N P; Rongen, G A

    2016-04-01

    Dipyridamole reduces reperfusion-injury in preclinical trials and may be beneficial in patients undergoing coronary angioplasty, but its effect on patients undergoing coronary artery bypass grafting (CABG) is unknown. We hypothesized that dipyridamole limits myocardial reperfusion-injury in patients undergoing CABG. The trial design was a double-blind trial randomizing between pretreatment with dipyridamole or placebo. In all, 94 patients undergoing elective on-pump CABG were recruited between February 2010 and June 2012. The primary endpoint was plasma high-sensitive (hs-) troponin-I at 6, 12, and 24 hours after reperfusion. Secondary endpoints were the occurrence of bleeding, arrhythmias, need for inotropic support, and intensive care unit length of stay. Finally, 79 patients (33 dipyridamole) were included in the per-protocol analysis. Dipyridamole did not significantly affect postoperative hs-troponin-I (change in plasma hs-troponin I -3% [95% confidence interval -23% to 36%]; P > 0.1). Secondary endpoints did not differ between groups. Dipyridamole prior to CABG does not significantly reduce postoperative hs-troponin release.

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

    PubMed Central

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

    2014-01-01

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

  2. The use of a Perma-Flow graft for coronary artery bypass surgery.

    PubMed

    Schmid, C; Weyand, M; Kerber, S; Breithardt, G; Scheld, H H

    1996-01-01

    We report on our first clinical use of a Perma-Flow graft for coronary artery bypass surgery (CABG). It may well be that repeated successful use of this graft will offer a chance for revascularization to patients who might otherwise have been denied for lack of appropriate vessels.

  3. Cardiac Surgery is Safe in Female Patients with a History of Breast Cancer

    PubMed Central

    Sommer, Stefanie; Aleksić, Ivan; Schimmer, Christoph; Schmidt-Hengst, Elisa; Leyh, Rainer G.; Sommer, Sebastian-Patrick

    2016-01-01

    Purpose: In cardiac surgery candidates, a concomitant history of breast cancer suggests adverse outcomes. The possibility of internal mammary artery (IMA) utilization and its patency rate is frequently discussed. Secondary, blood loss and wound related infections might be important issues. However, publications focusing on these issues are limited. Methods: We analyzed 32 patients with previously treated breast cancer undergoing cardiac bypass (CABG) and combined CABG surgery matched to 99 control subjects in a retrospective cohort study. Patients were analyzed regarding IMA utilization, blood loss and substitution and frequent perioperative complications as well as long-term mortality. Results: No significant differences between groups were observed regarding duration of surgery, IMA-utilization, incidence of infections and postoperative complications or mortality. A pronounced decline of hemoglobin/hematocrit was evident within the first 6 postoperative hours (3.3 ± 1.8 vs. 2.5 ± 1.8 mg/dl; p = 0.03) in breast cancer patients not related to an increased drainage loss but associated with an increase of international normalized ratio (INR) (0.39 ± 0.16 vs. 0.29 ± 0.24; p <0.01). Conclusion: In breast cancer patients, CABG and combined CABG procedures can safely be performed with comparable short- and long-term results. PMID:27181390

  4. Comparative study of single-injection, single-acquisition 99mTc-MIBI gated SPET and stress-rest perfusion SPET for the evaluation of myocardial viability after bypass surgery in coronary artery disease.

    PubMed

    Yoon, S N; Lee, D S; Chung, J K; Lee, M C

    2000-12-01

    In patients without previous myocardial infarction, the single-injection stress perfusion/rest function (SISPRF) approach using stress technetium-99m methoxyisobutylisonitrile (MIBI) gated single-photon emission tomography (SPET) can substitute for conventional stress-rest myocardial perfusion imaging for the assessment of myocardial viability. This study compared pre-operative single-injection, single-acquisition 99mTc-MIBI gated SPET and conventional stress-rest imaging for the prediction of myocardial viability in patients who underwent coronary artery bypass surgery (CABG). Rest thallium-201 SPET followed by stress 99mTc-MIBI gated SPET was performed in 20 patients [nine with previous myocardial infarction (MI) and 11 without previous MI). The study was performed before and 3 months after CABG, and viability assessment was validated by wall motion improvement after CABG. A four-point scoring system (0-3 for normal to absent tracer uptake) for 17 segments of the left ventricular myocardium was used for the assessment of stress and rest uptake. Wall motion, wall thickening and perfusion status were analysed by semi-quantitative visual assessment. On gated SPET, perfusion defect reversibility was considered present when a definite perfusion defect was observed and wall motion or thickening was normal or showed only a mild decrease. In patients with a previous MI, the left ventricular ejection fraction improved significantly after CABG (46% +/- 7% vs 42% +/- 11% before CABG, P < 0.05). In patients without previous MI, the ejection fraction improved significantly after CABG (50 +/- 12% vs 44% +/- 16% before CABG, P<0.05). In patients with previous MI, positive predictive values using the stress-rest reversibility and SISPRF approaches were 91% and 90%, respectively, and corresponding negative predictive values were 25% and 18%. In patients without previous MI, positive predictive values using the stress-rest and SISPRF approaches were 70% and 61%, respectively, and

  5. Predictors of stroke associated with coronary artery bypass grafting in patients with diabetes mellitus and multivessel coronary artery disease.

    PubMed

    Domanski, Michael J; Farkouh, Michael E; Zak, Victor; Feske, Steven; Easton, Donald; Weinberger, Jesse; Hamon, Martial; Escobedo, Jorge; Shrader, Peter; Siami, Flora S; Fuster, Valentin

    2015-05-15

    This study assesses demographic and clinical variables associated with perioperative and late stroke in diabetes mellitus patients after multivessel coronary artery bypass grafting (CABG). Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) is the largest randomized trial of diabetic patients undergoing multivessel CABG. FREEDOM patients had improved survival free of death, myocardial infarction, or stroke and increased overall survival after CABG compared to percutaneous intervention. However, the stroke rate was greater following CABG than percutaneous intervention. We studied predictors of stroke in CABG-treated patients analyzing separately overall, perioperative (≤30 days after surgery), and late (>30 days after surgery) stroke. For long-term outcomes (overall stroke and late stroke), Cox proportional hazards regression was used, accounting for time to event, and logistic regression was used for perioperative stroke. Independent perioperative stroke predictors were previous stroke (odds ratio [OR] 6.96, 95% confidence interval [CI] 1.43 to 33.96; p = 0.02), warfarin use (OR 10.26, 95% CI 1.10 to 96.03; p = 0.02), and surgery outside the United States or Canada (OR 9.81, 95% CI 1.28 to 75.40; p = 0.03). Independent late stroke predictors: renal insufficiency (hazard ratio [HR] 3.57, 95% CI 1.01 to 12.64; p = 0.048), baseline low-density lipoprotein ≥105 mg/dl (HR 3.28, 95% CI 1.19 to 9.02; p = 0.02), and baseline diastolic blood pressure (each 1 mm Hg increase reduces stroke hazard by 5%; HR 0.95, 95% CI 0.91 to 0.99; p = 0.03). There was no overlap between predictors of perioperative versus late stroke. In conclusion, late post-CABG strokes were associated with well-described risk factors. Nearly half of the strokes were perioperative. Independent risk factors for perioperative stroke: previous stroke, previous warfarin use, and CABG performed outside the United States or Canada.

  6. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery?

    PubMed Central

    Ogutu, Peter; Werner, Raphael; Oertel, Frank; Beyer, Michael

    2014-01-01

    A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether patients with severe asymptomatic carotid and coronary artery diseases should undergo simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). A total of 624 papers were found using the reported search, of which 20 represent the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study results of these papers are tabulated. Previous cohort studies showed mixed results, while advocating for the necessity of a randomized controlled trial (RCT). A recent RCT showed that patients undergoing prophylactic or simultaneous CEA + CABG had lower rates of stroke (0%) compared with delayed CEA 1–3 months after CABG (7.7%), without significant perioperative mortality difference. This study included patients with unilateral severe (>70%) asymptomatic carotid stenosis requiring CABG. An earlier partly randomized trial also showed better outcomes for patients undergoing simultaneous procedures (P = 0.045). Interestingly, systematic reviews previously failed to show compelling evidence supporting prophylactic CEA. This could be partly due to the fact that these reviews collectively analyse different cohort qualities. Neurological studies have, however, shown reduced cognitive and phonetic quality and function in patients with unilateral and bilateral asymptomatic carotid artery stenosis. Twenty-one RCTs comparing lone carotid artery stenting (CAS) and CEA informed the American Heart Association guidelines, which declared CAS comparable with CEA for symptomatic and asymptomatic carotid stenosis (CS). However, the risk of death/stroke for CAS alone is double that for CEA alone in the acute phase following onset of symptoms, while CEA alone is associated with a doubled risk of myocardial infarction. There is

  7. Impact of Baseline Angiographic Complexities Determined by Coronary Artery Bypass Grafting SYNTAX Score on the Prediction of Outcome After Percutaneous Coronary Intervention.

    PubMed

    Nakahashi, Takuya; Sakata, Kenji; Nomura, Akihiro; Yakuta, Yohei; Gamou, Tadatsugu; Terai, Hidenobu; Horita, Yuki; Ikeda, Masatoshi; Namura, Masanobu; Takamura, Masayuki; Kawashiri, Masa-Aki; Yamagishi, Masakazu; Hayashi, Kenshi

    2016-10-01

    Although Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score based on angiographic scoring system was developed in patients with previous coronary artery bypass grafting (CABG), few data exist regarding its prognostic utility in patients undergoing percutaneous coronary intervention (PCI). We examined 272 patients with previous CABG (217 men; mean age, 70.4 ± 9.7 years) undergoing PCI. Severity of the coronary anatomy was evaluated using CABG-SYNTAX score. The primary end point of this study was cardiovascular death. The baseline CABG-SYNTAX score ranged from 2 to 53.5, with an average of 26.0 ± 10.2. In the index procedures, PCI for the native coronary accounted for nearly all patients (88%). During follow-up (median 4.1 years), 40 cardiovascular deaths had occurred. In multivariate analysis, age >75 years (hazard ratio [HR] 2.82, 95% CI 1.45 to 5.52), left ventricular ejection fraction <40% (HR 2.99, 95% CI 1.39 to 6.07), end-stage renal disease (HR 2.90, 95% CI 1.15 to 6.75), peripheral artery disease (HR 2.20, 95% CI 1.10 to 4.64), and CABG-SYNTAX score >25 (HR 2.37, 95% CI 1.19 to 5.05) were independent predictors of cardiovascular death. After creating a composite risk score in consideration of identified predictors, the freedom from cardiovascular death at 5 years was 98%, 86%, and 58% in the low (0 to 1), medium (2), and high (3 to 5) scores, respectively (p <0.001). The area under the receiver-operating characteristic curve for cardiovascular death for the CABG-SYNTAX and composite risk scores were 0.66 and 0.77, respectively (p <0.05). In conclusion, the combination of angiographic and clinical characteristics is useful for risk stratification in patients with previous CABG undergoing PCI.

  8. The challenge of achieving 1% operative mortality for coronary artery bypass grafting: A multi-institution Society of Thoracic Surgeons Database analysis

    PubMed Central

    LaPar, Damien J.; Filardo, Giovanni; Crosby, Ivan K.; Speir, Alan M.; Rich, Jeffrey B.; Kron, Irving L.; Ailawadi, Gorav

    2016-01-01

    Objectives Cardiothoracic surgical leadership recently challenged the surgical community to achieve an operative mortality rate of 1.0% for the performance of isolated coronary artery bypass grafting (CABG). The possibility of achieving this goal remains unknown due to the increasing number of high-risk patients being referred for CABG. The purpose of our study was to identify a patient population in which this operative mortality goal is achievable relative to the estimated operative risk. Methods Patient records from a multi-institution (17 centers) Society of Thoracic Surgeons (STS) database for primary, isolated CABG operations (2001–2012) were analyzed. Multiple logistic regression modeling with spline functions for calculated STS predicted risk of mortality (PROM) was used to rigorously assess the relationship between estimated patient risk and operative mortality, adjusted for operative year and surgeon volume. Results A total of 34,416 patients (average patient age, 63.9 ± 10.7 years; 27% [n = 9190] women) incurred an operative mortality rate of 1.87%. Median STS predicted risk of mortality was 1.06% (interquartile range, 0.60% −2.13% ) and median surgeon CABG volume was 544 (interquartile range, 303–930) operations over the study period. After risk adjustment for the confounding influence of surgeon volume and operative year, the association between STS PROM and operative mortality was highly significant (P < .0001). More importantly, the adjusted spline function revealed that an STS PROM threshold value of 1.27% correlated with a 1.0% probability of death, accounting for 57.3% (n = 19,720) of the total study population. Further, the STS PROM demonstrated a limited predictive capacity for operative mortality for STS PROM > 25% as observed to expected mortality began to diverge. Conclusions Achieving the goal of 1.0% operative mortality for primary, isolated CABG is feasible in appropriately selected patients in the modern surgical era. However, this

  9. Different Treatment Strategies for Patients with Multivessel Coronary Disease and High SYNTAX Score.

    PubMed

    Xia, Fei; Jia, Dalin; Han, Yang; Wang, Shaojun; Wang, Xin

    2015-12-01

    We sought to evaluate the prognosis of different treatment strategies on patients with multivessel coronary disease and high SYNTAX score. 171 patients with multivessel coronary disease and SYNTAX score ε33, who underwent coronary angiography between July 2009 and July 2010 at our hospital were retrospectively selected and divided into incomplete and complete revascularization intervention groups (IR), a coronary artery bypass surgery group (CABG), a conservative drug therapy group according to treatment strategies chosen and agreed by the patients. These patients were followed up for 19.44 ± 5.73 months by telephone or outpatient service. We found the medical treatment group has a lower overall survival than the IR, CR group, and CABG group (P log-rank values are 0.03, 0.03, and 0.02, respectively). The medical treatment group also has a lower survival than the IR group, CR group, and CABG group in cerebral stroke and recurrent myocardial infarction (MI) (P log-rank values are 0.004, 0.03, and 0.001, respectively) and MACE events (P log-rank values are 0.003, 0.001 and P < 0.001, respectively). The medical treatment group and IR group have lower survival in recurrent angina pectoris than the CR group and CABG group (P log-rank values are 0.02, 0.02 and 0.03, 0.008, respectively). There are no significant differences between the CR group and the CABG group in number of deaths, strokes and recurrent MIs, MACE events, angina pectoris (P log-rank values are 0.69, 0.53, and 0.86, respectively). The IR group shows a lower survival than the CR group and CABG group only in angina pectoris (P log-rank values are 0.03 and 0.008, respectively). For the patients with a high SYNTAX score, medical treatment is still inferior to revascularization therapy (interventional therapy or coronary artery bypass surgery). It appears that the CABG is not obviously superior to the coronary intervention therapy. Complete revascularization and coronary artery bypass grafting

  10. National trends in utilization and outcomes of coronary revascularization procedures among people with and without type 2 diabetes in Spain (2001–2011)

    PubMed Central

    2014-01-01

    Background Diabetes is associated with a high risk of death due to coronary artery disease (CAD). People with diabetes suffering from CAD are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of coronary revascularization procedures in diabetic and non-diabetic patients in Spain between 2001 and 2011. Methods We identified all patients who had undergone coronary revascularization procedures, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. The incidence of discharges attributed to coronary revascularization procedures were calculated stratified by diabetes status. We calculated length of stay and in-hospital mortality (IHM). We apply joinpoint log-linear regression to identify the years in which changes in tendency occurred in the use of PCI and CABG in diabetic and non-diabetic patients. Multivariate analysis was adjusted by age, sex, year and comorbidity (Charlson comorbidity index). Results From 2001 to 2011, 434,108 PCIs and 79,986 CABGs were performed. According to the results of the joinpoint analysis, we found that sex and age-adjusted use of PCI increased by 31.4% per year from 2001 to 2003, by 15.9% per year from 2003 to 2006 and by 3.8% per year from 2006 to 2011 in patients with diabetes. IHM among patients with diabetes who underwent a PCI did not change significantly over the entire study period (OR 0.99; 95% CI 0.97-1.00). Among patients with diabetes who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 10.4% per year from 2001 to 2003, and then decreased by 1.1% through 2011. Diabetic patients who underwent a CABG had a 0.67 (95% CI 0.63-0.71) times lower probability of dying during hospitalization than those without diabetes. Conclusions The annual percent change in PCI procedures increased in diabetic and non

  11. Reduction of oxidative stress does not affect recovery of myocardial function: warm continuous versus cold intermittent blood cardioplegia.

    PubMed Central

    Biagioli, B.; Borrelli, E.; Maccherini, M.; Bellomo, G.; Lisi, G.; Giomarelli, P.; Sani, G.; Toscano, M.

    1997-01-01

    OBJECTIVE: To compare oxidative stress after cardiac surgery in patients treated with two different methods of myocardial protection: warm continuous versus cold intermittent blood cardioplegia. To correlate oxidative stress with postoperative myocardial dysfunction. DESIGN: Prospective, randomised, double blind, trial. SETTING: Institutional centre of cardiovascular surgery. PATIENTS: 20 patients were selected for coronary artery bypass surgery (CABG) on the following basis: stable angina, ejection fraction > 50%, double or triple vessel disease, no previous CABG or associated disease. Patients were randomised to two groups of 10 patients each. INTERVENTIONS: Patients underwent CABG with one of two different methods of myocardial protection and cardiopulmonary bypass. CBC group: intermittent cold blood antegrade-retrograde cardioplegia with moderate hypothermic cardiopulmonary bypass; WBC group: continuous warm blood antegrade-retrograde cardioplegia with mild hypothermic cardiopulmonary bypass. MAIN OUTCOME MEASURE: The index of oxidative stress used was the alteration of whole blood and plasma glutathione redox status. Samples were collected from the coronary sinus and peripheral vein before anaesthesia (T1), before aortic unclamping (T2), 15 minutes (T3), and 30 minutes (T4) after unclamping. Haemodynamic parameters were measured with thermodilution techniques. RESULTS: Oxidised glutathione and glutathione-cysteine mixed disulphide significantly increased in the coronary sinus plasma in the CBC group, and the overall redox balance of glutathione was decreased (P < 0.01) at T2-T4 versus T1, and compared with the WBC group. Comparable results were obtained for coronary sinus blood. There was no correlation between postoperative haemodynamic measurements and oxidative stress markers. CONCLUSIONS: Oxidative stress was significant in patients undergoing CABG using cold blood cardioplegia, while the warm technique minimised the effects of ischaemia. However

  12. Targeting C-reactive protein levels using high-dose atorvastatin before coronary artery bypass graft surgery

    PubMed Central

    Krivoy, Norberto; Adler, Zvi; Saloma, Ronen; Hawadie, Ashraf; Azzam, Zaher S

    2008-01-01

    BACKGROUND: Statin medication exhibits pleiotropic properties, such as improvement of endothelial function. AIM: To determine whether a high loading dose of atorvastatin prescribed before and after coronary artery bypass graft (CABG) surgery will attenuate the inflammatory response reflected in kinetic concentrations of C-reactive protein (CRP). METHODS: The individual area under the concentration-time curve (AUC) of CRP concentration was calculated for the first five days after CABG surgery and compared among three groups of patients: group A patients (n=16), who were on chronic statin therapy, were switched to an equivalent therapy of 20 mg atorvastatin daily for 120 h; group B patients (n=15), who were on chronic statin therapy, were switched to 80 mg atorvastatin daily (one dose 24 h before CABG surgery, one on the day of surgery and two further doses after surgery) followed by 40 mg/day up to 120 h after surgery; and group C patients (n=10), who were naive to statin therapy, underwent elective CABG surgery. RESULTS: The three groups were comparable according to measurements of their intra- and postoperative variables, except for their mean weight. The mean (± SEM) AUC-CRP for group B was 13,545±959.9 mg/L·h, significantly smaller (P=0.01) than that for group A (17,085±858.4 mg/L·h). In group C (statin-naïve patients), the AUC-CRP was 16,191±1447 mg/L·h, which was not significantly different from groups A and B, respectively. CONCLUSIONS: High loading doses of atorvastatin before CABG surgery reduced CRP concentration, expressed as AUC-CRP. This effect supports the idea that a high dose of atorvastatin is needed to attenuate the ‘negative’ inflammatory response. The present study also lends support to the possibility that high-dose atorvastatin positively improves post-open-heart surgery results. PMID:19343161

  13. Relation between preoperative renal dysfunction and cardiovascular events (stroke, myocardial infarction, or heart failure or death) within three months of isolated coronary artery bypass grafting.

    PubMed

    Holzmann, Martin J; Sartipy, Ulrik

    2013-11-01

    Renal dysfunction is related to long-term mortality and myocardial infarction after coronary artery bypass grafting (CABG). We aimed to investigate the association between preoperative renal dysfunction and early risk of stroke, myocardial infarction, or heart failure after CABG. From the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, we included all 36,284 patients who underwent primary isolated CABG from 2000 to 2008 in Sweden. The Swedish National Inpatient Registry was used to obtain the primary end point, which was rehospitalization for stroke, myocardial infarction, or heart failure ≤90 days after CABG. Logistic regression models were used to estimate the risk for the primary outcome and the secondary outcome of death from any cause, while adjusting for confounders. During 90 days of follow-up, there were 2,462 cardiovascular events and 617 deaths. In total, 17% of patients developed acute kidney injury postoperatively. Odds ratios with 95% confidence intervals for cardiovascular events after adjustment for age, gender, atrial fibrillation, left ventricular ejection fraction, diabetes mellitus, peripheral vascular disease, and history of myocardial infarction, heart failure, or stroke was 1.24 (1.06 to 1.45) in patients with an estimated glomerular filtration rate of 15 to 45 ml/min/1.73 m(2) but became nonsignificant after acute kidney injury was introduced into the statistical model. The risk of death was significantly increased in patients with estimated glomerular filtration rate of 15 to 45 ml/min/1.73 m(2) (odds ratio 1.76, 95% confidence interval 1.38 to 2.25) even after adjustment for all confounders. Renal dysfunction was associated with all-cause mortality but not with cardiovascular events during the first 3 postoperative months after primary isolated CABG.

  14. Coronary artery bypass grafting associated to aortic valve replacement in the elderly: survival and quality of life

    PubMed Central

    2012-01-01

    Myocardial ischemia is often associated to aortic valve stenosis in the elderly. Aim of this study was to evaluate the impact on survival and quality of life of CABG associated to aortic valve replacement in the septuagenarians and octogenarians. Between January 1991 and January 2010, 520 patients ageing > 70 years underwent aortic valve replacement with a mechanical prosthesis in two Institutions. They were divided into 2 groups: Group A included 406 patients undergoing isolated aortic valve replacement; Group B 114 patients receiving aortic valve replacement and CABG. A comparative analysis of long-term survival and quality of life (SF-36 test) was performed. Mean age was 74.2 ± 3.6 years (74.3 ± 3.6 in Group A, 74 ± 3.3 in Group B; p = 0.33). Hospital mortality was 9.5% (46 patients). Twenty-nine (7.8%) in Group A and 17 in Group B (15.2%)(p = 0.019). Actuarial survival was 88.5% ± 0.015 at 1 year, 81.9% ± 0.02 at 5 years, 76.6% ± 0.032 at 10 and 57.3 ± 0.1 at 15 years. Ten-year survival was 77% ± 0.034 in Group A and 77.8% ± 0.045 in Group B (p = 0.2). Multivariate analysis did not reveal associated CABG as a predictor of long term mortality. The scores obtained in the SF-36 test were similar in the two groups and significantly higher than those of the general population matched for country, age and sex (p < 0.001 in all domains). Associated CABG determines a significant increase of hospital mortality in the elderly undergoing aortic valve replacement. Survivors did not show differences in long-term outcome and quality of life according to the presence of associated CABG. PMID:22309837

  15. Comparison of health-related quality of life after percutaneous coronary intervention and coronary artery bypass surgery

    PubMed Central

    Yazdani-Bakhsh, Razieh; Javanbakht, Mehdi; Sadeghi, Masoumeh; Mashayekhi, Atefeh; Ghaderi, Hossein; Rabiei, Katayoun

    2016-01-01

    BACKGROUND Health-related quality of life (HRQOL) evaluation is an important measure of the impact of the disease. As more people with coronary heart disease (CHD) live longer, doctors and researchers want to know how they manage in day to day life. It looked like adults with CHD had a decrease QOL. The aim of this study was to comparison of HRQOL of patients who underwent percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) and to assess its main determinants in the whole sample of coronary artery disease (CAD) patients. METHODS The study was carried out to estimate HRQOL of 109 patients who underwent invasive coronary revascularization [PCI (n = 75) and CABG (n = 34)]. We applied HRQOL after 6 months and 2 years in both groups and scores were compared. The HRQOL data were obtained using MacNew Heart Disease questionnaire with dimensions emotional, physical and social that estimated. Data entry and analysis were performed by SPSS. RESULTS A total MacNew scale in CABG and PCI group in 6 months after treatment were 45.32 ± 13.75 and 53.52 ± 15.63, respectively (P = 0.010). After 2 years HRQOL mean changed to 51.176 ± 14.80 and 49.55 ± 16.22, respectively, in CABG and PCI group (P = 0.428). Our results in within-group analysis showed total MacNew scale and its subscales were changed significantly after 2 years in CABG and PCI group’s scores were detected. We found in the whole sample of CAD patients those who had a higher level of income and education and were not either overweight or obese experienced better HRQOL. CONCLUSION Our results showed that patients who underwent PCI experienced significantly higher HRQOL in 6 months after revascularization but over 24 months follow-up no difference was observed between the two groups. PMID:27752269

  16. How do We Manage Coronary Artery Disease in Patients with CKD and ESRD?

    PubMed

    Choi, Hoon Young; Park, Hyeong Cheon; Ha, Sung Kyu

    2014-12-01

    Chronic kidney disease (CKD) has been shown to be an independent risk factor for cardiovascular events. In addition, patients with pre-dialysis CKD appear to be more likely to die of heart disease than of kidney disease. CKD accelerates coronary artery atherosclerosis by several mechanisms, notably hypertension and dyslipidemia, both of which are known risk factors for coronary artery disease. In addition, CKD alters calcium and phosphorus homeostasis, resulting in hypercalcemia and vascular calcification, including the coronary arteries. Mortality of patients on long-term dialysis therapy is high, with age-adjusted mortality rates of about 25% annually. Because the majority of deaths are caused by cardiovascular disease, routine cardiac catheterization of new dialysis patients was proposed as a means of improving the identification and treatment of high-risk patients. However, clinicians may be uncomfortable exposing asymptomatic patients to such invasive procedures like cardiac catheterization, thus noninvasive cardiac risk stratification was investigated widely as a more palatable alternative to routine diagnostic catheterization. The effective management of coronary artery disease is of paramount importance in uremic patients. The applicability of diagnostic, preventive, and treatment modalities developed in nonuremic populations to patients with kidney failure cannot necessarily be extrapolated from clinical studies in non-kidney failure populations. Noninvasive diagnostic testing in uremic patients is less accurate than in nonuremic populations. Initial data suggest that dobutamine echocardiography may be the preferred diagnostic method. PCI with stenting is a less favorable alternative to CABG, however, it has a faster recovery time, reduced invasiveness, and no overall mortality difference in nondiabetic and non-CKD patients compared with CABG. CABG is associated with reduced repeat revascularizations, greater relief of angina, and increased long term

  17. Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts

    PubMed Central

    Frauenfelder, Thomas; Boutsianis, Evangelos; Schertler, Thomas; Husmann, Lars; Leschka, Sebastian; Poulikakos, Dimos; Marincek, Borut; Alkadhi, Hatem

    2007-01-01

    Purpose Coronary artery bypass graft (CABG) surgery represents the standard treatment of advanced coronary artery disease. Two major types of anastomosis exist to connect the graft to the coronary artery, i.e., by using an end-to-side or a side-to-side anastomosis. There is still controversy because of the differences in the patency rates of the two types of anastomosis. The purpose of this paper is to non-invasively quantify hemodynamic parameters, such as mass flow and wall shear stress (WSS), in end-to-side and side-to-side anastomoses of patients with CABG using computational fluid dynamics (CFD). Methods One patient with saphenous CABG and end-to-side anastomosis and one patient with saphenous CABG and side-to-side anastomosis underwent 16-detector row computed tomography (CT). Geometric models of coronary arteries and bypasses were reconstructed for CFD analysis. Blood flow was considered pulsatile, laminar, incompressible and Newtonian. Peri-anastomotic mass flow and WSS were quantified and flow patterns visualized. Results CFD analysis based on in-vivo CT coronary angiography data was feasible in both patients. For both types of CABG, flow patterns were characterized by a retrograde flow into the native coronary artery. WSS variations were found in both anastomoses types, with highest WSS values at the heel and lowest WSS values at the floor of the end-to-side anastomosis. In contrast, the highest WSS values of the side-to-side anastomosis configuration were found in stenotic vessel segments and not in the close vicinity of the anastomosis. Flow stagnation zones were found in end-to-side but not in side-to-side anastomosis, the latter also demonstrating a smoother stream division throughout the cardiac cycle. Conclusion CFD analysis of venous CABG based on in-vivo CT datasets in patients was feasible producing qualitative and quantitative information on mass flow and WSS. Differences were found between the two types of anastomosis warranting further

  18. Diaper rash

    MedlinePlus

    Dermatitis - diaper and Candida; Candida-associated diaper dermatitis; Diaper dermatitis; Dermatitis - irritant contact ... Diaper rashes are common in babies between 4 to 15 months old. They may be noticed more ...

  19. Cerebral angiography as a guide for therapy in isolated central nervous system vasculitis

    SciTech Connect

    Stein, R.L.; Martino, C.R.; Weinert, D.M.; Hueftle, M.; Kammer, G.M.

    1987-04-24

    The authors present a case of isolated central nervous system vasculitis documented by cerebral arteriography in which remission, using a treatment regimen of prednisone and cyclophosphamide, was guided by serial arteriography during a 15-month period.

  20. The introduction of a practice formulary in a military general practice.

    PubMed

    Morton, I N

    1990-10-01

    Over a 15 month period, all the scripts written by doctors in the Episkopi Garrison Medical Centre, Cyprus, were analysed. A formulary was produced by using the most popular items in that 15 month period and tested in a one month trial period. The idea was to find a practical and efficient method of producing a 'basic' formulary to which items could be added or removed after discussion with colleagues. PMID:2266530

  1. Episode-of-care physician payment: a study of coronary artery bypass graft surgery.

    PubMed

    Showstack, J A; Garnick, D W; Rosenfeld, K E; Luft, H S; Schaffarzick, R W; Tunis, S; Fowles, J

    1987-01-01

    Paying physicians for an episode of care is a possible alternative to current fee-for-service payment. We studied physician billing patterns for 512 Medicare beneficiaries who received coronary artery bypass graft (CABG) surgery in 1983. Relatively elaborate decision rules had to be created to exclude services that were not part of a routine CABG. We found that 72% of charges for an episode were associated with services provided on the day of surgery. Forty-seven percent of charges were by the primary surgeon, 15% by the assistant surgeon(s), and 9% by the anesthesiologist. Our results suggest that episode-of-care payment is a complex, and somewhat costly, alternative to other methods of prospective payment to physicians, although selective contracting by a health insurer for an episode of care for certain procedures might both reduce costs and improve quality. PMID:2961698

  2. Structure and functioning of a multidisciplinary 'Heart Team' for patients with coronary artery disease: rationale and recommendations from a joint BCS/BCIS/SCTS working group.

    PubMed

    Luckraz, Heyman; Norell, Michael; Buch, Mamta; James, Rachael; Cooper, Graham

    2015-10-01

    The decision-making process in the management of patients with ischaemic heart disease has historically been the responsibility of the cardiologist and encompasses medical management, percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Currently, there is significant geographical variability in the PCI:CABG ratio. There are now emerging recommendations that this decision-making process should be carried out through a multidisciplinary approach, namely the Heart Team. This work was carried out on behalf of The British Cardiovascular Society (BCS), Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) and British Cardiovascular Intervention Society (BCIS). This manuscript sets out the principles for the functioning of the Heart Team. This work has been approved by the Executive Committees of BCS/BCIS/SCTS.

  3. Vanishing Venous Coronary Artery Bypass Grafts after Sepsis

    PubMed Central

    Park, Soo Jin; Park, Ji Ye; Jung, Joonho; Hong, You Sun; Lee, Cheol Joo; Lim, Sang Hyun

    2016-01-01

    The dehiscence of saphenous vein grafts (SVGs) is a rare, often fatal, complication of coronary artery bypass grafting (CABG). We present the case of a 57-year-old man who underwent hemiarch graft interposition and CABG for a Stanford type A aortic dissection. Five months after discharge, the patient developed streptococcal sepsis caused by a hemodialysis catheter. Complete rupture of the proximal anastomoses of the saphenous veins and containment by the obliterated pericardial cavity was observed 25 months after the initial operation. The patient was successfully treated surgically. This report describes a patient who developed potentially fatal dehiscence of SVGs secondary to infection and outlines preventive and management strategies for this complication. PMID:27734001

  4. A rare cardiac haemangioma in the right ventricle diagnosed accurately using ¹⁸F-fluorodeoxyglucose-positron emission tomography.

    PubMed

    Matsuba, Tomoyuki; Hisashi, Yosuke; Yotsumoto, Goichi; Imoto, Yutaka

    2015-05-01

    A right ventricular cardiac tumour was incidentally detected in a 61-year-old man during a preoperative examination for coronary artery bypass grafting (CABG). Findings on computed tomography and magnetic resonance imaging suggested the differential diagnoses of myxoma, haemangioma and haemangiosarcoma, and it was difficult to identify whether the tumour was benign or malignant. (18)F-fluorodeoxyglucose-positron emission tomography strongly suggested a benign tumour. We enucleated the tumour, because an intraoperative frozen section also strongly suggested a benign origin. After resection, CABG under cardiopulmonary bypass was performed. Histopathological and immunohistochemical analysis indicated a cavernous haemangioma without evidence of malignant tissue. The patient has survived 20 months after surgery with no evidence of tumour recurrence.

  5. Assessment of coronary bypass graft patency by first-line multi-detector computed tomography.

    PubMed

    Pesenti-Rossi, D; Baron, N; Georges, J-L; Augusto, S; Gibault-Genty, G; Livarek, B

    2014-11-01

    The purpose of the study was to assess whether a strategy based on a MDCT performed routinely before CA can reduce the radiation dose during the CA, without increased global exposure in patients who need imaging of CABG. A total of 147 consecutive patients were included. The radiation dose during CA (KAP 12.1 vs 22.0 Gy/cm(2), P<.01) and the volume of iodinated contrast (155 vs 200 mL, P<.02) were reduced when preceded by a MDCT. Patients' cumulative exposures were not different in the 2 strategies (5.0 vs 5.1 mSv, P=.76). MDCT performed in first line is a valuable strategy for the assessment of CABG. PMID:25258019

  6. Spontaneous, Postpartum Coronary Artery Dissection and Cardiogenic Shock with Extracorporeal Membrane Oxygenation Assisted Recovery in a 30-Year-Old Patient

    PubMed Central

    Weis, Ricardo A.; Cubillo, Efrain I.; Chapital, Alyssa B.

    2016-01-01

    Coronary artery dissection is an infrequent cause of acute coronary syndrome in the general population. There is, however, a greater incidence of spontaneous coronary artery dissection (SCAD) in young women, especially in the peripartum period. However, the majority of cases have favorable outcomes with medical management or percutaneous coronary intervention; coronary artery bypass grafting (CABG) and transplantation are utilized in severe cases. This case is a one of a 30-year-old postpartum female with multivessel SCAD requiring CABG with subsequent biventricular failure and inability to wean from bypass. We believe this is the first reported case in which venoarterial extracorporeal membrane oxygenation (VA-ECMO) was used in the management of biventricular heart failure in a postpartum patient with SCAD. PMID:27127660

  7. Coronary artery bypass grafting in a patient with organophosphate poisoning.

    PubMed

    Pieris, Rajeeva R; Fernando, Ravindra

    2015-01-01

    A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning.

  8. The EXCEL and NOBLE trials: similarities, contrasts and future perspectives for left main revascularisation.

    PubMed

    Campos, Carlos M; Christiansen, Evald H; Stone, Gregg W; Serruys, Patrick W

    2015-01-01

    Unprotected left main coronary artery (ULMCA) stenosis has relatively high prevalence and exposes patients to a high risk for adverse cardiovascular events. The optimal revascularisation strategy (coronary artery bypass surgery [CABG] or percutaneous coronary intervention [PCI]) for patients with complex coronary artery disease is a topic of continuing debate. The introduction of the newer-generation drug-eluting stents (DES) -with documented improvements in both safety and efficacy- has prompted the interventional community to design two new dedicated randomised trials comparing CABG and PCI: the NOBLE (Coronary Artery Bypass Grafting Vs Drug Eluting Stent Percutaneous Coronary Angioplasty in the Treatment of Unprotected Left Main Stenosis) and EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials. The aims of the present review are to describe the similarities and contrasts between these two trials as well to explore their future implications in ULMCA treatment.

  9. Priming Reduced Extracorporeal Circulation Setup (PRECiSe) with the DeltaStream diagonal pump.

    PubMed

    Beholz, Sven; Kessler, Michael; Thölke, Ralf; Konertz, Wolfgang F

    2003-12-01

    Different systems for beating heart procedures and low priming systems limited to coronary artery bypass grafting (CABG) have been introduced. We describe Priming Reduced Extracorporeal Circulation Setup (PRECiSe), a new low priming system which sup-plies all the features of cardiopulmonary bypass (CPB). PRECiSe incorporates the DeltaStream diagonal pump, which pumps blood from the right atrium to the aorta via a membrane oxygenator and a filter; the system is placed beneath the patient's head resulting in extremely short tubing. A reservoir allows the use of suckers and vents. Autologous blood priming furthers reduces hemodilution. In a safety study the system was used for extracorporeal circulation in 11 patients undergoing CABG without adverse effects. By use of PRECiSe mean priming was reduced to 268.5 ml resulting in minimal hemo-dilution and transfusion requirements.

  10. Successful percutaneous coronary intervention for acute and chronic occlusion of the left main coronary artery: report of two cases and review of the literature.

    PubMed

    Ma, Gui-Zhou; Wang, Ying; Xu, Rong-He; Cai, Zhi-Xiong

    2016-04-01

    Total occlusion of the left main coronary artery (LMCA) is a rare but clinically serious event due to its poor prognosis. While coronary artery bypass grafting (CABG) is currently recommended for treatment of these patients, recent studies support the feasibility of treatment by percutaneous intervention (PCI). Here, we report the diagnoses and treatment of two cases of total occlusion of the LMCA. One patient presented with acute myocardial infarction complicated by cardiogenic shock resulting from acute occlusion of the LMCA, and the other patient presented with unstable angina pectoris resulting from chronic occlusion of the LMCA. Both cases were successfully treated with PCI. Our results in these cases suggest that PCI may be a safe and effective alternative to CABG for treatment of LMCA occlusion. PMID:27090033

  11. Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery.

    PubMed

    Dong, Zehua; Yu, Bangxu; Zhang, Quanfang; Pei, Haitao; Xing, Jinyan; Fang, Wei; Sun, Yunbo; Song, Zhen

    2016-01-01

    We investigated the effects of early rehabilitation therapy on prolonged mechanically ventilated patients after coronary artery bypass surgery (CABG).A total of 106 patients who underwent CABG between June 2012 and May 2015 were enrolled and randomly assigned into an early rehabilitation group (53 cases) and a control group (53 cases). The rehabilitation therapy consisted of 6 steps including head up, transferring from supination to sitting, sitting on the edge of bed, sitting in a chair, transferring from sitting to standing, and walking along a bed. The patients received rehabilitation therapy in the intensive care unit (ICU) after CABG in the early rehabilitation group. The control group patients received rehabilitation therapy after leaving the ICU.The results showed that the early rehabilitation therapy could significantly decrease the duration of mechanical ventilation (early rehabilitation group: 8.1 ± 3.3 days; control group: 13.9 ± 4.1 days, P < 0.01), hospital stay (early rehabilitation group: 22.0 ± 3.8 days; control group: 29.1 ± 4.6 days, P < 0.01), and ICU stay (early rehabilitation group: 11.7 ± 3.2 days; control group: 18.3 ± 4.2 days, P < 0.01) for patients requiring more than 72 hours prolonged mechanical ventilation. The results of Kaplan-Meier analysis showed that the proportions of patients remaining on mechanical ventilation in the early rehabilitation group were larger than that in the control group after 7 days of rehabilitation therapy (logrank test: P < 0.01). The results provide evidence for supporting the application of early rehabilitation therapy in patients requiring prolonged mechanical ventilation after CABG. PMID:26973269

  12. Renal effects of dexmedetomidine during coronary artery bypass surgery: a randomized placebo-controlled study

    PubMed Central

    2011-01-01

    Background Dexmedetomidine, an alpha2-adrenoceptor agonist, has been evaluated as an adjunct to anesthesia and for the delivery of sedation and perioperative hemodynamic stability. It provokes dose-dependent and centrally-mediated sympatholysis. Coronary artery bypass grafting (CABG) with extracorporeal circulation is a stressful procedure increasing sympathetic nervous system activity which could attenuate renal function due the interrelation of sympathetic nervous system, hemodynamics and renal function. We tested the hypothesis that dexmetomidine would improve kidney function in patients undergoing elective CABG during the first two postoperative days. Methods This was a double-blind, randomized, parallel-group study. Patients with normal renal function and scheduled for elective CABG were randomized to placebo or to infusion of dexmedetomidine to achieve a pseudo steady-state plasma concentration of 0.60 ng/ml. The infusion was started after anesthesia induction and continued until 4 h after surgery. The primary endpoint was creatinine clearance. Other variables included urinary creatinine and output, fractional sodium and potassium excretion, urinary potassium, sodium and glucose, serum and urinary osmolality and plasma catecholamine concentrations. The data were analyzed with repeated-measures ANOVA or Cochran-Mantel-Haenszel test. Results Sixty-six of 87 randomized patients were evaluable for analysis. No significant between-group differences were recorded for any indices of renal function except for a mean 74% increase in urinary output with dexmedetomidine in the first 4 h after insertion of a urinary catheter (p < 0.001). Confidence interval examination revealed that the sample size was large enough for the no-difference statement for creatinine clearance. Conclusions Use of intravenous dexmedetomidine did not alter renal function in this cohort of relatively low-risk elective CABG patients but was associated with an increase in urinary output. This study

  13. Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation

    PubMed Central

    Wijeysundera, Harindra C; Li, Lindsay; Braga, Vevien; Pazhaniappan, Nandhaa; Pardhan, Anar M; Lian, Dana; Leeksma, Aric; Peterson, Ben; Cohen, Eric A; Forsey, Anne; Kingsbury, Kori J

    2016-01-01

    Objective Transcatheter aortic valve implantation (TAVI) is generally more expensive than surgical aortic valve replacement (SAVR) due to the high cost of the device. Our objective was to understand the patient and procedural drivers of cumulative healthcare costs during the index hospitalisation for these procedures. Design All patients undergoing TAVI, isolated SAVR or combined SAVR+coronary artery bypass grafting (CABG) at 7 hospitals in Ontario, Canada were identified during the fiscal year 2012–2013. Data were obtained from a prospective registry. Cumulative healthcare costs during the episode of care were determined using microcosting. To identify drivers of healthcare costs, multivariable hierarchical generalised linear models with a logarithmic link and γ distribution were developed for TAVI, SAVR and SAVR+CABG separately. Results Our cohort consisted of 1310 patients with aortic stenosis, of whom 585 underwent isolated SAVR, 518 had SAVR+CABG and 207 underwent TAVI. The median costs for the index hospitalisation for isolated SAVR were $21 811 (IQR $18 148–$30 498), while those for SAVR+CABG were $27 256 (IQR $21 741–$39 000), compared with $42 742 (IQR $37 295–$56 196) for TAVI. For SAVR, the major patient-level drivers of costs were age >75 years, renal dysfunction and active endocarditis. For TAVI, chronic lung disease was a major patient-level driver. Procedural drivers of cost for TAVI included a non-transfemoral approach. A prolonged intensive care unit stay was associated with increased costs for all procedures. Conclusions We found wide variation in healthcare costs for SAVR compared with TAVI, with different patient-level drivers as well as potentially modifiable procedural factors. These highlight areas of further study to optimise healthcare delivery. PMID:27621832

  14. Meta-analysis of randomized controlled trials on magnesium in addition to beta-blocker for prevention of postoperative atrial arrhythmias after coronary artery bypass grafting

    PubMed Central

    2013-01-01

    Background Atrial arrhythmia (AA) is the most common complication after coronary artery bypass grafting (CABG). Only beta-blockers and amiodarone have been convincingly shown to decrease its incidence. The effectiveness of magnesium on this complication is still controversial. This meta-analysis was performed to evaluate the effect of magnesium as a sole or adjuvant agent in addition to beta-blocker on suppressing postoperative AA after CABG. Methods We searched the PubMed, Medline, ISI Web of Knowledge, Cochrane library databases and online clinical trial database up to May 2012. We used random effects model when there was significant heterogeneity between trials and fixed effects model when heterogeneity was negligible. Results Five randomized controlled trials were identified, enrolling a total of 1251 patients. The combination of magnesium and beta-blocker did not significantly decrease the incidence of postoperative AA after CABG versus beta-blocker alone (odds ratio (OR) 1.12, 95% confidence interval (CI) 0.86-1.47, P = 0.40). Magnesium in addition to beta-blocker did not significantly affect LOS (weighted mean difference −0.14 days of stay, 95% CI −0.58 to 0.29, P = 0.24) or the overall mortality (OR 0.59, 95% CI 0.08-4.56, P = 0.62). However the risk of postoperative adverse events was higher in the combination of magnesium and beta-blocker group than beta-blocker alone (OR 2.80, 95% CI 1.66-4.71, P = 0.0001). Conclusions This meta-analysis offers the more definitive evidence against the prophylactic administration of intravenous magnesium for prevention of AA after CABG when beta-blockers are routinely administered, and shows an association with more adverse events in those people who received magnesium. PMID:23343189

  15. Coronary bypass surgery in the presence of metastatic pheochromocytoma.

    PubMed

    Seery, Kristen; Ilsin, Burak; Kulik, Alexander

    2015-05-01

    The hemodynamic management of a patient with a pheochromocytoma presents special challenges due to the episodic release of catecholamines from the tumor, which threatens to provoke a hypertensive crisis. We present a patient with metastatic pheochromocytoma (bone, lung, lymph nodes) who underwent successful coronary artery bypass graft (CABG) surgery following premedication with phenoxybenzamine and metyrosine as well as the use of intraoperative phentolamine for the management of a hypertensive crisis in the operating room. PMID:25756842

  16. Quality-of-Life Outcomes in Surgical Treatment of Ischemic Heart Failure Quality-of-Life Outcomes With Coronary Artery Bypass Graft Surgery in Ischemic Left Ventricular Dysfunction

    PubMed Central

    Mark, Daniel B.; Knight, J. David; Velazquez, Eric J.; Wasilewski, Jaroslaw; Howlett, Jonathan G.; Smith, Peter K.; Spertus, John A.; Rajda, Miroslaw; Yadav, Rakesh; Hamman, Baron L.; Malinowski, Marcin; Naik, Ajay; Rankin, Gena; Harding, Tina M.; Drew, Laura A.; Desvigne-Nickens, Patrice; Anstrom, Kevin J.

    2014-01-01

    Background: The STICH (Surgical Treatment for Ischemic Heart Failure) trial compared a strategy of routine coronary artery bypass grafting (CABG) with guideline-based medical therapy for patients with ischemic left ventricular dysfunction. Objective: To describe treatment-related quality-of-life (QOL) outcomes, a major prespecified secondary end point in the STICH trial. Design: Randomized trial. (ClinicalTrials.gov: NCT00023595) Setting: 99 clinical sites in 22 countries. Patients: 1212 patients with a left ventricular ejection fraction of 0.35 or less and coronary artery disease. Intervention: Random assignment to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). Measurements: A battery of QOL instruments at baseline (98.9% complete) and 4, 12, 24, and 36 months after randomization (collection rates were 80% to 89% of those eligible). The principal prespecified QOL measure was the Kansas City Cardiomyopathy Questionnaire, which assesses the effect of heart failure on patients’ symptoms, physical function, social limitations, and QOL. Results: The Kansas City Cardiomyopathy Questionnaire overall summary score was consistently higher (more favorable) in the CABG group than in the medical therapy group by 4.4 points (95% CI, 1.8 to 7.0 points) at 4 months, 5.8 points (CI, 3.1 to 8.6 points) at 12 months, 4.1 points (CI, 1.2 to 7.1 points) at 24 months, and 3.2 points (CI, 0.2 to 6.3 points) at 36 months. Sensitivity analyses to account for the effect of mortality on follow-up QOL measurement were consistent with the primary findings. Limitation: Therapy was not masked. Conclusion: In this cohort of symptomatic high-risk patients with ischemic left ventricular dysfunction and multivessel coronary artery disease, CABG plus medical therapy produced clinically important improvements in several health status domains compared with medical therapy alone over 36 months. Primary Funding Source: National Heart, Lung, and Blood Institute. PMID

  17. Usefulness of 4-, 8-, and 16-slice computed tomography for detection of graft occlusion or patency after coronary artery bypass grafting.

    PubMed

    Stein, Paul D; Beemath, Afzal; Skaf, Elias; Kayali, Fadi; Janjua, Muhammad; Alesh, Issa; Olson, Ronald E

    2005-12-15

    The sensitivity and specificity of computed tomographic angiography for the evaluation of coronary artery bypass grafts (CABGs) was reviewed. A search of published studies in all languages was performed, incorporating electronic and manual components. A total of 985 patients with 2,200 CABGs participated in investigations with single-detector computed tomography (CT), 441 patients (1,246 CABGs) with 4-slice CT, none with 8-slice CT, and 144 patients (416 grafts) with 16-slice CT. Pooled data showed a sensitivity for the detection of complete occlusion with single-slice CT of 81% (402 of 494 patients), with 4-slice CT of 93% (293 of 315 patients), and with 16-slice CT of 99% (75 of 76 patients). The specificity, based on pooled data, using single-slice CT was 89% (1,507 of 1,697 patients), with 4-slice CT was 96% (878 of 915 patients), and with 16-slice CT was 98% (301 of 306 patients). The detection of complete occlusion and the detection of patency in saphenous vein bypass grafts and arterial bypass grafts were similar with multislice CT. Limited data were available on the detection of significant stenosis, exclusive of complete occlusion. With 4-slice CT, the sensitivity was 74% (23 of 31 patients) and was 88% (21 of 24 patients) with 16-slice CT. In conclusion, single-detector CT was able to detect graft patency, but it was not sensitive for graft occlusion. The data suggest that 4- and 16-slice CT can be used for the detection of complete graft occlusion or graft patency of CABGs. Significant stenosis was better assessed with 16-slice CT than with 4-slice CT. PMID:16360355

  18. Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery

    PubMed Central

    Goldsmith, Yulia; Chan, Jacqueline; Iskandir, Marina; Gulkarov, Iosif; Tortolani, Anthony; Brener, Sorin J.; Sacchi, Terrence J.; Heitner, John F.

    2015-01-01

    Background The significance of right ventricular ejection fraction (RVEF), independent of left ventricular ejection fraction (LVEF), following isolated coronary artery bypass grafting (CABG) and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR), independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery. Methods From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female) were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered <35% and <45%, respectively. Elective primary procedures include CABG (56%) and valve (44%). Thirty-day outcomes were perioperative complications, length of stay, cardiac re-hospitalizations and early mortaility; long-term (> 30 days) outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months. Findings Forty-eight patients had reduced RVEF (mean 25%) and 61 patients had normal RVEF (mean 50%) (p<0.001). Fifty-four patients had reduced LVEF (mean 30%) and 55 patients had normal LVEF (mean 59%) (p<0.001). Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05). Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03). Reduced LVEF did not influence long-term cardiac re-hospitalization. Conclusion Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures. PMID:26197273

  19. Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation

    PubMed Central

    Wijeysundera, Harindra C; Li, Lindsay; Braga, Vevien; Pazhaniappan, Nandhaa; Pardhan, Anar M; Lian, Dana; Leeksma, Aric; Peterson, Ben; Cohen, Eric A; Forsey, Anne; Kingsbury, Kori J

    2016-01-01

    Objective Transcatheter aortic valve implantation (TAVI) is generally more expensive than surgical aortic valve replacement (SAVR) due to the high cost of the device. Our objective was to understand the patient and procedural drivers of cumulative healthcare costs during the index hospitalisation for these procedures. Design All patients undergoing TAVI, isolated SAVR or combined SAVR+coronary artery bypass grafting (CABG) at 7 hospitals in Ontario, Canada were identified during the fiscal year 2012–2013. Data were obtained from a prospective registry. Cumulative healthcare costs during the episode of care were determined using microcosting. To identify drivers of healthcare costs, multivariable hierarchical generalised linear models with a logarithmic link and γ distribution were developed for TAVI, SAVR and SAVR+CABG separately. Results Our cohort consisted of 1310 patients with aortic stenosis, of whom 585 underwent isolated SAVR, 518 had SAVR+CABG and 207 underwent TAVI. The median costs for the index hospitalisation for isolated SAVR were $21 811 (IQR $18 148–$30 498), while those for SAVR+CABG were $27 256 (IQR $21 741–$39 000), compared with $42 742 (IQR $37 295–$56 196) for TAVI. For SAVR, the major patient-level drivers of costs were age >75 years, renal dysfunction and active endocarditis. For TAVI, chronic lung disease was a major patient-level driver. Procedural drivers of cost for TAVI included a non-transfemoral approach. A prolonged intensive care unit stay was associated with increased costs for all procedures. Conclusions We found wide variation in healthcare costs for SAVR compared with TAVI, with different patient-level drivers as well as potentially modifiable procedural factors. These highlight areas of further study to optimise healthcare delivery.

  20. Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery.

    PubMed

    Dong, Zehua; Yu, Bangxu; Zhang, Quanfang; Pei, Haitao; Xing, Jinyan; Fang, Wei; Sun, Yunbo; Song, Zhen

    2016-01-01

    We investigated the effects of early rehabilitation therapy on prolonged mechanically ventilated patients after coronary artery bypass surgery (CABG).A total of 106 patients who underwent CABG between June 2012 and May 2015 were enrolled and randomly assigned into an early rehabilitation group (53 cases) and a control group (53 cases). The rehabilitation therapy consisted of 6 steps including head up, transferring from supination to sitting, sitting on the edge of bed, sitting in a chair, transferring from sitting to standing, and walking along a bed. The patients received rehabilitation therapy in the intensive care unit (ICU) after CABG in the early rehabilitation group. The control group patients received rehabilitation therapy after leaving the ICU.The results showed that the early rehabilitation therapy could significantly decrease the duration of mechanical ventilation (early rehabilitation group: 8.1 ± 3.3 days; control group: 13.9 ± 4.1 days, P < 0.01), hospital stay (early rehabilitation group: 22.0 ± 3.8 days; control group: 29.1 ± 4.6 days, P < 0.01), and ICU stay (early rehabilitation group: 11.7 ± 3.2 days; control group: 18.3 ± 4.2 days, P < 0.01) for patients requiring more than 72 hours prolonged mechanical ventilation. The results of Kaplan-Meier analysis showed that the proportions of patients remaining on mechanical ventilation in the early rehabilitation group were larger than that in the control group after 7 days of rehabilitation therapy (logrank test: P < 0.01). The results provide evidence for supporting the application of early rehabilitation therapy in patients requiring prolonged mechanical ventilation after CABG.

  1. Percutaneous coronary intervention with vs without on-site cardiac surgery backup: a systematic review and meta-analysis.

    PubMed

    Zia, Mohammad I; Wijeysundera, Harindra C; Tu, Jack V; Lee, Douglas S; Ko, Dennis T

    2011-01-01

    Although the popularity of performing percutaneous coronary intervention (PCI) in centres without on-site cardiac surgery backup is increasing, the safety of this practice is unknown. Our goal was to perform a systematic review and meta-analysis of PCI with and without on-site cardiac surgery backup. We identified studies using computerized literature searches through July 2009. Main outcomes of interest included in-hospital mortality and early coronary artery bypass grafting (CABG). Analyses were stratified by procedure indication (primary PCI and nonprimary PCI). Pooled estimates were obtained using random-effects models. We identified 9 primary PCI studies (106,089 patients) and 7 nonprimary studies (910,422 patients) comparing centres with and without on-site cardiac surgery. For primary PCI, centres without on-site surgery had no significantly increased risk of in-hospital mortality (odds ratio [OR] 0.93; 95% confidence interval [CI], 0.83-1.05) or early CABG (OR 0.87; 95% CI, 0.68-1.11) compared with centres with on-site surgery. For nonprimary PCI, no increased risk of in-hospital mortality (OR 1.03; 95% CI, 0.64-1.66) and early CABG (OR 1.38; 95% CI, 0.65-2.95) was observed in centres without backup. However, significant heterogeneity existed in estimates of nonprimary PCI studies, suggesting substantial variation in outcomes of nonprimary PCI across centres without on-site cardiac surgery. We demonstrated that rates of in-hospital mortality and early CABG were similar at PCI centres with and without on-site cardiac surgery backup. However, variations in outcomes suggest that assurance of optimal outcomes at each PCI centre without on-site surgery is needed.

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

    PubMed Central

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

    2013-01-01

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

  3. Long-term planning to meet UK government coronary heart disease revascularization targets.

    PubMed

    Bowie, Cameron; Duff, Celia; Harper, Paul; Shahani, Arjan; Wilderspin, Hilary; Yates, Jan

    2004-05-01

    The National Service Framework (NSF) for Coronary Heart Disease, published in the UK in 2000, gave target intervention rates of 750 procedures per million population (pmp) for both percutaneous transluminal angioplasty (PTCA) and coronary artery bypass graft (CABG). This paper describes how one Regional Office of the Department of Health, with CABG and PTCA rates of around half the NSF target levels, designed a strategy to plan rationally to meet the derived population need for these procedures. A bottom-up needs assessment model was used to predict the population need for these procedures for the Eastern Region of the UK. The Excel-based model took account of the effects of demographic change, anticipated reduction in incidence of heart disease due to primary prevention programmes and the expected improvement in cardiology and cardiac surgery technologies. The model predicted that excess procedures would be required across the region over the next 20 years. Further access study modelling was used to determine the best location for additional tertiary cardiac centres. Further, a commissioning tool was produced that could compare the predicted need, including additional procedures needed to meet waiting list targets, with capacity available from a range of providers. These tools have been used successfully in the Eastern Region to increase the regional revascularization rates from 371 pmp CABG and 322 pmp PTCA in 2000 to planned rates of 453 pmp CABG and 447 pmp PTCA in 2002/2003, to recommend the building of a new tertiary cardiac centre in Essex in the next decade and to inform the commissioning of revascularization rates in three coronary heart disease networks.

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

    PubMed

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

    2012-10-01

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

  5. Effect of Obesity on Mortality and Morbidity After Coronary Artery Bypass Grafting Surgery in Iranian Patients

    PubMed Central

    Ardeshiri, Maryam; Faritous, Zahra; Ojaghi Haghighi, Zahra; Hosseini, Shirin; Baghaei, Ramin

    2014-01-01

    Background: Recent years have witnessed the emergence of obesity as a major public health concern. The drastic rise in obesity and its concomitant co-morbidities is a reflection of the recent changes in dietary habits in Iran and many other developing countries. A recent large population study in Tehran reported that 58% and 75% of middle-aged Iranian men and women, respectively, were either overweight or obese. Objectives: Considering the impact of obesity on mortality and morbidity after coronary artery bypass graft surgery (CABG), we sought to investigate the association between central obesity and the body mass index (BMI) and the post-CABG mortality and morbidity in Iranian patients. Patients and Methods: This prospective study was on 235 adult patients scheduled for isolated CABG in a university hospital. The patients were divided in two groups according to BMI ≥ 30 (obese; n = 60) and BMI < 30 (non-obese; n = 175). In-hospital and late (after 3 months) morbidity and mortality rates were compared between obese and non-obese patients. Results: A total of 235 patients (135 women) with a mean age of 59 ± 9.2 years (range = 29 to 79 years), mean BMI of 27.3 ± 4.2 (range = 17 to 40), and mean waist circumference of 101.2 ± 14.7 cm (range = 55 to 145 cm) were included. By the third postoperative month, wound infection had significantly increased in patients with BMI ≥ 30 (P = 0.022). In-hospital and late morbidity and mortality rates were comparable between the two groups (P > 0.05). Conclusions: In our patients obesity was a risk factor for wound infection but not atelectasis or the need for intra-aortic balloon pump or re-exploration. Obesity was not associated with increased in-hospital or 3 months mortality rates after CABG. PMID:24977121

  6. Effect of ischemic postconditioning on myocardial protection in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass

    PubMed Central

    Safaei, Nasser; Sheikhalizadeh, Mohammad Ali; Badalzadeh, Reza

    2016-01-01

    Introduction: Reperfusion injury is a well-known phenomenon following restoration of the coronary circulation after coronary artery bypass grafting (CABG) that impairs myocardial function. In order to control the severity of this injury, we aimed to investigate the effect of a new conditioning strategy namely ischemic postconditioning (IPOC) along with controlled aortic root reperfusion (CARR) on myocardial protection in CABG surgery with cardiopulmonary bypass. Methods: In a doubled blind clinical trial study, 51 patients undergoing first-time elective CABG were randomly divided in three groups: CARR, IPOC, and combination of IPOC and CARR. At the end of procedure and just before aortic cross-clamp removal, reperfusion was started as following: In CARR-receiving groups, the reperfusion was started with low perfusion pressures for 10 minutes, and in IPOC-receiving groups, three cycles of 1 minute episodes of ischemia separated by 1 minute episodes of reperfusion was applied as postconditioning protocol. Left ventricular ejection fraction (EF) (by echocardiography), inotrope requirement index, and myocardial arrhythmias were measured up to 72 hours after operation. Results: Echocardiography revealed that the recovery of EF after operation in IPOC group was significantly higher than those of two other groups (P < 0.05). Inotropic support requirement was significantly lower in IPOC groups. In addition, the incidence of atrial and ventricular arrhythmias after opening of aortic clamp and in intensive care unit (ICU) as well as recovery time of cardiac rhythm upon reperfusion were lowered by administration of IPOC, as compared with CARR group. Conclusion: The study suggests that IPOC may provide clinical benefits against reperfusion injury in patients undergoing CABG surgery and maintain the post ischemic left ventricular performance. PMID:27489599

  7. Effect of Citrate Phosphate Dextrose Solution on Reperfusion Injury in Coronary Artery Bypass Surgical Patients Undergoing Cardiopulmonary Bypass

    PubMed Central

    Yaghoubi, Alireza; Danaee, Saeid; Imani, Shahin; Sheikhalizadeh, Mohammadali; Ghojazadeh, Morteza

    2011-01-01

    Introduction Reperfusion injury is one of the most common phenomena associated with coronary artery bypass graft (CABG) .The mechanism of ischemia and reperfusion injury is not known precisely, but may be free radicals and other activated oxygen metabolites have an important role in tissue damage following reperfusion injury. This study was to evaluation of citrate solution effects on oxidative stress and cardiac function and Cardiac enzymes in patient's candidate to CABG. Methods In Double blind clinical trial study in Tabriz University of medical science, 50 patients candidate to CABG randomly divided in two groups and matched together according to sex, age and NYHA class. In intervention group after surgery and before the opening of the aortic clamping solution warm blood containing citrate phosphate dextrose (CPD; 3cc/100cc), value (100cc/min/m2BSA) for three minutes was administered. In control group, only pure blood administered. Oxidative stress markers measured in five stages and cardiac enzymes measured in three stages of surgery. Results Mean age 62.3±9.1 years including 30(60%) men and 20(40%) women. Ejection fractions between two groups were not significant before and after treatment. Administration of CPD was not significant effects on cardiac enzyme. Measurement of oxidative stress in different time were not different in malonil dialdehyde, superoxide dismutase and GPx but total antioxidant status were improved after intervention in compared with control group (p<0.001). Conclusion Results showed that CPD were positive effects of increasing in total antioxidant status after CABG, but in reduction of other oxidative markers were unlabeled. PMID:24250969

  8. Access to Coronary Artery Bypass Graft Surgery under Pay for Performance: Evidence from the Premier Hospital Quality Incentive Demonstration

    PubMed Central

    Epstein, Arnold M.; Joynt, Karen E.; Jha, Ashish K.; Orav, E. John

    2014-01-01

    Background Although Pay for Performance (P4P) has become common, many worry that P4P will lead providers to avoid offering surgical procedures to the sickest patients out of concern that poor outcomes will lead to financial penalties. Methods and Results We used Medicare data to compare change in rates of coronary artery bypass graft surgery (CABG) between 2002–03 and 2008–09 among patients with acute myocardial infarction (AMI) admitted to 126 hospitals participating in Medicare’s Premier Hospital Quality Incentive Demonstration P4P program (HQID) with patients in 848 control hospitals participating in public reporting alone. We examined rates for all AMI patients and those in the top decile of predicted mortality based on demographics, medical comorbidities and AMI characteristics. We identified 91,393 patients admitted for AMI in Premier hospitals and 502,536 Medicare patients admitted for AMI in control hospitals. CABG rates for AMI patients in Premier decreased from 13.6% in 2002–03 to 10.4% in 2008–09; there was a comparable decrease in non-Premier hospitals (13.6% to 10.6%, p-value for comparison of changes between Premier and non-Premier of 0.67). CABG rates for high-risk patients in Premier decreased from 8.4% in FY 2002–3 to 8.2% in 2008–9. Patterns were similar in non-Premier hospitals (8.4% to 8.3%, p-value for comparison of changes between Premier and non-Premier, 0.82). Conclusions Our results show no evidence of a deleterious impact of P4P on access to CABG for high-risk patients with AMI. These results should be reassuring to those concerned about the potential negative impact of P4P on high-risk patients. PMID:25160840

  9. The non-thyroidal illness syndrome after coronary artery bypass grafting: a 6-month follow-up study.

    PubMed

    Cerillo, Alfredo Giuseppe; Storti, Simona; Mariani, Massimiliano; Kallushi, Enkel; Bevilacqua, Stefano; Parri, Maria Serena; Clerico, Aldo; Glauber, Mattia

    2005-01-01

    The non-thyroidal illness syndrome (NTIS) is considered a transient and completely reversible phenomenon, but it has been shown that it may last for several days postoperatively after coronary artery bypass grafting (CABG) surgery. This study was undertaken to assess thyroid function 6 months after uncomplicated CABG. The thyroid profile was evaluated in 40 consecutive patients undergoing CABG preoperatively, at 0, 12, 48, and 120 h postoperatively, and at 6-month follow-up. Triiodothyronine (T3), free T3 (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) were assayed using a microparticle enzyme immunoassay. T4 and total serum thyroid hormone-binding capacity (T-uptake) were measured on the same samples using a fluorescence polarization immunoassay. Patients with severe systemic illness and patients treated with amiodarone were excluded. All patients were euthyroid at admission. Mean age was 67.4+/-9.0 years. There were 31 (77.5%) men. Typical NTIS was observed in all patients, and the FT3 concentration was still reduced by postoperative day 5 (p<0.0001). At 6-month follow-up, all patients were free from cardiac symptoms, and no new cardiac events were recorded. The thyroid profile was normal in 35 patients (87.5%). One patient (4.5%) had developed overt hypothyroidism. Two patients had isolated low T3 and FT3 levels with normal TSH. Two patients had moderately increased FT3 levels with suppressed TSH. In most uncomplicated patients, thyroid function returns to normal 6 months after CABG. However, we observed significant alterations of the thyroid profile in 5 out of 40 patients. Further studies are needed to define the long-term consequences of postoperative NTIS.

  10. OA01.26. Evaluation of tablet hrudayrog chintamani in management of coronary artery disease

    PubMed Central

    Palshetkar, Rahul; Khandare, Amit; Bhalerao, Supriya; Chhallani, Akshaykumar

    2012-01-01

    Purpose: Coronary Artery Disease is forecasted to be the most common cause of death globally, by 2020. The only standard care of treatment (SCT) for CAD i.e. CABG/PTCA is invasive and expensive. There is no established medical management for reversion of CAD except medical maintenance of CAD. We propose cost effective herbo-mineral preparation with the complete protocol, expected to cost US $ 500 against the cost of SCT: US 2000 +; which will avoid CABG/PTCA and the recurrence of CAD in post CABG/PTCA patients. The therapy would be beneficial for the contraindicated conditions of CABG/PTCA. Method: This is an open, single arm, prospective study with sample size of 20 patients in pilot study (2years) and 200 in the final study (5 yrs). Established CAD patients in the age group of 15-60, having LVEF >30% are recruited. The patient having Left Main Disease, proximal LAD disease >66%, other cardiac dysfunctions like MR, Left Ventricular Aneurism, VSD, LVESV> 60ml are excluded. Investigations include CAG (Day 0 and after 12 months), 2 D Echo, TMT,(BSL/HbA1c in stable DM2) and RFT/LFT every 4 months. Result: Interim analysis reveals major findings including, 1) significant reduction in CA blockage with improvement in TMT, 2DEcho and QOL, 2) statistical data of Dosha predominance in CAD, male to female ratio.3) Ayurvedic etiologies of CAD with prevalence of stress factor in majority of cases, 4) safety data of drugs after prolong administration of Ayurvedic Conclusion: Confirmation of reversion of CAD with improvement in QOL, No safety issue (though protocol includes herbomineral preparations), Challenges like recruitment, follow up, salient observations will be discussed in details, It is not a single drug or herbomineral but the complete Ayurvedic protocol proves effective in reversion of Tridoshtmaka disease like CAD.

  11. Racial disparities in the use of blood transfusion in major surgery

    PubMed Central

    2014-01-01

    Background Racial disparities in healthcare in the United States are widespread and have been well documented. However, it is unknown whether racial disparities exist in the use of blood transfusion for patients undergoing major surgery. Methods We used the University HealthSystem Consortium database (2009-2011) to examine racial disparities in perioperative red blood cells (RBCs) transfusion in patients undergoing coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy. We estimated multivariable logistic regressions to examine whether black patients are more likely than white patients to receive perioperative RBC transfusion, and to investigate potential sources of racial disparities. Results After adjusting for patient-level factors, black patients were more likely to receive RBC transfusions for CABG (AOR = 1.41, 95% CI: [1.13, 1.76], p = 0.002) and THR (AOR = 1.39, 95% CI: [1.20, 1.62], p < 0.001), but not for colectomy (AOR = 1.08, 95% CI: [0.90, 1.30], p = 0.40). Black-white disparities in blood transfusion persisted after controlling for patient insurance and hospital effects (CABG: AOR = 1.42, 95% CI: [1.30, 1.56], p < 0.001; THR: AOR = 1.43, 95% CI: [1.29, 1.58], p < 0.001). Conclusions We detected racial disparities in the use of blood transfusion for CABG and THR (black patients tended to receive more transfusions compared with whites), but not for colectomy. Reporting racial disparities in contemporary transfusion practices may help reduce potentially unnecessary blood transfusions in minority patients. PMID:24618049

  12. [Successful recanalisation of RCA CTO using retrograde approach].

    PubMed

    Król, Marek; Skwarna, Bartosz; Buszman, Paweł

    2009-03-01

    A 51-year-old female two years after CABG presented with unstable angina and inferior wall ischaemia. Coronary angiography revealed occluded graft to RCA and chronic total occlusion of RCA with good collateral flow from distal LAD to RCA. The CTO was successfully crossed and dilated through epicardial collaterals from distal LAD (retrograde approach). Finally, antegrade angioplasty with two stents implantation was performed achieving TIMI 3 flow.

  13. Acute Coronary Syndrome Does Not Have a Negative Impact on Outcomes after Coronary Artery Bypass Grafting in Patients with Left Main Disease

    PubMed Central

    Takanashi, Shuichiro

    2015-01-01

    Purpose: Early and long-term outcomes of coronary artery bypass grafting (CABG) in patients with left main disease (LMD) with acute coronary syndrome (ACS) have never been assessed. Methods: Between September 2004 and April 2012, 459 patients with LMD underwent first-time isolated CABG. Of those, 191 patients had ACS and 268 did not. Early and late postoperative outcomes were compared between two groups. Results: Patients in the LMD+ACS group were older and more likely to be female. Left ventricular ejection fraction was lower in the LMD+ACS group. In both groups, bilateral internal thoracic artery grafts were used in over 90% of patients and off-pump technique in over 95%. Operative death rate was not significantly different between the groups (LMD+ACS: 2.1% vs. LMD–ACS: 0.4%). Log-rank test revealed that the actuarial survival rate (79.2 ± 3.7% vs. 81.5 ± 3.5%) and freedom from major adverse cardiac and cerebrovascular events (MACCE) (69.2 ± 4.2% vs. 67.0 ± 4.1%) were similar between groups at 7 years. Multivariate analyses demonstrated that ACS was not identified as an independent predictor of operative death, late mortality, and late MACCE. Conclusion: ACS did not have a negative impact on early and late outcomes of CABG in patients with LMD. PMID:25641028

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

    PubMed

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

    2015-01-01

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

  15. Pseudotyping the adenovirus serotype 5 capsid with both the fibre and penton of serotype 35 enhances vascular smooth muscle cell transduction.

    PubMed

    Parker, A L; White, K M; Lavery, C A; Custers, J; Waddington, S N; Baker, A H

    2013-12-01

    Ex vivo gene therapy during coronary artery bypass grafting (CABG) holds great potential to prevent excessive smooth muscle cell (SMC) proliferation, neointima formation and graft failure. The most successful preclinical strategies to date have utilised vectors based on the species C adenovirus, Ad5, which engages the Coxsackie and Adenovirus receptor (CAR) as its primary attachment receptor. Profiling receptors on human SMCs demonstrated the absence of CAR but substantial expression of the species B receptor CD46. We performed transduction experiments using Ad5 and the CD46-utilising adenovirus Ad35, and found Ad35 significantly more efficient at transducing SMCs. To evaluate whether transduction could be further augmented, we evaluated chimeric CD46-utilising Ad5/Ad35 vectors comprising the Ad5 capsid pseudotyped with the Ad35 fibre alone (Ad5/F35) or in combination with the Ad35 penton (Ad5/F35/P35). In human smooth muscle cells (hSMCs), Ad5/F35/P35 mediated significantly higher levels of transduction than either parental vector or Ad5/F35. Ex vivo transduction experiments using mouse aortas from CD46 transgenics demonstrated that Ad5/F35/P35 was significantly more efficient at transducing SMCs than the other vectors tested. Finally, ex vivo transduction and immunofluorescent colocalisation experiments using human tissue from CABG procedures confirmed the preclinical potential of Ad5/F35/P35 as an efficient vector for vascular transduction during CABG.

  16. Molecular pathways activation in coronary artery bypass surgery: which role for pump avoidance?

    PubMed

    Parolari, Alessandro; Poggio, Paolo; Myasoedova, Veronika; Songia, Paola; Pilozzi, Alberto; Alamanni, Francesco; Tremoli, Elena

    2016-01-01

    In this study, we review current knowledge regarding molecular pathways activation and their possible mechanisms in the perioperative period of coronary artery bypass surgery (CABG). We also highlight the role of off-pump CABG as a possible way to better understand these biological changes.We show that, after both on-pump and off-pump CABG, there is a marked and protracted activation of several molecular pathways indicating increased inflammatory status, haemostasis activation, as well as increased oxidative stress and unfavourable endothelial milieu. These changes persist for days and even weeks after surgery. Interestingly, a relatively limited number of these pathways show a more pronounced activation in case of cardiopulmonary bypass use, and these markers are mainly associated with oxidative stress activation; on the contrary, the vast majority of the pathways has a similar course both in on and off-pump procedures. Surgical stress accounts for more protracted and marked molecular pathway perturbations overall, being the effect of cardiopulmonary, if any, limited to the very early hours after surgery. The near future of the translational research in coronary bypass surgery is to develop therapeutic strategies aimed at reducing this response, that is largely unrelated to cardiopulmonary bypass use, in order to reduce perioperative complications and to speed up patients' recovery.

  17. Epidemiology and ethics of coronary artery bypass surgery in an eastern county.

    PubMed

    Dickman, R L; Bukowski, S

    1982-02-01

    Despite an extensive literature on coronary artery bypass grafting (CABG) surgery in the last decade, relatively little has been written on the demographic or socioeconomic characteristics of patients who receive this limited medical resource. In the present study data were collected on all patients (N = 539) who received this procedure over a one-year period (July 1977 to June 1978) within Erie County in western New York. Using available census tract data, age-sex adjusted surgery rates by socioeconomic status are developed for defined geographic areas. Patients residing in the city of Buffalo and those from census tracts in the lowest quartile of median family income have dramatically lower surgery rates than do others in the county (P less than .001). Although these discrepancies in CABG surgery rates may be partially explained by differing incidence rates of the medical indications for CABG surgery, problems of access to the service may be operative. Three different principles of distributive justice (equality, liberty, and utility) are discussed in an attempt to see how they might be applicable to the pattern documented.

  18. Resource Use Trajectories for Aged Medicare Beneficiaries with Complex Coronary Conditions

    PubMed Central

    Federspiel, Jerome J; Stearns, Sally C; D'Arcy, Laura P; Geissler, Kimberley H; Beadles, Christopher A; Crespin, Daniel J; Carey, Timothy S; Rossi, Joseph S; Sheridan, Brett C

    2013-01-01

    Objective To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use. Data Sources Medicare inpatient and outpatient claims from 2002 to 2008 for patients receiving multivessel revascularization for symptomatic coronary disease in 2003–2004. Study Design This retrospective cohort study of 102,877 beneficiaries assessed survival, days in institutional settings, and Medicare payments for up to 6 years following receipt of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods A three-part estimator designed to provide robust estimates of a treatment's effect in the setting of mortality and censored follow-up was used. The estimator decomposes the treatment effect into effects attributable to survival differences versus treatment-related intensity of resource use. Principal Findings After adjustment, on average CABG recipients survived 23 days longer, spent an 11 additional days in institutional settings, and had cumulative Medicare payments that were $12,834 higher than PCI recipients. The majority of the differences in institutional days and payments were due to intensity rather than survival effects. Conclusions In this example, the survival benefit from CABG was modest and the resource implications were substantial, although further adjustments for treatment selection are needed. PMID:23347002

  19. Internal carotid artery rupture caused by carotid shunt insertion

    PubMed Central

    Illuminati, Giulio; Caliò, Francesco G.; Pizzardi, Giulia; Vietri, Francesco

    2015-01-01

    Introduction Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. Presentation of case A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful. Discussion Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect. Conclusion Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. PMID:26255001

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

    PubMed Central

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

    2014-01-01

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

  1. A Numerical Multiscale Framework for Modeling Patient-Specific Coronary Artery Bypass Surgeries

    NASA Astrophysics Data System (ADS)

    Ramachandra, Abhay B.; Kahn, Andrew; Marsden, Alison

    2014-11-01

    Coronary artery bypass graft (CABG) surgery is performed to revascularize diseased coronary arteries, using arterial, venous or synthetic grafts. Vein grafts, used in more than 70% of procedures, have failure rates as high as 50% in less than 10 years. Hemodynamics is known to play a key role in the mechano-biological response of vein grafts, but current non-invasive imaging techniques cannot fully characterize the hemodynamic and biomechanical environment. We numerically compute hemodynamics and wall mechanics in patient-specific 3D CABG geometries using stabilized finite element methods. The 3D patient-specific domain is coupled to a 0D lumped parameter circulatory model and parameters are tuned to match patient-specific blood pressures, stroke volumes, heart rates and heuristic flow-split values. We quantify differences in hemodynamics between arterial and venous grafts and discuss possible correlations to graft failure. Extension to a deformable wall approximation will also be discussed. The quantification of wall mechanics and hemodynamics is a necessary step towards coupling continuum models in solid and fluid mechanics with the cellular and sub-cellular responses of grafts, which in turn, should lead to a more accurate prediction of the long term outcome of CABG surgeries, including predictions of growth and remodeling.

  2. Aortic Wall Extracellular Matrix Proteins Correlate with Syntax Score in Patients Undergoing Coronary Artery Bypass Surgery

    PubMed Central

    Chiong, Terri; Cheow, Esther S. H.; Woo, Chin C.; Lin, Xiao Y.; Khin, Lay W.; Lee, Chuen N.; Hartman, Mikael; Sze, Siu K.; Sorokin, Vitaly A.

    2016-01-01

    Aims: The SYNTAX score correlate with major cardiovascular events post-revascularization, although the histopathological basis is unclear. We aim to evaluate the association between syntax score and extracellular matrix histological characteristics of aortic punch tissue obtained during coronary artery bypass surgery (CABG). This analysis compares coronary artery bypass surgery patients with High and Low syntax score which were followed up for one year period. Methods and Results: Patients with High (score ≥ 33, (n=77)) and Low Syntax Scores (score ≤ 22, (n=71)) undergoing elective CABG were recruited prospectively. Baseline clinical characteristics and surgical risks were well matched. At 1 year, EMACCE (Sum of cardiovascular death, stroke, congestive cardiac failure, and limb, gut and myocardial ischemia) was significantly elevated in the High syntax group (P=0.022). Mass spectrometry (MS)-based quantitative iTRAQ proteomic results validated on independent cohort by immunohistochemistry (IHC) revealed that the High syntax group had significantly upraised Collagen I (P<0.0001) and Elastin (P<0.0001) content in ascending aortic wall. Conclusion: This study shows that aortic extracellular matrix (ECM) differ between High and Low syntax groups with up-regulation of Collagen I and Elastin level in High Syntax Score group. This identifies aortic punches collected during CABG as another biomarker source related with atherosclerosis severity and possible clinical outcome. PMID:27347220

  3. The effect of solar-geomagnetic activity during hospital admission on coronary events within 1 year in patients with acute coronary syndromes

    NASA Astrophysics Data System (ADS)

    Vencloviene, J.; Babarskiene, R.; Milvidaite, I.; Kubilius, R.; Stasionyte, J.

    2013-12-01

    Some evidence indicates the deterioration of the cardiovascular system during space storms. It is plausible that the space weather conditions during and after hospital admission may affect the risk of coronary events in patients with acute coronary syndromes (ACS). We analyzed the data of 1400 ACS patients who were admitted to the Hospital Lithuanian University of Health Sciences, and who survived for more than 4 days. We evaluated the associations between geomagnetic storms (GS), solar proton events (SPE), and solar flares (SF) that occurred 0-3 days before and after hospital admission and the risk of cardiovascular death (CAD), non-fatal ACS, and coronary artery bypass grafting (CABG) during a period of 1 year; the evaluation was based on the multivariate logistic model, controlling for clinical data. After adjustment for clinical variables, GS occurring in conjunction with SF 1 day before admission increased the risk of CAD by over 2.5 times. GS 2 days after SPE occurred 1 day after admission increased the risk of CAD and CABG by over 2.8 times. The risk of CABG increased by over 2 times in patients admitted during the day of GS and 1 day after SPE. The risk of ACS was by over 1.63 times higher for patients admitted 1 day before or after solar flares.

  4. Amiodarone Versus Propafenone to Treat Atrial Fibrillation after Coronary Artery Bypass Grafting: A Randomized Double Blind Controlled Trial

    PubMed Central

    Nemati, Mohammad Hassan; Astaneh, Behrooz

    2016-01-01

    Background Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Several therapeutic and preventive strategies have been introduced for postoperative AF, but the treatment and prophylaxis of AF remain controversial. We aimed to compare the efficacy of intravenous amiodarone and oral propafenone in the treatment of AF after coronary artery bypass grafting (CABG). Methods This was a randomized controlled trial performed in two hospitals in Shiraz, Iran from 2009 to 2012. We included all patients who underwent elective CABG and developed AF postoperatively. The patients were randomly assigned to receive propafenone or amiodarone. The duration of AF, the success rate of the treatment, the need for cardioversion, the frequency of repeated AF, and the need for repeating the treatment were compared. Results The duration of the first (p=0.361), second (p=0.832), and third (p=0.298) episodes of AF, the need for cardioversion (p=0.998), and the need to repeat the first and second doses of drugs (p=0.557, 0.699) were comparable between the study groups. Repeated AF was observed in 17 patients (30.9%) in the propafenone group and 23 patients (34.3%) in the amiodarone group (p=0.704). Conclusion Oral propafenone and intravenous amiodarone are equally effective in the treatment and conversion of recent-onset AF after CABG. PMID:27298795

  5. Endoscopic vein harvesting: technique, outcomes, concerns & controversies

    PubMed Central

    Sarang, Zubair

    2013-01-01

    The choice of the graft conduit for coronary artery bypass grafting (CABG) has significant implications both in the short- and long-term. The patency of a coronary conduit is closely associated with an uneventful postoperative course, better long-term patient survival and superior freedom from re-intervention. The internal mammary artery is regarded as the primary conduit for CABG patients, given its association with long-term patency and survival. However, long saphenous vein (LSV) continues to be utilized universally as patients presenting for CABG often have multiple coronary territories requiring revascularization. Traditionally, the LSV has been harvested by creating incisions from the ankle up to the groin termed open vein harvesting (OVH). However, such harvesting methods are associated with incisional pain and leg wound infections. In addition, patients find such large incisions to be cosmetically unappealing. These concerns regarding wound morbidity and patient satisfaction led to the emergence of endoscopic vein harvesting (EVH). Published experience comparing OVH with EVH suggests decreased wound related complications, improved patient satisfaction, shorter hospital stay, and reduced postoperative pain at the harvest site following EVH. Despite these reported advantages concerns regarding risk of injury at the time of harvest with its potential detrimental effect on vein graft patency and clinical outcomes have prevented universal adoption of EVH. This review article provides a detailed insight into the technical aspects, outcomes, concerns, and controversies associated with EVH. PMID:24251019

  6. Genome-wide association study of acute kidney injury after coronary bypass graft surgery identifies susceptibility loci

    PubMed Central

    Stafford-Smith, Mark; Li, Yi-Ju; Mathew, Joseph P.; Li, Yen-Wei; Ji, Yunqi; Phillips-Bute, Barbara; Milano, Carmelo A.; Newman, Mark F.; Kraus, William E.; Kertai, Miklos D.; Shah, Svati H.; Podgoreanu, Mihai V.

    2015-01-01

    Acute kidney injury (AKI) is a common, serious complication of cardiac surgery. Since prior studies have supported a genetic basis for postoperative AKI, we conducted a genome-wide association study (GWAS) for AKI following coronary bypass graft (CABG) surgery. The discovery dataset consisted of 873 non-emergent CABG surgery patients with cardiopulmonary bypass (PEGASUS), while a replication dataset had 380 cardiac surgical patients (CATHGEN). Single nucleotide polymorphism (SNP) data were based on Illumina Human610-Quad (PEGASUS) and OMNI1-Quad (CATHGEN) BeadChips. We used linear regression with adjustment for a clinical AKI risk score to test SNP associations with the postoperative peak rise relative to preoperative serum creatinine concentration as a quantitative AKI trait. Nine SNPs meeting significance in the discovery set were detected. The rs13317787 in GRM7|LMCD1-AS1 intergenic region (3p21.6) and rs10262995 in BBS9 (7p14.3) were replicated with significance in the CATHGEN data set and exhibited significantly strong overall association following meta-analysis. Additional fine-mapping using imputed SNPs across these two regions and meta-analysis found genome wide significance at the GRM7|LMCD1-AS1 locus and a significantly strong association at BBS9. Thus, through an unbiased GWAS approach, we found two new loci associated with post-CABG AKI providing new insights into the pathogenesis of perioperative AKI. PMID:26083657

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

    PubMed

    Takahashi, Masao; Ishikawa, Toshihiro; Higashidani, Koichi; Katoh, Hiroki

    2004-09-01

    Off-pump coronary artery bypass grafting (CABG) has been rapidly increased, because of its less invasiveness with low complications. However, graft patency rate highly depends on the operators' capability due to technical difficulties. The SPY system, based on the fluorescence of indocyanine green, is an innovative device that permits validation of graft patency intra-operatively. Real time images of grafts are obtained with no need for catheterization, X-rays or iodine contrast medium. High-quality images could be obtained in all 290 grafts of 72 off-pump CABG cases (mean 4.0 grafts per patient). Four anastomoses (1.4%), including two proximal and two distal, were revised because of defects detected by SPY images. In one case, the SPY system revealed no blood flow in a radial sequential graft, although transit-time flow meter measurements showed a diastolic dominant pattern. SPY images provide critical information to surgeons to detect non-patent grafts, allowing them to be revised while the patient is still on the operating table. Using the SPY system, technical failures could be completely resolved during surgery. The use of the SPY system for intra-operative graft validation during off-pump CABG may become the gold standard for surgical management in the near future.

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

    PubMed Central

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

    2014-01-01

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

  9. Vasodilation Responses to Non-Selective α-Adrenergic Blockage of Coronary Bypass Grafts in Diabetic and Non-Diabetic Patients: In Vitro Study

    PubMed Central

    Gur, Ozcan; Gur, Demet Ozkaramanli; Gocmez, Semil Selcen; Ege, Turan

    2014-01-01

    Background: Adrenergic tonus is increased in atherosclerotic coronary arteries. In this study, we aimed to demonstrate in vitro effects of phentolamine, a reversible nonselective alpha (α) adrenergic blocker, on coronary artery bypass grafts (CABG) and compare its effects in diabetic and nondiabetic patients. Methods: A total number of 30 patients (15 diabetic and 15 nondiabetic) who were assigned to elective CABG surgery were enrolled into the study. For both groups of patients, 16 internal mammarian artery (IMA) samples, 16 saphenous vein (SV) samples and 16 radial artery (RA) samples were collected and studied in the tissue bath system. The vasodilatation responses to increasing doses of phentolamine were recorded. Results: When grafts were compared in terms of amount of vasodilatation to phentolamine, IMA had the most prominent vasodilatation followed by RA and SV respectively. Although the vasodilatation responses in nondiabetic patients were numerically higher than diabetic patients, there was no statistically difference between the groups. Conclusion: Phentolamine, a nonselective α adrenergic blocker, is proven to have equal vasodilatory effects in diabetic and nondiabetic CABG grafts and can safely be used both intravenously and topically in the perioperative period. PMID:25273273

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  12. Genetic Variants Are Not Associated with Outcome in Patients with Coronary Artery Disease and Left Ventricular Dysfunction: Results of the Genetic Sub-study of the Surgical Treatment for Ischemic Heart Failure (STICH) Trials

    PubMed Central

    Feldman, Arthur M.; She, Lilin; McNamara, Dennis M.; Mann, Douglas L.; Bristow, Michael R.; Maisel, Alan S.; Wagner, Daniel R.; Andersson, Bert; Chiariello, Luigi; Hayward, Christopher S.; Hendry, Paul; Parker, John D.; Racine, Normand; Selzman, Craig H.; Senni, Michele; Stepinska, Janina; Zembala, Marian; Rouleau, Jean; Velazquez, Eric J.; Lee, Kerry L.

    2015-01-01

    Objectives and Background We evaluated the ability of 23 genetic variants to provide prognostic information in patients enrolled in the Genotype Sub-studies of the Surgical Treatment for Ischemic Heart Failure (STICH) trials. Methods Patients in STICH Hypothesis 1 were randomized to medical therapy with or without CABG (Coronary Artery Bypass Grafting). Those in STICH Hypothesis 2 were randomized to CABG or CABG with left ventricular reconstruction. Results In patients assigned to STICH Hypothesis 2 (n=714), no genetic variant met the pre-specified Bonferroni-adjusted threshold for statistical significance (p<0.002); however, several met nominal prognostic significance: variants in the β2-adrenergic receptor gene (β2-AR Gln27Glu) and in the A1-adenosine receptor gene (A1-717 T/G) were associated with an increased risk of a subject dying or being hospitalized for a cardiac problem (p=0.027 and 0.031, respectively). These relationships remained nominally significant even after multivariable adjustment for prognostic clinical variables. However, none of the 23 genetic variants influenced all-cause mortality or the combination of death or cardiovascular hospitalization in the STICH Hypothesis 1 population (n=532) by either univariate or multivariable analysis. Conclusion We were unable to identify the predictive genotypes in optimally treated patients in these two ischemic heart failure populations. PMID:25592552

  13. How Do Hospitals Respond to Market Entry? Evidence from a Deregulated Market for Cardiac Revascularization.

    PubMed

    Li, Suhui; Dor, Avi

    2015-08-01

    Regulatory entry barriers to hospital service markets, namely Certificate of Need (CON) regulations, are enforced in many US states. Policy makers in other states are considering reinstating CON policies in tandem with service expansions mandated under the Affordable Care Act. Although previous studies examined the volume effects of CON, demand responses to actual entry into local hospital markets are not well understood. In this paper, we empirically examine the demand-augmenting, demand-redistribution, and risk-allocation effects of hospital entry by studying the cardiac revascularization markets in Pennsylvania, a state in which dynamic market entry occurred after repeal of CON in 1996. Results from interrupted time-series analyses indicate demand-augmenting effects for coronary artery bypass graft (CABG) and business-stealing effects for percutaneous coronary intervention (PCI) procedures: high entrant market share mitigated the declining incidence of CABG, but it had no significant effect on the rising trend in PCI use, among patients with coronary artery disease. We further find evidence that entry by new cardiac surgery centers tended to sort high-severity patients into the more invasive CABG procedure and low-severity patients into the less invasive PCI procedures. These findings underscore the importance of considering market-level strategic responses by hospitals when regulatory barriers are rescinded.

  14. The benefits of cognitive training after a coronary artery bypass graft surgery.

    PubMed

    de Tournay-Jetté, Emilie; Dupuis, Gilles; Denault, André; Cartier, Raymond; Bherer, Louis

    2012-10-01

    Cognitive deficits are frequent after coronary artery bypass graft surgery (CABG) in the elderly population. In fact, memory and attention deficits can persist several months after the surgery. Recent studies with healthy older adults have shown that memory and attention can be improved through cognitive training programs. The present study examined whether memory training (method of loci and story generation) and attentional training (dual-task computerized training) could improve cognitive functions in patients aged 65 years and older who underwent CABG surgery. Participants (n = 51) were assigned to one of three groups: (1) control group (tested at 1, 3 and 6 months after the surgery), (2) attention training followed by memory training, (3) memory training followed by attention training (groups 2 and 3: tested at 1, 2, 3 and 6 months after the surgery). The trainings took place between the 6th and 10th week following the surgery. The three groups were compared before and after each training program using attention and memory tests and neuropsychological tests. The results showed that attention and memory trainings lead to significant improvement in the cognitive domain that was trained. It thus seems that cognitive training can be a promising tool to enhance cognitive functions after a CABG surgery. PMID:22068879

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. Ultrastructural correlates of left ventricular contraction abnormalities in patients with chronic ischemic heart disease: determinants of reversible segmental asynergy postrevascularization surgery.

    PubMed

    Flameng, W; Suy, R; Schwarz, F; Borgers, M; Piessens, J; Thone, F; Van Ermen, H; De Geest, H

    1981-11-01

    The relationships between structural alterations and left ventricular (LV) contraction abnormalities were studied in patients with coronary artery disease (CAD). Transmural biopsies of the LV anterior free wall were taken during aortocoronary bypass surgery (CABG) in 62 patients. When preoperative anterior wall motion (AWM) was reduced, significant myocardial cell degeneration was found in patients with as well as without previous anterior infarction (MI). The amount of myocardial fibrosis was increased only in patients with ECG evidence of previous anterior MI (p less than 0.001). In a second series of 139 CAD patients, cineventriculograms performed before and 8 months after CABG were examined. In patients with patent grafts to the LV anterior wall not previously infarcted, reduced AWM became normal. In patients with previous anterior MI the outcome of AWM was unpredictable (usually unimproved). Thus the histologic correlate of reduced AWM in segments not previously infarcted was progressive loss of contractile material in otherwise viable myocardial cells. Some reversibility was suggested by restoration of resting function after CABG. Unpredictable results in segments associated with pathologic Q waves appear related to the fibrous component of these previously infarcted areas. PMID:6975559

  19. Does Pay-for-Performance Improve Surgical Outcomes? An Evaluation of Phase 2 of the Premier Hospital Quality Incentive Demonstration

    PubMed Central

    Shih, Terry; Nicholas, Lauren H.; Thumma, Jyothi R.; Birkmeyer, John D.; Dimick, Justin B.

    2013-01-01

    Objective We sought to determine whether the changes in incentive design in Phase 2 of Medicare’s flagship Pay-for-Performance program, the Premier Hospital Quality Incentive Demonstration (HQID), reduced surgical mortality or complication rates at participating hospitals. Background The Premier HQID was initiated in 2003 to reward high-performing hospitals. The program redesigned its incentive structure in 2006 to also reward hospitals that achieved significant improvement. The impact of the change in incentive structure on outcomes in surgical populations is unknown. Methods We examined discharge data for patients who underwent coronary artery bypass (CABG), hip replacement, and knee replacement at Premier hospitals and non-Premier hospitals in Hospital Compare from 2003–2009 in 12 states (n=861,411). We assessed the impact of incentive structural changes in 2006 on serious complications and 30-day mortality. In these analyses, we adjusted for patient characteristics using multiple logistic regression models. To account for improvement in outcomes over time, we used difference-in-difference techniques that compare trends in Premier vs. non-Premier hospitals. We repeated our analyses after stratifying hospitals into quintiles according to risk-adjusted mortality and serious complication rates. Results After restructuring incentives in 2006 in Premier hospitals, there were lower risk-adjusted mortality and complication rates for both cardiac and orthopedic patients. However, after accounting for temporal trends in non-Premier hospitals, there were no significant improvements in mortality for CABG (OR 1.09, 95% CI 0.92 to 1.28) or joint replacement (OR 0.81, 95% CI 0.58 to 1.12). Similarly, there were no significant improvements in serious complications for CABG (OR 1.05, 95% CI 0.97 to 1.14) or joint replacement (OR 1.12, 95% CI 1.01 to 1.23). Analysis of the “worst” quintile hospitals that were targeted in the incentive structural changes also did not

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

    PubMed Central

    2013-01-01

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

  1. Validation of Scoring Systems That Predict Outcomes in Patients With Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Chung, Wen-Jung; Chen, Chung-Yu; Lee, Fan-Yen; Wu, Chia-Chen; Hsueh, Shu-Kai; Lin, Cheng-Jei; Hang, Chi-Ling; Wu, Chiung-Jen; Cheng, Cheng-I.

    2015-01-01

    Abstract Several risk stratification scores, based on angiographic or clinical parameters, have been developed to evaluate outcomes in patients with left main coronary artery disease (LMCAD) who undergo coronary artery bypass grafting (CABG). This study aims to validate the predictive ability of different risk scoring systems with regard to long-term outcomes after CABG. This single-center study retrospectively re-evaluated the Synergy Between PCI with TAXUS and Cardiac Surgery (SYNTAX) score; EuroSCORE; age, creatinine, and ejection fraction (ACEF) score; modified ACEF score; clinical SYNTAX; logistic clinical SYNTAX score (logistic CSS); and Parsonnet scores for 305 patients with LMCAD who underwent CABG. The endpoints were 5-year rate of all-cause death and major adverse cardio-cerebral events (MACCEs), including cardiovascular (CV) death, myocardial infarction (MI), and stroke and target vessel revascularization (TVR). Compared with the SYNTAX score, other scores were significantly higher in discriminative ability for all-cause death (SYNTAX vs others: P < 0.01). The EuroSCORE ≥6 showed significant outcome difference on all-cause death, CV death, MI, and MACCE (P < .01). Multivariate analysis indicated the SYNTAX score was a non-significant predictor for different outcomes. Adjusted multivariate analysis revealed that the EuroSCORE was the strongest predictor of all-cause death (hazard ratio[HR]: 1.17; P < 0.001), CV death (HR: 1.16; P < 0.001), and MACCE (HR: 1.09; P = 0.01). The ACEF score and logistic CSS were predictive factors for TVR (HR: 0.25, P = 0.03; HR: 0.85, P = 0.01). The EuroSCORE scoring system most accurately predicts all-cause death, CV death, and MACCE over 5 years, whereas low ACEF score and logistic CSS are independently associated with TVR over the 5-year period following CABG in patients with LMCAD undergoing CABG. PMID:26061316

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

    PubMed

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

    2016-03-01

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

  3. Demographic and Socioeconomic Factors of Patients With Coronary Artery Diseases Undertreatment of Coronary Artery Bypass Grafting, Percutaneous Coronary Intervention and Drug Therapy in Mashhad, Iran

    PubMed Central

    Mirzaie, Maryam; Khajedaluee, Mohammad; Falsoleiman, Homa; Mirzaie, Asadollah; Emadzadeh, Mehdi Reza; Erfanian Taghvaei, Majid Reza

    2015-01-01

    Background: Considering the importance of preventing cardiovascular diseases, determining the contributing risk factors for ischemic heart disease which leads to atherosclerotic plaque, could be effective in selecting the required interventions. Objectives: This study aimed to evaluate socioeconomic factors in patients with Coronary Artery Diseases (CAD) in three treatment groups: Coronary Artery Bypass Grafting (CABG), Percutaneous Coronary Intervention (PCI) and drug therapy. By identifying and comparing the underlying factors in treatment groups, we can gather useful information for future planning and policy making in order to reduce and eliminate the contributing factors. Patients and Methods: This cross-sectional study was conducted on 760 patients with CAD referred to cardiovascular health centers in Mashhad, Iran, including Javad-Al-Aeme Heart Hospital, Qaem, Imam Reza and Dr. Shariati educational Hospital. Samples were collected through purposive sampling from January to March 2014. Based on the experts’ opinion, the subjects were categorized into three treatment groups: CABG, PCI, and drug therapy. Results: The mean age of total patients was 58.3 ± 11.5 years (P = 0.09). The proportion of rural patients in the PCI (26.7%) and drug therapy (27.5%) groups was twice as high as the CABG group (11.7%) (P < 0.001). The proportion of patients with higher educational level (higher than high school diploma) in the CABG group (35.9%) was higher than PCI and drug therapy groups (26.7%, 24.3%) (P = 0.006). Smoking, drinking and drug abuse were more common in the drug therapy group (P = 0.03, P = 0.02, and P < 0.001, respectively). One-vessel and three-vessel coronary artery diseases were more common in the drug and CABG groups, respectively (P < 0.001). Conclusions: In total, application of therapeutic approaches in patients with CAD depends on many factors. In our study not only risk factors such as gender, lifestyle, smoking, alcohol abuse, diabetes and

  4. Long-term impact of the ketogenic diet on growth and resting energy expenditure in children with intractable epilepsy

    PubMed Central

    GROLEAU, VERONIQUE; SCHALL, JOAN I; STALLINGS, VIRGINIA A; BERGQVIST, CHRISTINA A

    2014-01-01

    AIM The long-term effects of the ketogenic diet, a high fat diet for treating intractable epilepsy, on resting energy expenditure (REE) are unknown. The aim of this study was to evaluate the impact of 15 months of ketogenic diet treatment on growth and REE in children with intractable epilepsy. METHOD Growth, body composition and REE were assessed at baseline, 3 and 15 months in 24 children (14 males, 10 females; mean age 5y 6mo (SD 26mo), range 7mo–6y 5mo), 10 with cerebral palsy [CP]). Fifteen were identified as ketogenic diet responders at 3 months and continued on the ketogenic diet until 15 months. These were compared to 75 healthy children (43 males, 32 females; mean age 6y 3mo [SD 21mo] age range 2–9y). REE was expressed as percentage predicted, growth as height (HAz) and weight (WAz) z-scores, and body composition as fat and fat free mass (FFM). RESULTS HAz declined −0.2 and −0.6 from baseline to 3 and 15 months, respectively (p=0.001), while WAz was unchanged. In ketogenic diet responders, FFM, age and CP diagnosis predicted REE (overall R2=0.76, p<0.001) and REE did not change. REE adjusted for FFM was lower (p<0.01) in children with CP at baseline (mean [standard error], −143[51] kcals/d) and 15 months (−198[53] kcals/d) compared to the healthy children. INTERPRETATION After 15 months of the ketogenic diet, linear growth status declined while weight status and REE were unchanged. REE remained reduced in children with CP. PMID:24749520

  5. Dopamine D2 receptor status assessed by IBZM SPECT - A sensitive indicator for cerebral hypoxia

    SciTech Connect

    Tatsch, K.; Schwarz, J.; Welz, A.

    1995-05-01

    The striatum is highly sensitive to tissue hypoxia. Thus, it may be suggested that cerebral hypoxia could affect the integrity of the striatal receptor system. Purpose of the current SPECT investigations with IBZM was to evaluate whether hypoxic conditions cause detectable changes in the D2 receptor status. 25 controls and 30 pts with history of cerebral hypoxia (resuscitation after cardiac arrest: n=19, CABG surgery under cardiopulmonary bypass: n=11) were investigated with SPECT 2h p.i. of 185 MBq I-123 IBZM. For semiquant, evaluation transverse slices corrected for attenuation were used to calculate striatal to frontal cortex (S/FC) ratios. In 13/19 pts with cerebral hypoxia due to cardiac arrest IBZM binding was severely reduced after successful resuscitation. 7 died, 5 were in a vegetative state, 1 remained severely disabled. In 6/19 S/FC ratios were normal/mildly reduced, 2 of them had a good outcome, 4 were moderatley disabled. In pts with CABG IBZM binding was preoperatively normal. After hypoxia due to cardiac surgery striatal S/FC ratios decreased slightly, persisting on this level even 6 months after surgery. Neuropsychological/psychiatric testing showed only minor or transient changes in this group of patients. The striatal D2 receptor status seems to be a sensitive indicator for cerebral hypoxia. After hypoxia due to cardiac arrest IBZM results well correlate (in contrast to morphological or SEP findings) with the clinical outcome and thus may serve as early predictor of the individual prognosis. The moderate decline in IBZM binding following CABG surgery suggests mild cerebral hypoxia despite of protective hypothermia. Sensitively indicating cerebral hypoxia changes in the D2 receptor status assessed by IBZM SPECT may serve as a valuable diagnostic tool for testing neuroprotective drugs or modified surgical techniques.

  6. The effect of postoperative positive end-expiratory pressure on postoperative bleeding after off-pump coronary artery bypass grafting

    PubMed Central

    Salihoglu, Ece; Celik, Sezai; Ugurlucan, Murat; Caglar, Ilker Murat; Turhan-Caglar, Fatma Nihan; Isik, Omer

    2014-01-01

    Introduction To compare postoperative prophylactic use of two positive end-expiratory pressure (PEEP) levels in order to prevent postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery. Material and methods Sixty patients undergoing an elective off-pump CABG operation were included in this prospective, nonrandomized clinical trial. Patients were divided into two groups as receiving either 5 cm H2O (group 1) or 8 cm H2O PEEP (group 2) after the operation until being extubated. Chest tube outputs, use of blood products and other fluids, postoperative hemoglobin levels, accumulation of pleural and pericardial fluid after the removal of chest tubes, and duration of hospital stay were recorded and compared. Results Low- and high-pressure PEEP groups did not differ with regard to postoperative chest tube outputs, amounts of transfusions and crystalloid/colloid infusion requirements, or postoperative hemoglobin levels. However, low-pressure PEEP application was associated with significantly higher pleural (92 ±37 ml vs. 69 ±29 ml, p = 0.03) and pericardial fluid (17 ±5 ml vs. 14 ±6 ml, p = 0.04) accumulation. On the other hand, high-pressure PEEP application was associated with significantly longer duration of hospitalization (6.25 ±1.21 days vs. 5.25 ±0.91 days, p = 0.03). Conclusions Prophylactic administration of postoperative PEEP levels of 8 cm H2O, although safe, does not seem to reduce chest-tube output or transfusion requirements in off-pump CABG when compared to the lower level of PEEP. Further studies with larger sample sizes are warranted to confirm the benefits and identify ideal levels of PEEP administration in this group of patients. PMID:25395944

  7. Presentation and management of acute coronary syndromes among adult persons with haemophilia: results of an international, retrospective, 10-year survey.

    PubMed

    Fogarty, P F; Mancuso, M E; Kasthuri, R; Bidlingmaier, C; Chitlur, M; Gomez, K; Holme, P A; James, P; Kruse-Jarres, R; Mahlangu, J; Mingot-Castellano, M E; Soni, A

    2015-09-01

    Sparse data are available on presentation and management of acute coronary syndromes (ACS), including unstable angina and non-ST- and ST-elevation myocardial infarction, among persons with haemophilia (PWH). The aim of this study was to determine demographics, bleeding disorder characteristics, cardiovascular risk factors (CRFs), interventions, haemostatic protocol, revascularization outcomes and complications among PWH with ACS. Members of an international consortium comprising >2000 adult PWH retrospectively completed case report forms for episodes of ACS in a >10-year follow-up period (2003-2013). Twenty ACS episodes occurred among 19 patients [rate, 0.8% (95% CI 0.4, 1.2)]. Seven patients (37%) were aged <50 years; 10 (53%) had ≥3 CRFs. In 5/20 episodes (25%), the initial ACS management protocol was altered because of the bleeding disorder. None of the eight patients with severe haemophilia underwent coronary artery bypass grafting (CABG), compared with 54.5% of patients with non-severe disease (P = 0.02). Revascularization with percutaneous coronary intervention (PCI) or CABG was rated successful in 13/13 cases, with no excessive bleeding during initial management. During chronic exposure to antiplatelet agents, secondary haemophilia prophylaxis was more prevalent in patients with severe haemophilia compared with non-severe haemophilia (85.7% vs. 30%, P = 0.05). No ACS-related deaths occurred during initial management, but one patient with severe haemophilia A died of undetermined cause 36 months after the ACS event while on aspirin therapy. ACS occurs even among relatively younger PWH, typically in association with multiple CRFs. Revascularization with PCI/CABG is feasible, and antiplatelet agents plus secondary prophylaxis appears to be well tolerated in selected PWH with ACS.

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

    PubMed Central

    Tu, J V; Wu, K

    1998-01-01

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

  9. Incidence, Predictors, and Impact of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting in Military Veterans

    PubMed Central

    Cornwell, Lorraine D.; Bakshi, Ankur; Rachlin, Eric; Preventza, Ourania; Rosengart, Todd K.; Coselli, Joseph S.; LeMaire, Scott A.; Petersen, Nancy J.; Pattakos, Greg; Bakaeen, Faisal G.

    2016-01-01

    Little is known about the frequency and clinical implications of postoperative atrial fibrillation in military veterans who undergo coronary artery bypass grafting (CABG). We examined long-term survival data, clinical outcomes, and associated risk factors in this population. We retrospectively reviewed baseline, intraoperative, and postoperative data from 1,248 consecutive patients with similar baseline risk profiles who underwent primary isolated CABG at a Veterans Affairs hospital from October 2006 through March 2013. Multivariable logistic regression identified predictors of postoperative atrial fibrillation. Kaplan-Meier analysis was used to evaluate long-term survival (the primary outcome measure), morbidity, and length of hospital stay. Postoperative atrial fibrillation occurred in 215 patients (17.2%). Independent predictors of this sequela were age ≥65 years (odds ratios [95% confidence intervals], 1.7 [1.3–2.4] for patients of age 65–75 yr and 2.6 [1.4–4.8] for patients >75 yr) and body mass index ≥30 kg/m2 (2.0 [1.2–3.2]). Length of stay was longer for patients with postoperative atrial fibrillation than for those without (12.7 ± 6.6 vs 10.3 ± 8.9 d; P ≤0.0001), and the respective 30-day mortality rate was higher (1.9% vs 0.4%; P=0.014). Seven-year survival rates did not differ significantly. Older and obese patients are particularly at risk of postoperative atrial fibrillation after CABG. Patients who develop the sequela have longer hospital stays than, but similar long-term survival rates to, patients who do not. PMID:27777519

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

    PubMed Central

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

    2015-01-01

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

  11. Changes in anti-heat shock protein 27 antibody and C-reactive protein levels following cardiac surgery and their association with cardiac function in patients with cardiovascular disease.

    PubMed

    Rahsepar, Amir Ali; Mirzaee, Asadollah; Moodi, Fatemeh; Moohebati, Mohsen; Tavallaie, Shima; Khorashadizadeh, Fatemeh; Eshraghi, Ali; Alavi, Maryam-Sadat; Zarrabi, Laya; Sajjadian, Mostafa; Amini, Maral; Khojasteh, Roshanak; Paydar, Roghayeh; Mousavi, Somayeh; Ghayour-Mobarhan, Majid; Ferns, Gordon A

    2013-01-01

    The relationship between serum anti-heat shock protein (Hsp)27 antibody and high sensitive C-reactive protein (hs-CRP) levels and indices of cardiac function were investigated in patients undergoing coronary artery bypass grafting (CABG) or heart valve replacement. The changes in anti-Hsp27 antibody titers and hs-CRP levels were compared among patients undergoing off-pump and on-pump CABG or valvular heart replacement. Fifty-three patients underwent off-pump, on-pump CABG, and heart valvular replacement in each group. Serum anti-Hsp27 titers and hs-CRP values were measured 24 h before and after the operation and at discharge. Echocardiography was performed before surgery and before discharge. The results were compared with values from 83 healthy controls. hs-CRP levels increased and anti-Hsp27 antibody decreased following surgery (P < 0.001 and P < 0.05, respectively), although these changes were independent of operative procedure (P = 0.361 and P = 0.120, respectively). Anti-Hsp27 antibody levels were higher at the time of discharge (P = 0.016). Only in coronary patients were anti-Hsp27 antibody levels negatively associated with E/E' (r = -0.268, P = 0.022), a marker of pulmonary capillary wedge pressure. In conclusions, anti-Hsp27 antibody levels are associated with indices of cardiac function in coronary patients. Cardiopulmonary bypass had no significant effect on the induction of changes in anti-Hsp27 levels. Moreover, anti-Hsp27 antibody levels fell in all groups postoperatively; this may be due to the formation of immune complexes of antigen-antibody, and antibody levels were higher at the time of discharge.

  12. Coronary Artery Bypass Grafting in Native Americans

    PubMed Central

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

    2001-01-01

    BACKGROUND While the efficacy and safety of coronary artery bypass grafting (CABG) has been established in several clinical trials, little is known about its outcomes in Native Americans. MEASUREMENTS AND MAIN RESULTS We assessed clinical outcomes associated with CABG in 155 Native Americans using a national database of 18,061 patients from 25 nongovernmental, not-for-profit U.S. health care facilities. Patients were classified into five groups: 1) Native American, 2) white, 3) African American, 4) Hispanic, and 5) Asian. We evaluated for ethnic differences in in-hospital mortality and length of stay, and after adjusting for age, gender, surgical priority, case-mix severity, insurance status, and facility characteristics (volume, location, and teaching status). Overall, we found the adjusted risk for in-hospital death to be higher in Native Americans when compared to whites (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.5 to 9.8), African Americans (OR, 3.4; 95% CI, 1.1 to 9.9), Hispanics (OR, 7.1; 95% CI, 2.5 to 20.3), and Asians (OR, 2.8; 95% CI, 1.1 to 7.0). No significant differences were found in length of stay after adjustment across ethnic groups. CONCLUSIONS The risk of in-hospital death following CABG may be higher in Native Americans than in other ethnic groups. Given the small number of Native Americans in the database (n = 155), however, further research will be needed to confirm these findings. PMID:11556933

  13. Single nucleotide polymorphisms in cholesteryl ester transfer protein gene and recurrent coronary heart disease or mortality in patients with established atherosclerosis.

    PubMed

    Virani, Salim S; Lee, Vei-Vei; Brautbar, Ariel; Grove, Megan L; Nambi, Vijay; Alam, Mahboob; Elayda, MacArthur; Wilson, James M; Willerson, James T; Boerwinkle, Eric; Ballantyne, Christie M

    2013-11-01

    It is not known whether genetic variants in the cholesteryl ester transfer protein (CETP) gene are associated with recurrent coronary heart disease events or mortality in secondary prevention patients. Among 3,717 patients with acute coronary syndrome or coronary artery bypass grafting (CABG) enrolled in a prospective genetic registry, we evaluated whether CETP gene variants previously shown to be associated with reduced CETP activity and high-density lipoprotein cholesterol increase ("A" allele for both TaqIB [rs708272] and rs12149545) are associated with a reduction in recurrent myocardial infarction (MI), recurrent revascularization, or death. At 4.5 years of follow-up, 439 recurrent MI, 698 recurrent revascularizations, and 756 deaths occurred. Using an additive model of inheritance, the "A" allele for rs708272 was not associated with recurrent MI (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.78 to 1.17 for AG; HR 0.89, 95% CI 0.67 to 1.19 for AA; compared with GG genotype), recurrent revascularization (HR 1.13, 95% CI 0.95 to 1.33 for AG; HR 1.05, 95% CI 0.84 to 1.32 for AA), or mortality (HR 1.02, 95% CI 0.86 to 1.19 for AG; HR 1.11, 95% CI 0.91 to 1.37 for AA) in the overall cohort. Similar results were seen for the "A" allele for rs12149545. In the CABG subgroup, AG genotype for rs708272 was associated with an increased mortality (HR 1.38, 95% CI 1.06 to 1.79) compared with GG genotype. Results remained consistent using dominant model of inheritance. In conclusion, genetic CETP variants were not associated with recurrent MI or recurrent revascularization in overall cohort with a possible mortality increase in patients who underwent CABG.

  14. Respiratory pressures and expiratory peak flow rate of patients undergoing coronary artery bypass graft surgery

    PubMed Central

    Gimenes, Camila; de Godoy, Irma; Padovani, Carlos Roberto; Gimenes, Rodrigo; Okoshi, Marina Politi; Okoshi, Katashi

    2012-01-01

    Summary Background To evaluate clinical and laboratorial parameters that predict decreased respiratory function in patients subjected to coronary artery bypass graft surgery (CABG). Material/Methods This was a prospective study evaluating 61 patients subjected to CABG with cardiopulmonary bypass, median sternotomy, and under mechanical ventilation for up to 24 h. One day before surgery, clinical information was recorded. Maximal inspiratory (MIP) and expiratory (MEP) pressures, and expiratory peak flow rate (EPFR) values were assessed 1 day before surgery and on the fifth postoperative day. Student’s t test, 2-way ANOVA, Pearson’s linear correlation, and logistic regression were used for statistical analysis. Results Patients were 63±10 years old, 67% males. Arterial hypertension was found in 75.4% of the patients, diabetes in 31.2%, dyslipidemia in 63.9%, tabagism in 25%, and chronic obstructive pulmonary disease (COPD) in 16.4%. Previous myocardial infarction was found in 67%. Preoperative hemoglobin levels were 12.8±1.71 g/dL. Older individuals had lower preoperative MEP and EPFR values. Preoperatively, positive association was found between hemoglobin levels and maximal respiratory pressures and EPFR values. Patients with both class III angina and COPD presented higher reductions in pulmonary pressures between the preoperative period and the 5th postoperative day. Conclusions Older age and low hemoglobin levels are associated with preoperative low maximal respiratory pressures and EPFR. The combination of severe angina and COPD results in higher postoperative reduction of maximal respiratory pressures for patients who underwent CABG. PMID:22936191

  15. Prospective versus retrospective ECG-gated 64-detector coronary CT angiography for evaluation of coronary artery bypass graft patency: comparison of image quality, radiation dose and diagnostic accuracy.

    PubMed

    Lee, Jae Hwan; Chun, Eun Ju; Choi, Sang Il; Vembar, Mani; Lim, Cheong; Park, Kay-Hyun; Choi, Dong-Ju

    2011-06-01

    We aimed to evaluate image quality, radiation dose and diagnostic accuracy of coronary CT angiography (CCTA) with a prospectively gated transverse-axial scan (PGT) compared with a retrospectively gated helical scan (RGH), using a 64-slice scanner in patients who underwent coronary artery bypass graft (CABG). Of the 131 consecutive patients that underwent CABG using 64-slice multidetector row computed tomography during 2008, patients with heart rate (HR) of <75 beats/minute (bpm), and HR variation <10 bpm were included in the study. PGT was performed on 39 patients with 93 grafts, with RGH performed on 43 patients with 102 grafts. Image quality (1: excellent-4: poor) and estimated radiation dose were compared between the two groups. Of these, a total of 64 segments in 26 patients were subjected to invasive coronary angiography (ICA) for clinical reasons. Diagnostic accuracy of CCTA for evaluation of graft was performed between the two groups with ICA as a reference standard in terms of significant stenosis (≥ 50% of luminal stenosis). The image quality was not statistically different in the two groups. Mean effective radiation dose was 6.5 mSv in PGT-group, which was significantly lower than that in the RGH-group (21.2 mSv; P < 0.001). There was no statistically significant difference in diagnostic accuracy between the two groups (PGT-group versus RGH-group; 93.1% versus 91.4%). PGT can achieve dose reductions of up to 70% compared to RGH while maintaining image quality and high diagnostic accuracy in patients undergoing CABG. PMID:21678128

  16. Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial.

    PubMed

    Marashi, Seyed Mojtaba; Saeedinia, Seyed Mostafa; Sadeghi, Mostafa; Movafegh, Ali; Marashi, Shaqayeq

    2015-12-01

    A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG). This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction) as gabapentin group or received talc powder as placebo (placebo group). Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety verbal analog scale (VAS) at the pre-induction room in gabapentin and placebo groups were 2 and 4, respectively that was significantly lower in the former group (P. value =0.04 ); however, regarding median of pain score no difference was observed between them (P. value =0.07). Gabapentin (1200 mg) given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG.

  17. Acrolein generation stimulates hypercontraction in isolated human blood vessels

    SciTech Connect

    Conklin, D.J. . E-mail: dj.conklin@louisville.edu; Bhatnagar, A.; Cowley, H.R.; Johnson, G.H.; Trent, M.B.; Boor, P.J.

    2006-12-15

    Increased risk of vasospasm, a spontaneous hyperconstriction, is associated with atherosclerosis, cigarette smoking, and hypertension-all conditions involving oxidative stress, lipid peroxidation, and inflammation. To test the role of the lipid peroxidation- and inflammation-derived aldehyde, acrolein, in human vasospasm, we developed an ex vivo model using human coronary artery bypass graft (CABG) blood vessels and a demonstrated acrolein precursor, allylamine. Allylamine induces hypercontraction in isolated rat coronary artery in a semicarbazide-sensitive amine oxidase activity (SSAO) dependent manner. Isolated human CABG blood vessels (internal mammary artery, radial artery, saphenous vein) were used to determine: (1) vessel responses and sensitivity to acrolein, allylamine, and H{sub 2}O{sub 2} exposure (1 {mu}M-1 mM), (2) SSAO dependence of allylamine-induced effects using SSAO inhibitors (semicarbazide, 1 mM; MDL 72274-E, active isomer; MDL 72274-Z, inactive isomer; 100 {mu}M), (3) the vasoactive effects of two other SSAO amine substrates, benzylamine and methylamine, and (4) the contribution of extracellular Ca{sup 2+} to hypercontraction. Acrolein or allylamine but not H{sub 2}O{sub 2}, benzylamine, or methylamine stimulated spontaneous and pharmacologically intractable hypercontraction in CABG blood vessels that was similar to clinical vasospasm. Allylamine-induced hypercontraction and blood vessel SSAO activity were abolished by pretreatment with semicarbazide or MDL 72274-E but not by MDL 72274-Z. Allylamine-induced hypercontraction also was significantly attenuated in Ca{sup 2+}-free buffer. In isolated aorta of spontaneously hypertensive rat, allylamine-induced an SSAO-dependent contraction and enhanced norepinephrine sensitivity but not in Sprague-Dawley rat aorta. We conclude that acrolein generation in the blood vessel wall increases human susceptibility to vasospasm, an event that is enhanced in hypertension.

  18. Association between the Gensini Score and Carotid Artery Stenosis

    PubMed Central

    Fidan, Serdar; Tabakçı, Mehmet Mustafa; Toprak, Cuneyt; Alizade, Elnur; Acar, Emrah; Bayam, Emrah; Tellice, Muhammet; Naser, Abdurrahman; Kargın, Ramazan

    2016-01-01

    Background and Objectives The aim of this study was to evaluate the association between the extent of coronary artery disease assessed by the Gensini score and/or the SYNTAX score and the significant carotid stenosis in patients undergoing coronary artery bypass grafting (CABG). Subjects and Methods A total of 225 patients who had carotid doppler ultrasonography prior to CABG were included retrospectively. Significant coronary artery disease was assumed as a lumen diameter stenosis of ≥50% in any of the major epicardial coronary arteries. The severity of carotid stenosis was determined by B-mode and duplex ultrasonography. Clinically significant carotid stenosis was defined as peak systolic velocity greater than 125 cm/s. Results The mean value of SYNTAX score and Gensini score was highest in patients allocated to significant carotid stenosis (22.98±7.32, p<0.001 and 77.40±32.35, p<0.001, respectively). The other risk factors for significant carotid stenosis were found to be male gender (p=0.029), carotid bruit (p<0.001), diabetes (p=0.021), left main disease (p=0.002), 3-vessel disease (p=0.008), chronic total coronary occlusion (p=0.001), and coronary artery calcification (p=0.001) in univariate analysis. However, only the Gensini score (odds ratio[OR]=1.030, p=0.004), carotid bruit (OR=0.068, p<0.001), and male gender (OR=0.190, p=0.003) were the independent predictors. The Gensini score cut off value predicting significant carotid stenosis was 50.5 with 77% sensitivity (p<0.001). Conclusion The Gensini score may be used to identify patients at high risk for significant carotid stenosis prior to CABG. PMID:27721854

  19. The Effect of Pre-Emptive Dexmedetomidine on the Incidence of Post-Thoracotomy Pain Syndrome in Patients Undergoing Coronary Artery Bypass Grafting

    PubMed Central

    Jabbary Moghaddam, Morteza; Barkhori, Ali; Mirkheshti, Alireza; Hashemian, Morteza; Amir Mohajerani, Seyed

    2016-01-01

    Background Post-thoracotomy pain syndrome (PTPS) is pain that recurs or persists along a thoracotomy incision for at least two months following surgery. Dexmedetomidine (dex) is an α-2 agonist that also has analgesic, sedative-hypnotic, and sympatholytic properties. Objectives To determine the effect of pre-emptive dexmedetomidine on the incidence of PTPS in patients undergoing coronary artery bypass grafting (CABG). Patients and Methods This randomized clinical trial enrolled 104 candidates for elective coronary artery bypass grafting (CABG) and randomly assigned them to either a dex group or a control group. In the dex group, dexmedetomidine 0.5 µg/kg/hour was infused from the initiation of anesthesia until postoperative extubation in the intensive-care unit. Two months after surgery, the patients were contacted by telephone and interviewed to determine the presence of pain at the thoracotomy scars. Results Fifty-four patients were placed in the control group, and 50 patients were assigned to the dex group. The age, sex, and body mass index were not significantly different between the two groups of study (P > 0.05). The incidence of PTPS was 11/50 (22%) patients in the dex group and 28/54 patients (52%) in the control group. A chi-square test revealed a significant difference in the incidence of PTPS after two months between the dex and control groups (P = 0.032). Conclusions PTPS is a common problem following CABG, and pre-emptive therapy with dex may decrease neuropathic pain. PMID:27660748

  20. The effect of cyclosporin-A on peri-operative myocardial injury in adult patients undergoing coronary artery bypass graft surgery: a randomised controlled clinical trial

    PubMed Central

    Hausenloy, DJ; Kunst, G; Boston-Griffiths, E; Kolvekar, S; Chaubey, S; John, L; Desai, J; Yellon, DM

    2014-01-01

    Objective Cyclosporin-A (CsA) has been reported to reduce myocardial infarct size in both the experimental and clinical settings. This protective effect is dependent on its ability to prevent the opening of the mitochondrial permeability transition pore, a critical determinant of cell death in the setting of acute ischaemia-reperfusion injury. Whether CsA can reduce the extent of peri-operative myocardial injury (PMI) in patients undergoing coronary artery bypass graft (CABG) surgery is unknown, and is investigated in this randomised controlled clinical trial. Methods 78 adult patients undergoing elective CABG surgery were randomised to receive either an intravenous bolus of CsA (2.5 mg/kg) or placebo administered after induction of anaesthesia and prior to sternotomy. PMI was assessed by measuring serum cardiac enzymes, troponin T (cTnT) and CK-MB at 0, 6, 12, 24, 48 and 72 h after surgery. Results There was no significant difference in mean peak cTnT levels between control (n=43) and CsA treatment (n=40) patients (0.56±0.06 ng/mL with control vs 0.35±0.05 ng/mL with CsA; p=0.07). However, in higher-risk patients with longer cardiopulmonary bypass times, there was a significant reduction in PMI with CsA therapy (p=0.049), with a reduced postoperative cTnT rise by 0.03 ng/mL for every 10 min, when compared with control. Conclusions In patients with longer cardiopulmonary bypass times, a single intravenous bolus of CsA administered prior to CABG surgery reduced the extent of PMI. PMID:24488610

  1. Value of preoperative echocardiography in the prediction of postoperative atrial fibrillation following isolated coronary artery bypass grafting.

    PubMed

    Açil, Tayfun; Cölkesen, Yücel; Türköz, Riza; Sezgin, Alpay Turan; Baltali, Mehmet; Gülcan, Oner; Demircan, Senol; Yildirir, Aylin; Ozin, Bülent; Müderrisoğlu, Haldun

    2007-11-01

    The value of echocardiography, especially tissue Doppler imaging (TDI), in the assessment of risk of postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is not clear. One hundred two consecutive patients (80 men; mean age 61 +/- 10 years) who underwent elective isolated CABG were included in the study. All patients underwent conventional transthoracic echocardiography and TDI of the left and right heart before surgery. Also, 24-hour Holter recordings were obtained for all patients. The study end point was the development of postoperative AF. The surgical mortality rate was 2%. Postoperative AF occurred in 18 patients (18%). Patients with postoperative AF have been significantly older than patients without postoperative AF (73 +/- 7 vs 58 +/- 9 years, respectively; p <0.001). Compared with patients without postoperative AF, a significantly higher proportion of patients with postoperative AF experienced paroxysmal AF before surgery (6% vs 33%, respectively; p = 0.001). Patients with postoperative AF had a significantly larger mean left atrial diameter compared with patients without postoperative AF (37 +/- 3 vs 35 +/- 3 mm, respectively; p = 0.012). Multivariate logistic regression analysis identified age as the most significant predictor of postoperative AF (odds ratio 1.254, 95% confidence interval 1.127 to 1.396; p <0.001). Of the echocardiographic variables, only left atrial diameter was identified as a significant predictor of postoperative AF (odds ratio 1.250, 95% confidence interval 1.055 to 1.562; p = 0.047). In conclusion, in the prediction of postoperative AF after isolated CABG, preoperative transthoracic echocardiography, including both conventional echocardiography and TDI, is of little value. PMID:17950794

  2. Early operative comparison of two epicardial left atrial appendage occluding systems applied during off-pump coronary revascularisation in patients with persistent atrial fibrillation

    PubMed Central

    Emery, Robert; Gryszko, Leszek; Kaczejko, Kamil; Żegadło, Arkadiusz; Frankowska, Emilia; Mróz, Jakub; Skrobowski, Andrzej

    2016-01-01

    Introduction Atrial fibrillation (AF) increases long-term mortality and stroke rate in patients having coronary artery bypass grafting (CABG). Because oral anticoagulation (OAC) is associated with both a significant incidence of discontinuation and well known complication rates, left atrial appendage occlusion might be beneficial for stroke prevention. This study presents the first clinical and practical comparison of two epicardial left appendage occluders (LAAO) accruing experience in application during off-pump coronary revascularisation in patients with persistent AF. Material and methods Fifteen consecutive patients with persistent AF were assigned to intraoperative LAA occlusion with either TigerPaw System II (n = 8) or AtriClip (n = 7) device during off-pump CABG and concomitant left atrial epicardial ablation. Both systems were analysed in terms of ease and safety of application along with intraoperative LAA occlusion success. Results Surgical risk was increased in the study population (mean EuroScore II: 3.2 ± 0.3%). In all patients in the AtriClip group successful off-pump LAA occlusion confirmed by intraoperative transoesophageal echocardiography was achieved. The TigerPaw application was quicker and easier, but in 2 patients it was unsuccessful. During the hospital stay there were no bleeding or thromboembolic events recorded. Conclusions In a pilot cohort epicardial LAAO during off-pump CABG in patients with persistent AF was performed safely and successfully with an AtriClip device. The TigerPaw System requires technological improvement. It might be useful to adapt the use of the type of occluding device to the LAA morphologic type and target revascularisation vessels to avoid the additional use of a heart positioner or obviate coronary compression. PMID:27212972

  3. A Study on the Occurrence and Prevention of Perioperative Stroke after Coronary Artery Bypass Grafting

    PubMed Central

    Nakata, Kin-Ichi; Iida, Mitsuru; Yoshitake, Isamu; Wakui, Shinji; Osaka, Shunji; Kimura, Haruka; Takahashi, Kana; Ishi, Yusuke; Yaoita, Hiroko; Arimoto, Munehito; Hata, Hiroaki; Shiono, Motomi; Takayama, Tadateru; Hirayama, Atsushi

    2015-01-01

    Cerebral infarction after coronary artery bypass grafting (CABG) is a serious complication and a problem that remains unsolved. We will report the onset of cerebral infarction in CABG patients in our institution, and its cause, preventive method. The subjects of this research were 761 patients who underwent on-pump isolated CABG. Preoperative, intraoperative and postoperative factors, onset of cerebral infarction and atrial fibrillation were investigated. Postoperative cerebral infarction and postoperative atrial fibrillation were recognized in 1.4% and 24% of the patients, respectively. The risk factors for cerebral infarction were carotid artery stenosis, cardiopulmonary bypass time >180 min, postoperative atrial fibrillation, and β-blocker non-use. The risk factors for postoperative atrial fibrillation were 75 or higher years of age, chronic kidney diseases, emergency surgery, cardiopulmonary bypass time >180 min, intraoperative carperitide non-use, intraoperative landiolol hydrochloride non-use, preoperative angiotensin II receptor blockers (ARB) non-use, preoperative calcium antagonist use, preoperative statin use, postoperative β-blocker non-use, and postoperative aldosterone blocker non-use. The results of this study showed that cerebral infarction occurs frequently in patients who have developed atrial fibrillation, and it was considered that perioperative cerebral infarction can be prevented by perioperative β-blocker, carperitide, anticoagulation therapy and adequate extracorporeal circulation. Since preoperative, intraoperative and postoperative drug use is closely involved in the risk factor for postoperative atrial fibrillation, it was considered possible that adequate perioperative drug therapy can prevent atrial fibrillation and onset of cerebral infarction. (This article is a secondary publication of J Jpn Coron Assoc 2014; 20: 91–7.)

  4. Influence of colloid infusion on coagulation during off-pump coronary artery bypass grafting

    PubMed Central

    Muralidhar, K; Garg, Rajnish; Mohanty, SK; Banakal, Sanjay

    2010-01-01

    This study was conducted to determine the influence of colloid infusion on coagulation in patients undergoing off-pump coronary artery bypass grafting (OP-CABG). Thirty patients undergoing elective OP-CABG received medium molecular weight hydroxyethyl starch group I (MMW-HES 200/0.5), low molecular weight hydroxyethyl starch group II (LMW-HES 130/0.4) or gelatin group III (GEL) in a prospective randomized trial. Blood samples were assessed for hemoglobin (Hb), activated coagulation time (ACT), prothrombin time (PT), activated partial thromboplastin time (aPPT), platelet count, fibrinogen and von Willebrand factor (vWF) at specified intervals. Total volume of the colloid infused and postoperative chest-time drainage was also measured. There was a significant decrease in Hb, platelet count, fibrinogen levels in all these groups, which did not warrant blood transfusion. After the colloid infusion, vWF decreased significantly to 67% from baseline in group I as compared to 85 and 79% in group II and group III, respectively. vWF levels remained lower than the baseline value in the first 24 hours in group I, whereas this factor level increased above the baseline values in groups II and III, 6 hours postoperatively. Postoperative chest tube drainage in 24 hours was significantly higher in group I (856 ± 131 ml) as compared to group II (550 ± 124 ml) and group III (582 ± 159 ml). LMW-HES 130/0.4 was superior to MMW-HES 200/0.5 and gelatin in patients undergoing OP-CABG, in terms of better preservation of coagulation associated with enhanced volume effect. PMID:20661354

  5. Genome-Wide Association Study of New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Kertai, Miklos D.; Li, Yi-Ju; Ji, Yunqi; Qi, Wenjing; Lombard, Frederick W.; Shah, Svati H.; Kraus, William E.; Stafford-Smith, Mark; Newman, Mark F.; Milano, Carmelo A.; Waldron, Nathan; Podgoreanu, Mihai V.; Mathew, Joseph P.

    2016-01-01

    BACKGROUND Postoperative atrial fibrillation (AF) is a potentially life-threatening complication after coronary artery bypass graft (CABG) surgery. Genetic predisposition may predict risk for developing postoperative AF. METHODS Study subjects underwent CABG surgery with cardiopulmonary bypass at Duke University Medical Center. In a discovery cohort of 877 individuals from the Perioperative Genetics and Safety Outcomes Study (PEGASUS), we performed a genome-wide association study (GWAS) using a logistic regression model with a covariate adjustment for AF risk index. Single-nucleotide polymorphisms (SNPs) that met a P<5×10−5 were further tested using a replication dataset of 304 individuals from the CATHeterization GENetics (CATHGEN) biorepository, followed by meta-analysis. Potential pathways related to postoperative AF were identified through gene enrichment analysis using the top GWAS SNPs (P<10−4). RESULTS Nineteen SNPs met the a priori defined discovery threshold for replication, but only 3 met nominal significance (P<0.05) in the CATHGEN group, with only one – rs10504554, in the intronic region in lymphocyte antigen 96 (LY96) – showing the same direction of the effect for postoperative AF (odds ratio [OR]=0.48; 95% CI: 0.34–0.68, P=2.9×10−5 vs OR=0.55; 95% CI: 0.31–0.99, P=0.046), and strong overall association by meta-analysis (meta-P=4.0×10−6). Gene enrichment analysis highlighted the role of LY96 in pathways of biologic relevance to activation and modulation of innate immune responses. Our analysis also showed potential association between LY96 and nuclear factor NF-kappa-B interaction, and postoperative AF through their relevance to inflammatory signaling pathways. CONCLUSIONS In patients undergoing CABG surgery, we found genetic polymorphisms in LY96 associated with decreased risk for postoperative AF. PMID:26385043

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

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

  7. LDL apheresis for cholesterol embolism following coronary artery bypass graft surgery--a case report.

    PubMed

    Sanai, Toru; Matsui, Rei; Hirano, Tadashi

    2006-01-01

    A 76-year-old man without any prior history of abnormal urinalysis findings or renal insufficiency demonstrated mild renal dysfunction after coronary bypass graft surgery (CABG). Two months after CABG, pain and blueness in the toes (blue toe syndrome) appeared and, the serum creatinine level (S-Cr) increased from 1.2 to 2.0 mg/dL. On admission (3 months later), the urinary protein level was 0.5 g/day, white blood cell count 8,300/microL with eosinophils (Eo) 10.5%, S-Cr 2.1 mg/dL, and low-density lipoprotein (LDL) 106 mg/dL. Acute renal failure and blue toe syndrome due to a cholesterol embolism (CE) were diagnosed. Alprostadil 40 microg/day orally for 2 weeks and alprostadil 40 microg/day intravenously were used for 5 weeks, and Eo were 250/microL, S-Cr 2.5 mg/dL; however, blue toe syndrome gradually developed. At 8 weeks after admission, limaprost alfadex 30 microg/day orally was used for 3 weeks. However, the Eo gradually rose to 1,520/microL, S-Cr to 3.0 mg/dL, and LDL to 135 mg/dL, and LDL apheresis was therefore performed 20 times for CE. The data just after LDL apheresis was performed 10 times were as follows: Eo 1,120/microL, S-Cr 4.0 mg/dL, and LDL 89 mg/dL, and blue toe syndrome had disappeared. At 10 months after the first LDL apheresis, the Eo were 630/microL, S-Cr 2.9 mg/dL, and LDL 109 mg/dL. As a result, LDL apheresis was found to be beneficial for the treatment of CE with acute renal failure and blue toe syndrome after CABG.

  8. String-sign in left internal thoracic artery is associated with regression in left main trunk stenosis after coronary artery bypass.

    PubMed

    Yokoyama, Ken; Miyauchi, Katsumi; Kawamura, Masaki; Kajimoto, Kan; Dohi, Tomotaka; Yamagami, Shinichiro; Kano, Tatsuzi; Amano, Atsushi; Hosoda, Yasuyuki; Daida, Hiroyuki

    2011-01-01

    The left internal thoracic artery (LITA) is the conduit of choice for coronary artery bypass (CABG) due to favorable long-term patency. Uncommonly, diffuse narrowing like a string without significant stenosis of an anastomosis is observed in the LITA graft (called "string sign"). Isolated left main trunk (LMT) diseases were reported to regress in some cases. However, the relationship between "string sign" and the regression of solitary LMT disease remains unknown.We retrospectively studied 40 consecutive patients with isolated LMT stenosis who underwent CABG using LITA and who underwent angiography before and after operation (31 males, 9 females, mean age, 65.0 years). The patients were divided into 2 groups according to the postoperative angiographic outcomes of the LITA graft: one group included patients with "string sign" (6 patients), the other group consisted of patients with a patent LITA graft (34 patients).There were no significant differences in clinical backgrounds between the two groups. The 2 groups showed similar quantitative % coronary artery stenosis of the LMT before operation (77.5% versus 76.8%) and the observation period was similar in both groups. Coronary angiography after CABG revealed that % stenosis of the LMT in patients with "string sign" was significantly less than that in patients with a patent LITA graft (41.7 ± 26% versus 82.5 ± 11%, P < 0.001). Regression in LMT was significantly more frequently observed in the "string sign group". Furthermore, ostial stenosis was more frequent in patients with "string sign". "String phenomenon" of the LITA graft is one of the signs related to the regression of LMT stenosis, and especially in ostial stenosis of the LMT.

  9. Do the Preferences of Healthcare Provider Selection Vary among Rural and Urban Patients with Different Income and Cause Different Outcome?

    PubMed Central

    Chung, Kuo-Piao; Wei, Chung-Jen; Chien, Kuo-Liong

    2016-01-01

    Background Equal access to healthcare facilities and high-level quality of care are important strategies to eliminate the disparity in outcome of care. However, the existing literature regarding how urban or rural dwelling patients with different income level select healthcare providers is insufficient. The purposes of this study were to examine whether differences of healthcare provider selection exist among urban and rural coronary artery bypass surgery (CABG) patients with different income level. If so, we further investigated the associated impact on mortality. Methods A retrospective, multilevel study design was conducted using claims data from 2007–2011 Taiwan’s Universal Health Insurance Scheme. Healthcare providers’ performance and patients’ travelling distance to hospitals were used to define the patterns of healthcare provider selection. Baron and Kenny’s procedures for mediation effect were conducted. Results There were 10,108 CABG surgeries included in this study. The results showed that urban dwelling and higher income patients were prone to receive care from better-performance providers. The travelling distances of urban dwelling patients was 15 KM shorter, especially when they received better-performance provider’s care. The results also showed that the difference of healthcare provider selection and mortality rate existed between rural and urban dwelling patients with different income levels. After the procedure of mediation effect testing, the results showed that the healthcare provider selection partially mediated the relationships between patients’ residential areas with different income levels and 30-day mortality. Conclusion Preferences of healthcare provider selection vary among rural and urban patients with different income, and such differences partially mediated the outcome of care. Health authorities should pay attention to this issue, and propose appropriate solutions to eliminate the disparity in outcome of CABG care. PMID

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

    SciTech Connect

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

    1989-06-15

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

  11. A multicentre Spanish study for multivariate prediction of perioperative in-hospital cerebrovascular accident after coronary bypass surgery: the PACK2 score†

    PubMed Central

    Hornero, Fernando; Martín, Elio; Rodríguez, Rafael; Castellà, Manel; Porras, Carlos; Romero, Bernat; Maroto, Luis; Pérez De La Sota, Enrique

    2013-01-01

    OBJECTIVES To develop a multivariate predictive risk score of perioperative in-hospital stroke after coronary artery bypass grafting (CABG) surgery. METHOD A total of 26 347 patients were enrolled from 21 Spanish hospital databases. Logistic regression analysis was used to predict the risk of perioperative stroke (ictus or transient ischaemic attack). The predictive scale was developed from a training set of data and validated by an independent test set, both selected randomly. The assessment of the accuracy of prediction was related to the area under the ROC curve. The variables considered were: preoperative (age, gender, diabetes mellitus, arterial hypertension, previous stroke, cardiac failure and/or left ventricular ejection fraction <40%, non-elective priority of surgery, extracardiac arteriopathy, chronic kidney failure and/or creatininemia ≥2 mg/dl and atrial fibrillation) and intraoperative (on/off-pump). RESULTS Global perioperative stroke incidence was 1.38%. Non-elective priority of surgery (priority; OR = 2.32), vascular disease (arteriopathy; OR = 1.37), cardiac failure (cardiac; OR = 3.64) and chronic kidney failure (kidney; OR = 6.78) were found to be independent risk factors for perioperative stroke in uni- and multivariate models in the training set of data; P < 0.0001; AUC = 0.77, 95% CI 0.73–0.82. The PACK2 stroke CABG score was established with 1 point for each item, except for chronic kidney failure with 2 points (range 0–5 points); AUC = 0.76, 95% CI 0.72–0.80. In patients with PACK2 score ≥2 points, off-pump reduced perioperative stoke incidence by 2.3% when compared with on-pump CABG. CONCLUSIONS PACK2 risk scale shows good predictive accuracy in the data analysed and could be useful in clinical practice for decision making and patient selection. PMID:23628652

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

    PubMed Central

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

    2013-01-01

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

  13. Comparison between mechanical properties of human saphenous vein and umbilical vein

    PubMed Central

    2012-01-01

    Background As a main cause of mortality in developed countries, Coronary Artery Disease (CAD) is known as silent killer with a considerable cost to be dedicated for its treatment. Coronary Artery Bypass Graft (CABG) is a common remedy for CAD for which different blood vessels are used as a detour. There is a lack of knowledge about mechanical properties of human blood vessels used for CABG, and while these properties have a great impact on long-term patency of a CABG. Thus, studying these properties, especially those of human umbilical veins which have not been considered yet, looks utterly necessary. Methods Umbilical vein, as well as human Saphenous vein, are respectively obtained after cesarean and CABG. First, histological tests were performed to investigate different fiber contents of the samples. Having prepared samples carefully, force-displacement results of samples were rendered to real stress–strain measurements and then a fourth-order polynomial was used to prove the non-linear behavior of these two vessels. Results Results were analyzed in two directions, i.e. circumferentially and longitudinally, which then were compared with each other. The comparison between stiffness and elasticity of these veins showed that Saphenous vein’s stiffness is much higher than that of umbilical vein and also, it is less stretchable. Furthermore, for both vessels, longitudinal stiffness was higher than that of circumferential and in stark contrast, stretch ratio in circumferential direction came much higher than longitudinal orientation. Conclusion Blood pressure is very high in the region of aorta, so there should be a stiff blood vessel in this area and previous investigations showed that stiffer vessels would have a better influence on the flow of bypass. To this end, the current study has made an attempt to compare these two blood vessels’ stiffness, finding that Saphenous vein is stiffer than umbilical vein which is somehow as stiff as rat aortic vessels. As

  14. The impact of off-pump surgery in end-organ function: practical end-points.

    PubMed

    Parissis, Haralabos; Mbarushimana, Simon; Ramesh, Bandigowdanapalya C; Parissis, Mondrian; Lampridis, Savvas; Mhandu, Peter; Al-Alao, Bassel

    2015-01-01

    Most surgeons perform coronary bypass surgery with the aid of cardiopulmonary bypass, which inflicts a massive systemic inflammatory response to the body leading to adverse clinical outcome. In an attempt to make CABG less invasive, interest have been diverted to the off pump technique.The current review attempts to bring an insight onto the last ten years knowledge on the off-pump impact in end organ function, with an aim to draw some clear conclusions in order to allow practitioners to reflect on the subject. PMID:26555853

  15. Coronary Artery-Bypass-Graft Surgery Increases the Plasma Concentration of Exosomes Carrying a Cargo of Cardiac MicroRNAs: An Example of Exosome Trafficking Out of the Human Heart with Potential for Cardiac Biomarker Discovery

    PubMed Central

    Emanueli, Costanza; Fiorentino, Francesca; Reeves, Barnaby C.; Beltrami, Cristina; Mumford, Andrew; Clayton, Aled; Gurney, Mark; Shantikumar, Saran; Angelini, Gianni D.

    2016-01-01

    Introduction Exosome nanoparticles carry a composite cargo, including microRNAs (miRs). Cultured cardiovascular cells release miR-containing exosomes. The exosomal trafficking of miRNAs from the heart is largely unexplored. Working on clinical samples from coronary-artery by-pass graft (CABG) surgery, we investigated if: 1) exosomes containing cardiac miRs and hence putatively released by cardiac cells increase in the circulation after surgery; 2) circulating exosomes and exosomal cardiac miRs correlate with cardiac troponin (cTn), the current “gold standard” surrogate biomarker of myocardial damage. Methods and Results The concentration of exosome-sized nanoparticles was determined in serial plasma samples. Cardiac-expressed (miR-1, miR-24, miR-133a/b, miR-208a/b, miR-210), non-cardiovascular (miR-122) and quality control miRs were measured in whole plasma and in plasma exosomes. Linear regression analyses were employed to establish the extent to which the circulating individual miRs, exosomes and exosomal cardiac miR correlated with cTn-I. Cardiac-expressed miRs and the nanoparticle number increased in the plasma on completion of surgery for up to 48 hours. The exosomal concentration of cardiac miRs also increased after CABG. Cardiac miRs in the whole plasma did not correlate significantly with cTn-I. By contrast cTn-I was positively correlated with the plasma exosome level and the exosomal cardiac miRs. Conclusions The plasma concentrations of exosomes and their cargo of cardiac miRs increased in patients undergoing CABG and were positively correlated with hs-cTnI. These data provide evidence that CABG induces the trafficking of exosomes from the heart to the peripheral circulation. Future studies are necessary to investigate the potential of circulating exosomes as clinical biomarkers in cardiac patients. PMID:27128471

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

    NASA Astrophysics Data System (ADS)

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

    2008-01-01

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

  17. Potential Effect of L-Carnitine on the Prevention of Myocardial Injury after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Dastan, Farzaneh; Hajhossein Talasaz, Azita; Mojtahedzadeh, Mojtaba; Karimi, Abbasali; Salehiomran, Abbas; Bina, Payvand; Jalali, Arash; Aghaie, Zahra

    2015-01-01

    Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG) surgery. Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery) or a control group (n = 67). CK-MB (creatine kinase, muscle-brain subunits) and troponin T (TnT) levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively. Results: Our study included 134 patients (99 [73.8%] males) at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group) and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group) did not show any significant differences (p value=0.93 and 0.08, respectively). Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group), but the difference was not significant (p value = 0.28). TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34). Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels. PMID:26110005

  18. Infections in open heart surgery.

    PubMed

    Baddour, L M; Kluge, R M

    1989-01-01

    More than 250,000 open heart surgical procedures are performed annually in the United States. The majority of these procedures are coronary artery bypass grafts (CABG) and valve replacements. In this forum our authors discuss the kinds of infections that occur in patients following open heart surgery, as well as the documented risk factors and microbiology of these infections. We also asked each author to outline the criteria used to diagnose post open heart surgery infections, and to address associated consequences and complications. Finally, we were interested in each author's definition of the infection control practitioner's role in the prevention of this particular subset of nosocomial infections.

  19. Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications

    PubMed Central

    Bowling, A; Bond, M; McKee, D; McClay, M; Banning, A; Dudley, N; Elder, A; Martin, A; Blackman, I

    2001-01-01

    OBJECTIVES—To assess whether patients with heart disease in a single UK hospital have equitable access to exercise testing, coronary angiography, and coronary artery bypass graft surgery (CABG).
METHOD—Retrospective analysis of patients' medical case notes (n = 1790), tracking each case back 12 months and forward 12 months from the patient's date of entry to the study.
SETTING—Single UK district hospital in the Thames Region.
PATIENTS—Patients (elective and emergency) with a cardiac ICD inpatient code at discharge or death, or who were referred to cardiology or care of the elderly unit over a 12 month period in 1996-7 (new episodes) were included.
RESULTS—Analysis of 1790 hospital case notes revealed that, despite having indications for intervention identical to those of younger patients, older patients (that is, those aged > 75 years) and women, independently, were significantly less likely to undergo exercise tolerance testing (exercise ECG) and cardiac catheterisation. The similar trends for age and access to CABG did not achieve significance. While clinical priority scores also independently predicted access to cardiac catheterisation and CABG, considerable numbers of patients in high clinical priority groups were not referred for either procedure.
CONCLUSIONS—The management and treatment of older patients and women with cardiac disease may be different from that of younger patients and men. Given the similarity of the indications for treatment and the lack of significant contraindications or comorbidities as a cause for these differences, one possible explanation is that these patients are being discriminated against principally because of their age and sex. Although clinical priority scores independently predicted access to catheterisation and CABG, large proportions of patients in high priority groups were not referred. This implies that the New Zealand priority scoring system may be more equitable than UK practice. The cost

  20. Isolated coronary artery bypass grafting in extracorporeal circulation in patients over 65 years old – does age still matter?

    PubMed Central

    Walczak, Andrzej; Ostrowski, Stanisław; Wrona, Ewa; Bartczak, Karol; Jaszewski, Ryszard

    2014-01-01

    Introduction Coronary artery bypass grafting (CABG) is conducted more and more commonly in patients in advanced age. Aim of the study To analyze the influence of age and concurrent risk factors on the complications and early mortality after CABG. Material and methods Medical records of 2194 patients were analyzed retrospectively. A group of 1303 patients who had undergone isolated CABG was selected. 106 (4.8%) patients were excluded due to missing data in their medical records. The remaining 1197 patients were divided into two subgroups by age: 1st group < 65 years (n = 662; 55.3%); 2nd group ≥ 65 years (n = 535; 44.7%). Results The total 30-day mortality was 3.93% and was six times higher in the older group (1.21 vs. 7.29%; p < 0.001). Complications were observed in 176 (14.70%) patients, more often in the older group (10.42% vs. 20.0%; p < 0.001). In this group all kinds of complications were noted more often and in particular: postoperative myocardial infarction (1.96% vs. 5.42%; p = 0.001), respiratory dysfunction (1.36% vs. 4.11%; p = 0.005), neurological complications (1.81% vs. 3.74%; p = 0.04) and multi-organ dysfunction syndrome (0.30% vs. 1.68%, p = 0.03). The older patients required longer time under mechanical ventilation (24.0 ± 27.9 vs. 37.0 ± 74.1 hours; p = 0.004) and stayed longer in the intensive care unit: 2.5 ± 3.0 vs. 4.1 ± 7.84 days; p < 0.001. Independent predictors of death were: female sex [OR (95% CI) = 2.4 (1.2-4.5)], age ≥ 65 years [OR = 4.9 (2.1-11.1)], eGFR < 60 mL/min/1.73 m2 [OR = 2.2 (1.0-4.7)], time at extracorporeal circulation > 72 minutes [OR = 5.5 (2.7-10.9)] and left main stem stenosis (> 50%) [OR = 2.4 (1.3-4.6)]. Conclusions Age still significantly influences postoperative complications and mortality after isolated CABG. PMID:26336419

  1. CTS Trials Network: A paradigm shift in the surgical treatment of moderate ischemic mitral regurgitation?

    PubMed

    Afifi, Ahmed

    2015-01-01

    The Cardiothoracic Surgery Trials Network has reported results of the one-year follow up of their randomized trial "Surgical Treatment of Moderate Ischemic Mitral Regurgitation". They studied 301 patients with moderate ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG) with or without mitral repair with the primary end-point of change in left ventricular end-diastolic volume index (LVEDVI) at one year and multiple clinical and echocardiographic secondary endpoints. Although their results were against repairing the mitral valve, the debate on surgical management of moderate IMR remains unsettled.

  2. CTS Trials Network: A paradigm shift in the surgical treatment of moderate ischemic mitral regurgitation?

    PubMed Central

    Afifi, Ahmed

    2015-01-01

    The Cardiothoracic Surgery Trials Network has reported results of the one-year follow up of their randomized trial “Surgical Treatment of Moderate Ischemic Mitral Regurgitation”. They studied 301 patients with moderate ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG) with or without mitral repair with the primary end-point of change in left ventricular end-diastolic volume index (LVEDVI) at one year and multiple clinical and echocardiographic secondary endpoints. Although their results were against repairing the mitral valve, the debate on surgical management of moderate IMR remains unsettled. PMID:26779511

  3. Physician reaction to price changes: an episode-of-care analysis.

    PubMed

    Lee, A J; Mitchell, J B

    1994-01-01

    Physicians may respond to fee reductions in a variety of ways. This episode-of-care analysis examines the impact of surgical fee reductions (mandated by the Omnibus Budget Reconciliation Acts [OBRAs] of 1986-87) on the overall pattern and cost of health care services provided in association with the surgical procedure itself. The study focuses on six procedure groups: cataract extractions; total hip replacement; total knee replacement; coronary artery bypass graft (CABG) surgery; upper gastrointestinal (GI) endoscopy; and prostatectomy. Only two of these procedures give significant evidence for the existence of a service volume offset to the fee reductions. PMID:10172299

  4. Physician Reaction to Price Changes: An Episode-of-Care Analysis

    PubMed Central

    Lee, A. James; Mitchell, Janet B.

    1994-01-01

    Physicians may respond to fee reductions in a variety of ways. This episode-of-care analysis examines the impact of surgical fee reductions (mandated by the Omnibus Budget Reconciliation Acts [OBRAs] of 1986-87) on the overall pattern and cost of health care services provided in association with the surgical procedure itself. The study focuses on six procedure groups: cataract extractions; total hip replacement; total knee replacement; coronary artery bypass graft (CABG) surgery; upper gastrointestinal (GI) endoscopy; and prostatectomy. Only two of these procedures give significant evidence for the existence of a service volume offset to the fee reductions. PMID:10172299

  5. No evidence of myocardial restoration following transplantation of mononuclear bone marrow cells in coronary bypass grafting surgery patients based upon cardiac SPECT and 18F-PET

    PubMed Central

    Tossios, Paschalis; Müller-Ehmsen, Jochen; Schmidt, Matthias; Scheid, Christof; Ünal, Nermin; Moka, Detlef; Schwinger, Robert HG; Mehlhorn, Uwe

    2006-01-01

    Background We tested the hypothesis, that intramyocardial injection of mononuclear bone marrow cells combined with coronary artery bypass grafting (CABG) surgery improves tissue viability or function in infarct regions with non-viable myocardium as assessed by nuclear imaging techniques. Methods Thus far, 7 patients (60 ± 10 [SD] years) undergoing elective CABG surgery after a myocardial infarction were included in this study. Prior to sternotomy, bone marrow was harvested by sternal puncture. Mononuclear bone marrow cells were isolated by gradient centrifugation and resuspended in 2 ml volume of Hank's buffered salt solution. At the end of CABG surgery 10 injections of 0.2 ml each were applied to the core area and borderzones of the infarct. Global and regional perfusion and viability were evaluated by ECG-gated 99mTc-tetrofosmin myocardial single-photon emission computed tomograph (SPECT) imaging and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in all study patients < 6 days before and 3 months after the intervention. Results Non-viable segments indicating transmural defects were identified in 5 patients. Two patients were found to have non-transmural defects before surgery. Concomitant surgical revascularisation and bone marrow cell injection was performed in all patients without major complications. The median total injected mononuclear cell number was 7.0 × 107 (range: 0.8–20.4). At 3 months 99mTc-tetrofosmin SPECT and 18F-FDG-PET scanning showed in 5 patients (transmural defect n = 4; non-transmural defect n = 1) no change in myocardial viability and in two patients (transmural defect n = 1, non-transmural defect n = 1) enhanced myocardial viability by 75%. Overall, global and regional LV ejection fraction was not significantly increased after surgery compared with the preoperative value. Conclusion In CABG surgery patients with non-viable segments the concurrent use of intramyocardial cell transfer did not show any clear improvement in

  6. Patency rates and the role of newer grafts in coronary artery bypass grafting.

    PubMed

    Rai, Mridula; Rustagi, Tarun

    2013-10-01

    Coronary artery bypass grafting (CABG) was one of major surgical advances of the 20th century and it has proven to be one of the most effective and long-lasting therapies in the treatment of ischemic heart disease. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. We seek to review the emerging role and patency rates of newer arterial grafts in comparison with the traditional saphenous vein grafts.

  7. Surgical removal of an intravascular ultrasonography catheter captured in a stent after percutaneous coronary intervention.

    PubMed

    Minami, Hiroya; Asada, Tatsuro; Gan, Kunio; Yamada, Akitoshi; Sato, Masanobu

    2011-03-01

    A-79-year-old woman underwent percutaneous coronary intervention (PCI) to the right coronary artery (RCA) for effort angina, followed by intravascular ultrasonography (IVUS) to ascertain stent expansion. The IVUS catheter became entangled in the stent and could not be withdrawn from the outside. The patient was transferred to our hospital for its surgical removal. For the emergent surgery, we opened the stent region in the RCA and directly removed the IVUS catheter with the twisted stent. Additional coronary artery bypass grafting (CABG) involving three vessels was performed. She was discharged 42 days after surgery. PMID:21448795

  8. Take a Bite Out of Crime: Get Ready To Celebrate 20 Years. Crime Prevention Month Action Kit.

    ERIC Educational Resources Information Center

    National Crime Prevention Council, Washington, DC.

    This Crime Prevention Month kit is designed to help plan crime prevention month activities for 1999 and into 2000, the year the Take a Bite Out of Crime character, McGruff the Crime Dog, celebrates 20 years of existence. This 15-month planning calendar provides long-term strategies for preventing crime in the community, which can be carried out…

  9. Self-Monitoring in Middle Childhood: Personality and Social Correlates.

    ERIC Educational Resources Information Center

    Musser, Lynn M.; Browne, Beverly A.

    1991-01-01

    Measures of self-monitoring and other measures were completed by 93 elementary school children on 3 occasions during a 15-month period. Self-monitoring was related to peer acceptance and self-esteem, but the relation may have been influenced by gender. Boys' self-monitoring correlated with popularity measures, whereas girls' did not. (BC)

  10. Transition to Child Care: Associations With Infant-Mother Attachment, Infant Negative Emotion, and Cortisol Elevations

    ERIC Educational Resources Information Center

    Ahnert, Lieselotte; Gunnar, Megan R.; Lamb, Michael E.; Barthel, Martina

    2004-01-01

    Seventy 15-month-old infants were studied at home before starting child care, during adaptation (mothers present) and separation (first 9 days without mothers) phases, and 5 months later. Security of infantmother attachment was assessed before and 3 months after child care began. In the separation phase, salivary cortisol rose over the first 60…

  11. Modifications of Systematic Ignoring in the Management of Infant Sleep Disturbance: Efficacy and Infant Distress

    ERIC Educational Resources Information Center

    France, Karyn G.; Blampied, Neville

    2005-01-01

    Systematic ignoring and two modifications of it (systematic ignoring with minimal parental check and systematic ignoring with parental presence) were evaluated for treatment of Infant Sleep Disturbance (ISD). Fifteen infants (6-15 months of age) participated in a study utilising a multiple-baseline design across the three treatment programs.…

  12. Decline of phosphorus, copper, and zinc in anaerobic lagoon columns receiving pretreated influent

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In a 15-month meso-scale column study, we evaluated the effect of manure pretreatment on reduction of total suspended solids (TSS), total phosphorus (TP), soluble reactive phosphorus (SRP), copper (Cu) and zinc (Zn) in swine lagoons using (i) enhanced solid–liquid separation with polymer (SS) and (i...

  13. Water quality and nitrogen mass loss from anaerobic lagoon columns receiving pretreated influent

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Control methods are needed to abate ammonia losses from swine anaerobic lagoons to reduce contribution of confined swine operations to air pollution. In a 15-month meso-scale column study, we evaluated the effect of manure pretreatment on water quality, reduction of N losses, and sludge accumulation...

  14. A Tobacco-Free Campus Ambassador Program and Policy Compliance

    ERIC Educational Resources Information Center

    Ickes, Melinda. J.; Rayens, Mary Kay; Wiggins, Amanda T.; Hahn, Ellen J.

    2015-01-01

    Objective: Assess impact and feasibility of a Tobacco-Free Ambassador Program on campus policy compliance. Participants: Trained Ambassadors made 253 visits to campus sites over 15 months to observe and/or approach violators. Methods: Policy violators were observed at 23 locations during Wave 1 (April-June 2012) and/or Wave 2 (April-June 2013).…

  15. Treatment of combined endodontic-periodontic lesions by intentional replantation and application of hydroxyapatites.

    PubMed

    Yu, Liying; Xu, Beiyun; Wu, Bin

    2003-02-01

    A case of combined endodontic-periodontic lesions on a mandibular first molar was treated by intentional replantation and application of hydroxyapatites. Four months after the surgery, a porcelain-mental full crown restoration was completed. The 15-month follow-up examination showed that the tooth was clinically and radiographically healthy and functioned well.

  16. Fostering Solutions: Bringing Brief-Therapy Principles and Practices to the Child Welfare System

    ERIC Educational Resources Information Center

    Flemons, Douglas; Liscio, Michele; Gordon, Arlene Brett; Hibel, James; Gutierrez-Hersh, Annette; Rebholz, Cynthia L.

    2010-01-01

    This article describes a 15-month university-community collaboration that was designed to fast-track children out of foster care. The developers of the project initiated resource-oriented "systems facilitations," allowing wraparound professionals and families to come together in large meetings to solve problems and find solutions. Families also…

  17. Metachronous Bilateral Posterior Tibial Artery Aneurysms in Ehlers-Danlos Syndrome Type IV

    SciTech Connect

    Hagspiel, Klaus D.; Bonatti, Hugo; Sabri, Saher; Arslan, Bulent; Harthun, Nancy L.

    2011-04-15

    Ehlers-Danlos syndrome type IV is a life-threatening genetic connective tissue disorder. We report a 24-year-old woman with EDS-IV who presented with metachronous bilateral aneurysms/pseudoaneurysms of the posterior tibial arteries 15 months apart. Both were treated successfully with transarterial coil embolization from a distal posterior tibial approach.

  18. POTENTIAL IMPACTS OF ORGANIC WASTES ON SMALL STREAM WATER QUALITY

    EPA Science Inventory

    We monitored concentrations of dissolved organic carbon (DOC), dissolved oxygen (DO) and other parameters in 17 small streams of the South Fork Broad River (SFBR) watershed on a monthly basis for 15 months. Our monthly monitoring results showed a strong inverse relationship betwe...

  19. Brief Report: Attachment Security in Infants At-Risk for Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Haltigan, John D.; Ekas, Naomi V.; Seifer, Ronald; Messinger, Daniel S.

    2011-01-01

    Little is known about attachment security and disorganization in children who are at genetic risk for an Autism Spectrum Disorder (ASD) prior to a possible diagnosis. The present study examined distributions of attachment security and disorganization at 15-months of age in a sample of infant siblings of older children with (ASD-sibs; n = 51) or…

  20. MMR Vaccine (Measles, Mumps, and Rubella)

    MedlinePlus

    ... who is already infected.Measles, mumps, and rubella (MMR) vaccine can protect children (and adults) from all three ... Who should get MMR vaccine and when?Children should get 2 doses of MMR vaccine: First Dose: 12 to 15 months of age Second ...

  1. NANOFILTRATION FOULANTS FROM A TREATED SURFACE WATER

    EPA Science Inventory

    The foulant from pilot nanofiltration membrane elements fed conventionally-treated surface water for 15 months was analyzed for organic, inorganic, and biological parameters. The foulant responsible for flux loss was shown to be a film layer 20 to 80 um thick with the greatest de...

  2. Behavioral Dimensions in One-Year-Olds and Dimensional Stability in Infancy.

    ERIC Educational Resources Information Center

    Hagekull, Berit; And Others

    1980-01-01

    The dimensional structure of infants' behavioral repertoire was shown to be highly stable over 3 to 15 months of age. Factor analysis of parent questionnaire data produced seven factors named Intensity/Activity, Regularity, Approach-Withdrawal, Sensory Sensitivity, Attentiveness, Manageability and Sensitivity to New Food. An eighth factor,…

  3. [Condylomata acuminata and HIV infection--an epidemiologic study].

    PubMed

    Senff, H; Kuhlwein, A; Caspar, A; Stieler, W

    1988-11-15

    Within a period of 15 months, 134 patients suffering from condylomata acuminata were investigated with regard to simultaneous infection with HIV. 3 of these patients--2 showing warts in the anal region, 1 on the glans penis--were found positive for anti-HIV antibodies.

  4. Coordinating Educational Assessment Across College Centers.

    ERIC Educational Resources Information Center

    Churchill, Ruth; And Others

    An operational model developed as a result of a systematic analysis of three distinctly different Antioch centers--Juarez Lincoln University, Philadelphia Graduate Center, and Antioch-New England (the Keene Center)--is presented. Juarez Lincoln offers a 15-month program leading to the Master of Education degree. Many of the students are Mexican…

  5. Visceral Leishmaniasis in a UK Toddler following a Short Trip to a Popular Holiday Destination in Spain

    PubMed Central

    Ladhani, Shamez N.

    2014-01-01

    We herein present the case of a 15-month-old with visceral leishmaniasis diagnosed in the UK following a short trip to a popular holiday destination in Spain. Four months after the initial symptoms, the diagnosis was made incidentally on microscopy of a bone marrow biopsy taken for suspected haematological malignancy after the child developed hepatosplenomegaly, pancytopaenia, and Klebsiella pneumoniae septicaemia. PMID:25180113

  6. Sociocultural Settings Influence the Emergence of Prelinguistic Deictic Gestures

    ERIC Educational Resources Information Center

    Salomo, Dorothe; Liszkowski, Ulf

    2013-01-01

    Daily activities of forty-eight 8- to 15-month-olds and their interlocutors were observed to test for the presence and frequency of triadic joint actions and deictic gestures across three different cultures: Yucatec-Mayans (Mexico), Dutch (Netherlands), and Shanghai-Chinese (China). The amount of joint action and deictic gestures to which infants…

  7. Becoming a nurse: role formation among accelerated baccalaureate students.

    PubMed

    Ostrogorsky, Tanya L; Raber, Anjanette M; McKinley Yoder, Claire; Nielsen, Ann E; Lutz, Kristin F; Wros, Peggy L

    2015-01-01

    To understand nursing role formation for students enrolled in an accelerated baccalaureate nursing program, end-of-term narrative reflections from 34 students were analyzed over the course of the 15-month program. Using thematic analysis, 4 major themes were identified: evolving role perception, extending nursing student-patient interaction, engaging with health care team and systems of care, and expanding clinical thinking.

  8. Mothers, Fathers, and Toddlers: Parental Psychosocial Functioning as a Context for Young Children's Sleep

    ERIC Educational Resources Information Center

    Bernier, Annie; Bélanger, Marie-Ève; Bordeleau, Stéphanie; Carrier, Julie

    2013-01-01

    The aim of this study was to investigate the prospective relations between parental psychosocial functioning and toddlers' sleep consolidation. Investigators met with 85 families 3 times, when children were 15 months (Time 1 [T1]), 18 months (T2), and 2 years of age (T3). Mothers and fathers completed questionnaires pertaining to their…

  9. Residential Substance Abuse Treatment for State Prisoners: Breaking the Drug-Crime Cycle among Parole Violators.

    ERIC Educational Resources Information Center

    Stohr, Mary K.; Hemmens, Craig; Baune, Diane; Dayley, Jed; Gornik, Mark; Kjaer, Kirstin; Noon, Cindy

    This Research for Practice examines the Residential Substance Abuse Treatment (RSAT) program at the South Idaho Correctional Institution. The program targets parole-violating inmates with substance abuse problems in an effort to reduce recidivism. Researchers conducted a 15-month evaluation of the program's process to identify strengths and…

  10. 42 CFR 488.308 - Survey frequency.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Ownership; (ii) Entity responsible for management of a facility (management firm); (iii) Nursing home...) STANDARDS AND CERTIFICATION SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES Survey and Certification of... a standard survey of each SNF and NF not later than 15 months after the last day of the...

  11. 42 CFR 488.308 - Survey frequency.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Ownership; (ii) Entity responsible for management of a facility (management firm); (iii) Nursing home...) STANDARDS AND CERTIFICATION SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES Survey and Certification of... a standard survey of each SNF and NF not later than 15 months after the last day of the...

  12. 42 CFR 488.308 - Survey frequency.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Ownership; (ii) Entity responsible for management of a facility (management firm); (iii) Nursing home...) STANDARDS AND CERTIFICATION SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES Survey and Certification of... a standard survey of each SNF and NF not later than 15 months after the last day of the...

  13. 42 CFR 488.308 - Survey frequency.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Ownership; (ii) Entity responsible for management of a facility (management firm); (iii) Nursing home...) STANDARDS AND CERTIFICATION SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES Survey and Certification of... a standard survey of each SNF and NF not later than 15 months after the last day of the...

  14. 42 CFR 488.308 - Survey frequency.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Ownership; (ii) Entity responsible for management of a facility (management firm); (iii) Nursing home...) STANDARDS AND CERTIFICATION SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES Survey and Certification of... a standard survey of each SNF and NF not later than 15 months after the last day of the...

  15. Airborne fungi--a resurvey

    SciTech Connect

    Meyer, G.H.; Prince, H.E.; Raymer, W.J.

    1983-07-01

    A 15-month survey of airborne fungi at 14 geographical stations was conducted to determine the incidence of different fungal genera. Five of these stations were surveyed 25 years earlier. A comparison between previous studies and present surveys revealed similar organisms at each station with slight shifts in frequency of dominant genera.

  16. Early Attachment Organization Moderates the Parent-Child Mutually Coercive Pathway to Children's Antisocial Conduct

    ERIC Educational Resources Information Center

    Kochanska, Grazyna; Barry, Robin A.; Stellern, Sarah A.; O'Bleness, Jessica J.

    2009-01-01

    This multimethod study of 101 mothers, fathers, and children elucidates poorly understood role of children's attachment security as "moderating" a common maladaptive trajectory: from parental power assertion, to child resentful opposition, to child antisocial conduct. Children's security was assessed at 15 months, parents' power assertion observed…

  17. 42 CFR 442.109 - Certification period for ICF/IIDs: General provisions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Certification period for ICF/IIDs: General... ICFs/IID § 442.109 Certification period for ICF/IIDs: General provisions. (a) A survey agency may... of each ICF/IID not later than 15 months after the last day of the previous survey. (b) The...

  18. 42 CFR 442.109 - Certification period for ICF/IIDs: General provisions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Certification period for ICF/IIDs: General... ICFs/IID § 442.109 Certification period for ICF/IIDs: General provisions. (a) A survey agency may... of each ICF/IID not later than 15 months after the last day of the previous survey. (b) The...

  19. 42 CFR 442.109 - Certification period for ICF/IIDs: General provisions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Certification period for ICF/IIDs: General... ICFs/IID § 442.109 Certification period for ICF/IIDs: General provisions. (a) A survey agency may... of each ICF/IID not later than 15 months after the last day of the previous survey. (b) The...

  20. Child Temperament Moderates Effects of Parent-Child Mutuality on Self-Regulation: A Relationship-Based Path for Emotionally Negative Infants

    ERIC Educational Resources Information Center

    Kim, Sanghag; Kochanska, Grazyna

    2012-01-01

    This study examined infants' negative emotionality as moderating the effect of parent-child mutually responsive orientation (MRO) on children's self-regulation (n = 102). Negative emotionality was observed in anger-eliciting episodes and in interactions with parents at 7 months. MRO was coded in naturalistic interactions at 15 months.…

  1. The Salience of Family Worldview in Mourning an Elderly Husband and Father

    ERIC Educational Resources Information Center

    Black, Helen K.; Santanello, Holly R.

    2012-01-01

    Objective: The purpose of this study was to qualitatively explore family reaction to the death of the elderly husband and father in the family. Methods: We qualitatively interviewed 34 families (a family included a widow and 2 adult biological children) approximately 6-15 months after the death. In private, one-on-one in-depth interviews, we…

  2. 13 CFR 108.530 - Restrictions on investments of idle funds by NMVC Companies.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... regulations of the Federal Deposit Insurance Corporation, as amended (12 CFR 325.103). (2) Exception: You may..., which mature within 15 months from the date of the investment; or (2) Repurchase agreements with... repurchase agreements must be direct obligations of, or obligations guaranteed as to principal and...

  3. 13 CFR 107.530 - Restrictions on investments of idle funds by leveraged Licensees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... forth in regulations of the Federal Deposit Insurance Corporation, as amended (12 CFR 325.103). (2... United States, which mature within 15 months from the date of the investment; or (2) Repurchase... underlying the repurchase agreements must be direct obligations of, or obligations guaranteed as to...

  4. Supernumerary chromosome marker (1) in a developmentally delayed child

    SciTech Connect

    Lanphear, N.; Oppenheimer, S.; Lamb, A.

    1995-07-03

    A 15-month-old boy with mild developmental delay and several minor anomalies was found to be mosaic 46,XY/47,XY,+mar(1). The marker r(1) was a small de novo ring identified by FISH with a painting type DNA probe. 9 refs., 3 figs.

  5. Obstruction of the Aorta and Left Pulmonary Artery After Gianturco Coil Occlusion of Patent Ductus Arteriosus

    SciTech Connect

    Kuo, H.-Cg; Ko, Sheung-Fat; Wu, Yu-Tsun; Huang, Chien-Fu; Chien, Shao-Ju; Tiao, Mao-Meng; Liang, Chi-Di

    2005-01-15

    We report an unusual case of simultaneous obstruction of the left pulmonary artery and descending thoracic aorta after Gianturco coil occlusion in a 15-month-old boy. The diagnosis was made by echocardiography and cardiac angiography. At surgery, thrombi coating on the protruded parts of the Gianturco coil in the pulmonary artery and aorta were found.

  6. Deletion 5q35.3

    SciTech Connect

    Stratton, R.F.; Tedrowe, N.A.; Tolworthy, J.A.; Patterson, R.M.; Ryan, S.G.; Young, R.S.

    1994-06-01

    The authors report on a 15-month-old boy with a de novo deletion of the terminal band of 5q, macrocephaly, mild retrognathia, anteverted nares with low flat nasal bridge, telecanthus, minor earlobe anomalies, bellshaped chest, diastasis recti, short fingers, and mild developmental delay.

  7. Maternal and Child Contributions to Cortisol Response to Emotional Arousal in Young Children from Low-Income, Rural Communities

    ERIC Educational Resources Information Center

    Blair, Clancy; Granger, Douglas A.; Kivlighan, Katie T.; Mills-Koonce, Roger; Willoughby, Michael; Greenberg, Mark T.; Hibel, Leah C.; Fortunato, Christine K.

    2008-01-01

    Relations of maternal and child characteristics to child cortisol reactivity to and recovery from emotional arousal were examined prospectively at approximately 7 months of age (infancy) and then again at approximately 15 months of age (toddlerhood). The sample was diverse and population based (N = 1,292 mother-infant dyads) and included families…

  8. Beyond the Abaya: School Reform in the Middle East

    ERIC Educational Resources Information Center

    Albon, Nerissa

    2009-01-01

    This autoethnography focuses on a study undertaken during the writers 15 month employment in a Muslim girls' school in the United Arab Emirates. The paper outlines a school improvement project in the Abu Dhabi Emirate and the imposition of an Australian curriculum on the schools involved in this program. The teachers in these schools were exposed…

  9. Desegregation and Dropping Out in One School District.

    ERIC Educational Resources Information Center

    Doss, David A.

    Students of ninth-grade age in Austin, Texas, were studied to discover how desegregation affected dropout rates for Blacks, Hispanics, and Anglo/Others. Examination of the gross dropout percentages over the first 15 months suggests that impacted-only (nonreassigned, but in impacted schools) minority students were twice as likely to drop out as…

  10. Infants' Categorization of Novel Objects with More or Less Obvious Features

    ERIC Educational Resources Information Center

    Welder, Andrea N.; Graham, Susan A.

    2006-01-01

    In five experiments, 14- to 15-month-old infants' categorization of objects on the basis of more or less obvious features was investigated. Using an object examining paradigm, a total of 200 infants were familiarized with novel objects that shared either more obvious features (i.e., easily visible) or less obvious features (i.e., accessible by…

  11. A Program for Training Physician-Investigators.

    ERIC Educational Resources Information Center

    Lehotay, Denis C.; And Others

    1982-01-01

    A Pittsburgh program to encourage physicians to choose clinical investigation careers consists of nine months of formal lectures and laboratory training and 15 months of a supervised laboratory research project. The curriculum ranges from basic laboratory techniques and biomedical content to advanced instrumentation, statistical analysis, computer…

  12. Childrens Hospital Inservice Education Curriculum.

    ERIC Educational Resources Information Center

    Lutz, Joan

    A description is provided of a 15-month, in-service nursing education program at Childrens Hospital (Los Angeles, California). The first sections of the paper describe Childrens Hospital and provide a rationale for the hospital-based program. A listing of program goals and objectives is also provided, indicating that the curriculum is designed to…

  13. Tevatron targets three-year extension

    NASA Astrophysics Data System (ADS)

    Harris, Margaret

    2010-09-01

    Fermilab's Tevatron collider could get a new lease on life following a campaign to keep the facility running beyond the end of 2011, when the rival Large Hadron Collider (LHC) at CERN is scheduled to shut down for 15 months of repairs.

  14. Rubella: Make Sure Your Child Gets Vaccinated

    MedlinePlus

    ... first dose at 12 through 15 months of age and the second dose at 4 through 6 years of age, before entering school. Your child's doctor may also ... might not otherwise have access to vaccines. To learn more, visit the VFC website or ask your ... in other languages: MMR and MMRV Adult Immunization Schedule (anyone over ...

  15. Correlates of Coparenting during Infancy

    ERIC Educational Resources Information Center

    Lindsey, Eric W.; Caldera, Yvonne; Colwell, Malinda

    2005-01-01

    This study examined family characteristics associated with the coparenting behavior of 60 parents with an 11- to 15-month-old infant (30 boys, 30 girls) during a structured triadic play session. Mothers reported on family demographics, social support, and child temperament. Both parents reported on their self-esteem and childrearing beliefs.…

  16. Decline of phosphorus, copper, and zinc in anaerobic swine lagoon columns receiving pretreated influent

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Land application of both anaerobic lagoon liquid and sludge can increase nutrient accumulation beyond soil assimilative capacity and become a threat to water quality in regions with intensive confined swine production. In a 15-month meso-scale column study, we evaluated the effect of manure pretreat...

  17. Lesson Study: A Professional Development Model for Mathematics Reform

    ERIC Educational Resources Information Center

    Taylor, Ann R.; Anderson, Shari; Meyer, Karen; Wagner, Mary Kay; West, Christine

    2005-01-01

    In this action research report 4 teachers and 1 teacher educator use the Japanese lesson study model of professional development for 15 months in rural Carlinville, Illinois. In March 2001, 4 teachers identified a goal to improve their students' understanding of two step word problems in 2nd grade elementary mathematics. Teachers completed three…

  18. The Impact of Specific Prior Experiences on Infants' Extension of Animal Properties

    ERIC Educational Resources Information Center

    Furrer, Stephanie D.; Younger, Barbara A.

    2008-01-01

    We examined the influence of prior exposure to specific animal properties on 15-month-old infants' inductive generalization. Using picture books, 29 infants were trained on properties linked in a congruent or incongruent manner with four animal categories. A generalized imitation task was then administered to assess patterns of property extension…

  19. Dampening of Adrenocortical Responses during Infancy: Normative Changes and Individual Differences.

    ERIC Educational Resources Information Center

    Gunnar, Megan R.; And Others

    1996-01-01

    Examined changes in cortisol and behavioral responses in 83 infants. Found that salivary cortisol responses before and after inoculation were high at 2 months, decreased between 2 and 4 months, remained stable, then declined again between 6 and 15 months. Found some evidence that emergence of circadian rhythm in cortisol might be related to early…

  20. 30 CFR 203.84 - What is in a net revenue and relief justification report?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... INTERIOR MINERALS REVENUE MANAGEMENT RELIEF OR REDUCTION IN ROYALTY RATES OCS Oil, Gas, and Sulfur General... of the Interior, MMS. Qualifying months for an oil and gas lease are the most recent 12 months out of... than oil and gas leases are the most recent 12 of the last 15 months having some production. (a)...

  1. Early Cognitive Development and Its Relation to Maternal Physiologic and Behavioral Responsiveness.

    ERIC Educational Resources Information Center

    Donovan, W. L.; Leavitt, L. A.

    1978-01-01

    Twenty-two mothers whose physiologic responses to infant signals had been recorded at an earlier date were videotaped with their infants during a feeding session when the infant was 9 months of age. Infants' development of the object concept was assessed at 15 months. (JMB)

  2. Effect of early immunization on antibody response to reimmunization with measles vaccine as demonstrated by enzyme-linked immunosorbent assay (ELISA).

    PubMed

    Murphy, M D; Brunell, P A; Lievens, A W; Shehab, Z M

    1984-07-01

    A measles epidemic in San Antonio, Texas provided a population of children who were immunized at less than or equal to 10 months of age and reimmunized at greater than or equal to 15 months of age. Of these children, 302 were evaluated for measles antibody by the sensitive enzyme-linked immunosorbent assay (ELISA), and their responses were compared with those of 300 children who had been immunized at the customary time (greater than or equal to 15 months) with a single immunization. There were only five seronegative findings in each group. The children immunized at the customary time did have significantly higher (P less than .001) antibody titers than the children immunized at less than or equal to 10 months and reimmunized at greater than or equal to 15 months. These results indicate that early immunization followed by reimmunization may be indicated when young infants are at significant risk of measles exposure. This approach should not create an increased number of serologically nonresponsive children when reimmunized at greater than or equal to 15 months.

  3. Longitudinal Associations between Fathers' Heavy Drinking Patterns and Children's Psychosocial Adjustment

    ERIC Educational Resources Information Center

    Andreas, Jasmina Burdzovic; O'Farrell, Timothy J.

    2007-01-01

    Psychosocial adjustment in children of alcoholics (N = 114) was examined in the year before and at three follow-ups in the 15 months after their alcoholic fathers entered alcoholism treatment, testing the hypothesis that children's adjustment problems will vary over time as a function of their fathers' heavy drinking patterns. Three unique…

  4. Does Individual Treatment for Alcoholic Fathers Benefit Their Children? A Longitudinal Assessment

    ERIC Educational Resources Information Center

    Andreas, Jasmina Burdzovic; O'Farrell, Timothy J.; Fals-Stewart, William

    2006-01-01

    Psychosocial adjustment in children of alcoholics (COAs; N = 125) was examined before and at 3 follow-ups in the 15 months after their fathers entered alcoholism treatment. Before their fathers' treatment, COAs exhibited greater overall and clinical-level symptomatology than children from the demographically matched comparison sample, but they…

  5. Beyond the Information Given: Infants' Transfer of Actions Learned through Imitation

    ERIC Educational Resources Information Center

    Yang, Dahe; Sidman, Jason; Bushnell, Emily W.

    2010-01-01

    Five experiments were conducted to investigate infants' ability to transfer actions learned via imitation to new objects and to examine what components of the original context are critical to such transfer. Infants of 15 months observed an experimenter perform an action with one or two toys and then were offered a novel toy that was not…

  6. Infants' and Mothers' Offers and Requests: The Effects of Physical Context and Infant Walking.

    ERIC Educational Resources Information Center

    Messinger, Daniel; Fogel, Alan

    This study examined how change occurs in infant gestural communication. Five infants were videotaped once a week from 10 to 12 months and twice a week from 12 to 15 months during play sessions with their mothers in a laboratory playroom. These sessions consisted of 10 minutes of a structured play context in which infants were seated at a table at…

  7. Nonverbal Communication Skills in Young Children with Autism

    ERIC Educational Resources Information Center

    Chiang, Chung-Hsin; Soong, Wei-Tsuen; Lin, Tzu-Ling; Rogers, Sally J.

    2008-01-01

    Objective: The study was to examine nonverbal communication in young children with autism. Methods: The participants were 23 young children with autism (mean CA = 32.79 months), 23 CA and MA-matched children with developmental delay and 22 18-20-month-old, and 22 13-15-month-old typically developing toddlers and infants. The abbreviated Early…

  8. [Scimitar syndrome associated to pulmonary atresia with interventricular communication. First reported case].

    PubMed

    Alva, Carlos; Valero, Gillermo; Martínez, Arturo; Riera, Carlos; David, Felipe; Jiménez, Santiago; Ortegón, José; Sánchez, Agustín; López, Diana; Ramírez, Erick

    2004-01-01

    We present the case of a 15 months-old male with Scimitar Syndrome associated with ventricular septal defect and pulmonary atresia. The diagnosis was made by cardiac catheterization and angiography and was confirmed by the necropsy. Clinical and surgical considerations of this exceptional association were made. To the best of our knowledge this is the first case reported in the relevant literature.

  9. Understanding Preemptive Parenting: Relations with Toddlers' Misbehavior, Overreactive and Lax Discipline, and Praise

    ERIC Educational Resources Information Center

    Dowling, Carey Bernini; Slep, Amy M. Smith; O'Leary, Susan G.

    2009-01-01

    The relations among preemptive parenting (i.e., a hypothetical set of strategies parents can use prior to child misbehavior that serves to prevent or avoid undesirable child behaviors), dysfunctional discipline, and praise were examined. Forty mother-toddler (M age = 26.15 months, SD = 5.60) dyads interacted in a standard laboratory task designed…

  10. 26 CFR 20.2053-1 - Deductions for expenses, indebtedness, and taxes; in general.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954... decedent's estate, within 9 months (15 months in the case of the estate of a decedent dying before January...) Effective/applicability date. This section applies to the estates of decedents dying on or after October...

  11. 26 CFR 20.2053-1 - Deductions for expenses, indebtedness, and taxes; in general.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16... decedent's estate, within 9 months (15 months in the case of the estate of a decedent dying before January...) Effective/applicability date. This section applies to the estates of decedents dying on or after October...

  12. 26 CFR 20.2053-1 - Deductions for expenses, indebtedness, and taxes; in general.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16... decedent's estate, within 9 months (15 months in the case of the estate of a decedent dying before January...) Effective/applicability date. This section applies to the estates of decedents dying on or after October...

  13. ENVIRONMENTAL TECHNOLOGY VERIFICATION REPORT: STORMWATER SOURCE AREA TREATMENT DEVICE; PRACTICAL BEST MANAGEMENT OF GEORGIA, INC., CRYSTALSTREAM� WATER QUALITY VAULT MODEL 1056

    EPA Science Inventory

    Verification testing of the Practical Best Management, Inc., CrystalStream™ stormwater treatment system was conducted over a 15-month period starting in March, 2003. The system was installed in a test site in Griffin, Georgia, and served a drainage basin of approximately 4 ...

  14. A Prosthetic Memory: An Application of the Prosthetic Environment Concept

    ERIC Educational Resources Information Center

    Fowler, Roy S., Jr.; And Others

    1972-01-01

    A set of artifical reminders'' are developed to compensate for a profound memory deficit in a young brain damaged male. The prosthetic memory techniques are described, and his increase in functional level is documented. A report of a 15-month follow-up is included. (Author)

  15. Development of Preferences for the Human Body Shape in Infancy.

    ERIC Educational Resources Information Center

    Slaughter, Virginia; Heron, Michelle; Sim, Susan

    2002-01-01

    Two studies investigated development of infants' visual preferences for the human body shape. Results indicated that 18-month-olds had a reliable preference for scrambled body shapes over typical body shapes in line drawings, while 12- and 15-month-olds did not respond differentially. In condition using photographs, only 18-month-olds had reliable…

  16. Infants' Perception of Affordances of Slopes under High- and Low-Friction Conditions

    ERIC Educational Resources Information Center

    Adolph, Karen E.; Joh, Amy S.; Eppler, Marion A.

    2010-01-01

    Three experiments investigated whether 14- and 15-month-old infants use information for both friction and slant for prospective control of locomotion down slopes. In Experiment 1, high- and low-friction conditions were interleaved on a range of shallow and steep slopes. In Experiment 2, friction conditions were blocked. In Experiment 3, the…

  17. Longitudinal Modeling of Adolescents' Activity Involvement, Problem Peer Associations, and Youth Smoking

    ERIC Educational Resources Information Center

    Metzger, Aaron; Dawes, Nickki; Mermelstein, Robin; Wakschlag, Lauren

    2011-01-01

    Longitudinal associations among different types of organized activity involvement, problem peer associations, and cigarette smoking were examined in a sample of 1040 adolescents (mean age = 15.62 at baseline, 16.89 at 15-month assessment, 17.59 at 24 months) enriched for smoking experimentation (83% had tried smoking). A structural equation model…

  18. Effect of Foster Care on Young Children's Language Learning

    ERIC Educational Resources Information Center

    Windsor, Jennifer; Benigno, Joann P.; Wing, Christine A.; Carroll, Patrick J.; Koga, Sebastian F.; Nelson, Charles A., III; Fox, Nathan A.; Zeanah, Charles H.

    2011-01-01

    This report examines 174 young children's language outcomes in the Bucharest Early Intervention Project, the first randomized trial of foster placement after institutional care. Age of foster placement was highly correlated with language outcomes. Placement by 15 months led to similar expressive and receptive language test scores as typical age…

  19. The Impact of Short-Term Food Regulations in New Zealand Schools

    ERIC Educational Resources Information Center

    Cushman, Penni

    2012-01-01

    Purpose: In New Zealand, legislation was introduced to regulate the types of food sold and promoted in schools but 15 months later, part of the legislation was repealed. The purpose of this paper is to determine the extent to which a sample of schools implemented positive changes when the legislation was introduced and the extent to which they…

  20. Pelvic floor muscle training for erectile dysfunction and climacturia 1 year after nerve sparing radical prostatectomy: a randomized controlled trial.

    PubMed

    Geraerts, I; Van Poppel, H; Devoogdt, N; De Groef, A; Fieuws, S; Van Kampen, M

    2016-01-01

    This study aimed to determine whether patients with persistent erectile dysfunction (ED), minimum 12 months after radical prostatectomy (RP), experienced a better recovery of erectile function (EF) with pelvic floor muscle training (PFMT) compared with patients without this intervention. Second, we aimed to investigate the effect of PFMT on climacturia. All patients, who underwent RP, with persistent ED of minimum 1 year post operation were eligible. The treatment group started PFMT immediately at 12 months post operation and the control group started at 15 months after RP. All patients received PFMT during 3 months. The sample size needed to detect with 80% power a 6 points-difference regarding the EF-domain of the International Index of Erectile Function (IIEF), was at least 12 subjects per group. Patients were evaluated using the IIEF and questioned regarding climacturia. Differences between groups at 15 months were evaluated with Mann-Whitney U-test and Fisher's exact test. As a result, the treatment group had a significantly better EF than the control group at 15 months after surgery (P=0.025). Other subdomains of the IIEF remained constant for both groups. The effect of PFMT was maintained during follow-up. At 15 months, a significantly higher percentage of patients in the treatment group showed an improvement regarding climacturia (P=0.004).

  1. Effects of Lisdexamfetamine Dimesylate Treatment for ADHD on Growth

    ERIC Educational Resources Information Center

    Faraone, Stephen V.; Spencer, Thomas J.; Kollins, Scott H.; Glatt, Stephen J.

    2010-01-01

    Objective: To complete an exploratory uncontrolled study of the effects of lisdexamfetamine dimesylate (LDX) on growth of children treated for attention-deficit/hyperactivity disorder (ADHD). Method: Height, weight, and body mass index (BMI) from 281 children ages 6 to 13 years from longitudinal assessments up to 15 months were compared to norms…

  2. Ask Dr. Sue.

    ERIC Educational Resources Information Center

    Aronson, Susan S.

    1990-01-01

    Discusses the need for child care providers to be sure children in their care who are between the ages of 15 months and 5 years have had Haemophilus influenzae type b (Hib) vaccine. Urges child care center staff to avoid use of bean bag infant cushions and to inform parents about the hazards posed by the cushions. (DR)

  3. Mind-Mindedness as a Multidimensional Construct: Appropriate and Nonattuned Mind-Related Comments Independently Predict Infant-Mother Attachment in a Socially Diverse Sample

    ERIC Educational Resources Information Center

    Meins, Elizabeth; Fernyhough, Charles; de Rosnay, Marc; Arnott, Bronia; Leekam, Susan R.; Turner, Michelle

    2012-01-01

    In a socially diverse sample of 206 infant-mother pairs, we investigated predictors of infants' attachment security at 15 months, with a particular emphasis on mothers' tendency to comment appropriately or in a non-attuned manner on their 8-month-olds' internal states (so-called mind-mindedness). Multinomial logistic regression analyses showed…

  4. Activity Level as a Dimension of Temperament in Toddlers: Its Relevance for the Organismic Specificity Hypothesis.

    ERIC Educational Resources Information Center

    Gandour, Mary Jane

    1989-01-01

    Findings indicated a significant interaction between activity level and intensity of stimulation in predicting exploratory competence and total exploration among 52 toddlers of 15 months of age who were observed in their homes 6 times over a 4-week period. (RH)

  5. Indirect Effects and Infants' Reaction to Strangers.

    ERIC Educational Resources Information Center

    Feiring, Candice; And Others

    1984-01-01

    Examined whether an infant's reaction to a stranger would be indirectly influenced by the infant observing a stranger-third party interaction. Subjects were 45 15-month-old infants. Results suggest indirect effects influence social interactions and show that significant others can play an important role in mediating these effects. (Author/RH)

  6. Infant Search Strategies with Containers That Move But Do Not Alter the Location at Which Contents Can Be Found.

    ERIC Educational Resources Information Center

    Lloyd, S. E.; Freeman, N. H.

    1983-01-01

    A number of hypotheses about infants' delayed search accuracy have been based upon the notion that a location associated with repeated retrieval of an object attains privileged status. However, a test of performance in 12- and 15-month-old infants showed them to be indifferent to location. (Author/RH)

  7. Early Career Patterns for Social Work Graduates

    ERIC Educational Resources Information Center

    Choi, Mi Jin; Urbanski, Paul; Fortune, Anne E.; Rogers, Crystal

    2015-01-01

    This study examines master's of social work graduates' early careers. Six cohorts graduating from 2002 through 2007 (N = 246) completed a questionnaire 9-15 months after graduation. Most reported adequate or exceptional preparation on both generalist and advanced concentration practice behaviors. Almost all direct practice graduates and 2/3 of…

  8. Marijuana and Health. Report of a Study by a Committee of the Institute of Medicine, Division of Health Sciences Policy.

    ERIC Educational Resources Information Center

    Institute of Medicine (NAS), Washington, DC.

    This report, written for the general public, presents the results of a 15-month study of the health-related effects of marijuana. The introduction describes the goals and procedure for the study, including the composition of the 22-member steering committee and its functions, and the sources of information used for the study, i.e., published…

  9. Pathways to Bilingualism: Young Children's Home Experiences Learning English and Spanish

    ERIC Educational Resources Information Center

    Rodriguez, M. Victoria

    2010-01-01

    Nowadays, more and more young children in the United States have the experience of speaking a language other than English at home, and many parents choose to educate their children bilingually. This study explored the home-language experiences, in English and Spanish, of three young Latino girls ages 15 months, 16 months, and 30 months,…

  10. Object Representation in Infants' Coordination of Manipulative Force

    ERIC Educational Resources Information Center

    Mash, Clay

    2007-01-01

    This study examined infants' use of object knowledge for scaling the manipulative force of object-directed actions. Infants 9, 12, and 15 months of age were outfitted with motion-analysis sensors on their arms and then presented with stimulus objects to examine individually over a series of familiarization trials. Two stimulus objects were used in…

  11. "Going the Extra Mile in Downscaling: Why Downscaling is not jut "Plug-and-Play"

    EPA Science Inventory

    This presentation provides an example of doing additional work for preprocessing global climate model data for use in regional climate modeling simulations with the Weather Research and Forecasting (WRF) model. In this presentation, results from 15 months of downscaling the Comm...

  12. Just a Talking Book? Word Learning from Watching Baby Videos

    ERIC Educational Resources Information Center

    Robb, Michael B.; Richert, Rebekah A.; Wartella, Ellen A.

    2009-01-01

    This study examined the relationship between viewing an infant DVD and expressive and receptive language outcomes. Children between 12 and 15 months were randomly assigned to view "Baby Wordsworth," a DVD highlighting words around the house marketed for children beginning at 12 months of age. Viewings took place in home settings over 6 weeks.…

  13. Earthwatching. A Collection of Scripts from the First Year of Earthwatch/Radio.

    ERIC Educational Resources Information Center

    Weimer, Linda, Ed.; Abbott, Barbara, Ed.

    One-page scripts selected from a collection of 300 radio programs, presented September 1972-December 1973, comprise this publication. Taken together they form a 15-month environmental chronicle. Subject categories include water quality, the oceans, the Great Lakes, air, land, life: plants/animals/man, and energy. Earthwatch radio stations are…

  14. Weathering the Superstorm: From Texts to Twitter--How Campus Communicators Overcame Hurricane Sandy

    ERIC Educational Resources Information Center

    Towns, Gail

    2013-01-01

    By the time Superstorm Sandy struck New Jersey in late October 2012, Kathy Corbalis, executive director of communications and college relations at Atlantic Cape Community College, and her team were battle-tested. In the 15 months before the hurricane, the college experienced two bomb threats via Twitter, a lockdown due to gunfire, an on-campus…

  15. Motor Origins of Tool Use

    ERIC Educational Resources Information Center

    Kahrs, Bjorn A.; Jung, Wendy P.; Lockman, Jeffrey J.

    2013-01-01

    The current study examines the developmental trajectory of banging movements and its implications for tool use development. Twenty (6- to 15-month-old) infants wore reflective markers while banging a handled cube; movements were recorded at 240 Hz. Results indicated that through the second half-year, banging movements undergo developmental changes…

  16. A Search for Sources of Treatment Effects in a Teacher Effectiveness Training Program.

    ERIC Educational Resources Information Center

    Harris, Alene Hawes

    This study investigated possible sources of teacher change in the Stallings Effective Use of time (EUOT) staff development program administered to preservice teachers. These sources were: (1) the full EUOT program with feedback plus workshops; (2) feedback only; and (3) the trainer as post-treatment observer. Over a 15-month period, 20 student…

  17. 49 CFR 195.446 - Control room management.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... method of recording controller shift-changes and any hand-over of responsibility between controllers. (c... added or moved and when other changes that affect pipeline safety are made to field equipment or SCADA... calibrated or changed and at least once each calendar year, but at intervals not to exceed 15 months;...

  18. 49 CFR 195.446 - Control room management.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... method of recording controller shift-changes and any hand-over of responsibility between controllers. (c... added or moved and when other changes that affect pipeline safety are made to field equipment or SCADA... calibrated or changed and at least once each calendar year, but at intervals not to exceed 15 months;...

  19. 49 CFR 195.446 - Control room management.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... method of recording controller shift-changes and any hand-over of responsibility between controllers. (c... added or moved and when other changes that affect pipeline safety are made to field equipment or SCADA... calibrated or changed and at least once each calendar year, but at intervals not to exceed 15 months;...

  20. 49 CFR 195.446 - Control room management.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... method of recording controller shift-changes and any hand-over of responsibility between controllers. (c... added or moved and when other changes that affect pipeline safety are made to field equipment or SCADA... calibrated or changed and at least once each calendar year, but at intervals not to exceed 15 months;...

  1. Regulatory Behaviors and Stress Reactivity among Infants at High Risk for Fetal Alcohol Spectrum Disorders: An Exploratory Study

    ERIC Educational Resources Information Center

    Jirikowic, Tracy; Chen, Maida; Nash, Jennifer; Gendler, Beth; Olson, Heather Carmichael

    2016-01-01

    Introduction: This article examines regulatory behaviors and physiological stress reactivity among 6-15 month-old infants with moderate to heavy prenatal alcohol exposure (PAE), a group at very high risk for fetal alcohol spectrum disorders and self-regulation impairments, compared to low risk infants with no/low exposure. Participants: Eighteen…

  2. BAS Brings Continuous Savings to Nebraska School District.

    ERIC Educational Resources Information Center

    Energy Management Technology, 1985

    1985-01-01

    Discusses advantages of a building automation system (BAS) used for monitoring and controlling 16 buildings (1,000,000 square feet). Problems solved and savings occurred with air handlers, indoor pool, minerals in boilers, and service tunnels. The system included numerous advantages for operators and paid for itself in 15 months. (DH)

  3. The Viability of Live Online Reference: An Assessment

    ERIC Educational Resources Information Center

    Horowitz, Lisa R.; Flanagan, Patricia A.; Helman, Deborah L.

    2005-01-01

    The MIT Libraries enthusiastically implemented real-time online reference service in September 2001. After 15 months, Ask Us!--Live was suspended due to ongoing software problems. This article describes the four-part assessment of the service with recommendations for the future. (Contains 6 figures and 21 notes.)

  4. Winning the Referendum Battle in Education.

    ERIC Educational Resources Information Center

    Graves, Joseph J., Jr.

    This book offers the strategies and techniques that administrators, the board of education, and a group of volunteers in one school district utilized in a successful 15-month referendum battle. The book has 16 chapters. Chapter 1 examines trends, voter attitudes, and facing reality. Chapter 2 outlines the basics for starting a referendum, and…

  5. Effects of Exogenous and Endogenous Distracters on Immediate and Long-Term Recall in Toddlers

    ERIC Educational Resources Information Center

    Dixon, Wallace E., Jr.; Lawman, Hannah G.; Johnson, Elizabeth B. H.; May, Sarah; Patton, Leslie A.; Lowe, Allison K.; Snyder, Courtney M.

    2012-01-01

    We explored the role that exogenous and endogenous competitors for attention play in infants' abilities to encode and retain information over a 6-month period. Sixty-six children visited the laboratory at 15 months, and 32 returned for a second visit at 21 months. Children observed models of conventional- relation and enabling-relation action…

  6. Efficacy of a Preventive Intervention for Youths Living with HIV.

    ERIC Educational Resources Information Center

    Rotheram-Borus, Mary Jane; Lee, Martha B.; Murphy, Debra A.; Futterman, Donna; Duan, Naihua; Birnbaum, Jeffrey M.; Lightfoot, Marguerita

    2001-01-01

    Examined HIV transmission behaviors and health practices among HIV-infected youths over 15 months following participation in a preventive intervention that emphasized coping with HIV and reducing risky behaviors. The intervention resulted in increases in social support coping and reductions in risky sexual and lifestyle behaviors specifically…

  7. Computer-Based Training for Library Staff: A Demonstration Project Using HyperCard. Final Performance Report.

    ERIC Educational Resources Information Center

    Bayne, Pauline S; Rader, Joe C.

    The purpose of this project was to demonstrate that computer-based training (CBT) sessions, produced as HyperCard stacks (files), are an efficient and effective component for staff training in libraries. The purpose was successfully met in the 15-month period of development, evaluation, and implementation, and the University of Tennessee (UT)…

  8. ORGANIC WASTE CONTAMINATION INDICATORS IN SMALL GEORGIA PIEDMONT STREAMS

    EPA Science Inventory

    We monitored concentrations of dissolved organic carbon(DOC) and dissolved oxygen (DO), and other parameters in 17 small streams of the South Fork Broad River watershed on a monthly basis for 15 months. Here we present estimates of the amounts of organic waste input to these wate...

  9. Development of Intentionality in the Vocalization of Handicapped Infants Reared in a Hospital Setting.

    ERIC Educational Resources Information Center

    Bochner, Sandra

    1986-01-01

    The 15-month study followed the vocal development of five handicapped (Down Syndrome, hydrocephalus, and spina bifida) hospital reared infants. Results suggested that only the two less handicapped infants demonstrated use of sounds for social interaction and that the other infants used vocalization primarily as protest or self-stimulation.…

  10. Cooing, Crying, Cuddling: Infant Brain Development. [Videotape].

    ERIC Educational Resources Information Center

    National Association for the Education of Young Children, Washington, DC.

    Noting recent neuroscience research findings suggesting that caregivers play a vital role in brain development, this videotape explores the process of brain development during the first 15 months of life and presents implications for infant care. Part 1 of the 28-minute video discusses basic infant development and brain research, focusing on how…

  11. A Flipped Spoon and Chin Prompt to Increase Mouth Clean

    ERIC Educational Resources Information Center

    Dempsey, Jack; Piazza, Cathleen C.; Groff, Rebecca A.; Kozisek, Jennifer M.

    2011-01-01

    We treated the liquid refusal of a 15-month-old girl using 2 antecedent manipulations: flipped spoon and chin prompt. Use of the chin prompt in the absence of the flipped spoon failed to produce increases in mouth clean (a product measure of swallowing). By contrast, modest increases in mouth clean resulted from the implementation of the flipped…

  12. Change in Children's Understanding of Others' Intentional Actions

    ERIC Educational Resources Information Center

    Bellagamba, Francesca; Camaioni, Luigia; Colonnesi, Cristina

    2006-01-01

    The study investigated children's intention understanding using a longitudinal design. Thirty-two Italian children were tested on the "Demonstration of Intention" in the Re-enactment paradigm devised by Meltzoff (1995a), at two ages. Mean age was 12 months at the first session and 15 months at the second session. Previous research by Meltzoff…

  13. Vocal Motor Schemes.

    ERIC Educational Resources Information Center

    McCune, Lorraine; Vihman, Marilyn May

    A study examined the consistency of consonant use in the infant's transition period from babbling to early words. Phonetic data were collected from the speech of 10 infants aged 9 to 15 months. Analysis of consonant distribution patterns indicate striking segmental preferences in all 10 children, with some segments more prominent for the sample as…

  14. Using Mentoring to Develop Professional Teaching Knowledge for Problem-Based Historical Inquiry

    ERIC Educational Resources Information Center

    Saye, John W.; Kohlmeier, Jada; Brush, Thomas; Mitchell, Linda; Farmer, Charles

    2009-01-01

    This case study examined how mentoring experiences might encourage teachers to consider and adopt a problem-based historical inquiry (PBHI) framework for teaching. We mentored six teachers over 15 months as they planned and implemented PBHI teaching, reflected on their experiences, and then engaged in peer mentoring of other teachers. Data…

  15. The Second Child: Family Transition and Adjustment.

    ERIC Educational Resources Information Center

    Stewart, Robert B., Jr.

    Synthesizing the methodologies of developmental psychology, family sociology, and systems theory, this 15-month longitudinal study examined familial role adjustments in 41 suburban families after the birth of a second child. Using interviews, observations, and rating scales, the study examined families during the third trimester of the second…

  16. A Structural Equation Model of Burnout and Job Exit among Child Protective Services Workers.

    ERIC Educational Resources Information Center

    Drake, Brett; Yadama, Gautam N.

    1996-01-01

    Uses a structural equation model to examine the three elements of the Maslach Burnout Inventory (MBI)--emotional exhaustion, depersonalization, and personal accomplishment--in relation to job exit among child protective services workers over a 15-month period. The model was supported, showing the relevance of all three MBI elements of job exit.…

  17. Weighting of Vowel Cues Explains Patterns of Word-Object Associative Learning

    ERIC Educational Resources Information Center

    Curtin, Suzanne; Fennell, Christopher; Escudero, Paola

    2009-01-01

    Previous research has demonstrated that infants under 17 months have difficulty learning novel words in the laboratory when the words differ by only one consonant sound, irrespective of the magnitude of that difference. The current study explored whether 15-month-old infants can learn novel words that differ in only one vowel sound. The rich…

  18. Relational and Individual Resources as Predictors of Empathy in Early Childhood

    ERIC Educational Resources Information Center

    Moreno, Amanda J.; Klute, Mary M.; Robinson, JoAnn L.

    2008-01-01

    The goal of this study was to examine children's cognitive and language development and social engagement of mother as mediators of the relationship between maternal emotional availability at 15 months and children's empathy at the ages of two and four. Participants were 661 low-income, ethnically diverse mother-child dyads participating in a…

  19. Studying the Cost and Value of Library Services: Final Report. Technical Report APLAB/94-3/1,2,3,4.

    ERIC Educational Resources Information Center

    Kantor, Paul B.; And Others

    This is the final technical report (in three parts) of a 15-month long project to study the costs and value of library functions at five major research libraries. Twenty-one services or service aspects were studied, and numerous measures of the importance or benefit of the service to the users were made. These measures were studied together to lay…

  20. Validation of the Sexual Assault Symptom Scale II (SASS II) Using a Panel Research Design

    ERIC Educational Resources Information Center

    Ruch, Libby O.; Wang, Chang-Hwai

    2006-01-01

    To examine the utility of a self-report scale of sexual assault trauma, 223 female victims were interviewed with the 43-item Sexual Assault Symptom Scale II (SASS II) at 1, 3, 7, 11, and 15 months postassault. Factor analyses using principal-components extraction with an oblimin rotation yielded 7 common factors with 31 items. The internal…

  1. Infant Imitation from Televised Peer and Adult Models

    ERIC Educational Resources Information Center

    Seehagen, Sabine; Herbert, Jane S.

    2011-01-01

    Developmental changes in learning from peers and adults during the second year of life were assessed using an imitation paradigm. Independent groups of 15- and 24-month-old infants watched a prerecorded video of an unfamiliar child or adult model demonstrating a series of actions with objects. When learning was assessed immediately, 15-month-old…

  2. A Comparison of the Sleep-Wake Patterns of Cosleeping and Solitary-Sleeping Infants

    ERIC Educational Resources Information Center

    Mao, Amy; Burnham, Melissa M.; Goodlin-Jones, Beth L.; Gaylor, Erika E.; Anders, Thomas F.

    2004-01-01

    This study examined whether 3-15, month-old cosleeping infants displayed differences in time spent in active versus quiet sleep, and in the number/duration of nighttime awakenings when compared with solitary-sleeping infants; and also whether they spent the majority of the night sleeping face-to-face, as previously reported. Nine cosleeping and…

  3. Stepping Stones to Others' Minds: Maternal Talk Relates to Child Mental State Language and Emotion Understanding at 15, 24, and 33 Months

    ERIC Educational Resources Information Center

    Taumoepeau, Mele; Ruffman, Ted

    2008-01-01

    This continuation of a previous study (Taumoepeau & Ruffman, 2006) examined the longitudinal relation between maternal mental state talk to 15- and 24-month-olds and their later mental state language and emotion understanding (N = 74). The previous study found that maternal talk about the child's desires to 15-month-old children uniquely predicted…

  4. Babbling, Chewing, and Sucking: Oromandibular Coordination at 9 Months

    ERIC Educational Resources Information Center

    Steeve, Roger W.; Moore, Christopher A.; Green, Jordan R.; Reilly, Kevin J.; McMurtrey, Jacki Ruark

    2008-01-01

    Purpose: The ontogeny of mandibular control is important for understanding the general neurophysiologic development for speech and alimentary behaviors. Prior investigations suggest that mandibular control is organized distinctively across speech and nonspeech tasks in 15-month-olds and adults and that, with development, these extant forms of…

  5. Circulating Discourses of Minority Education: The Linguistic Construction of Modernity in Globalizing Taiwan

    ERIC Educational Resources Information Center

    Lin, Shumin

    2015-01-01

    Drawing on 15 months of fieldwork in Taiwan, this article analyzes circulating discourses and practices across heterogeneous scales that conflate Taiwanese minority-language elders with foreign brides as nonmodern and childlike. The assiduous production and reproduction of historically and geographically displaced linguistic Others is part and…

  6. The performance and capabilities of terrestrial organisms in extreme and unusual gaseous and liquid environments. Performance of fungi in exotic and harsh environments

    NASA Technical Reports Server (NTRS)

    Siegel, S. M.

    1975-01-01

    The growth of Penicillium in saline and low temperature conditions during a 15 month incubation period was studied. Data are also given on the potential 1f fungu for modification of the surface geochemistry of the earth and the capacity of these fungi to solubilize and concentrate metals.

  7. A Micro-Analysis of Mother-Infant Interaction. Behavior Regulating Social Contact Between a Mother and her 3 1/2 Month-Old Twins

    ERIC Educational Resources Information Center

    Stern, Daniel N.

    1971-01-01

    An example of controlling" maternal behavior with 3 1/2-month-old twins is studied by a method of frame-by-frame film analysis. Characteristic infant behaviors regulating social contact with the mother are identified and followed through 15 months. (Author)

  8. Ideas that Work With Young Children. Learning Self-Esteem and Self-Discipline through Play.

    ERIC Educational Resources Information Center

    Greenberg, Polly

    1989-01-01

    Describes learning that takes place during children's play. Scenarios involve a 15-month-old who tries to work keys into a sideboard, a 2 1/2-year-old who takes a truck from other children, and a 4-year-old who plays with blocks with other children. (RJC)

  9. Infants' Generalizations about Other People's Emotions: Foundations for Trait-Like Attributions

    ERIC Educational Resources Information Center

    Repacholi, Betty M.; Meltzoff, Andrew N.; Toub, Tamara Spiewak; Ruba, Ashley L.

    2016-01-01

    Adults often attribute internal dispositions to other people and down-play situational factors as explanations of behavior. A few studies have addressed the origins of this proclivity, but none has examined emotions, which rank among the more important dispositions that we attribute to others. Two experiments (N = 270) explored 15-month-old…

  10. Rett Syndrome: A Longitudinal Developmental Case Report.

    ERIC Educational Resources Information Center

    Garber, Norman; Veydt, Nicole

    1990-01-01

    The clinical course of development of a 14-year-old girl with Rett Syndrome is outlined. Results indicated a general stagnation in gross and fine motor skills, self-help skills, communication, and cognition, beginning at approximately 15 months. No skills progressed beyond the 2-year level despite several years of intensive intervention.…

  11. Long-Term Persistence of Relaxation-Induced Blood Pressure Lowering during the Working Day.

    ERIC Educational Resources Information Center

    Agras, W. Stewart; And Others

    1983-01-01

    Evaluated essential hypertension patients (N=30) 15 months after treatment consisting of either relaxation training or blood pressure monitoring. Results showed significantly greater lowering of diastolic blood pressure for those receiving relaxation training both in clinic and during the working day. (LLL)

  12. The "Special" Way: Mary Paxton and Her Journalism Degree.

    ERIC Educational Resources Information Center

    Flocke, Elizabeth Lynne

    The only woman in the first graduating class of the world's first school of journalism at the University of Missouri, Mary Paxton Keeley was offered a position as a special reporter for the "Kansas City Post" in 1910. As was typical for female journalists at the time, most of Paxton's assignments during her 15 months with the "Post" were special…

  13. Developing Healthcare Practice through Action Learning: Individual and Group Journeys

    ERIC Educational Resources Information Center

    Wilson, Valerie; McCormack, Brendan; Ives, Glenice

    2008-01-01

    Action Learning is now a well established strategy for reflective inquiry in healthcare. Whilst a great deal is know about action learning there has been inadequate research on the process of learning that takes place, and the impact that this holds for individuals, groups or organisations. This article reports on the findings of 15-month action…

  14. Speech Reading and Learning to Read: A Comparison of 8-Year-Old

    ERIC Educational Resources Information Center

    Harris, Margaret; Moreno, Constanza

    2006-01-01

    Nine children with severe-profound prelingual hearing loss and single-word reading scores not more than 10 months behind chronological age (Good Readers) were matched with 9 children whose reading lag was at least 15 months (Poor Readers). Good Readers had significantly higher spelling and reading comprehension scores. They produced significantly…

  15. Infants Learn Baby Signs from Video

    ERIC Educational Resources Information Center

    Dayanim, Shoshana; Namy, Laura L.

    2015-01-01

    There is little evidence that infants learn from infant-oriented educational videos and television programming. This 4-week longitudinal experiment investigated 15-month-olds' (N = 92) ability to learn American Sign Language signs (e.g., patting head for hat) from at-home viewing of instructional video, either with or without parent support,…

  16. Comparison of TIVA and Desflurane Added to a Subanaesthetic Dose of Propofol in Patients Undergoing Coronary Artery Bypass Surgery: Evaluation of Haemodynamic and Stress Hormone Changes

    PubMed Central

    Akarsu Ayazoğlu, Tülin; Onk, Oruç Alper; Aksüt, Mehmet; Günay, Murat; Turkmen, Kultigin; Özensoy, Aynur; Yazıcı Ersoy, Çiğdem; Çoban, Abdulkadir

    2016-01-01

    Introduction. Increased levels of stress hormones are associated with mortality in patients undergoing coronary artery bypass grafting (CABG). Aim. To compare total intravenous anaesthesia (TIVA) and desflurane added to a subanaesthetic dose of propofol. Material and Methods. Fifty patients were enrolled in this study. Fentanyl (3–5 mcg/kg/h) was started in both groups. Patients were divided into two groups. The PD group (n = 25) received 1 minimum alveolar concentration (MAC) desflurane anaesthesia in addition to propofol infusion (2-3 mg/kg/h), while P group (n = 25) received propofol infusion (5-6 mg/kg/h) only. Biochemical data, cortisol, and insulin levels were measured preoperatively (T0), after initiation of CPB but before cross-clamping the aorta (T1), after removal of the cross-clamp (T2), and at the 24th postoperative hour (T3). Results. Systolic, diastolic, and mean arterial pressure levels were significantly higher in PD group than those in P group in T1 and T2 measurements (p ≤ 0.05). CK-MB showed a significant decrease in group P (p ≤ 0.05). When we compared both groups, cortisol levels were significantly higher in PD group than P group (p ≤ 0.05). Conclusion. Stress and haemodynamic responses were better controlled using TIVA than desflurane inhalation added to a subanaesthetic dose of propofol in patients undergoing CABG. PMID:27547757

  17. Three-dimensional CFD/MRI modeling reveals that ventricular surgical restoration improves ventricular function by modifying intraventricular blood flow.

    PubMed

    Khalafvand, S S; Zhong, L; Ng, E Y K

    2014-10-01

    Surgical ventricular restoration (SVR) is designed to normalize distorted ventricular shape and size in patients with left ventricular (LV) dysfunction and akinetic and dyskinetic segments. This study is aimed to quantify the characteristics of LV as a pump for a case before and after SVR, which is followed by coronary artery bypass grafting (CABG). We hypothesize that SVR+CABG improves heart flow. A patient with heart failure had magnetic resonance (MR) scans before and 4 months after SVR. LV endocardial geometries were semi-automated segmented and reconstructed using our customized algorithm. The arbitrary Lagrangian-Eulerian formulation of Navier-Stokes equations was solved to derive the flow patterns and calculate pressure differences in LV. After SVR, LV ejection fraction increased from 34% to 48% in patient but was still lower than normal (70%). Second, LV vortices were stronger than pre-surgery but still weaker than normal. The maximum pressure differences between ventricular base and apex increased from 180 to 400 Pa during diastole, from 252 to 560 Pa during systole, respectively. As anticipated, SVR reduced LV volumes and augmented LV ejection fraction. Three-dimensional CFD/MRI modeling suggests that improved diastolic and systolic ventricular function after SVR is associated with changes in intraventricular blood flow.

  18. Comparison of TIVA and Desflurane Added to a Subanaesthetic Dose of Propofol in Patients Undergoing Coronary Artery Bypass Surgery: Evaluation of Haemodynamic and Stress Hormone Changes.

    PubMed

    Onk, Didem; Akarsu Ayazoğlu, Tülin; Onk, Oruç Alper; Aksüt, Mehmet; Günay, Murat; Turkmen, Kultigin; Özensoy, Aynur; Yazıcı Ersoy, Çiğdem; Çoban, Abdulkadir

    2016-01-01

    Introduction. Increased levels of stress hormones are associated with mortality in patients undergoing coronary artery bypass grafting (CABG). Aim. To compare total intravenous anaesthesia (TIVA) and desflurane added to a subanaesthetic dose of propofol. Material and Methods. Fifty patients were enrolled in this study. Fentanyl (3-5 mcg/kg/h) was started in both groups. Patients were divided into two groups. The PD group (n = 25) received 1 minimum alveolar concentration (MAC) desflurane anaesthesia in addition to propofol infusion (2-3 mg/kg/h), while P group (n = 25) received propofol infusion (5-6 mg/kg/h) only. Biochemical data, cortisol, and insulin levels were measured preoperatively (T0), after initiation of CPB but before cross-clamping the aorta (T1), after removal of the cross-clamp (T2), and at the 24th postoperative hour (T3). Results. Systolic, diastolic, and mean arterial pressure levels were significantly higher in PD group than those in P group in T1 and T2 measurements (p ≤ 0.05). CK-MB showed a significant decrease in group P (p ≤ 0.05). When we compared both groups, cortisol levels were significantly higher in PD group than P group (p ≤ 0.05). Conclusion. Stress and haemodynamic responses were better controlled using TIVA than desflurane inhalation added to a subanaesthetic dose of propofol in patients undergoing CABG. PMID:27547757

  19. Giant right coronary artery aneurysms presenting as a cardiac mass

    PubMed Central

    Wang, Huanhuan; Zhang, Yin; Xie, Yanbo; Wang, Hongyue; Yuan, Jinqing

    2016-01-01

    Abstract Introduction: Coronary artery aneurysm (CAA) is defined as coronary dilatation which exceeds the diameter of the normal adjacent artery segments or the diameter of the patient's largest coronary artery by 1.5 times. The incidence of giant CAA is difficult to be determined, since only few reports have been described in the literature. Methods and Results: A 65-year-old man was referred to our hospital because of a “mass” in the right heart detected on echocardiography at a regular medical health examination, while he experienced no any symptoms. Coronary angiography showed the severe stenosis of the left anterior descending artery (LAD) and the left circumflex artery (LCX) and the diffusely ectatic change of the right coronary artery (RCA), but no mass was found in any of these arteries. Coronary computed tomography angiography (CTA) confirmed that the “mass” was the giant aneurysms of RCA with thrombus. He received coronary artery bypass graft (CABG) with thrombectomy. The histopathology showed the deposits of lipid and hyalin in the tunica intima, the focal calcifications, the very thin tunica media, and the disappearance of the part of the tunica media in the RCA. Conclusions: Coronary artery aneurysm which may contain thrombus can complicate a diagnostic coronary angiography due to the risk of distal embolization and may lead to myocardial infarction. This case report demonstrates 2 RCA aneurysms with a thrombus presenting as a giant “mass” which was successfully treated by CABG with thrombectomy. PMID:27661045

  20. What's wrong with this artery? A medical disease discovered by a surgeon

    PubMed Central

    Singh, Vasvi; Luthra, Saurav; Kouides, Ruth; Gadir, Abdel K

    2014-01-01

    A 50-year-old man presenting with chest pain had positive stress echocardiography; and angiogram showed single artery coronary stenosis, presumed to be atherosclerotic. He was started on optimal medical therapy with good compliance. Four months later, he had a myocardial infarction (MI) and cardiac catheterisation surprisingly showed interval development of severe three-vessel stenosis. He underwent coronary artery bypass grafting (CABG), during which the cardiothoracic surgeon noticed severely inflamed coronary arteries, concerning for vasculitis. Following CABG, the patient continued to have chest pain and was admitted again for MI within 4 months of surgery. Subsequent autoimmune workup was consistent with sarcoidosis. He was started on immunosuppressive therapy for presumed sarcoid-related coronary vasculitis, and 23 months later, the patient has not developed further ischaemic events. This is a rare case and extends the clinical spectrum of cardiac sarcoidosis, presenting with rapidly progressive coronary stenosis most likely due to vasculitis, mimicking atherosclerotic coronary artery disease. PMID:25246466

  1. A unique stenosis in saphenous vein graft visualized by optical coherence tomography.

    PubMed

    Koeda, Yorihiko; Itoh, Tomonori; Fusazaki, Tetsuya; Nakamura, Motoyuki; Morino, Yoshihiro

    2014-03-01

    We present a case of a unique stenosis in a 12-year-old saphenous vein graft (SVG), to the right coronary artery, which was visualized by optical coherence tomography (OCT), before percutaneous coronary intervention. The patient was an 80-year-old man in whom the stenosis was documented by area-detector coronary computed tomography. OCT imaging demonstrated that the culprit lesion was a venous valve containing a thrombus before preintervention imaging. Coronary stenting was performed with a distal protection device, and pathologic examination of the aspirate verified the OCT findings. Coronary angiography 12 years previously, just after coronary artery bypass surgery (CABG), had shown a completely normal SVG without any suspicion of a venous valve. These OCT images suggested the possibility that the culprit lesion was an "upside down" venous valve that was not visualized by angiography just after surgery, but could be a cause of late SVG stenosis following CABG. OCT imaging is very useful for clarifying the etiology of the stenosis in cases of ambiguous angiographic lesions. PMID:23712599

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

    PubMed

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

    2007-12-01

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

  3. The nature of surgeon human capital depreciation.

    PubMed

    Hockenberry, Jason M; Helmchen, Lorens A

    2014-09-01

    To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Examining 188 surgeons who performed 56,315 CABG surgeries in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. Among emergent patients treated by high-volume providers, where temporal distance is most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.4 percentage points. This is consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications. Our estimates imply additional intraprocedural treatment intensity has a cost per life-year preserved of $7871-18,500, well within conventional cost-effectiveness cutoffs. PMID:24973949

  4. Barriers to the universal adoption of bilateral internal mammary artery grafting.

    PubMed

    Umakanthan, Jeremiah; Jeyakumar, Panch; Umakanthan, Branavan; Jeyakumar, Nikeshan; Senthilkumar, Nadarajah; Saraswathy, Mathioli R; Umakanthan, Padminidevi; Umakanthan, Janani; Sial, Tamoor; Abrina, Sofia; Buendia, Frances M; Pan, Irene; Kamath, Ramadas K; Pathmarajah, Canagaratnam; Sivalingam, Kanagaratnam; Nathan, Shan A; Sunder, Shun K; Mahendra, Tom; Umakanthan, Ramanan

    2015-04-01

    The left internal mammary artery (LIMA) graft is considered the "gold standard" of coronary artery bypass grafting (CABG). This conduit provides increased survival, symptomatic relief, increased freedom from myocardial infarction, and increased freedom from re-intervention when compared to saphenous venous grafting. It has a remarkable long term patency rate with clinical and angiographic outcomes that are unmatched by other conduits. Given the fact that patients often require more than one graft during a coronary revascularization procedure, the prospect of bilateral internal mammary artery (BIMA) grafting has been very appealing to some surgeons. BIMA grafting has been extensively studied via multiple retrospective and prospective cohort studies and findings have indicated that BIMA grafting can have an increased survival benefit when compared to LIMA grafting alone. As a result, this technique has accrued increasing popularity over the course of the last decade. Yet, questions still remain on whether BIMA grafting is the optimal treatment modality for patients in terms of long-term prognosis. There is limited data at the present time from randomized controlled trials and only 4-12% of CABGs performed today utilize BIMA grafting. Concerns regarding perioperative complications, which patient subsets are at higher risks for complications from the technique, and the technical challenges involved in utilizing and teaching the technique have limited its widespread use. PMID:25644543

  5. Prediction of death, myocardial infarction, and worsening chest pain using thallium scintigraphy and exercise electrocardiography

    SciTech Connect

    Staniloff, H.M.; Forrester, J.S.; Berman, D.S.; Swan, H.J.

    1986-12-01

    Although used extensively, there is little published information on the prognostic ability of exercise /sup 201/Tl scintigraphy. Accordingly, 1 yr after testing we contacted 819 patients without previous MI or CABG seen in our laboratory during a 2-yr period. Events were defined as death from a cardiovascular cause, nonfatal MI, or worsening clinical state requiring CABG. The event rate was 3.9 events per 100 patients per year. There was univariate prognostic information when comparing the highest and lowest categories as risk ratios for chest pain characteristics (2.7), sex (2.3), exercise duration (3.1), ST slope (2.5), and thallium pattern (11.6), intensity of perfusion defect (17.2), and number of abnormal regions (8.7). However, the strongest predictors were also the least common. Prognostic ability was improved by combining the results categorically, as the number of abnormal tests (13.9). The highest risk ratio, 20.5:1, was obtained by combining results through discriminant function analysis. We conclude that exercise thallium scintigraphy provides prognostic information, although the most predictive patterns are uncommon. Combining the results of multiple test results improves the prognostic ability.

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

    PubMed

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

    2016-02-01

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

  7. Bypass Grafting Versus Percutaneous Intervention-Which Is Better in Multivessel Coronary Disease: Lessons From SYNTAX and Beyond.

    PubMed

    Farooq, Vasim; Serruys, Patrick W

    2015-01-01

    The landmark Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Trial has aided in reducing the area of uncertainty in decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with complex coronary artery disease. As part of the SYNTAX Trial, quantification of the coronary artery disease burden was prospectively undertaken by the Heart Team - consisting of at least an interventional cardiologist and cardiac surgeon - utilising the anatomical SYNTAX Score (www.syntaxscore.com) as a clinical tool in order to agree that equivalent anatomical revascularisation could be achieved. The anatomical SYNTAX Score is now advocated in both European and US revascularisation guidelines to guide decision-making between CABG and PCI as part of the SYNTAX pioneered Heart Team approach. In addition, the SYNTAX Trial has lead to the development and validation of the SYNTAX Score II, in which the anatomical SYNTAX Score was augmented with clinical variables, to allow for more objective and tailored decision making for the individual patient. Prospective validation of the SYNTAX Score II tool is currently ongoing in the SYNTAX II (ClinicalTrials.gov Identifier: NCT02015832) and EXCEL (ClinicalTrials.gov identifier: NCT01205776) trials. The present paper presents lessons learned from SYNTAX, including the development and/or validation of several SYNTAX based clinical tools, and the potential implications for current and future clinical practice.

  8. Comparison of transesophageal echocardiographic and scintigraphic estimates of left ventricular end-diastolic volume index and ejection fraction in patients following coronary artery bypass grafting

    SciTech Connect

    Urbanowicz, J.H.; Shaaban, M.J.; Cohen, N.H.; Cahalan, M.K.; Botvinick, E.H.; Chatterjee, K.; Schiller, N.B.; Dae, M.W.; Matthay, M.A. )

    1990-04-01

    Transesophageal echocardiography (TEE) has become a commonly used monitor of left ventricular (LV) function and filling during cardiac surgery. Its use is based on the assumption that changes in LV short-axis ID reflect changes in LV volume. To study the ability of TEE to estimate LV volume and ejection immediately following CABG, 10 patients were studied using blood pool scintigraphy, TEE, and thermodilution cardiac output (CO). A single TEE short-axis cross-sectional image of the LV at the midpapillary muscle level was used for area analysis. Between 1 and 5 h postoperatively, simultaneous data sets (scintigraphy, TEE, and CO) were obtained three to five times in each patient. End-diastolic (EDa) and end-systolic (ESa) areas were measured by light pen. Ejection fraction area (EFa) was calculated (EFa = (EDa - ESa)/EDa). When EFa was compared with EF by scintigraphy, correlation was good (r = 0.82 SEE = 0.07). EDa was taken as an indicator of LV volume and compared with LVEDVI which was derived from EF by scintigraphy and CO. Correlation between EDa and LVEDVI was fair (r = 0.74 SEE = 3.75). The authors conclude that immediately following CABG, a single cross-sectional TEE image provides a reasonable estimate of EF but not LVEDVI.

  9. [Characteristics of therapy of acute myocardial infarction in diabetes].

    PubMed

    Motz, W; Kerner, W

    2012-05-01

    Therapy of acute myocardial infarction (STEMI and NSTEMI) in diabetics does not principally differ from that of non-diabetic patients. Due to the higher mortality in diabetics reperfusion measures, such as direct percutaneous coronary intervention (PCI), should be rapidly performed. An intensive drug treatment with thrombocyte aggregation inhibitors, angiotensin-converting enzyme (ACE) inhibitors and beta-receptor blocking agents must be carried out according to the current guidelines. An important factor is the high risk of renal failure due to the contrast dye administered during PCI in the presence of pre-existing diabetic kidney damage which should be limited to 100 ml if possible. Direct PCI should be limited to the infarcted vessel. After stabilization a comprehensive strategy to cure coronary artery disease, whether with PCI or coronary artery bypass graft (CABG) should be finalized. If severe coronary 3-vessel disease is present, CABG should be favored in diabetic patients. After surviving an acute myocardial infarction differentiated metabolic monitoring is mandatory.

  10. Insights into the pathogenesis of vein graft disease: lessons from intravascular ultrasound

    PubMed Central

    Murphy, Gavin J; Angelini, Gianni D

    2004-01-01

    The success of coronary artery bypass grafting (CABG) is limited by poor long-term graft patency. Saphenous vein is used in the vast majority of CABG operations, although 15% are occluded at one year with as many as 50% occluded at 10 years due to progressive graft atherosclerosis. Intravascular ultrasound (IVUS) has greatly increased our understanding of this process. IVUS studies have shown that early wall thickening and adaptive remodeling of vein grafts occurs within the first few weeks post implantation, with these changes stabilising in angiographically normal vein grafts after six months. Early changes predispose to later atherosclerosis with occlusive plaque detectable in vein grafts within the first year. Both expansive and constrictive remodelling is present in diseased vein grafts, where the latter contributes significantly to occlusive disease. These findings correlate closely with experimental and clinicopathological studies and help define the windows for prevention, intervention or plaque stabilisation strategies. IVUS is also the natural tool for evaluating the effectiveness of pharmacological and other treatments that may prevent or slow the progression of vein graft disease in clinical trials. PMID:15268762

  11. Numerical analysis of Venous External Scaffolding Technology for Saphenous Vein Grafts.

    PubMed

    Meirson, T; Orion, E; Avrahami, I

    2015-07-16

    This paper presents a method for analyzing and comparing numerically Saphenous Vein Grafts (SVGs) following Coronary Artery Bypass Graft surgery (CABG). The method analyses the flow dynamics inside vein grafts with and without supporting using Venous External Scaffolding Technology (VEST). The numerical method uses patients׳ specific computational fluid dynamics (CFD) methods to characterize the relevant hemodynamic parameters of patients׳ SVGs. The method was used to compare the hemodynamics of six patient׳s specific model and flow conditions of stented and non-stented SVGs, 12 months post-transplantation. The flow parameters used to characterize the grafts׳ hemodynamics include Time Averaged Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI) and Relative Residence Time (RRT). The effect of stenting was clearly demonstrated by the chosen parameters. SVGs under constriction of VEST were associated with similar spatial average of TAWSS (10.73 vs 10.29 dyn/cm(2)), yet had fewer lesions with low TAWSS, lower OSI (0.041 vs 0.08) and RRT (0.12 vs 0.24), and more uniform flow with less flow discrepancies. In conclusion, the suggested method and parameters well demonstrated the advantage of VEST support. Stenting vein grafts with VEST improved hemodynamic factors which are correlated to graft failure following CABG procedure. PMID:25869720

  12. Evaluation of olfactory memory after coronary artery bypass grafting

    PubMed Central

    Yurttas, Veysel; Bilgi, Murat; Demırhan, Abdullah; Apuhan, Tayfun; Bugra, Onursal; Daglar, Bahadir

    2014-01-01

    Introduction This study determined whether coronary artery bypass grafting (CABG) surgery has any effect on olfactory function, employing the Brief Smell Identification Test (B-SIT). Material and methods All the participants were informed preoperatively about the B-SIT test and the mode of its application. The test was performed by each patient preoperatively (d0) as well as 1 (d1) and 3 (d3) days following the surgery. C-reactive protein (CRP) levels were recorded at the same time as the smell test. Results This prospective study included 45 patients. The mean age was 67 ± 7.55, and the group was 29% male. The mean durations of cross clamping and cardiopulmonary bypass were 54 ± 32 min and 62.5 ± 37.0 min, respectively. Eleven different odors were tested. Significant differences were observed for several odors: leather between d0 and d3, pine between d0 and d3, onion between d0 and d1, onion between d0 and d3, and soap between d0 and d1. The postoperative CRP levels were significantly higher than the preoperative levels. The correlation analysis determined that the postoperative CRP levels were negatively correlated with the B-SIT score (r = –0.48, p = 0.001). Conclusions Our findings suggest that patients after CABG are prone to develop olfactory dysfunction in the early postoperative period and that olfactory dysfunction is associated with postoperative CRP levels. PMID:26336453

  13. Medicare's Hospital Compare quality reports appear to have slowed price increases for two major procedures.

    PubMed

    Dor, Avi; Encinosa, William E; Carey, Kathleen

    2015-01-01

    Previous research has found that Hospital Compare, Medicare's public reporting initiative, has had little impact on patient outcomes. However, little is known about the initiative's impact on hospital prices, which may be significant because private insurers are generally well positioned to respond to quality information when negotiating prices with hospitals. We estimated difference-in-differences models of the effects of Hospital Compare quality reporting on transaction prices for two major cardiac procedures, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). States that had mandated their own public reporting systems before the implementation of Hospital Compare formed the control group. We found that prices for these procedures continued to increase overall after the initiation of Hospital Compare quality scores, but the rate of increase was significantly lower in states with no quality reporting metrics of their own before Hospital Compare, when compared to the control states (annual rates of increase of 4.4 percent versus 8.7 percent for PCI, and 3.9 percent versus 10.6 percent for CABG, adjusted for overall inflation). This finding implies that Hospital Compare provided leverage to purchasers in moderating price increases, while adding competitive pressures on hospitals. Providing accurate quality information on both hospitals and health plans could benefit consumers. PMID:25561646

  14. The nature of surgeon human capital depreciation.

    PubMed

    Hockenberry, Jason M; Helmchen, Lorens A

    2014-09-01

    To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Examining 188 surgeons who performed 56,315 CABG surgeries in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. Among emergent patients treated by high-volume providers, where temporal distance is most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.4 percentage points. This is consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications. Our estimates imply additional intraprocedural treatment intensity has a cost per life-year preserved of $7871-18,500, well within conventional cost-effectiveness cutoffs.

  15. Intravenous Catheter-Associated Candidemia due to Candida membranaefaciens: The First Iranian Case.

    PubMed

    Aghili, Seyed Reza; Shokohi, Tahereh; Boroumand, Mohammad Ali; Hashemi Fesharaki, Shirinsadat; Salmanian, Bahar

    2015-04-01

    The incidence of candidemia due to the uncommon non-albicans Candida species appears to be increasing, and certain species such as Candida (C.) membranaefaciens have been reported in some clinical researches. Vascular catheters are considered the likely culprit for the sudden emergence of hospital-acquired candidemia. The identification of C. membranaefaciens can be problematic in clinical practice owing to its phenotypic resemblance to C. guilliermondii. We report the first case of C. membranaefaciens in Iran, which occurred in a 70-year-old woman, who had coronary artery bypass grafting (CABG). We isolated germ-tube negative yeast from both blood culture and central venous catheter (CVC) tip culture on brain-heart infusion agar, Sabouraud dextrose agar plates, and biphasic brain-heart infusion media bottle; it developed smooth, pink colonies on CHROMagar Candida. By using the polymerase chain reaction and sequencing of theinternal transcribed spacer region of rDNA, we identified C. membranaefaciens. After the removal of the CVC and initiation of Fluconazole treatment, the patient's condition gradually improved and she was discharged from the hospital. The early detection of organisms in the catheter, removal of the catheter, and treatment with anti-fungal antibiotics have an important role in controlling disease and preventing septicemia after CABG. As C. membranaefaciens is an opportunistic Candida species, both clinicians and microbiologists should be aware of the factors that confer fast diagnosis and appropriate treatment. PMID:26110010

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

    PubMed Central

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

    2016-01-01

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

  17. Significance of Interferon-γ in Coronary Artery Bypass Surgery

    PubMed Central

    Abo Deeb, Azza A.; Samee, Mohammed; Raju, Ramanathan; Shirazian, Djamshid; Acinapura, Anthonay J.; Cunningham, Joseph N.

    2001-01-01

    Background: Gamma interferon (IFN-γ) is produced by activated natural killer and T cells under pathologic circumstances. The objective of our study was to compare the level of IFN-γ in open and endoscopic methods of vein harvesting for coronary artery bypass surgery (CABG). Method: Ninety samples of human saphenous veins harvested from patients prepared for CABG. Pre- and post-procedure sera of the patients, in addition to super-natants of 3-day endothelial cell culture, were analyzed for IFN-γ. Results: The mean preoperative IFN-γ level (0.09 ± 0.03 pg/mL) and that for postoperative sera (0.08 ± 0.02 pg/mL) were not significantly different (P = 0.2). The mean IFN-γ level in endothelial cell culture from the endoscopic (0.18 ± 0.21 pg/mL) and the open method (0.19 ± 0.39 pg/mL) were not significant (P = 0.89). Conclusion: We recommend the endoscopic method of vein harvesting because of its lower morbidity and earlier hospital discharge. PMID:11548832

  18. The clinical impact of perfusion scintigraphy with dipyridamole

    SciTech Connect

    Schechtmann, N.; Dae, M.; Lanzer, P.; Sajardo, L.; Faulkner, D.; Botvinick, E.

    1984-01-01

    In order to assess their clinical impact, the authors analyzed perfusion scintigrams (PS) with dipyridamole (D) and the resultant clinical management in 41 consecutive patients (PTS). Population mean age was 67, with 22 males and represented 14% of those having PS. Fifteen PTS had rest chest pain of unknown cause and 26 PTS had pain typical or suggestive of angina but couldn't undergo dynamic stress due to claudication, arthritis, amputation, stroke, recent surgery or other disability. Four PTS were studies for surgical clearance, 3 following angiography to assess coronary pathophysiology and 9 had prior negative or equivocal stress PS at suboptimal levels. Among 18 PTS with reversible scintigraphic abnormalities, 10 underwent subsequent catheterization, with successful CABG in 7, PTCA in 1, aggressive medical treatment of ischemia in 11, and 2 had noncoronary surgery delayed. One PT with associated extensive fixed abnormalities underwent CABG and died late in heart failure. Among 23 PTS without significant scintigraphic reversibility, 8 with normal studies were discharged, 3 went on to uncomplicated noncardiac surgery and 11 PTS, 9 with dilated cardiomyopathy, were managed without therapeutic change. D infusion was uncomplicated and related findings on PS correlated well with coronary angiography, where available in 19 of 20 PTS. PS with D: 1) is safe; 2) correlates closely with coronary anatomy; and 3) adds unique, important pathophysiologic information to clinical evaluation and impacts strongly on the management of a large number of PTS with known or suspected coronary disease.

  19. Emergency revascularization procedures in patients with acute ST-elevation myocardial infarction due to acute total occlusion of unprotected left main coronary artery: a report of five cases.

    PubMed

    Aygül, Nazif; Aygül, Meryem Ulkü; Ozdemir, Kurtuluş; Altunkeser, Bülent Behlül

    2010-03-01

    Several studies have compared the efficacy of elective coronary artery stenting and coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery (ULMCA) disease. However, a definite reperfusion modality has yet to be established in ST-elevation myocardial infarction (STEMI) due to acute total occlusion of ULMCA, which has catastrophic clinical results. We presented five patients (3 males, 2 females; mean age 59 years; range 53 to 67 years) with acute anterior STEMI and angiographically documented acute total occlusion of ULMCA. On presentation, all the patients had chest pain and four patients were in cardiogenic shock. All the patients were taken to the catheterization room with minimum delay. Intra-aortic balloon counterpulsation was used during coronary angiography in all the patients. Three patients underwent PCI and, after balloon predilatation, bare-metal stents were implanted and TIMI III flow was achieved. One patient who had atrial fibrillation on admission died on the 14th day of hospitalization after PCI due to pump failure. After diagnostic coronary angiography, two patients were submitted to surgery for emergency CABG. They both died, one within two hours of admission during preparation of the surgical team, and the other on the third postoperative day. Both were in cardiogenic shock on admission.

  20. Medicare's Hospital Compare quality reports appear to have slowed price increases for two major procedures.

    PubMed

    Dor, Avi; Encinosa, William E; Carey, Kathleen

    2015-01-01

    Previous research has found that Hospital Compare, Medicare's public reporting initiative, has had little impact on patient outcomes. However, little is known about the initiative's impact on hospital prices, which may be significant because private insurers are generally well positioned to respond to quality information when negotiating prices with hospitals. We estimated difference-in-differences models of the effects of Hospital Compare quality reporting on transaction prices for two major cardiac procedures, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). States that had mandated their own public reporting systems before the implementation of Hospital Compare formed the control group. We found that prices for these procedures continued to increase overall after the initiation of Hospital Compare quality scores, but the rate of increase was significantly lower in states with no quality reporting metrics of their own before Hospital Compare, when compared to the control states (annual rates of increase of 4.4 percent versus 8.7 percent for PCI, and 3.9 percent versus 10.6 percent for CABG, adjusted for overall inflation). This finding implies that Hospital Compare provided leverage to purchasers in moderating price increases, while adding competitive pressures on hospitals. Providing accurate quality information on both hospitals and health plans could benefit consumers.

  1. Anesthetic Propofol-Induced Gene Expression Changes in Patients Undergoing Coronary Artery Bypass Graft Surgery Based on Dynamical Differential Coexpression Network Analysis

    PubMed Central

    Huang, Li-Jun; Chen, Na-Mi

    2016-01-01

    We aimed to determine the influence of anesthetic propofol on gene expression in patients treated by coronary artery bypass graft (CABG) surgery based on differential coexpression network (DCN) and to further reveal the novel mechanisms of the cardioprotective effects of propofol. Firstly, we constructed the DCN for disease condition based on Pearson correlation coefficient (PCC) and weight value. Secondly, the inference of modules was applied to search modules from DCN with same members but varied connectivity. Furthermore, we measured the statistical significance of the modules for selecting differential modules (DMs). Finally, attract method was used for DMs analysis to select key modules. Based on the δ value, 11928 edges and 2956 nodes were chosen to construct DCNs. A total of 29 seed genes were selected. Moreover, by quantifying connectivity changes in shared gene modules across different conditions, 8 DMs with higher connectivity dynamics were identified. Then, we extracted key modules using attract method, there were 8 key modules, and the top 3 modules were module 1, 2, and 3. Furthermore, GCG, PPY, and PON1 were initial seed genes of these 3 key modules, respectively. Accordingly, GCG and PON1 might exert important roles in the cardioprotective effects of propofol during CABG. PMID:27437027

  2. Anesthetic Propofol-Induced Gene Expression Changes in Patients Undergoing Coronary Artery Bypass Graft Surgery Based on Dynamical Differential Coexpression Network Analysis.

    PubMed

    Yu, Da; Huang, Li-Jun; Chen, Na-Mi

    2016-01-01

    We aimed to determine the influence of anesthetic propofol on gene expression in patients treated by coronary artery bypass graft (CABG) surgery based on differential coexpression network (DCN) and to further reveal the novel mechanisms of the cardioprotective effects of propofol. Firstly, we constructed the DCN for disease condition based on Pearson correlation coefficient (PCC) and weight value. Secondly, the inference of modules was applied to search modules from DCN with same members but varied connectivity. Furthermore, we measured the statistical significance of the modules for selecting differential modules (DMs). Finally, attract method was used for DMs analysis to select key modules. Based on the δ value, 11928 edges and 2956 nodes were chosen to construct DCNs. A total of 29 seed genes were selected. Moreover, by quantifying connectivity changes in shared gene modules across different conditions, 8 DMs with higher connectivity dynamics were identified. Then, we extracted key modules using attract method, there were 8 key modules, and the top 3 modules were module 1, 2, and 3. Furthermore, GCG, PPY, and PON1 were initial seed genes of these 3 key modules, respectively. Accordingly, GCG and PON1 might exert important roles in the cardioprotective effects of propofol during CABG. PMID:27437027

  3. Minimally invasive cardiac surgery-coronary artery bypass graft.

    PubMed

    Lemma, Massimo; Atanasiou, Thanos; Contino, Monica

    2013-01-01

    Coronary artery bypass graft (CABG) is among the most common operations performed in the world. Different surgical strategies can be used with different invasiveness. This paper describes a recent development of the technique that merges the advantages resulting from both the adoption of an 'off-pump no-touch aorta operation' and a 'complete arterial revascularization through a left minithoracotomy' in a single procedure. This operation is currently known with the acronym MICS (minimally invasive cardiac surgery)-CABG (minimally invasive cardiac surgery). It is an off-pump operation performed through a minithoracotomy in the fourth or fifth left intercostal space across the midclavicular line. The left internal thoracic artery (LITA) is harvested under direct vision using a special rib-retractor with multiple interchangeable thoracotomy blades, including blades to use with lift systems for proximal artery harvesting, while the right radial artery (RA) is harvested endoscopically. A Y-connection is made between the two arteries. The LITA is used to bypass the left anterior descending coronary artery, while the right RA is used on the obtuse marginal branches and/or the posterior descending coronary artery. A special coronary stabilizer and a heart positioner with a shaft for remote thoracic insertion are needed.

  4. Lasers in the treatment of ischemic heart disease in China

    NASA Astrophysics Data System (ADS)

    Zhang, Yongzhen; Chen, Mingzhe

    2000-10-01

    Myocardial revascularization by laser is a new treatment modality for chronic, severe, refractory angina in the patients with coronary heart disease that is not amenable to angioplasty (PTCA) or bypass surgery (CABG). Transmyocardial revascularization (TMR), typically requiring open thoracotomy, uses laser to create channels that would directly carry blood from left ventricular cavity into the ischemic myocardium. Current data indicate that TMR may provide these patients with improvement in angina severity, quality of life, and myocardial perfusion. The greatest potential future use of TMR is as an adjunct to CABG in patients with disease that prevents bypass grafting due to lack of distal targets or a conduit. Recently, as percutaneous (catheter-based) myocardial revascularization (PMR) has been developed with laser technology that permits the creation of channels from the endocardial surface of the left ventricle. The early results with PMR seem encouraging. Randomized clinical trial has demonstrated symptomatic improvement and increased exercise capacity. The risk: benefit ratio for PMR appears to be much more favorable than that for TMR. The mechanisms of action of them have not yet been clearly elucidated, and several theories have been proposed, including channel patency, angiogenesis, denervation, and placebo effect. The challenge of TMR/PMR is related to improvement of perioperative outcomes and long-term survival without worsening of left ventricular function. In future, it may be feasible to combine TMR/PMR with intramyocardial delivery of angiogenic growth factors to induce further new blood vessel formation.

  5. Anti-inflammatory effects of propofol during cardiopulmonary bypass: A pilot study

    PubMed Central

    Samir, A.; Gandreti, N.; Madhere, M.; Khan, A.; Brown, M.; Loomba, V.

    2015-01-01

    Introduction: Propofol has been suggested as a useful adjunct to cardiopulmonary bypass (CPB) because of its potential protective effect on the heart mediated by a decrease in ischemia-reperfusion injury and inflammation at clinically relevant concentrations. In view of these potentially protective properties, which modulate many of the deleterious mechanism of inflammation attributable to reperfusion injury and CPB, we sought to determine whether starting a low dose of propofol infusion at the beginning of CPB would decrease inflammation as measured by pro-inflammatory markers. Materials and Methods: We enrolled 24 patients undergoing elective coronary artery bypass graft (CABG). The study group received propofol at rate of 120 mcg/kg/min immediately after starting CPB and was maintained throughout the surgery and for the following 6 hours in the intensive care unit (ICU). The control group received propofol dose of 30-50 mcg/kg/min which was started at the time of chest closure with wires and continued for the next 6 hours in the ICU. Interleukins (IL) -6, -8 and -10 and tumor necrosis factor alpha (TNFalpha) were assayed. Result: The most significant difference was in the level of IL-6 which had a P value of less than 0.06. Starting a low dose propofol early during the CPB was not associated with significant hemodynamic instability in comparison with the control group. Conclusion: Our study shows that propofol may be suitable as an anti-inflammatory adjunct for patients undergoing CABG. PMID:26440235

  6. The effects of oxygen induced pulmonary vasoconstriction on bedside measurement of pulmonary gas exchange.

    PubMed

    Weinreich, Ulla M; Thomsen, Lars P; Rees, Stephen E; Rasmussen, Bodil S

    2016-04-01

    In patients with respiratory failure measurements of pulmonary gas exchange are of importance. The bedside automatic lung parameter estimator (ALPE) of pulmonary gas exchange is based on changes in inspired oxygen (FiO2) assuming that these changes do not affect pulmonary circulation. This assumption is investigated in this study. Forty-two out of 65 patients undergoing coronary artery bypass grafting (CABG) had measurements of mean pulmonary arterial pressure (MPAP), cardiac output and pulmonary capillary wedge pressure thus enabling the calculation of pulmonary vascular resistance (PVR) at each FiO2 level. The research version of ALPE was used and FiO2 was step-wise reduced a median of 0.20 and ultimately returned towards baseline values, allowing 6-8 min' steady state period at each of 4-6 levels before recording the oxygen saturation (SpO2). FiO2 reduction led to median decrease in SpO2 from 99 to 92 %, an increase in MPAP of 4 mmHg and an increase in PVR of 36 dyn s cm(-5). Changes were immediately reversed on returning FiO2 towards baseline. In this study changes in MPAP and PVR are small and immediately reversible consistent with small changes in pulmonary gas exchange. This indicates that mild deoxygenation induced pulmonary vasoconstriction does not have significant influences on the ALPE parameters in patients after CABG.

  7. Patient-related outcomes five years after coronary artery bypass graft surgery.

    PubMed

    Skinner, J S; Farrer, M; Albers, C J; Neil, H A; Adams, P C

    1999-02-01

    For five years, we prospectively studied 353 consecutive patients undergoing first-time coronary artery bypass graft surgery (CABG) for stable angina in the North of England. Angina was present before surgery in nearly all patients, in 20% 3 months after surgery, and in 48% after 60 months. The Nottingham Health Profile, showed a significant improvement in perceived health status (PHS) 12 and 60 months after surgery compared with preoperation. However, PHS at 60 months was worse than at 12 months in the dimensions 'pain' and 'physical mobility' in part 1, and in 'looking after the home' and 'taking holidays' in part 2. Employment rates were 36%, 34% and 21%, before, and 12 and 60 months after surgery, respectively. Working at 12 and 60 months was associated with age below retirement age, work preoperation and absence of angina, and at 12 months also with male gender and waiting time < 6 months. This study describes everyday clinical practice. The significant improvement in angina symptoms and PHS after CABG persists for at least 5 years. However, only one third of patients in this geographical area return to work, and this is not solely dependent on clinical symptoms.

  8. The dangers of gathering data: surgeon-specific outcomes revisited.

    PubMed

    Ferraris, Victor A; Ferraris, Suellen P; Wehner, Paulette S; Setser, Edward R

    2011-12-01

    The accuracy of risk adjustment is important in developing surgeon profiles. As surgeon profiles are obtained from observational, nonrandomized data, we hypothesized that selection bias exists in how patients are matched with surgeons and that this bias might influence surgeon profiles. We used the Society of Thoracic Surgeons risk model to calculate observed to expected (O/E) mortality ratios for each of six cardiac surgeons at a single institution. Propensity scores evaluated selection bias that might influence development of risk-adjusted mortality profiles. Six surgeons (four high and two low O/E ratios) performed 2298 coronary artery bypass grafting (CABG) operations over 4 years. Multivariate predictors of operative mortality included preoperative shock, advanced age, and renal dysfunction, but not the surgeon performing CABG. When patients were stratified into quartiles based on the propensity score for operative death, 83% of operative deaths (50 of 60) were in the highest risk quartile. There were significant differences in the number of high-risk patients operated upon by each surgeon. One surgeon had significantly more patients in the highest risk quartile and two surgeons had significantly less patients in the highest risk quartile (p < 0.05 by chi-square). Our results show that high-risk patients are preferentially shunted to certain surgeons, and away from others, for unexplained (and unmeasured) reasons. Subtle unmeasured factors undoubtedly influence how cardiac surgery patients are matched with surgeons. Problems may arise when applying national database benchmarks to local situations because of this unmeasured selection bias.

  9. Implantation of a Novel Allogeneic Mesenchymal Precursor Cell Type in Patients with Ischemic Cardiomyopathy Undergoing Coronary Artery Bypass Grafting: an Open Label Phase IIa Trial.

    PubMed

    Anastasiadis, Kyriakos; Antonitsis, Polychronis; Westaby, Stephen; Reginald, Ajan; Sultan, Sabena; Doumas, Argirios; Efthimiadis, George; Evans, Martin John

    2016-06-01

    Heart failure is a life-limiting condition affecting over 40 million patients worldwide. Ischemic cardiomyopathy (ICM) is the most common cause. This study investigates in situ cardiac regeneration utilizing precision delivery of a novel mesenchymal precursor cell type (iMP) during coronary artery bypass surgery (CABG) in patients with ischemic cardiomyopathy (LVEF < 40 %). The phase IIa safety study was designed to enroll 11 patients. Preoperative scintigraphy imaging (SPECT) was used to identify hibernating myocardium not suitable for conventional myocardial revascularization for iMP implantation. iMP cells were implanted intramyocardially in predefined viable peri-infarct areas that showed poor perfusion, which could not be grafted due to poor target vessel quality. Postoperatively, SPECT was then used to identify changes in scar area. Intramyocardial implantation of iMP cells with CABG was safe with preliminary evidence of efficacy of improved myocardial contractility and perfusion of nonrevascularized territories resulting in a significant reduction in left ventricular scar area at 12 months after treatment. Clinical improvement was associated with a significant improvement in quality of life at 6 months posttreatment in all patients. The results suggest the potential for in situ myocardial regeneration in ischemic heart failure by delivery of iMP cells. PMID:27037806

  10. Safety and efficacy of an ultrashort-acting β1-blocker on left ventricular dysfunction.

    PubMed

    Ito, Nobuhisa; Tashiro, Tadashi; Morishige, Noritsugu; Nishimi, Masaru; Hayashida, Yoshio; Minematsu, Noritoshi; Kuwahara, Go; Sukehiro, Yuta; Teratani, Hiromitsu

    2012-08-01

    Landiolol hydrochloride, an ultrashort-acting β1-selective blocker, is a highly regulated drug. This study evaluated the safety and efficacy of this drug for cases of coronary artery bypass grafting (CABG) with left ventricular dysfunction. Between September 2006 and August 2009, 32 patients with a left ventricular ejection fraction of <40% underwent CABG. Two groups of patients, a group administered landiolol hydrochloride and a control group not administered this drug, were compared. The administration of landiolol hydrochloride was initiated at 1 μg/kg per minute (γ) after cardiopulmonary bypass in on-pump cases and after completion of all the distal anastomoses in off-pump cases. We observed no significant differences between the groups with respect to preoperative patient background or incidences of complications, except for postoperative atrial fibrillation. The heart rate decreased significantly 30 minutes after landiolol hydrochloride administration, but no change was observed in arterial pressure. No change was observed in other parameters; the hemodynamics were stable. The occurrence of atrial fibrillation during the intensive care unit stay (during landiolol hydrochloride administration) was significantly lower in the administration group. The difference remained significant after multiple logistic regression analysis; landiolol hydrochloride was the sole inhibitory factor. PMID:22917822

  11. [Off-pump coronary artery bypass via median sternotomy].

    PubMed

    Yaku, Hitoshi; Doi, Kiyoshi

    2006-07-01

    Off-pump coronary artery bypass grafting (off-pump CABG: OPCAB) is a useful technique of coronary revascularization in terms of reduction of operative mortality and morbidity. Because the biggest advantage of OPCAB may be that it can prevent perioperative stroke, we selected patients for OPCAB based on the preoperative evaluation of neck and intracranial vessels. We could totally eliminate intraoperative stroke in patients undergoing OPCAB, although some patients with a severe neck vessel disease developed postoperative stroke/transient ischemic attack in an early postoperative period (the 4th approximately 8th postoperative day) mostly due to thrombosis from the diseased vessel. Therefore, high-risk patients with a severe neck vessel disease should be treated with a more aggressive anticoagulation protocol postoperatively. As for the quality of grafting, the number of graft, the rate of complete revascularization, and early graft patency were comparable between OPCAB and CABG with a cardiopulmonary bypass. The long-term results in terms of freedom from cardiac death and cardiac events were also comparable. We conclude that we could achieve less invasiveness in coronary revascularization by using an OPCAB technique without compromising the quality of grafting.

  12. Implementation of a patient-family pathway: effects on patients and families.

    PubMed

    Sagehorn, K K; Russell, C L; Ganong, L H

    1999-05-01

    The purpose of this study was to discover whether implementation of a patient-family pathway with patients and families undergoing coronary artery bypass graft (CABG) surgery impacted anxiety, information with care planning, and patient length of stay. Using an experimental design, a sample of 60 patients and family members was studied. Each patient and his or her designated family member received either the patient-family pathway or the hospital's standard care planning. Findings indicated no statistically significant differences in state anxiety or information with care planning between patients and family members receiving the patient-family pathway and those receiving standard care planning. There was no statistically significant difference in length of stay between the two patient groups. The results indicate that the CABG patient-family pathway has limited value to patients and families as measured in this study. Resources can be real-located to other uses that may have a more positive impact on the patient and family experience.

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

    PubMed Central

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

    2015-01-01

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

  14. Fibrinogen reduction and coagulation in cardiac surgery: an investigational study.

    PubMed

    Gielen, Chantal L I; Grimbergen, Jos; Klautz, Robert J M; Koopman, Jaap; Quax, Paul H A

    2015-09-01

    Fibrinogen as precursor of fibrin plays an essential role in clot formation. There are three main mechanisms associated with a reduction in fibrinogen concentration during cardiac surgery: hemodilution, consumption, and degradation. Moreover, early fibrinogen degradation products (FgDPs) can interfere with normal fibrin formation of intact fibrinogen. The aim of this study was to determine the relative contributions of hemodilution, consumption, and degradation to fibrinogen loss in cardiac surgery and to evaluate the effects fibrinogen degradation products on blood clot formation in vitro. First, fibrin and fibrinogen concentrations, their degradation products, hematocrit, and albumin concentrations were compared in 10 patients before and after isolated coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. Second, ex-vivo fibrinogen supplementation experiments were performed. Finally, the effects of purified FgDPs on clotting time and clot firmness were established in vitro in whole blood by ROTEM. Fibrinogen plasma concentration decreased 30% during surgery. This drop appears to be mainly caused by hemodilution, as both hematocrit and albumin levels decreased and no relevant increase in D-dimer levels and FgDPs was observed. Furthermore, the coagulation profile normalized after addition of purified fibrinogen. Early FgDPs demonstrated a significant impact on in-vitro whole blood clotting. Although early FgDPs have a pronounced effect on blood clot formation in vitro and therefore may induce or enhance in vivo coagulopathy, the drop of fibrinogen concentration seen after CABG surgery (using tranexamic acid) is primarily caused by hemodilution. PMID:26083991

  15. A patient with possible TRALI who developed pulmonary hypertensive crisis and acute pulmonary edema during cardiac surgery.

    PubMed

    Kojima, Taiki; Nishisako, Ryo; Sato, Hideo

    2012-06-01

    There are very few case reports of transfusion-related acute lung injury (TRALI) under close hemodynamic monitoring. We encountered a case of possible TRALI during on-pump coronary artery bypass grafting (CABG). A 66-year-old man who had undergone on-pump CABG was administered fresh frozen plasma (FFP). One hour after FFP transfusion, pulmonary hypertensive crisis and subsequent hypoxic decompensation occurred. A second cardiopulmonary bypass (CPB) was needed for circulatory and respiratory deterioration. Extracorporeal life support (ECLS), intraaortic balloon pumping (IABP), and nitric oxide therapy were required after the surgery. Despite the severity of the initial state, his recovery was comparatively smooth. ECLS and IABP were removed on postoperative day (POD)1; the patient was extubated and discharged from the ICU on POD7 and POD12, respectively. The diagnosis of TRALI was confirmed by human leukocyte antigen antibody detection in the administered FFP. In addition, lymphocytic immunofluorescence test showed that a cross-match of the plasma from the pooled FFP against the recipient leukocytes was positive. The clinical course of the pulmonary artery hypertension was followed by a decrease in dynamic lung compliance. The mechanism of this phenomenon is unclear. However, it might suggest the possibility of vasoconstriction or obstruction of the peripheral pulmonary artery preceding lung damage, as in the case in animal models reported previously.

  16. Doppler derived quantitative flow estimate in coronary artery bypass graft: a computational multiscale model for the evaluation of the current clinical procedure.

    PubMed

    Ponzini, Raffaele; Lemma, Massimo; Morbiducci, Umberto; Montevecchi, Franco M; Redaelli, Alberto

    2008-09-01

    In order to investigate the reliability of the so called mean velocity/vessel area formula adopted in clinical practice for the estimation of the flow rate using an intravascular Doppler guide wire instrumentation, a multiscale computational model was used to give detailed predictions on flow profiles within Y-shaped coronary artery bypass graft (CABG) models. At this purpose three CABG models were built from clinical patient's data and used to evaluate and compare, in each model, the computed flow rate and the flow rate estimated according to the assumption of parabolic velocity profile. A consistent difference between the exact and the estimated value of the flow rate was found in every branch of all the graft models. In this study we showed that this discrepancy in the flow rate estimation is coherent to the theory of Womersley regarding spatial velocity profiles in unsteady flow conditions. In particular this work put in evidence that the error in flow rate estimation can be reduced by using the estimation formula recently proposed by Ponzini et al. [Ponzini R, Vergara C, Redaelli A, Veneziani A. Reliable CFD-based estimation of flow rate in haemodynamics measures. Ultrasound Med Biol 2006;32(10):1545-55], accounting for the unsteady nature of blood, applicable in the clinical practice without resorting to further measurements. PMID:17980641

  17. Gender and cardiac surgery.

    PubMed

    Koch, Colleen Gorman; Nussmeier, Nancy A

    2003-09-01

    The increased operative mortality and morbidity of women compared with men undergoing CABG surgery results from multiple differences in presentation, preoperative risk profile, and surgical factors. Investigators have found consistently that women present with a different preoperative risk profile than do men. Women more commonly have factors associated with increased short- and long-term mortality, such as less frequent use of IMA grafts. Differences in study design and patient population may contribute to variability in short- and long-term mortality among the various studies. The lack of representation of women in older clinical trials has hindered our understanding of the management of CAD in women; this situation must be remedied in future studies, [95]. Known physiologic and anatomic differences must be evaluated for their effects on outcomes. Further studies are needed to evaluate gender-related differences in autonomic responses to acute coronary occlusion, complications related to cardiopulmonary bypass, susceptibility to abnormalities in coagulation, and other factors that might account for discrepant outcomes in men versus women undergoing CABG [96]. Beyond these factors, specific pharmacologic and therapeutic considerations, such as the role of estrogen replacement therapy, need to be clarified. As further knowledge accumulates, it is hoped that gender-specific risk factors can be mitigated and protective factors exploited, thereby improving the outcomes for all cardiac surgery patients.

  18. The Effects of Near-Infrared Spectroscopy on the Neurocognitive Functions in the Patients Undergoing Coronary Artery Bypass Grafting with Asymptomatic Carotid Artery Disease: A Randomized Prospective Study

    PubMed Central

    Erkin, Alper; Saclı, Hakan; Demirtas, Mucahit; Percin, Bilal; Diler, Mevriye Serpil; Kırali, Kaan

    2015-01-01

    Purpose: The purpose of this study was to research the use of near-infrared spectroscopy (NIRS) on the neurocognitive functions in the patients undergoing coronary artery bypass grafting (CABG) with asymptomatic carotid artery disease. Methods: The study design was carried out with the participation of 79 patients in a prospective, randomized and double blind control method. The patients were separated into two groups as NIRS (n = 43) and no NIRS (n = 36). A neurocognitive test was applied preoperatively and postoperatively to all patients before discharge. Cognitive functions were evaluated by applying the Montreal Cognitive Assessment test (MoCA). Results: The decrease in the postoperative score of mean MoCA in no NIRS group was statistically significant when compared to preoperatively (p <0.001). Postoperative mean MoCA score was found to be significantly higher in NIRS group (NIRS: 26.8 ± 1.9 vs. no NIRS: 23.6 ± 2.5, p <0.001). It has been determined that there was a moderately positive significant correlation between the increase in the NIRS used patients (%) and increase in the MoCA score of the patients (r = 0.59, p <0.001). Conclusion: Intraoperative NIRS usage in the patients undergoing CABG with carotid artery disease might be useful due to its postoperative positive effects on the cognitive functions. PMID:26133933

  19. Platelet dysfunction detected at high shear in patients with heart valve disease.

    PubMed

    Francis, J L

    2000-05-01

    Whether patients with valvular heart disease have a defect of platelet function has been unclear. Despite evidence that these individuals have an abnormality detectable only under conditions of high shear stress, no methods have been widely available to adequately assess platelet function under such conditions. The Platelet Function Analyzer (PFA)-100 measures platelet function in a high shear environment and is well suited to the detection of platelet dysfunction in the clinical laboratory. The instrument records the time for platelets to occlude a membrane coated with collagen and either epinephrine (CEPI) or ADP (CADP). We studied the PFA-100 in 398 patients before open heart surgery; 308 for coronary artery bypass grafting (CABG) and 90 for aortic or mitral valve replacement (VR). Patients were classified as normal (CEPI < or = 153 s); 'aspirin effect' (CEPI > 153 s but CADP < or = 109 s) or abnormal (CEPI > 153 s and CADP > 109 s). In the CABG group, 41.2% were classified as normal, 43.2% as 'aspirin effect' and 15.6% as abnormal. In contrast, in patients undergoing VR, these values were 6.7, 11.1 and 82.4%, respectively. Patients with valvular disease had significantly longer closure times for both CEPI and CADP tests (P < 0.001). In addition, the valvular disease group had a significantly higher proportion of patients with markedly prolonged (> 150 s) closure times in the CADP cartridge (43.3 vs. 3.6%, respectively). Only one (0.3%) patient in the CABG group had non-closure (> 300 s) in the CADP test compared to seven (7.8%) in the valvular disease group. Three of six patients in the latter group bled excessively during surgery. We conclude that abnormal CADP closure is much more frequent among patients with aortic or mitral valve disease compared to those with coronary artery disease. This may reflect pre-existing high-shear damage to platelets that renders them refractory to subsequent shear activation and aggregation in the PFA-100 system. Further studies

  20. Do implantable cardioverter defibrillators improve survival in patients with severe left ventricular systolic dysfunction after coronary artery bypass graft surgery?

    PubMed

    Fazal, Iftikhar A; Bates, Matthew G D; Matthews, Iain G; Turley, Andrew J

    2011-06-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether implantable cardioverter defibrillators (ICD) improve survival in patients with severe left ventricular systolic dysfunction (LVSD) after coronary artery bypass graft (CABG) surgery. ICDs are designed to terminate potentially fatal cardiac tachyarrhythmias. A right ventricular lead is mandatory for detection, pacing and defibrillation capabilities. Dual chamber ICDs have an additional right atrial lead and are used for patients with conventional atrioventricular pacing indications. More sophisticated, biventricular devices exist to provide cardiac resynchronisation therapy (CRT) in addition to defibrillation (CRT-D). ICDs have been extensively investigated in patients with LVSD post myocardial infarction and in patients with non-ischaemic cardiomyopathy for both secondary prevention (history of ventricular arrhythmias) and primary prevention (deemed high risk for ventricular arrhythmias). This best evidence topic aims to review the evidence and its applicability to patients post CABG. Nine hundred and sixteen papers were identified using the search method outlined. Eight randomised controlled trials, two meta-analyses, and one non-randomised trial, in addition to international guidelines presented the best evidence to answer the clinical question. The current evidence base and guidelines suggest that ICDs should be considered for all patients with LVSD [ejection fraction (EF) ≤30-40%] receiving optimal pharmacological management, who are ≥40 days post MI [four weeks for National Institute for Health and Clinical Excellence (NICE)] and in New York Heart Association (NYHA) class I-III. UK NICE guidelines require in addition; non-sustained ventricular tachycardia (NSVT) on a Holter monitor and inducible ventricular tachycardia at electrophysiological study for EF between 30 and 35%; or a QRS >120 ms if EF <30%. The North American guidelines

  1. [Comparative assessment of immediate outcomes of surgical treatment of patients with coronary artery disease and lesion of the brachiocephalic arteries].

    PubMed

    Drozhzhin, E V; Ibragimov, O R; Koval'chuk, D N; Efanov, Iu M; Zor'kin, A A; Ibragimova, E A; Urvantseva, I A

    2014-01-01

    From 2000 to 2011, a total of 52 patients with combined atherosclerotic lesions of the coronary and brachiocephalic arteries were subjected to a single-stage operation. Depending on the type of operative intervention, all patients were subdivided into two groups: Group One comprising 13 patients who underwent coronary artery bypass grafting (CABG) in a combination with simultaneous stenting of the internal carotid artery, and Group Two consisting of 39 patients subjected to CABG with simultaneous carotid endarterectomy. Assessing the intraoperative parameters revealed that in Group One patients the average duration of operations was significantly lower (179.6±6.4 minutes versus 273.2±5.6 minutes in Group Two, p<0.001) and the time of assisted circulation was less than in Group Two, averaging 75.9±4.5 versus 115.2±3.8 minutes, respectively (p<0.001). The duration of pulmonary artificial ventilation in Group One patients was less than in Group Two patients (9.7±2.6 hours versus 25±4.8 hours, respectively, p< 0.01). Also the duration of staying in the critical care unit was shorter in Group One patients than in Group Two patients (21.5±3.3 versus 82.1±8.0 hours, respectively, p<0.001). The overall hospital mortality rate amounted to 12.8% (5 patients), with all deaths having occurred in Group Two. The lethal outcomes were caused by acute myocardial infarction in three cases, one patient died of progressing multiple-organ failure on the background of acute impairment of cerebral circulation and one death was caused by thrombosis of the mesenteric artery with the development of intestinal gangrene and peritonitis. In the structure of hospital complications cardiac insufficiency was prevalent (23.1% and 59.0% for Groups One and Group Two patients, respectively, p<0.05). Analysing the incidence and structure of other postoperative complications revealed no statistically significant differences between the groups. Our study demonstrated that using surgical methods

  2. Moderate hypothermia and its effects in reducing the applied dose of anesthetics for patients with opium dependence in cardiac surgery: A randomized controlled trial

    PubMed Central

    Taghadomi, Reza Jalaian; Golmakani, Ebrahim; Alizadeh, Kambiz; Mottahedi, Behrooz; Rahdari, Ali; Sheybani, Shima

    2016-01-01

    Background An increasing number of patients addicted to opium are experiencing awareness during coronary artery bypass surgery (CABG) as a result of tolerance to anesthetics. Objectives This research was primarily intended to determine the potential diminishing effects of moderate hypothermia on anesthetic dosage and recall of anesthesia during the procedure. Methods In this double-blind randomized controlled trial, a total of 80 CABG candidates with known addiction to opium were divided into two groups: one normothermic (N) and the other moderately hypothermic (H), both undergoing induction as well as close monitoring from September 2014 to January 2016. The candidates were initially set for a target bispectral index (BIS) score of between 40 and 60. As the score rose to 60, an additional dose of propofol was administered, alongside rise in blood pressure and tear-shedding. To enhance the accuracy of our evaluation of anesthetic depth, we also used two questionnaires to test candidates’ recall filled with the assistance of a colleague 24 hours following surgery. Independent-samples t-test and chi-square test were used by SPSS v 18 for data analysis. Results Eighty patients were studied in two groups of normothermic (N) (n = 40) and hypothermic (H) (n = 40). Given similar demographic data as well as the duration of surgery, we arrived at a propofol dose of 122.52±13.11 cc for normothermic patients and 101.28±14.06 cc for hypothermic subjects (p=0.001). As for fentanyl, the total required sum came up to 39.60±21.04 cc and 31.72±5.81 cc for the above-mentioned groups in order (p=0.025). Moreover, the post-operative interview showed that there was no report of a patient with memory recall following surgery. Conclusions Moderate hypothermia can substantially reduce the need for anesthetics in patients with addiction to opium when undergoing CABG surgery. Trial registration This study is registered in Iranian Registry of Clinical Trials with registration number of

  3. A new model to predict acute kidney injury requiring renal replacement therapy after cardiac surgery

    PubMed Central

    Pannu, Neesh; Graham, Michelle; Klarenbach, Scott; Meyer, Steven; Kieser, Teresa; Hemmelgarn, Brenda; Ye, Feng; James, Matthew

    2016-01-01

    Background: Acute kidney injury after cardiac surgery is associated with adverse in-hospital and long-term outcomes. Novel risk factors for acute kidney injury have been identified, but it is unknown whether their incorporation into risk models substantially improves prediction of postoperative acute kidney injury requiring renal replacement therapy. Methods: We developed and validated a risk prediction model for acute kidney injury requiring renal replacement therapy within 14 days after cardiac surgery. We used demographic, and preoperative clinical and laboratory data from 2 independent cohorts of adults who underwent cardiac surgery (excluding transplantation) between Jan. 1, 2004, and Mar. 31, 2009. We developed the risk prediction model using multivariable logistic regression and compared it with existing models based on the C statistic, Hosmer–Lemeshow goodness-of-fit test and Net Reclassification Improvement index. Results: We identified 8 independent predictors of acute kidney injury requiring renal replacement therapy in the derivation model (adjusted odds ratio, 95% confidence interval [CI]): congestive heart failure (3.03, 2.00–4.58), Canadian Cardiovascular Society angina class III or higher (1.66, 1.15–2.40), diabetes mellitus (1.61, 1.12–2.31), baseline estimated glomerular filtration rate (0.96, 0.95–0.97), increasing hemoglobin concentration (0.85, 0.77–0.93), proteinuria (1.65, 1.07–2.54), coronary artery bypass graft (CABG) plus valve surgery (v. CABG only, 1.25, 0.64–2.43), other cardiac procedure (v. CABG only, 3.11, 2.12–4.58) and emergent status for surgery booking (4.63, 2.61–8.21). The 8-variable risk prediction model had excellent performance characteristics in the validation cohort (C statistic 0.83, 95% CI 0.79–0.86). The net reclassification improvement with the prediction model was 13.9% (p < 0.001) compared with the best existing risk prediction model (Cleveland Clinic Score). Interpretation: We have developed

  4. Platelet dysfunction detected at high shear in patients with heart valve disease.

    PubMed

    Francis, J L

    2000-05-01

    Whether patients with valvular heart disease have a defect of platelet function has been unclear. Despite evidence that these individuals have an abnormality detectable only under conditions of high shear stress, no methods have been widely available to adequately assess platelet function under such conditions. The Platelet Function Analyzer (PFA)-100 measures platelet function in a high shear environment and is well suited to the detection of platelet dysfunction in the clinical laboratory. The instrument records the time for platelets to occlude a membrane coated with collagen and either epinephrine (CEPI) or ADP (CADP). We studied the PFA-100 in 398 patients before open heart surgery; 308 for coronary artery bypass grafting (CABG) and 90 for aortic or mitral valve replacement (VR). Patients were classified as normal (CEPI < or = 153 s); 'aspirin effect' (CEPI > 153 s but CADP < or = 109 s) or abnormal (CEPI > 153 s and CADP > 109 s). In the CABG group, 41.2% were classified as normal, 43.2% as 'aspirin effect' and 15.6% as abnormal. In contrast, in patients undergoing VR, these values were 6.7, 11.1 and 82.4%, respectively. Patients with valvular disease had significantly longer closure times for both CEPI and CADP tests (P < 0.001). In addition, the valvular disease group had a significantly higher proportion of patients with markedly prolonged (> 150 s) closure times in the CADP cartridge (43.3 vs. 3.6%, respectively). Only one (0.3%) patient in the CABG group had non-closure (> 300 s) in the CADP test compared to seven (7.8%) in the valvular disease group. Three of six patients in the latter group bled excessively during surgery. We conclude that abnormal CADP closure is much more frequent among patients with aortic or mitral valve disease compared to those with coronary artery disease. This may reflect pre-existing high-shear damage to platelets that renders them refractory to subsequent shear activation and aggregation in the PFA-100 system. Further studies

  5. Geographic Variability in Potentially Discretionary Red Blood Cell Transfusions After Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Likosky, Donald S.; Al-Attar, Paul M.; Malenka, David J.; Furnary, Anthony P.; Lehr, Eric J.; Paone, Gaetano; Kommareddi, Mallika; Helm, Robert; Jin, Ruyun; Maynard, Chuck; Hanson, Eric C.; Olmstead, Elaine M.; Mackenzie, Todd A.; Ross, Cathy S.; Zhang, Min

    2016-01-01

    We assessed regional differences in potentially discretionary [<3 units of red blood cell (RBC)] transfusions across 56 medical centers and 11,200 patients undergoing isolated non-emergent coronary artery bypass (CABG) surgery. Regional variation in overall RBC rates remained after risk adjustment, perhaps due to differences in regional practice environments. Objective A number of established regional quality improvement collaboratives have partnered to assess and improve care across their regions under the umbrella of the “Cardiac Surgery Quality IMPROVEment (IMPROVE) Network”. The first effort of the IMPROVE Network has been to assess regional differences in potentially discretionary [<3 units of red blood cell (RBC)] transfusions. Methods We examined 11,200 patients undergoing isolated non-emergent coronary artery bypass (CABG) surgery across 56 medical centers in four IMPROVE Network regions between January 2008 and June 2012. Each center submitted the most recent 200 patients who received 0, 1, or 2 units of RBC transfusion during the index admission. Patient and disease characteristics, intra-operative practices, and percentage of cases receiving RBC transfusions were collected. Region-specific transfusion rates were calculated, after adjusting for pre- and intra-operative factors among region-specific centers. Results There were small, but significant, differences in patient case mix across regions. RBC transfusions of 1 or 2 units occurred among 25.2% (2,826/11,200) of CABG procedures. Significant variation in use and number of RBCs existed across regions [None: 74.8% (min:max 70.0%, 84.1%), 1 unit: 9.7% (5.1%, 11.8%), 2 units: 15.5% (9.1%, 18.2%)], p<0.001. Variation in overall transfusion rates remained after adjustment (9.1% – 31.7%, p<0.001). Conclusions Delivery of small volumes of RBC transfusions was common, yet varied across geographic regions. These data suggest that differences in regional practice environments, including transfusion

  6. Gene signatures of postoperative atrial fibrillation in atrial tissue after coronary artery bypass grafting surgery in patients receiving β-blockers

    PubMed Central

    Kertai, Miklos D.; Qi, Wenjing; Li, Yi-Ju; Lombard, Frederick W.; Liu, Yutao; Smith, Michael. P.; Stafford-Smith, Mark; Newman, Mark F.; Milano, Carmelo A.; Mathew, Joseph P.; Podgoreanu, Mihai V.

    2016-01-01

    Atrial tissue gene expression profiling may help to determine how differentially expressed genes in the human atrium before cardiopulmonary bypass (CPB) are related to subsequent biologic pathway activation patterns, and whether specific expression profiles are associated with an increased risk for postoperative atrial fibrillation (AF) or altered response to β-blocker (BB) therapy after coronary artery bypass grafting (CABG) surgery. Right atrial appendage (RAA) samples were collected from 45 patients who were receiving perioperative BB treatment, and underwent CABG surgery. The isolated RNA samples were used for microarray gene expression analysis, to identify probes that were expressed differently in patients with and without postoperative AF. Gene expression analysis was performed to identify probes that were expressed differently in patients with and without postoperative AF. Gene set enrichment analysis (GSEA) was performed to determine how sets of genes might be systematically altered in patients with postoperative AF. Of the 45 patients studied, genomic DNA from 42 patients was used for target sequencing of 66 candidate genes potentially associated with AF, and 2,144 single-nucleotide polymorphisms (SNPs) were identified. We then performed expression quantitative trait loci (eQTL) analysis to determine the correlation between SNPs identified in the genotyped patients, and RAA expression. Probes that met a false discovery rate < 0.25 were selected for eQTL analysis. Of the 17,678 gene expression probes analyzed, 2 probes met our prespecified significance threshold of false discovery rate < 0.25. The most significant probe corresponded to vesicular overexpressed in cancer – prosurvival protein 1 gene (VOPP1; 1.83 fold change; P = 3.47 × 10−7), and was up-regulated in patients with postoperative AF, whereas the second most significant probe, which corresponded to the LOC389286 gene (0.49 fold change; P = 1.54 × 10−5), was down-regulated in patients

  7. Medical costs associated with cardiovascular events among high-risk patients with hyperlipidemia

    PubMed Central

    Bonafede, Machaon M; Johnson, Barbara H; Richhariya, Akshara; Gandra, Shravanthi R

    2015-01-01

    Objectives This study descriptively examined acute and longer term direct medical costs associated with a major cardiovascular (CV) event among high-risk coronary heart disease risk-equivalent (CHD-RE) patients. It also gives a firsthand look at fatal versus nonfatal CV events. Methods The MarketScan® Commercial Claims and Encounters Database was used to identify adults with a CV event in 2006–2012 with hyperlipidemia or lipid-lowering therapy use in the 18 months prior to one of the following inpatient CV events: myocardial infarction, ischemic stroke, unstable angina, transient ischemic attack, percutaneous coronary intervention, or coronary artery bypass graft (CABG). Patients were required to have a preindex diagnosis of at least one of the following: peripheral arterial disease, abdominal aortic aneurysm, carotid artery disease, or diabetes. A subset analysis was conducted with patients with data linkable to the Social Security Administration Master Death File. Direct medical costs were reported for each quarter following a CV event, for up to 36 months after the first CV event. Results In total, 38,609 CHD-RE patients were included, mean age 57 years, 31% female. CABG, myocardial infarction, and percutaneous coronary intervention were the most frequent and most expensive first CV events, accounting for >75% of all first CV events with mean first quarter costs ranging from $17,454 (nonfatal transient ischemic attack) to $125,690 (fatal CABG). Overall, 15% of those with a first CV event went on to have a second event during the 36-month study period with mean first quarter nonfatal and fatal costs similar to first event levels. Third CV events were rare, happening in less than 3% of patients. Conclusion CV events among CHD-RE patients were costly regardless of sequence, averaging $47,433 in the first 90 days following an event and remaining high, never returning to preevent levels. When fatal, first CV event costs were 1.2 to 2.9 times higher than when

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

    SciTech Connect

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

    1982-11-01

    Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The right anterior oblique gated first-pass technique was used to assess LVEF response to maximal exercise (Wmax), while the left anterior oblique equilibrium-gated technique was used to assess LVEF and relative LV volume changes during graded submaximal exercise. Mean LVEF was unchanged at rest after CABG by both the first-pass (60 +/- 12% vs 60 +/- 12%) and equilibrium-gated (61 +/- 13% vs 62 +/- 13%) measurements. At Wmax, mean first-pass LVEF was significantly higher postoperatively than preoperatively (63 +/- 17% vs 53 +/- 17%; p less than 0.01) with a higher Wmax (750 +/- 182 vs 590 +/- 202 kpm/min; p less than 0.001) and higher rate-pressure product (302 +/- 59 vs 222 +/- 57 units; p less than 0.001). Similarly, equilibrium-gated LVEF levels during graded exercise, using stepwise regression analysis, were significantly higher postoperatively than preoperatively (p less than 0.001); at the highest graded work load, they averaged 63 +/- 19% postoperatively and 53 +/- 17% preoperatively, with higher work loads (500 +/- 190 vs 417 +/- 155; p less than 0.05) and higher rate-pressure products (271 +/- 55 vs 207 +/- 53; p less than 0.001). The increase in exercise LVEF after surgery was due to a marked decrease in the ratio, relative to resting values, of counts-based end-systolic volumes during submaximal exercise (preoperatively 1.91 +/- 1.04; postoperatively 1.14 +/- 0.46; p less than 0.01). The five subjects in whom LVEF decreased significantly during exercise postoperatively all had one or more blocked or stenosed grafts. This study documents, by two independent radionuclide techniques, an improved LVEF during exercise at an increased maximal work capacity and rate-pressure product 3 months after successful CABG.

  9. In situ soil remediation speeds site closure

    SciTech Connect

    Not Available

    1994-03-01

    An automotive parts manufacturing site in Madison, Wisconsin contaminated primarily with 1,1,1-trichloroethane (TCA) achieved closure in 15 months using an in situ soil remediation technology that improved soil conditions nearly a thousand fold. TCA concentrations were as high as 19,600 ppb. However, TCA levels dropped to 20 ppb after one year of system operation, prompting the state agency to grant closure for the remediation project in late 1992, following 15 months of operation. The groundwater remediation system is a packed-to-wet air stripper. It includes two groundwater extraction wells, each pumping 30 gallons per minute, and three soil vadose zone wells with a total design capacity of 100 cubic feet per minute. The soil-vapor extraction system included two 15-foot-deep wells and a 40-foot-deep well connected to a blower with condensate-recovery equipment.

  10. Career Readiness: A Potential Pathway through which Urban Youth Exposure to Stress Influences Adult Health

    PubMed Central

    Johnson, Sarah Lindstrom; Tandon, S. Darius; Cheng, Tina L.

    2015-01-01

    A growing body of research provides support for the detrimental effects of stress during childhood on future adult health, however, less is known about how stress disrupts normal developmental processes. This pathway may be particularly relevant for urban adolescents who are exposed to additional contextual stressors. This study will longitudinally explore how psychological stress from multiple domains influences urban adolescents' career readiness. Two hundred youth (ages 14-21) completed surveys assessing their school, family, neighborhood and health stress. Path analysis using a parallel process model found that school and neighborhood stress at 6 months were significantly associated with decreased career readiness at 15 months. Health stress at baseline was related to an increased report of career readiness at 15 months, which was moderated by parental closeness. These findings suggest that experiences of stress for urban youth negatively impact their planning for the future, particularly in the absence of supportive parental relationships. PMID:26937057

  11. Long-term Internship through Cooperative Education with Regional Industries

    NASA Astrophysics Data System (ADS)

    Takahashi, Kenzo; Hase, Hiroyuki

    The long term internship is one of special educational programs for graduate students of Graduate School of Engineering in University of Fukui. This is a collaborative program between university and industries where selected post-graduate students are dispatched to companies for a long term and educated in real business environments. It is the final goal of the program to develop sophisticated specialists who would be able to catch the business strategy in industries and solve any problems by themselves. The program is managed in a semester (6 months) and contains 1.5 month prior education of preliminary special knowledge, ethics and secrecy, about 3 month dispatch with long-term internship, and 1.5 month post-education for complementary education and presentation. This paper presents the effect of this program which has been evolving since 2005.

  12. Stormwater-NPDES monitoring program at the Rocky Flats Plant, near Denver, Colorado

    SciTech Connect

    Steele, T.D.; Kunkel, J.R. ); Fiehweg, R.E. )

    1993-01-01

    This paper highlights results of this stormwater NPDES permit-application monitoring program (ASI, 1991b; 1992; 1993). Over a 15-month monitoring period, 32 events were sampled at various surface-water and/or bulk-precipitation sites included in the monitoring network. Evaluation has been made of the effectiveness of obtaining comprehensive hydrograph coverage for a number of storm-runoff/high-flow events as well as in obtaining data over a range of hydrologic conditions and time of year. Examples of event-sample coverage are provided, as well as an assessment of resultant event-generated water-quality data. During the 15-month monitoring period, a total of 116 storm-runoff/high-flow samples (32 events) and 19 bulk-precipitation samples were collected.

  13. Early Communicative Gestures Prospectively Predict Language Development and Executive Function in Early Childhood

    PubMed Central

    Kuhn, Laura J.; Willoughby, Michael T.; Wilbourn, Makeba Parramore; Vernon-Feagans, Lynne; Blair, Clancy B.

    2014-01-01

    Using an epidemiological sample (N =1117) and a prospective longitudinal design, this study tested the direct and indirect effects of preverbal and verbal communication (15 months to 3 years) on EF at age 4 years. Results indicated that whereas gestures (15 months), as well as language (2 and 3 years) were correlated with later EF (φs >= .44), the effect was entirely mediated through later language. In contrast, language had significant direct and indirect effects on later EF. Exploratory analyses indicated that the pattern of results was comparable for low and not-low income families. The results were consistent with theoretical accounts of language as a precursor of EF ability, and highlighted gesture as an early indicator of EF. PMID:24773289

  14. Elemental composition of suspended particulates as functions of space and time in Cleveland, Ohio

    NASA Technical Reports Server (NTRS)

    Neustadter, H. E.; King, R. B.; Fordyce, J. S.

    1975-01-01

    An approach to the analysis of a very large elemental concentration data set. The particular data considered was generated by instrumental neutron activation and emission spectroscopy analyses of over 750 24-hour ambient air particulate samples collected at 16 sites in Cleveland, Ohio, during the 15 months from August 1971 thru October 1972. Examples are presented that show the use of multiple approaches to interpreting the data, including pairwise correlation statistics, selective data plotting and cluster analysis.

  15. [Bacterial pollution of the littoral waters of the northern suburbs of Tunis].

    PubMed

    Capapé, C; Chadli, A

    1986-01-01

    The authors present in this paper a study of the bacterial pollution of inshore waters of northern suburbs of Tunis, on the basis of 180 sampled collected in 15 different stations, 15 monthly (one for each station). Three districts have been considered: Raouad-Gammarth, La Marsa-Carthage and La Goulette. This last district is mostly submitted to the bacterial pollution, caused by its neighbourhood of the lagoon of Tunis "reserve of pollution" and of the city of Tunis.

  16. A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence.

    PubMed

    Bermudez, Diana; Benjamin, Michelle T; Porter, Sarah E; Saunders, Pamela A; Myers, Neely Anne Laurenzo; Dutton, Mary Ann

    2013-05-01

    This article presents the beginning mindfulness experiences of low income, minority women with a history of intimate partner violence. Ten women participated in a Mindfulness-Based Stress Reduction group, three interviews and a focus group over 15 months. Using an interpretive phenomenological analysis approach, we derived the following themes: struggles to practice meditation; a vision of growing and helping; personal improvements, and interpersonal improvements. We share recommendations for clinical practice. PMID:23561069

  17. Conservative Treatment of an Invaginated Maxillary Lateral Incisor with a C-shaped Canal Using Cone-Beam Computed Tomography

    PubMed Central

    Forghani, Maryam; Moghim Farooji, Elaheh; Abuchenari, Javad; Bidar, Maryam; Eslami, Neda

    2015-01-01

    This report describes the non-surgical treatment of an invaginated maxillary lateral incisor with two fused roots. The mesial root had a C-shaped canal, while the distal one had a type III dens invagination. Cone-beam computed tomography (CBCT) was used to help with the diagnosis and treatment decision making. Clinical and radiographic follow-up revealed satisfactory periapical repair and absence of symptoms after 15 months. PMID:26576164

  18. A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence.

    PubMed

    Bermudez, Diana; Benjamin, Michelle T; Porter, Sarah E; Saunders, Pamela A; Myers, Neely Anne Laurenzo; Dutton, Mary Ann

    2013-05-01

    This article presents the beginning mindfulness experiences of low income, minority women with a history of intimate partner violence. Ten women participated in a Mindfulness-Based Stress Reduction group, three interviews and a focus group over 15 months. Using an interpretive phenomenological analysis approach, we derived the following themes: struggles to practice meditation; a vision of growing and helping; personal improvements, and interpersonal improvements. We share recommendations for clinical practice.

  19. [INFLUENCE OF HYPERICUM PERFORATUM L. HERB POLYPHENOLS PREPARATION WITH MINERALS ON THE STATE OF PERIODONTAL CONNECTIVE TISSUE MATRIX OF RATS IN CONDITION OF PERIODONTITIS MODELING].

    PubMed

    Kosenko, K N; Nikolaeva, A V; Tkachenko, E K; Novosel'skaia, N G

    2014-01-01

    In experiments on 22 white 1.5-month-old rats-males there were studied influence of Hypericum perforatum L. and minerales from Dyovit® on periodont's tissues under periodontits modelling. Examined preparation normalizes level of glicosaminoglicanes in gum, but did not completely show protective effects relative to collagen's fraction. In periodont's bone preparation decreases resorbrtion; increases activity of AlP and in the same time normalizes activity of AcP.

  20. Examination using modern low dose Multislice-CT (MS-CT) in otorhinolaryngology in a six-week-old baby.

    PubMed

    Heidelberg, Sokiranski R; Heidelberg, Plinkert M; Istanbul, Yildiz F; Ulm, Pirsig W

    2016-06-01

    A 6-week-old girl suffered from a growing and recurrently bleeding mass of unrecognizable origin, obstructing the left nose. Using low-dose Multislice-CT the exact diagnostic localization could be found within one minute in the sleeping baby without sedation or general anesthesia. The result of this imaging enabled the successful complete microscopic removal of a hemangioma from the left inferior turbinate. Follow-up after 15 months showed normal nasal finds.