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Sample records for arterial bypass anastomosis

  1. Biomedical Engineering Approach to Evaluate Anastomosis Methods for Coronary Artery Bypass Grafting

    Institute of Scientific and Technical Information of China (English)

    M.Umezu; J.Kawai; J.Suehiro; M.Arita; Y.Shiraishi; K.Iwasaki; T.Tanaka; H.Niinami

    2004-01-01

    There are two different methods for coronary artery bypass grafting: end-to-side and side-to-side anastomosis. In vitro mock test, flow visualization and animal experiments were performed in parallel to compare the hemodynamic effect between two methods. Thus, bioengineers can provide practical useful information to the clinical team.

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

    Science.gov (United States)

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

    2016-05-01

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

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Poulikakos Dimos

    2007-09-01

    Full Text Available Abstract 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

  5. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... don't help, you may need coronary artery bypass surgery. The surgery creates a new path for ... narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more ...

  6. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  7. Omentum Free Flap Anastomosed to Arterial Bypass in Open Knee Dislocation: Case Report and Discussion

    OpenAIRE

    Pauchot, Julien; Ducroux, Emilie; Leclerc, Grégoire; Obert, Laurent; Sergent, Anne Pauline

    2015-01-01

    Objective: To report on the original surgical management of a patient with severe trauma of both legs involving anastomosis of an omentum free flap with an emergency vascular bypass. Methods: After stabilization of the knee with an external fixator, a femoral-tibial bypass graft was performed to revascularize the leg with the contralateral great saphenous vein. Ten days later, an omentum free flap was used with an end-to-side arterial anastomosis between the right gastroepiploic artery and by...

  8. Outflow distribution at the distal anastomosis of infrainguinal bypass grafts.

    Science.gov (United States)

    Fisher, R K; How, T V; Bakran, A; Brennan, J A; Harris, P L

    2004-03-01

    Outflow distribution at the distal anastomosis of infrainguinal bypass grafts remains unquantified in vivo, but is likely to influence flow patterns and haemodynamics, thereby impacting upon graft patency. This study measured the ratio of distal to proximal outflow in 30 patients undergoing infrainguinal bypass for lower limb ischaemia, using a flow probe and a transit-time ultrasonic flow meter. The mean outflow distribution was approximately 75% distal to 25% proximal, with above knee anastomoses having a greater proportion of distal flow (84%) compared to below knee grafts (73%). These in vivo flow characteristics differ significantly from those used in theoretical models studying flow phenomena (50:50 and/or 100:0), and should be incorporated into future research. PMID:14757463

  9. Coronary Artery Bypass

    Science.gov (United States)

    ... to 3 days in the Intensive Care Unit (ICU). Life After Bypass After bypass surgery, your doctor will recommend that you join a cardiac rehabilitation program. These programs help you make lifestyle changes ...

  10. CLINICAL ADVANTAGES OF TOTAL CAVOPULMONARY ANASTOMOSIS WITHOUT CARDIOPULMONARY BYPASS

    Institute of Scientific and Technical Information of China (English)

    Jun-min Chu; Qing-yu Wu; Jian-ping Xu

    2005-01-01

    Objective To evaluate surgical methods and results of extracardiac conduit total cavopulmonary anastomosis (ECTCPA) without cardiopulmonary bypass (CPB).Methods From May 2000 to April 2003, 11 patients with functional univentricle underwent off-pump EC-TCPA (noCPB group). Their postoperative outcome was retrospectively compared with a 17-patient group who underwent EC-TCPA with cardiopulmonary bypass (CPB group) over a concurrent time period.Results There was 1 operative death in no-CPB group and 2 in CPB group; early postoperative hemodynamics appeared to significantly improve in no-CPB group. Blood and platelet transfusions decreased and blood plasma transfusion significantly lowered in no-CPB group compared with CPB group (P = 0.036). Postoperative courses of patients in no-CPB group were smooth and event free, and extubation time was substantially short. Intensive cares unit stay (P=0.04) and hospital stay (P= 0.02) postoperation were significantly shorter, hospital costs were significantly reduced (P= 0.004) in no-CPB group compared with CPB group.Conclusions EC-TCPA without use of CPB is not a difficult procedure; the procedure results in improvement in postoperative hemodynamics, and decreased use of blood and blood products. It is a more efficient operation with more short recovery time and reduced hospital stay.

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

    Science.gov (United States)

    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.

  12. Assessment of Grafts and Coronary Arteries with 64-slice Computer Tomography(CT) Angiography after Coronary Artery Bypass Surgery - our experiences

    OpenAIRE

    Veljanovska, Lidija; Sokolov, V.; Milev, Ivan; Idrizi, Spend; Mitrev, Zan

    2008-01-01

    The use of 64 slice CT (GE Light-Speed VCT) in evaluation of pathway and patency of the grafts, distal anastomosis and native vascular net in patients (pts) after coronary artery bypass grafting (CABG).

  13. An improved algorithm for coronary bypass anastomosis segmentation in epicardial ultrasound sequences

    DEFF Research Database (Denmark)

    Jørgensen, Alex Skovsbo; Schmidt, Samuel Emil; Staalsen, Niels-Henrik;

    2016-01-01

    Epicardial ultrasound (EUS) can be used for intra-operative quality assessment of coronary artery bypass anastomoses. To quantify the anastomotic quality from EUS images, the area of anastomotic structures has to be extracted from EUS sequences. Currently, this is done manually as no objective...... methods are available. We used an automatic anastomosis segmentation algorithm to extract the area of anastomotic structures from in vivo EUS sequences obtained from 16 porcine anastomoses. The algorithm consists of four major components: vessel detection, vessel segmentation, segmentation quality control...... and inter-frame contour alignment. The segmentation accuracy was assessed using m-fold cross-validation based on 830 manual segmentations of the anastomotic structures. A Dice coefficient of 0.879 (±0.073) and an absolute area difference of 16.95% (±17.94) were obtained. The proposed segmentation algorithm...

  14. Superficial temporal artery to proximal posterior cerebral artery bypass through the anterior temporal approach

    Directory of Open Access Journals (Sweden)

    Satoru Takeuchi

    2015-01-01

    Full Text Available Background: The superficial temporal artery (STA to proximal posterior cerebral artery (PCA (P2 segment bypass is one of the most difficult procedures to perform because the proximal PCA is located deep and high within the ambient cistern. STA to proximal PCA bypass is usually performed through a subtemporal approach or posterior transpetrosal approach, and rarely through a transsylvian approach. The aim of this study was to describe the operative technique of STA to proximal PCA bypass through a modified transsylvian approach (anterior temporal approach. Methods: STA to proximal PCA bypass was performed through an anterior temporal approach in three patients with intracranial aneurysm. We describe the details of the surgical technique. Results: The STA was successfully anastomosed to the proximal PCA in all cases. One patient suffered hemiparesis and aphasia due to infarction in the anterior thalamoperforating artery territory. Conclusions: STA to proximal PCA bypass can be performed through an anterior temporal approach in selected patients. We recommend that every precaution, including complete hemostasis, placement of cellulose sponges beneath the recipient artery to elevate the site of the anastomosis, and placement of a continuous drainage tube at the bottom of the operative field to avoid blood contamination during the anastomosis, should be taken to shorten the temporary occlusion time.

  15. Epicardial ultrasound in coronary artery bypass surgery

    OpenAIRE

    Budde, R.P.J.

    2005-01-01

    Chapter 1 Coronary artery bypass surgery (CABG) is traditionally performed via a median sternotomy approach on cardiopulmonary bypass (arrested heart). Since the mid 1990ties, beating heart, minimally invasive and even totally endoscopic CABG are (re)explored. In all approaches to CABG, the surgeon may face several intraoperative difficulties: 1. Localization of the target coronary artery for bypass grafting. 2. Selection of the optimal anastomotic site on the target coronary artery. 3. Asses...

  16. Phrenic Nerve Injury during Coronary Artery Bypass

    OpenAIRE

    Guinn, Gene A.; Beall, Arthur C.; Lamki, Neela; Heibig, Jacques; Thornby, John

    1990-01-01

    After coronary artery bypass, some patients have diaphragmatic elevation, usually on the left side. To test our hypothesis that this phenomenon is due to phrenic nerve injury resulting from either 1) dissection of the proximal portion of the left internal mammary artery or 2) topical cooling of the heart with icy slush, we performed the following 2-part study. First, we reviewed our hospital records of 99 coronary artery bypass patients, 55 of whom had received left internal mammary artery gr...

  17. Internal carotid-cerebellar artery anastomosis. So-called persistent trigeminal artery variant

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    Tanohata, Kazunori; Maehara, Tadayuki; Noda, Masanobu; Katoh, Hiromi

    1987-09-01

    Five cases of internal carotid-cerebellar artery anastomosis are presented. These anomalous vessels are identical to the so-called persistent trigeminal artery variant (PTAV). In our cases, two superior cerebellar arteries (SCAs), two anterior inferior cerebellar arteries (AICAs) and one posterior inferior cerebellar artery (PICA) arose from the precavernous segment of the internal carotid artery. We discuss the embryolgical and neuroradiological aspects of this anomaly.

  18. Numerical Simulation of Coronary Artery Bypass Graft with an Assistant Graft

    Institute of Scientific and Technical Information of China (English)

    WANG Wei; WANG Feng

    2014-01-01

    The conventional bypass design is to implant a graft on the stenosed host artery allowing blood to flow bypass the stenotic artery. However, restenosis is a challenging problem which finally results in reoperation. The purpose of this paper is to propose a new bypass graft design of coronary artery with an assistant graft for the treatment of coronary artery stenosis. An additional assistant graft was employed in the new design compared with the conventional ETS anastomosis. Numerical simulations were performed by means of finite volume method using computational fluid dynamics (CFD) solver. Results demonstrated that the new anastomoses model provided a more smooth flow at the distal ETS anastomosis without any stagnation point on anastomotic bed and vortex formation in the heel region. Oscillatory shear index (OSI) and time-averaged wall shear stress gradient (TAWSSG) at the artery bed of the distal ETS anastomosis were reduced. The coronary artery bypass graft with an assistant graft is feasible to improve the local hemodynamics and diminish the probability of restenosis in the treatment of coronary artery stenosis.

  19. Multimodality imaging of coronary artery bypass grafts

    NARCIS (Netherlands)

    Salm, Liesbeth Pauline

    2006-01-01

    This thesis describes multiple imaging modalities to examine coronary artery bypass grafts, and the research which was performed to further develop noninvasive imaging techniques to detect stenoses in native coronary arteries and bypass grafts in patients who experienced recurrent chest pain after c

  20. SIMPLIFIED LAPAROSCOPIC GASTRIC BYPASS WITH GASTROJEJUNAL LINEAR MECHANICAL ANASTOMOSIS: TECHNICAL ASPECTS

    Science.gov (United States)

    PALERMO, Mariano; SERRA, Edgardo

    2016-01-01

    ABSTRACT Background: Gastric bypass is a restrictive and malabsorptive surgery. The restrictive part consists in the creation of a small gastric pouch. The gastrointestinal bypass serves as the malabsorptive element. Aim: To describe a simplified gastric bypass approach for morbid obese patients, showing our results, and also remarking the importance of this technique for reducing the learning curve. Method: The patient is positioned in a split legs position and carefully strapped to the operating room table, with the surgeon between the patient's legs. Five trocars are inserted after pneumoperitoneum at the umbilicus. Dissection of the esophagogastric angle and lesser curvature is mandatory before the gastric pouch manufacturing. This pouch is done with two blue load staplers. Using a blue load linear stapler inserted only half way into the hole in the pouch is used to perform the gastrojejunal anastomosis and in order to create an anastomosis that is about 2 cm in length. A side-to-side jejunojejunostomy is done with a white load linear stapler. The last step of the gastric bypass consists in the cut of the jejunum between the two anastomosis with a white load linear stapler. Blue test is performed in order to detect leaks. Results: From January 2012 to December 2015, 415 simplified RYGB were performed. Gender: 67% female and 33 % males. Average of BMI 44.7. Mean age was 42 years old. Mean operative time 79 min. 39 % of this sample had T2 diabetes. Regarding complications were observed, one fistula, one gastrojejunal stenosis and one obstruction due to a bezoar. Conclusion: The described technique is a simplified approach in which all the anastomosis are performed in the upper part of the abdomen, allowing the surgeons to be more systematized and avoiding them to make mistakes in the confection of the Roux-en-Y anastomosis. This simplified gastric bypass is a safe and reproducible technique. PMID:27683785

  1. Graft patency in off-pump and conventional coronary artery bypass grafting for treatment of triple vessel coronary disease

    Institute of Scientific and Technical Information of China (English)

    胡盛寿; 王小启; 宋云虎; 吕锋

    2003-01-01

    Objective To compare graft patency in off-pump and conventional coronary artery bypass grafting by using the transit time flow meter in the treatment of triple vessel coronary artery disease. Methods Between June 2000 and April 2001, 60 patients with triple vessel coronary artery disease underwent coronary artery bypass grafting. They were divided into two groups: off-pump and conventional coronary artery bypass. All completed grafts were tested intraoperatively using Transit Time Flow Measurement (TTFM). Preoperative and postoperative variables of the two groups were also compared. Results There were no significant differences in sex, age, weight, acute or remote myocardial infarction, hypertension, diabetes and type of bypass grafts between the two groups. The number of bypass grafts and the assisted respiratory time of the off-pump coronary artery bypass grafting (OPCAB) group were significantly less than those of the conventional coronary artery bypass grafting (CCABG) group. The flow and pulsatile index (PI) of the left anterior descending artery bypass grafts and the right coronary artery bypass grafts were not significantly different between the OPCAB and CCABG groups. The flow of OM in the CCABG group with the multiple anastomosis site of sequential grafts was higher than that in the OPCAB group. Diffused narrow coronary artery bypass grafts in both groups had less flow.Conclusion No signficant differences in graft patency were observed in patients with triple vessel coronary artery disease who had undergone OPCAB or CCABG.

  2. Occipital artery-to-posterior inferior cerebellar artery anastomosis with multiple-layer dissection of suboccipital muscles under a reverse C-shaped skin incision.

    Science.gov (United States)

    Katsuno, Makoto; Tanikawa, Rokuya; Uemori, Genki; Kawasaki, Kazutsune; Izumi, Naoto; Hashimoto, Masaaki

    2015-06-01

    Although occipital artery (OA)-to-posterior inferior cerebellar artery (PICA) anastomosis is the most familiar reconstruction for posterior cerebral circulation, the procedure is considered difficult because of the anatomical complex course of OA and the depth of the operative field at the anastomosis site. Therefore, we attempted a safe and reliable method for OA-to-PICA anastomosis under multiple-layer dissection of suboccipital muscles and a reverse C-shaped skin incision. We reviewed the clinical records of patients who underwent OA-to-PICA anastomosis in our institute, and report the outcome with special emphasis on graft patency and surgical complications. Nine patients are described. In one patient the bypass was accomplished at the cortical segment of the PICA and in all others at the caudal loop. The average time for de-clamping the PICA was 29 min and 29 s. Although the overall graft patency rate was 100%, one patient showed a new medulla infarction at the time of post-operatory three-dimensional computed tomography angiography. Besides a secure OA-to-PICA anastomosis, this technique allows safe harvest of the OA and the creation of a shallow and wide anastomosis field. PMID:25633907

  3. Reoperations for occluded arterial bypasses in the lower limbs

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background We reviewed the outcomes of reoperations for 29 patients (30 limbs) who had undergone occluded arterial bypass in the lower limbs from May 1996 to September 2005. Methods The 30 lower limbs of the 29 patients with arteriosclerotic obstruction received 44 reoperations, including thrombectomy alone (group T, 27) and inflow or outflow reconstruction plus thrombectomy (group C, 17). Among the 17 operations in group C, 17.6% (3/17) were inflow reconstructions involving the axillary-femoral (1), aorta-iliac (1) and aorta-femoral (1) arteries, and 76.4% (13/17) outflow reconstructions involving the femoral-popliteal bypass-tibial (8), femoral-tibial (1), femoral-popliteal bypass-popliteal arteries below the knee (2), and the femoral-popliteal bypass-tibial-peroneal trunk (2). One patient (1 limb) underwent both inflow and outflow reconstructions with an iliac arterial stent and a graft-popliteal anastomosis patch. Polytetrafluoroethylene (PTFE) grafts were used in the inflow or outflow reconstructions abve the knee. Autovenous grafts or autovenously combined PTFE grafts were used in the outflow reconstructions below the knee. Results The percentages of Fontaine stage III and IV before primary operation and reoperation were 60% (18/30) and 86.7% (26/30), respectively (P0.05). Among 42 reoperations, 19 failed within 1 month in groups T (16) and C (3) (P0.05). The rate of limb salvage was 64.29% (18/28). Conclusions The percentages of Fontaine stage III and IV before reoperation may be much higher than those before primary operation. Thrombectomy plus inflow/outflow reconstruction creates patency better than thrombectomy alone for re-occluded bypass.

  4. CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass)

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    Chen, Yueqin [Hospital of Qingdao University, Department of Radiology, Qingdao (China); Hospital of Jining Medical College, CT Department, Jining (China); Xu, Wenjian [Hospital of Qingdao University, Department of Radiology, Qingdao (China); Guo, Xiang; Shi, Zhitao; Sun, Zhanguo; Wang, Jiehuan [Hospital of Jining Medical College, CT Department, Jining (China); Gao, Lingyun [Hospital of Jining Medical College, MR Department, Jining (China); Jin, Feng [Hospital of Jining Medical College, Department of Neurosurgery, Jining (China); Chen, Weijian; Yang, Yunjun [Hospital of Wenzhou Medical University, Department of Radiology, Wenzhou (China)

    2016-01-15

    To evaluate the utility of CT perfusion (CTP) for the assessment of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with Moyamoya syndrome (MMS). Twenty-four consecutive MMS patients, who underwent unilateral STA-MCA bypass surgery, received CTP before and after surgery. The relative perfusion parameter values of surgical hemispheres before treatment were compared with post-treatment values. All patients underwent CT angiography (CTA) before and after surgery in order to confirm the patency of bypass. The follow-up CTA after surgery clearly demonstrated 20 (20/24, 83.3 %) bypass arteries, whereas four (16.7 %) bypass arteries were occluded or very small. Postoperative rMTT and rTTP values (P < 0.05) of the surgical side were significantly lower than pre-operation. In patients (n = 20) with bypass patency, postoperative rCBF, rMTT and rTTP values (P < 0.05) of the surgical side were significantly improved. However, the differences of all parameters were not significant (P > 0.05) in the patients (n = 4) without bypass patency after revascularization. This study demonstrates that CTP can provide a crucial quantitative assessment of cerebral haemodynamic changes in MMS before and after STA-MCA anastomosis. (orig.)

  5. Epicardial ultrasound in coronary artery bypass surgery

    NARCIS (Netherlands)

    Budde, R.P.J.

    2005-01-01

    Chapter 1 Coronary artery bypass surgery (CABG) is traditionally performed via a median sternotomy approach on cardiopulmonary bypass (arrested heart). Since the mid 1990ties, beating heart, minimally invasive and even totally endoscopic CABG are (re)explored. In all approaches to CABG, the surgeo

  6. Coronary Artery Bypass Graft Surgery (Beyond the Basics)

    Science.gov (United States)

    ... for people with coronary heart disease is called "percutaneous coronary intervention" (PCI), or "stenting." This involves using a flexible ... artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention Coronary artery bypass grafting in patients with cerebrovascular ...

  7. Persistent primitive trigeminal artery associated with monocular blindness and external carotid-vertebral artery anastomosis

    Science.gov (United States)

    Yin, Suo; Zhang, Hong T.; Zhang, Dao P.; Zhang, Shu L.

    2015-01-01

    In this paper, we present 2 rare cases of persistent embryonic anastomoses. In one case, the patient presented with persistent trigeminal artery along with multiple foci of cerebral infarction as well as central retinal artery thrombosis. In the other case, the patient had direct anastomosis of the vertebral artery with ipsilateral external carotid artery as well as pontine infarction, aneurysm, and unilateral hypoplasia of the vertebral artery. The findings in these cases may shed light on the clinical presentation of such persistent anastomoses and aid their detection in clinical settings. PMID:25935186

  8. Persistent primitive trigeminal artery associated with monocular blindness and external carotid-vertebral artery anastomosis.

    Science.gov (United States)

    Yin, Suo; Zhang, Hong T; Zhang, Dao P; Zhang, Shu L

    2015-05-01

    In this paper, we present 2 rare cases of persistent embryonic anastomoses. In one case, the patient presented with persistent trigeminal artery along with multiple foci of cerebral infarction as well as central retinal artery thrombosis. In the other case, the patient had direct anastomosis of the vertebral artery with ipsilateral external carotid artery as well as pontine infarction, aneurysm, and unilateral hypoplasia of the vertebral artery. The findings in these cases may shed light on the clinical presentation of such persistent anastomoses and aid their detection in clinical settings. PMID:25935186

  9. CO2 vascular anastomosis of atherosclerotic and calcified arteries

    Science.gov (United States)

    White, John V.; Leefmans, Eric; Stewart, Gwendolyn J.; Katz, Mira L.; Comerota, Anthony J.

    1990-06-01

    The technique for CO2 laser fusion vascular anastomosis in normal vessels has been well established. Normal arterial wall has a predictable thermal response to the incident laser energy, with rapid heating and cooling of collagen within the arterial wall. Since atherosclerosis involves subendothelial cellular proliferation, lipid and calcium deposition, it may modify the thermal responsiveness of the arterial wall. To this study, CO2 laser fusion anastomoses were attempted in rabbits with non-calcific atherosclerosis and humans with calcific atherosclerosis. All anastomoses were successfully completed without alteration in technique despite the presence of plaque at the site of laser fusion. Histology of rabbit vessels revealed the classic laser fusion cap within the adventitia and persistent atherosclerotic plaque at the flow surface. Duplex imaging of patients post-operatively demonstrated long term anastomotic patency in 2 of 3 fistulae. These results suggest that neither non-calcified or calcified atherosclerosis significantly alters the arterial wall thermal responsiveness to CO2 laser energy or inhibits creation of laser fusion anastomoses. Therefore, this technique may be applicable to the treatment of patients with atherosclerotic occlusive disease.

  10. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

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    ROBOT-ASSISTED MINIMALLY INVASIVE CORONARY ARTERY BYPASS SURGERY OPERATION PINNACLEHEALTH HARRISBURG HOSPITAL HARRISBURG, PA 00:00:08 ... Hospital campus. We are going to witness a robot-assisted minimally invasive coronary artery bypass surgery operation. ...

  11. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ROBOT-ASSISTED MINIMALLY INVASIVE CORONARY ARTERY BYPASS SURGERY OPERATION PINNACLEHEALTH HARRISBURG HOSPITAL HARRISBURG, PA 00:00:08 ... Hospital campus. We are going to witness a robot-assisted minimally invasive coronary artery bypass surgery operation. ...

  12. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... completely endoscopic coronary artery bypass grafting procedure using robotics. We call this operation a “TECAB,” “Totally Endoscopic ... scrub nurse, also a lot of experience with robotics now. And Dr. Atiq Rahman, fellow here for ...

  13. Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery

    Science.gov (United States)

    Boodhwani, Munir; Hanet, Claude; de Kerchove, Laurent; Navarra, Emiliano; Astarci, Parla; Noirhomme, Philippe; El Khoury, Gebrine

    2016-01-01

    Background— Bilateral internal thoracic arteries (BITA) have demonstrated superior patency and improved survival in patients undergoing coronary artery bypass grafting. However, the optimal configuration for BITA utilization and its effect on long-term outcome remains uncertain. Methods and Results— We randomly assigned 304 patients undergoing coronary artery bypass grafting using BITA to either in situ or Y grafting configurations. The primary end point was 3-year angiographic patency. Secondary end points included major adverse cardiac and cerebrovascular events (ie, death from any cause, stroke, myocardial infarction, or repeat revascularization) at 7 years. More coronary targets were able to be revascularized using internal thoracic arteries in patients randomized to Y grafting versus in situ group (3.2±0.8 versus 2.4±0.5 arteries/patient; PURL: http://www.clinicaltrials.gov. Unique identifier: NCT01666366. PMID:27406988

  14. Anomalous external carotid artery-internal carotid artery anastomosis in two patients with proximal internal carotid arterial remnants

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Cho, Young Dae; Kang, Hyun Seung; Kim, Jeong Eun; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyong [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of)

    2015-08-15

    Two angiographic instances of anomalous external carotid artery (ECA) and internal carotid artery (ICA) anastomosis are described, each occurring at the C2-3 level and bearing remnants of proximal ICA. The ICA remnant of one patient (identifiable immediately upon bifurcation of the common carotid artery) was hypoplastic, and that of the other patient was an occluded arterial stump. These features are not typical of non-bifurcating ICA. The occipital artery originated from an anomalous connection in one instance and from the main trunk of the ECA (just past the ECA-ICA connection) in the other.

  15. Management of Super-super Obese Patients: Comparison Between Mini (One Anastomosis) Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Madhok, Brijesh; Mahawar, Kamal K; Boyle, Maureen; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-07-01

    Management of super-super obese patients poses a particular challenge for bariatric surgeons. Many staged algorithms exist for these patients. Essentially all of these involve a lower-risk procedure like sleeve gastrectomy first before a definitive second-stage procedure like gastric bypass or duodenal switch. This study compares our results with 19 mini (one anastomosis) gastric bypass and 56 sleeve gastrectomy in super-super obese patients. Sleeve gastrectomy patients were significantly older. There was no mortality or major complication in either group. There was no minor complication in mini (one anastomosis) gastric bypass group compared to two in the sleeve gastrectomy group. Mini (one anastomsosis) gastric bypass patients experienced significantly higher weight loss compared to sleeve gastrectomy patients at 6 months, 1 year, and 2 years after surgery.

  16. Audiometric changes after coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Khorsandi M T

    2007-09-01

    Full Text Available Background: Hearing is one of the most significant senses; There fore, any defect can be frightening. The incidence of sever hearing loss following coronary artery bypass surgery has been estimated as one per thousand. This Prospective study carried out to determine hearing effects of coronary artery bypass surgery."nMethods: age, audiometric changes before and after surgery (hearing levels at multiple frequencies, speech reception threshold and speech discrimination score, minimum blood pressure during the operation, and the time on bypass, measured on One hundred consecutive patients who candidate for coronary artery bypass surgery and the results analysed."nResults: One hundred patients completed the tests. Based on hearing changes found on pre- and post-operative tests, the patients were divided into 3 groups: Those with no change (47 patients according to their audiometric results; those with slight changes ≤10 db (43 patients; and those having average deficits of more than 10 db (10 patients. All the patients were male. None of the patients had complete or severe sensorineural hearing loss. The third group had more prolonged pumping duration when compared with the others groups (p=0.002. Furthermore, 90 percent of patients with a sensorineural hearing loss more than 10 db had diabetes mellitus and hyperlipidemia as risk factors."nConclusion: Sudden sensorineural hearing loss is a sequela in patients who undergoing coronary artery bypass surgery; however, it was usually mild and asymptomatic. Pumping time during the operation is a significant factor in occurring of this complication. With proper treatment of underlying diseases and eliminating the risk factors with improvement of our cardiopulmonary pumps we probably can get better hearing results.

  17. Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Inoue, Kaiji [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

    2012-01-15

    Rarely in the anterior circulation, an anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid artery and anastomoses with the A1-A2 junction of the anterior communicating artery. Right-side predominance is known. To our knowledge, the incidence of carotid-anterior cerebral artery anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid-anterior cerebral artery anastomosis (two men, one woman), representing an incidence of 0.086%. The anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid-anterior cerebral artery anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system. (orig.)

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

    Science.gov (United States)

    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

  19. Patient's Perception About Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Kelminda Maria Bulhões Mendonça

    2015-10-01

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

  20. [Robot-assisted Coronary Artery Bypass Grafting].

    Science.gov (United States)

    Ishikawa, Norihiko; Watanabe, Go

    2016-07-01

    The application for robot-assisted coronary surgery ranges from internal thoracic artery (ITA) harvesting with hand-sewn anastomoses to totally endoscopic coronary artery bypass grafting (TECAB), either on- or off-pump. The bilateral IMA can be harvested with the aid of a surgical robot and then multivessel bypass grafting can follow. Such robot-assisted minimally invasive direct coronary artery bypass grafting is called "ThoraCAB". Surgical robots cannot only endoscopically harvest the ITA but they can also anastomose the coronary artery in TECAB. But TECAB still has the difficulties, such as narrow surgical field in Japanese patients. Both procedures have the significant advantages of minimizing surgical trauma, such as reduced comlications, faster return back to normal activities and being improved cosmesis, and which have resulted in the development of minimally invasive surgery. Robot-assisted cardiac surgery for structural heart disease has been approved by the Ministry of Health, Labour and Welfare (MHLW) since December 2015, however, robot-assisted cardiac surgery for TECAB has not been approved yet in Japan.

  1. Coronary artery bypass grafting for Kawasaki disease

    Institute of Scientific and Technical Information of China (English)

    GUO Hong-wei; CHANG Qian; XU Jian-ping; SONG Yun-hu; SUN Han-song; HU Sheng-shou

    2010-01-01

    Background Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5±0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months),clincal angina disappeared or improved. Cardiac function was in Class Ⅰ-Ⅱ (NYHA).Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

  2. Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats.

    Science.gov (United States)

    Cavin, Jean-Baptiste; Voitellier, Eglantine; Cluzeaud, Françoise; Kapel, Nathalie; Marmuse, Jean-Pierre; Chevallier, Jean-Marc; Msika, Simon; Bado, André; Le Gall, Maude

    2016-09-01

    The technically easier one-anastomosis (mini) gastric bypass (MGB) is associated with similar metabolic improvements and weight loss as the Roux-en-Y gastric bypass (RYGB). However, MGB is controversial and suspected to result in greater malabsorption than RYGB. In this study, we compared macronutrient absorption and intestinal adaptation after MGB or RYGB in rats. Body weight and food intake were monitored and glucose tolerance tests were performed in rats subjected to MGB, RYGB, or sham surgery. Carbohydrate, protein, and lipid absorption was determined by fecal analyses. Intestinal remodeling was evaluated by histology and immunohistochemistry. Peptide and amino acid transporter mRNA levels were measured in the remodeled intestinal mucosa and those of anorexigenic and orexigenic peptides in the hypothalamus. The MGB and RYGB surgeries both resulted in a reduction of body weight and an improvement of glucose tolerance relative to sham rats. Hypothalamic orexigenic neuropeptide gene expression was higher in MGB rats than in RYGB or sham rats. Fecal losses of calories and proteins were greater after MGB than RYGB or sham surgery. Intestinal hyperplasia occurred after MGB and RYGB with increased jejunum diameter, higher villi, and deeper crypts than in sham rats. Peptidase and peptide or amino acid transporter genes were overexpressed in jejunal mucosa from MGB rats but not RYGB rats. In rats, MGB led to greater protein malabsorption and energy loss than RYGB. This malabsorption was not compensated by intestinal overgrowth and increased expression of peptide transporters in the jejunum.

  3. Experimental investigations of the steady flow through an idealized model of a femoral artery bypass

    Directory of Open Access Journals (Sweden)

    Giurgea Corina

    2014-03-01

    Full Text Available The present paper presents the steps taken by the authors in the first stage of an experimental program within a larger national research project whose objective is to characterize the flow through a femoral artery bypass with a view to finding solutions for its optimization. The objective of the stage is to investigate by means of the PIV method the stationary flow through a bypass model with an idealized geometry. A bypass assembly which reunites the idealized geometry models of the proximal and distal anastomoses, and which respects the lengths of a femoral artery bypass was constructed on the basis of data for a real patient provided by medical investigations. With the aim of testing the model and the established experimental set-up with regard to their suitability for the assessment of the velocity field associated to the steady flow through the bypass, three zones that can restore the whole distal anastomosis were PIV investigated. The measurements were taken in the conditions of maintained inflow at the bypass entry of 0.9 l / min (Re = 600. The article presents comparatively the flow spectra and the velocity fields for each zone obtained in two situations: with the femoral artery completely occluded and completely open.

  4. An experimental study on minimally occlusive laser-assisted vascular anastomosis in bypass surgery: the importance of temperature monitoring during laser welding procedures.

    Science.gov (United States)

    Esposito, G; Rossi, F; Puca, A; Albanese, A; Sabatino, G; Matteini, P; Lofrese, G; Maira, G; Pini, R

    2010-01-01

    Laser welding has been proposed as an alternative technique to conventional stitching in microvascular anastomosis, with the advantages of improving the vascular healing process and reducing the risk of malfunction of a bypass. Our group recently proposed a laser-assisted end-to-side anastomotic technique, providing the advantages of laser welding and reducing the occlusion time of the recipient vessel, that is important in neurosurgical bypass procedures, in order to reduce the risk of cerebral ischemia. This in vivo study focuses on the control of the temperature dynamics developing in the welded tissue. A jugular vein graft was harvested and implanted on the rabbit carotid artery by means of two end-to-side anastomosis. Laser welding procedure was then carried out to implant the bypass. A real-time monitoring of the temperature during welding was performed with an infrared thermocamera, in order to control the laser-induced heating effect on the external surface of the vessel walls. The temperature analysis highlighted the dynamic of the heating effect in space and time and enabled us to define an optimal temperature range in operative conditions. The temperature control provided safe tissue heating confined within the directly irradiated area, with negligible damage to surrounding tissues, as well as effective sealing and welding of the vessel edges at the anastomotic sites. The average occlusion time of the carotid artery was about 11 minutes. After a follow-up of 30 days, all the bypasses were patent and no signs of thrombosis or leak point pressure were present, thus confirming the safety of this laser-assisted anastomotic procedure. PMID:20846478

  5. T-Stenting-and-Small-Protrusion Technique for Bifurcation Stenoses After End-to-Side Anastomosis of Transplant Renal Artery and External Iliac Artery: Report of Two Cases

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Yong, E-mail: cheny102@163.com; Ye, Peng, E-mail: thomas19871223@163.com [Southern Medical University, Department of Interventional Radiology, Nanfang Hospital (China); Jiang, Wen-jin, E-mail: 18653501187@163.com [Yantai Yuhuangding Hospital (China); Ma, Shuo-yi, E-mail: mazelong123456789@126.com; Zhao, Jian-bo, E-mail: zhaojianbohgl@163.com; Zeng, Qing-le, E-mail: doctorzengqingle@126.com [Southern Medical University, Department of Interventional Radiology, Nanfang Hospital (China)

    2015-10-15

    Bifurcation stenoses after end-to-side anastomosis of transplant renal artery (TRA) and external iliac artery (EIA), including stenoses at the anastomosis and the iliac artery proximal to the TRA, are rare. In the present article, we report two successfully managed cases of bifurcation stenoses after end-to-side anastomosis of the TRA and EIA using the technique of T-stenting and small protrusion (TAP stenting)

  6. Current status of coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin

    2009-01-01

    @@ Surgical revascularization for atherosclerotic heart disease, also called coronary artery bypass grafting (CABG), was first performed in 1962, and is one of the great achievements in medicine. Relief of angina, improvement of exercise tolerance, and the realization of survival benefit have been documented.1 CABG has been used in multi-vessel disease and left main stenosis for over 40 years.2 In the last two decades the mortality of CABG has decreased to less than 2% despite an aging population with increased risk factors. However, percutaneous coronary intervention (PCI), especially with drug-eluting stents, has been challenging CABG, While PCI has improved, CABG has also progressed with better peri-operative management, a higher use of arterial grafting, off-pump surgery, and improved techniques with minimally invasive surgical options.3,4

  7. Application of side-to-side anastomosis of the lesser curvature of stomach and jejunum in gastric bypass

    Science.gov (United States)

    Bai, Ri-Xing; Yan, Wen-Mao; Li, You-Guo; Xu, Jun; Zhong, Zhi-Qiang; Yan, Ming

    2016-01-01

    AIM To evaluate the feasibility of side-to-side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Seventy-seven patients received side-to-side anastomosis of the lesser curvature of stomach and jejunum by utilization of linear stapler in LRYGB from April 2012 to July 2015 were retrospectively analyzed. RESULTS All patients were successfully completed laparoscopic gastric bypass with the side-to-side anastomosis of the lesser curvature of stomach and jejunum. No patient was switched to laparotomy during operation. No early complications including gastrointestinal anastomotic bleeding, fistula, obstruction, deep vein thrombosis, incision infections, intra-abdominal hernia complications were found. One patient complicated with stricture of gastrojejunal anastomosis (1.3%) and six patients complicated with incomplete intestinal obstruction (7.8%). BMI and HbA1c determined at 3, 6, 12, 24 mo during follow up period were significantly reduced compared with preoperative baselines respectively. The percentage of patients who maintain HbA1c (%) < 6.5% without taking antidiabetic drugs reached to 61.0%, 63.6%, 75.0%, and 63.6% respectively. The outcome parameters of concomitant diseases were significantly improved too. CONCLUSION Present surgery is a safety and feasibility procedure. It is effective to lighten the body weight of patients and improve type 2 diabetes and related complications. PMID:27729746

  8. Magnetic navigation in patients with coronary artery bypass grafting.

    Science.gov (United States)

    Ramcharitar, Steve; van Geuns, Robert-Jan

    2009-05-01

    Magnetic navigation (MN) can precisely control a percutaneous coronary interventions (PCI) guidewire or a device in three-dimensional space within the body without requiring reshaping of the tip to access vessels or areas of the heart that are often challenging using conventional wires. In this article we review and report on the use of magnetic navigation system in secondary revascularisation of coronary arterial bypass grafts (CABG). MN was successfully used in the secondary revascularisation of failed conventional CABG cases. Retrograde PCI through a LIMA is not only feasible but the wires can manage complex stenoses involving a bifurcation by using 3D reconstruction software. Difficult anatomies such as a hairpin bend as highlighted in this paper found at a saphenous vein graft (SVG) anastomosis can be overcome by co-integrating a CTCA 3D dataset for navigation. Preliminary data supports potential advantages in reduction of contrast media usage, crossing and fluoroscopy times and suggest that larger randomised studies are warranted. PMID:19736073

  9. Laser Doppler flowmeter study on regional cerebral blood flow in early stage after standard superficial temporal artery-middle cerebral artery bypass surgery for moyamoya disease

    Institute of Scientific and Technical Information of China (English)

    GESANG Dun-zhu; ZHANG Dong; ZHAO Ji-zong; WANG Shuo; ZHAO Yuan-li; WANG Rong; SUN Jian-jun; MENG Ze

    2009-01-01

    Background Standard superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery is an effective treatment for moyamoya disease, but recent evidence suggests that postoperative cerebral hyperperfusion can occur. In this study, the trendline of changes in regional cerebral blood flow (rCBF) after surgery were continually monitored near the site of anastomosis in order to investigate both the efficacy of the procedure for improving rCBF and the possible riskof hyperperfusion.Methods Standard STA-MCA bypass surgery was performed on 13 patients, rCBF was measured continually using laser Doppler flowmetry (LDF) until the 5th day after the operation with the LDF probe implanted adjacent to the area of the anastomosis. The trendline of rCBF changes postoperatively was recorded for the analysis performed using SPSS 13.0.Results The baseline LDF value of cortical rCBF was (84.68±14.39) perfusion unit (PU), which was linear relative to absolute perfusion volume before anastomosis and (88.90±11.26) PU immediately after anastomosis (P >0.05). The value changed significantly from before to after anastomosis (P 0.05).Conclusions STA-MCA anastomosis improves the cerebral blood supply significantly in the early stage after surgery,however, the risk of symptomatic hyperperfusion may exist, which may possibly occur on the 1st day and 5th day after surgery. A LDF is useful for postoperative monitoring for both the efficacy of bypass and possible risk of neurologic deterioration or bleeding from hyperperfusion.

  10. The effect on patency of type, shape and volume of a vein collar used at the distal anastomis of PTFE-bypass to arteries below-knee

    DEFF Research Database (Denmark)

    Lundgren, F; Schroeder, Torben Veith

    2012-01-01

    The aim of this paper was to study the effect on patency rate of different types of vein collar (Miller's original or St Mary's boot), different length/height shapes of vein collar, and different vein collar volumes at the distal anastomosis of PTFE-bypass grafts to below-knee arteries in patients...... with critical limb ischemia....

  11. Gastrojejunal Anastomosis Complications and Their Management after Laparoscopic Roux-en-Y Gastric Bypass

    Directory of Open Access Journals (Sweden)

    Yannick Fringeli

    2015-01-01

    Full Text Available Background. Complications at the gastrojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass (LRYGB are challenging in terms of diagnosis, therapy, and prevention. This study aims at identifying these complications and discussing their management. Methods. Data of 228 patients who underwent a LRYGB between October 2008 and December 2011 were reviewed retrospectively to evaluate the frequency and treatment of complications such as stenoses, marginal ulcers, perforated marginal ulcers, or anastomotic leaks related to the operation. Results. Follow-up information was available for 209 patients (91.7% with a median follow-up of 38 months (range 24–62 months. Of these patients 16 patients (7.7% experienced complications at the gastrojejunostomy. Four patients (1.9% had stenoses and 12 patients (5.7% marginal ulcers, one of them with perforation (0.5%. No anastomotic leaks were reported. One case with perforated ulcer and one with recurrent ulcers required surgical revision. Conclusion. Gastrojejunal anastomotic complications are frequent and occur within the first few days or up to several years after surgery. Stenoses or marginal ulcers are usually successfully treated nonoperatively. Laparoscopic repair, meanwhile, is an appropriate therapeutic option for perforated ulcers.

  12. Dextrocardia with situs inversus totalis: coronary artery bypass grafting.

    Science.gov (United States)

    Hashmi, Salila; Anis, Mariam; Darr, Umer

    2012-01-01

    Dextrocardia with situs inversus is a rare congenital abnormality involving a left-handed mal rotation of the visceral organs. The incidence of coronary artery disease is the same as that in the general population. Performing coronary artery bypass surgery on patients with dextrocardia poses a more challenging task. It is recommended that the right internal mammary artery be the first choice of graft for the anterior descending artery for a "situs inversus" situation. We report 2 cases of patients with Dextrocardia who developed coronary artery disease and underwent coronary artery bypass grafting. Also mentioned is the slight difference in our technique.

  13. Quantitative cerebral perfusion assessment using microscope-integrated analysis of intraoperative indocyanine green fluorescence angiography versus positron emission tomography in superficial temporal artery to middle cerebral artery anastomosis

    Directory of Open Access Journals (Sweden)

    Shinya Kobayashi

    2014-01-01

    Full Text Available Background: Intraoperative qualitative indocyanine green (ICG angiography has been used in cerebrovascular surgery. Hyperperfusion may lead to neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA anastomosis. The purpose of this study is to quantitatively evaluate intraoperative cerebral perfusion using microscope-integrated dynamic ICG fluorescence analysis, and to assess whether this value predicts hyperperfusion syndrome (HPS after STA-MCA anastomosis. Methods: Ten patients undergoing STA-MCA anastomosis due to unilateral major cerebral artery occlusive disease were included. Ten patients with normal cerebral perfusion served as controls. The ICG transit curve from six regions of interest (ROIs on the cortex, corresponding to ROIs on positron emission tomography (PET study, was recorded. Maximum intensity (I MAX , cerebral blood flow index (CBFi, rise time (RT, and time to peak (TTP were evaluated. Results: RT/TTP, but not I MAX or CBFi, could differentiate between control and study subjects. RT/TTP correlated (|r| = 0.534-0.807; P < 0.01 with mean transit time (MTT/MTT ratio in the ipsilateral to contralateral hemisphere by PET study. Bland-Altman analysis showed a wide limit of agreement between RT and MTT and between TTP and MTT. The ratio of RT before and after bypass procedures was significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.60 ± 0.032 and 0.80 ± 0.056, respectively; P = 0.017. The ratio of TTP was also significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.64 ± 0.081 and 0.85 ± 0.095, respectively; P = 0.017. Conclusions: Time-dependent intraoperative parameters from the ICG transit curve provide quantitative information regarding cerebral circulation time with quality and utility comparable to information obtained by PET. These parameters may help predict the occurrence of postoperative

  14. Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery

    Science.gov (United States)

    Boodhwani, Munir; Hanet, Claude; de Kerchove, Laurent; Navarra, Emiliano; Astarci, Parla; Noirhomme, Philippe; El Khoury, Gebrine

    2016-01-01

    Background— Bilateral internal thoracic arteries (BITA) have demonstrated superior patency and improved survival in patients undergoing coronary artery bypass grafting. However, the optimal configuration for BITA utilization and its effect on long-term outcome remains uncertain. Methods and Results— We randomly assigned 304 patients undergoing coronary artery bypass grafting using BITA to either in situ or Y grafting configurations. The primary end point was 3-year angiographic patency. Secondary end points included major adverse cardiac and cerebrovascular events (ie, death from any cause, stroke, myocardial infarction, or repeat revascularization) at 7 years. More coronary targets were able to be revascularized using internal thoracic arteries in patients randomized to Y grafting versus in situ group (3.2±0.8 versus 2.4±0.5 arteries/patient; P<0.01). The primary end point did not show significant differences in graft patency between groups. Secondary end points occurred more frequently in the in situ group (P=0.03), with 7-year rates of 34±10% in the in situ and 25±12% in the Y grafting groups, driven largely by a higher incidence of repeat revascularization in the in situ group (14±4.5% versus 7.4±3.2% at 7 years; P=0.009). There were no significant differences in hospital mortality or morbidity or in late survival, myocardial infarction, or stroke between groups. Conclusions— Three-year systematic angiographic follow-up revealed no significant difference in graft patency between the 2 BITA configurations. However, compared with in situ configuration, the use of BITA in a Y grafting configuration results in lower rates of major adverse cardiovascular and cerebrovascular events at 7 years. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01666366. PMID:27406988

  15. The relationship between suture number and the healing process of end-to-end arterial anastomosis

    Directory of Open Access Journals (Sweden)

    Winston B Yoshida

    1997-06-01

    Full Text Available In spite of the grate experience accumulated in vascular repairing, the ideal number of sutures for vascular anastomosis remains controversial. It is generally thought that the more stitches applied in a vascular anastomosis, the lesser resistant the anastomosis will be. The purpose of this study was to test this hypothesis in 20 rabbits, in which both carotid arteries were cross sectioned and repaired by end-to-end anastomosis with 8 interrupted sutures in one side (G1 and 16 in the other side (G2. After 3 and 15 days, the animals were randomly allocated for tensile strength, hydroxyproline determination (7 animals and for histologic analysis of the anastomosis (3 animals. Conventional staining procedures (hematoxylin-eosin and Masson methods and the picrosirius red polarization (PSP technique for collagen type determination were used. From 3 to 15 days, the tensile strength increased in both groups, from 265.0±-44.4g to 391.2±-49.0g in G1 and from 310.0±-71.5g to 348.7±-84.0g in G2 (p<0.005, with no statistical difference between the groups in each period of study. The hydroxyproline content, expressed as hydroxyproline/protein ratio, varied from 0.04±-0.01 to 0.05±-0.02 in G1 and from 0.05±-0.01 to 0.05±-0.02 in G2, with no significant difference between periods and groups. The histology showed similar inflammatory and reparative aspects in both groups. In both groups and periods the PSP technique demonstrated predominantly type I collagen in relation to type III collagen in the anastomosis. We concluded that even doubling the number of stitches, the healing process and strength did not change in the arterial anastomosis.

  16. Acute traumatic subclavian artery thrombosis and its successful repair via resection and end-to-end anastomosis

    Institute of Scientific and Technical Information of China (English)

    Saulat H Fatimi; Amna Anees; Marium Muzaffar; Hashim M Hanif

    2010-01-01

    Subclavian artery thrombosis is a rare complication of clavicle fractures. We reported a 20-year-old man who was admitted to the emergency room after a road traffic accident. He was a pedestrian who was initially hit by a bus and after he fell down on the road, he was run over by a car. On evaluation, he was found to have multiple facial and rib fractures, distal right humerus and right clavicle fracture. Significantly, right radial pulse was absent. After further evaluation including Doppler studies and an angiography which revealed complete obstruction of right subclavian artery just distal to its 1st portion, the patient was urgently taken to the operation room. A midclavicular fracture was adjacent to the injured vessel. We established proximal and distal control, removed damaged part. After mobilizing the subclavian artery, an end-to-end anastomosis was made. Then open reduction and internal fixation of right distal humerus was performed. The rest of the postoperative course was unremarkable. To prevent complications of subclavian artery thrombosis, different treatment modalities can be used, including anticoagulation therapy,angioplasty, stenting and bypass procedures.

  17. Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures

    Directory of Open Access Journals (Sweden)

    Ramon Vilallonga

    2015-01-01

    Full Text Available Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve. We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.

  18. Coronary artery bypass surgery without cardiopulmonary bypass: short- and mid-term results.

    Science.gov (United States)

    Mishra, Y; Mehta, Y; Kohli, V M; Kohli, V; Mairal, M; Mishra, A; Bapna, R K; Trehan, N

    1997-01-01

    From March 1994 to April 1997, 433 patients had undergone coronary artery bypass grafting without cardiopulmonary bypass in our institute. Sixty-eight patients had various organ dysfunctions and/or aortic atheroma or calcification and were regarded as high risk for cardiopulmonary bypass. In 277 patients surgery was performed through midline sternotomy, while in 156 minithoracotomy approach was used. In 361 patients single coronary artery bypass grafting was done, and in 72 two-coronary arteries were bypassed. In 63 patients who had graftable vessels in anterior wall and diffusely diseased ungraftable vessels in posterolateral and/or inferior wall, transmyocardial laser revascularisation was also done along with coronary artery bypass grafting to achieve complete myocardial revascularisation. Nine patients in this series were also subjected to simultaneous carotid endarterectomy along with myocardial revascularisation. In two patients complementary percutaneous transluminal coronary angioplasty of left circumflex coronary artery was done five days after minithoracotomy and left internal mammary artery to left anterior descending coronary artery bypass grafting. Forty-two cases were extubated in operating room. Average blood loss was 260 ml. Six patients were reexplored for postoperative bleeding. Seven patients had perioperative myocardial infarction. One developed neurological complication. Hospital mortality was 2.3 percent (10/433 cases) and four deaths were due to malignant ventricular arrhythmias. Nine patients developed chest wound complications. Average hospital stay after operation was six days, 423 patients were discharged from hospital and all of them were asymptomatic. During three years follow-up (range 3 to 38 months) there were three known cardiac deaths. Ninety percent (391) patients reported to the follow-up clinic and 91 percent of them were angina-free. In patients who were subjected to transmyocardial laser revascularisation along with coronary

  19. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ... Harrisburg Hospital campus. We are going to witness a robot-assisted minimally invasive coronary artery bypass surgery ... you're starting to do and maybe give a little background on the patient's condition? 00:00: ...

  20. Antiplatelet therapy at the time of coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Kremke, Michael; Tang, Mariann; Bak, Mikkel;

    2013-01-01

    OBJECTIVES: The purpose of this multicentre cohort study was to examine the relationship between antiplatelet therapy (APT) at the time of coronary artery bypass grafting (CABG) and postoperative bleeding complications, transfusion requirements and adverse cardiovascular events. METHODS: A matched...

  1. Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols

    DEFF Research Database (Denmark)

    Houlind, Kim; Fenger-Grøn, Morten; Holme, Susanne J.;

    2014-01-01

    OBJECTIVE: To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol. METHODS: In a randomized, controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off......-pump coronary artery bypass surgery. Heparin was given to achieve an activated clotting time of 400 seconds before arteriotomy in both groups. After the procedure, protamine sulfate was given to revert the activated clotting time to less than 120 seconds. Coronary angiography was performed 6 months after...... not increase the risk of stenosis of the coronary artery distal to the anastomosis. CONCLUSIONS: Despite comparable heparinization, graft patency after off-pump surgery was inferior to that after on-pump surgery....

  2. Gastrojejunal anastomosis stricture after laparoscopic gastric bypass: Our experience with 62 patients Estenosis de la anastomosis gastroyeyunal en el bypass gástrico laparoscópico: Nuestra experiencia con 62 pacientes

    Directory of Open Access Journals (Sweden)

    A. Campillo-Soto

    2010-03-01

    Full Text Available Objective: gastrojejunal stricture (GYS, not only is a common complication after laparoscopic gastric bypass (LGBP, but its frequency is about 15% according to bibliography. Our aim is to present our experience after 62 LGBP. Patients and method: from January 2004 to September-2006, we performed 62 consecutive laparoscopic gastric bypass (Wittgrove's technique. The gastrojejunal anastomosis is performed with auto suture material type CEAA No 21 termino-lateral (ILS, Ethicon. In 4 cases (6.45% was converted to laparotomy, perform the anastomosis in the same way. Monitoring has a range of 3-35 months, conducted in 61 patients because one patient died of pulmonary thromboembolism in the immediate postoperative period after reoperation, after two weeks of gastric bypass, by necrosis of a small fragment of the remnant gastric. In all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. When gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation (recommending dilate the anastomosis to a maximum 1.5 cm. Results: five cases (8.1% developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and in 1 case by endoscopy. Two patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion (circumferentially sclerosis within 48 hours of surgery and sclerosis of bleeding points. All cases were resolved by endoscopic dilatation. At follow-up has not been detected re-stricture. Conclusion: Clinically, gastrojejunal stricture results in a progressive oral intolerance, revealing stenosis between 1 and 3 months postoperatively. The situations of sclerosis of the bleeding lesions favor, especially in cases of extensive sclerosis. In cases of suspected barium transit offers us a high diagnostic yield. Endoscopic dilatation resolved, so far, all cases.Objetivo: la estenosis de la anastomosis gastroyeyunal representa una

  3. Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Background Total arterial revascularization (TAR) was widely utilized in coronary artery bypass grafting (CABG) as a result of its better long-term effect compared with vein grafts.Of the arterial conduits,radial artery (RA) gained popularity for its easy availability and reported long-term patency.Thus,the objective of this study was to investigate the effect of RA in TAR in CABG.Methods From January 2000 to December 2006,85 patients (56 male and 29 female) at a mean age of 57.0±5.2 years,underwent TAR in CABG RA and left internal mammary artery (LIMA) with composite Y or T and seauential grafting techniques were used.Post-operative complications were recorded and follow-up was performed.Results Eighty-five LIMA and 149 RA grafts including 21 single and 64 bilateral RA were collected.A total of 87 distal anastomoses were done with the LIMA and another 152 were done with the RA,with the mean number of diStal anastOmosis per patient of 2.81±0.47.The proximal RA ends were anastomsed directly to the aorta in 140 grafts with Y or T graft off in situ LIMA in 9,Yor T graft off Rain 9.The distal end was anastomsed to right coronary artery system in 92,to Obtuse margma in 46,to diagonal in 19 and to ramous intermedius in 5.Nine sequential anastomoses were Derformed with RA.Nine composite Y or T grafts were constructed with RA and LIMA while another 9 were constructed with RA and RA.One (1.2%) patient died,3 patients (3.5%) experienced acute renal failure and 2 (2.4%) developed stroke.All patienfs were still alive and no patient had evidences of newly occurred myocardial infarction or angina after a mean tollow-up of 36.5±4.1 months (6-67 months).Postoperatively at 6 month,mean left ventricular ejective fraction was increased to 0.49±0.09,compared with that of 0.43±0.11 preoperatively (P=0.027).Postoperative mean New York Heart Association class was 2.5±0.5,compared with that of 3.0±0.4 preoperatively (P=0.003).Conclusions TAR with arterial conduits of which RA was

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

    Science.gov (United States)

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

    2016-03-21

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

  5. Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Karimi Fatemeh

    2007-01-01

    Full Text Available Abstract Background Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. Methods 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male underwent preoperative ultrasonography for assessment of carotid artery wall thickness. Results Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8% had significant ( Conclusion Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

  6. Minimally invasive coronary artery bypass grafting: initial Connecticut experience.

    Science.gov (United States)

    Tellides, G; Maragh, M R; Smith, J M; Kopf, G S; Ezekowitz, M; Remetz, M; Elefteriades, J A

    1997-03-01

    We report the initial Connecticut experience with minimally invasive coronary artery bypass grafting. This procedure allows bypass grafting to the left anterior descending coronary artery utilizing the internal mammary artery as the conduit. The procedure is minimally invasive because it is performed through a mini-thoracotomy incision in the fourth anterior intercostal space and it is conducted without the use of cardiopulmonary bypass. The procedure has been applied to 13 patients operated between February and October 1996. All but one patient selected were poor candidates for conventional coronary artery bypass surgery because of advanced age (6), chronic renal failure/dialysis/kidney transplant (4), redo status with vulnerable grafts (1), severe peripheral vascular disease (6), severe chronic obstructive pulmonary disease (4). All patients survived operation and were discharged in good condition. Mean postoperative intubation time was seven hours and mean hospital stay was 4.5 days despite the very high pre-existing comorbidity of these patients. All patients are alive at the current follow-up time. Two patients required a conventional bypass procedure for occlusion of the minimally invasive graft, the first because of diffuse disease in the target artery and the second attributable to the technical limitations of minimally invasive coronary artery bypass grafting; both tolerated the subsequent procedure well. All patients are now angina-free. All four grafts studied by routine postoperative angiography were widely patent. Routine post-operative exercise nuclear imaging was normal in an additional patient. This procedure of minimally invasive coronary artery bypass grafting offers significant advantages compared to the conventional bypass procedure (short hospital stay, quick recovery, and, especially, avoidance of cerebrovascular accidents caused by the heart-lung machine). This minimally invasive procedure is expected to apply to a growing percentage of

  7. The thrill of success: central arterial-venous anastomosis for hypertension.

    Science.gov (United States)

    Fudim, Marat; Stanton, Alice; Sobotka, Paul A; Dolan, Eamon; Krum, Henry

    2014-12-01

    Excess blood pressure remains the most important risk factor for cardiovascular and renal disease. Poly pharmacy has been proved safe and effective under clinical trial circumstances; however, the majority of patients fail to sustain pharmaceutical persistence and adherence. The opportunity to offer patients a treatment or device in addition or perhaps instead of drug therapy alone may significantly broaden the options for patients and allow greater success in hypertensive therapy. In this review, we examine the potential of a fixed-volume central arterial-venous anastomosis to reduce blood pressure in hypertensive patients, review possible mechanisms by which the anastomosis may reduce blood pressure, and consider the unique clinical trial opportunities posed by this therapy.

  8. ANALYSIS OF 312 CASES OF REPEAT CORONARY ARTERY BYPASS GRAFTING

    Institute of Scientific and Technical Information of China (English)

    陈长志; 陆佩中

    2003-01-01

    Objective To evaluate repeat coronary artery bypass grafting (CABG) in 312 patients.Methods The data of 312 patients (average age 65±9 years) who had CABG operation in Hartford hospital were collected and analyzed. The mean duration follow up after the first CABG was 11.8±4.5 years. A total of 1069 bypass grafts were performed. Among them, 386 were arterial grafts such as internal mammary artery, radial artery and gastroepiploic artery; 682 were venous grafts and 1 Gore-Tex graft. Results The operative mortality was 4. 5%. Fifteen patients (4. 8%) had peri-operative myocardial infarction and 46 patients (15%) had low cardiac output syndrome. Intra-aortic balloon pump (IABP) was used in 131 patients before, during and after operation. One hundred and nineteen patients weaned off IABP and recovered. ConclusionAlthough the difficulties and risk factors were increased, the results of redo CABG were still good.

  9. The Effects of Systemic IGF-I on the Arterial Anastomosis in Rats

    Directory of Open Access Journals (Sweden)

    Baris Keklik

    2014-04-01

    Full Text Available Objective: In this study, we aimed to document the effects of a well-known agent and mdash; and ldquo;insulin-like growth factor (IGF-I and rdquo; and mdash; on the microvascular anastomosis site. Methods: Sixteen Sprague-Dawley rats were used in this study. The rats were classified randomly into two equally numbered groups (eight rats each: the control (Group 1 and the experiment group (Group 2. The femoral artery was dissected completely in all rats. Following division of the artery, anastomoses were conducted with microvascular techniques. Forty-five minutes after the anastomoses, an Acland milking test was performed in order to check the patency and the first surgical session was terminated. In the second stage, LONG and reg; R3 IGF-I human (Sigma-Aldrich, St. Louis, Missouri, United States solution was introduced to Group 2 (experimental group intraperitoneally in doses of 2 mg/kg on the day of the surgery in addition to the third and seventh days postoperatively. On the 4th postoperative week, the patency of the anastomoses was evaluated with the Acland milking test. In addition, one centimeter of a vascular segment including the anastomosis site was excised and stained with hematoxylin-eosin. They were evaluated for edema, inflammation, vascular wall injury, intimal hyperplasia, medial atrophy, thrombus, calcification, foreign body reactions, and the endothelial proliferation. Results: The Acland milking test showed a 100% vascular patency in both groups. A statistically significant difference was found between the experimental and control groups in terms of edema and vascular wall injury (p0.05. Conclusion: Under the light of the obtained data, IGF-I was effective in preventing the edema and vascular wall injury at the anastomosis site. However, the net positive clinical effect on anastomosis patency necessitates further studies. [Arch Clin Exp Surg 2014; 3(2.000: 87-93

  10. Assessment of Hyperperfusion by Brain Perfusion SPECT in Transient Neurological Deterioration after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis Surgery

    International Nuclear Information System (INIS)

    Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery.middle cerebral artery (STA-MCA) anastomosis surgery. A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: 50±16 yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using 99mTc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of the

  11. Assessment of Hyperperfusion by Brain Perfusion SPECT in Transient Neurological Deterioration after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Won; Kim, Yu Kyeong; Lee, Sang Mi; Eo, Jae Sun; Oh, Chang Wan; Lee, Won Woo; Paeng, Jin Chul; Kim, Sang Eun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2008-08-15

    Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery.middle cerebral artery (STA-MCA) anastomosis surgery. A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: 50{+-}16 yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using 99mTc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of

  12. A rare variant of persistent trigeminal artery: cavernous carotid-cerebellar artery anastomosis--a case report and a systematic review.

    Science.gov (United States)

    Raphaeli, Guy; Bandeira, Alexandra; Mine, Benjamin; Brisbois, Denis; Lubicz, Boris

    2009-12-01

    We report a very rare anomalous anatomic variant of the cavernous internal carotid artery supplying directly the posterior inferior cerebellar artery, with no basilar artery opacification. A systematic review as well as a description of other variants of trigeminal-cerebellar anastomosis is given. PMID:19517204

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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. Extracranial-intracranial bypass surgery utilizing homologous arterial grafts irradiated with high voltage cathode rays. Experimental study and clinical application

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Yutaka (Kansai Medical School, Moriguchi, Osaka (Japan))

    1982-06-01

    Homologous and heterologous arterial segments were implanted in Fisher rats subcutaneously for the purpose of examining the antibody titer of the recipients' serum after implantation by means of the immune-adherence hemagglutination method. The antibody titer after implantation both of homologous and heterologous grafts decreased to 1/8 by 2.0 million (M) rads irradiation of high voltage cathode rays. The results suggested that high voltage cathode ray irradiation was not enough for heterologous graft to suppress its tissue reaction. Homografts taken from dogs 3 or 6 hours after sacrifice were irradiated with 2.0 M rads and transplanted in canine carotid artery using the technic of end-to-end anastomosis. Angiograms 6 months after operation revealed excellent patency rate in all the grafts of 28 dogs. furthermore, findings of the grafts from 1 week to 5 years after operation on scanning and transmission electron microscopies were evaluated. Clinical application of bypass surgery from the main trunk of the superficial temporal artery to M/sub 2/ portion of the middle cerebral artery, using 20 cm long irradiated arterial homograft, was carried out in patients with episodic cerebral ischemia. Angiogram 4 days after operation showed excellent filling of the middle cerebral circulation through the graft both in the retrograde and antegrade. This bypass procedure provided a good deal of blood flow soon after the operation, resulting in good protection of the ischemic hemisphere. Thus, bypass surgery using irradiated homograft proved to be useful enough for the ischemic cerebrovascular disease.

  16. Improvement of C peptide zero BMI 24-34 diabetic patients after tailored one anastomosis gastric bypass (BAGUA

    Directory of Open Access Journals (Sweden)

    M. Garcia-Caballero

    2013-01-01

    Full Text Available Background: Although bariatric surgery proved to be a very effective method in the treatment of patients in whose pancreas still produce insulin (type 2 diabetes, the accompanied metabolic syndrome and their diabetes complications, there is no information on the effect of this type of surgery in BMI24-34 patients when pancreas do not produce insulin at all (type 1, LADA and long term evolution type 2 diabetes among others. Patients and methods: We report preliminary data of a serie of 11 patients all with a C-peptide values below 0.0 ng/ml. They were followed for 6 to 60 months (mean 19 months after surgery. We studied the changes in glycemic control, evolution of the metabolic syndrome and diabetes complications after one anastomosis gastric bypass (BAGUA. Results: All values relative to glycemic control were improved HbA1c (from 8.9 ± 0.6 to 6.7 ± 0.2%, FPG (Fasting Plasma Glucose [from 222.36 ± 16.87 to 94 ± 5 (mg/dl] as well as the daily insulin requirement of rapid (from 40.6 ± 12.8 to 0 (U/d and long-lasting insulin (from 41.27 ± 7.3 U/day to 15.2 ± 3.3 U/day. It resolved 100% of the metabolic syndrome diseases as well as severe hypoglycaemia episodes present before surgery and improved some serious complications from diabetes like retinopathy, nephropathy, neuropathy, peripheral vasculopathy and cardiopathy. Conclusions: Tailored one anastomosis gastric bypass in BMI 24-34 C peptide zero diabetic patients eliminated the use of rapid insulin, reduced to only one injection per day long-lasting insulin and improved the glycemic control. After surgery disappear metabolic syndrome and severe hypoglycaemia episodes and improves significantly retinopathy, neuropathy, nephropathy, peripheral vasculopathy and cardiopathy.

  17. Cephalic veins in coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Licht, P; Jakobsen, Erik; Lerbjerg, G;

    1996-01-01

    Various alternative conduits for aortocoronary bypass grafting have been suggested when the saphenous vein quality is inadequate. During a 10-year period we have used the cephalic vein in 39 patients. Eighteen entered an angiographic follow-up study. A total of 31 arm vein grafts were used with 4...

  18. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... is in place right now. There’s usually some slack or redundancy in the balloon once we initially ... go on bypass, and then it’s without any slack in the right position, and we can inflate ...

  19. Fabric heart retractor for coronary artery bypass operations.

    Science.gov (United States)

    Kazama, S; Ishihara, A

    1993-06-01

    A new device for heart retraction during coronary artery bypass operations has been developed. It provides safe and steady support and an unobstructed view of the lateral, posterior, and inferior surfaces of the heart; in addition, it is easy to handle.

  20. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ... PINNACLEHEALTH HARRISBURG HOSPITAL HARRISBURG, PA 00:00:08 JOHN PENNOCK, MD: Welcome this evening to PinnacleHealth Harrisburg ... artery bypass surgery operation. My name is Dr. John Pennock. I'm going to introduce you shortly ...

  1. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... and we also like that aspect of this new type of surgery. The internal mammary artery is ... when it’s needed. Internal mammary artery. That’s a new word. That’s a new word, huh? Naked or ...

  2. Minimally invasive cardiac surgery-coronary artery bypass graft.

    Science.gov (United States)

    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.

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

    OpenAIRE

    Serruys, Patrick; Morice, Marie-Claude; Kappetein, Arie Pieter; Colombo, Antonio; Holmes, David; Mack, Michael; Stahle, E.; Feldman, Ted; Brand, Marcel, van den; Bass, Eric; Dyck, Nic; Leadly, Katrin; Dawkins, Keith; Mohr, Friedrich

    2009-01-01

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

  4. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... artery. Yes. Okay. And we see some fat calcium plaque here on the vessel. This part is ... ancient Greek, to make an opening between two channels. So I think we are almost ready to ...

  5. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... Artery Bypass” grafting. Let me first introduce our team here. My name is Johannes Bonatti. I’m ... the anesthesia side, Patrick Odonker, leading the anesthesia team, working with Teresa Nemitz. It is a special ...

  6. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... This usually leads us to the fifth intercostal space here on the anterior axillary node. This is ... for the peripheral arteries. Okay. Again, fifth intercostal space, anterior axillary line is where we are with ...

  7. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... the sternum and cannulate the aorta and the right atrium. In this operation, since we are not ... exactly perpendicular to the camera port here. All right. The femoral artery will be used to give ...

  8. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... 10 minutes. Okay. Good. We’re in the safety zone. Okay. One important things is that the ... on the coronary artery, and I just, for safety reasons, would like to keep this part. We’ ...

  9. Who Needs Coronary Artery Bypass Grafting?

    Science.gov (United States)

    ... Rehabilitation Coronary Heart Disease Heart Attack Heart Surgery Percutaneous Coronary Intervention Send a link to NHLBI to someone by ... coronary arteries that can't be treated with percutaneous coronary intervention (PCI), also known as coronary angioplasty. Your doctor ...

  10. TECAB - Totally Endoscopic Coronary Artery Bypass

    Science.gov (United States)

    ... of the patient’s artery is, could be near occlusive, and we want to continue profusing the leg ... It’s very helpful. It’s like a pilot is training in a simulator. The postage is also very ...

  11. Passive graft perfusion in off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    LU Feng; JI Bing-yang; LIU Jin-ping; LIU Ming-zheng; WANG Gu-yan; HU Sheng-shou

    2007-01-01

    Background Myocardial protection during off-pump coronary artery bypass grafting (OPCABG) is a multifactorial problem in which maintaining stable systemic hemodynamics is very important. In this study passive graft perfusion (PGP) was applied to investigate the effect during and after OPCABG as evaluated by cardiac troponin I (CTnl) and hemodynamic indexes.Methods Thirty first-time patients underwent OPCABG under one surgeon. They were randomly divided into two groups: The passive graft perfusion group (PGP, n=15) received distal coronary perfusion during the anastomosis and immediate graft perfusion after the distal anastomosis. The control group, no graft perfusion group, (NGP, n=15)received no graft perfusion after the distal anastomosis. The results of the two protocols were evaluated by concentration of CTnl and hemodynamic indexes before induction and after operation.Results There were no statistically significant differences between these two groups in their perioperation parameters.The level of CTnl increased postoperatively, reached its peak at 6 hours (P<0.05) and recovered by the 6 days postoperative. Compared with the control group the concentration of CTnl in the PGP group was significantly lower at 6 and 24 hours (P<0.01). Compared with the NGP group, cardiac index (Cl) in the PGP group was higher at 12 and 24 hours after operation (P<0.05). The period of mechanical ventilation was significantly shorter in the PGP group than in the NGP group (P<0.05).Conclusion PGP can increase the flow to the myocardium and shorten the heart ischemia time, thus maintain stable systemic hemodynamics, supply a satisfactory Cl after surgery and improve surgery outcome.

  12. Aorta-LITA Bypass Grafting with Saphenous Vein in a Patient Undergoing Coronary Artery Surgery with Subclavian Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Kerim Çağlı

    2011-12-01

    Full Text Available The internal thoracic artery (ITA is the primary graft for coronary artery bypass grafting and can not be used if there is subclavian artery stenosis (SAS. Aorto-axillary, carotid-subclavian bypass and also angioplasty with stenting or other interventional treatments are acceptable procedures for SAS treatment. Aorta-ITA bypass with saphenous vein can be alternative and simple technique for SAS to save Winslow pathway for patients with peripheral artery disease.

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

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle; T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating pat

  14. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... of the patient’s artery is, could be near occlusive, and we want to continue profusing the leg ... It’s very helpful. It’s like a pilot is training in a simulator. The postage is also very ...

  15. On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in Elderly Patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Houlind, Kim; Kjeldsen, Bo Juul;

    2012-01-01

    Conventional coronary artery bypass grafting performed with the use of cardiopulmonary bypass is a well-validated treatment for patients with ischemic heart disease. Off-pump coronary artery bypass grafting (OPCAB) has been suggested to reduce the number of perioperative complications, especially...

  16. Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: A case report

    Directory of Open Access Journals (Sweden)

    Atsushi Nanashima

    2016-01-01

    Conclusion: By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important.

  17. Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying Pancreatic Cancer: A Case Report and Review of the Literature.

    Science.gov (United States)

    Bellorin, Omar; Kundel, Anna; Ramirez-Valderrama, Alexander; Castro, Armando

    2015-01-01

    Introduction. We describe a case of gastrojejunal anastomosis perforation after gastric bypass on a patient with underlying pancreatic cancer. Case Description. A 54-year-old female with past surgical history of gastric bypass for morbid obesity and recent diagnosis of unresectable pancreatic cancer presents with abdominal pain, peritonitis, and sepsis. Computerized axial tomography scan shows large amount of intraperitoneal free air. The gastric remnant is markedly distended and a large pancreatic head mass is seen. Intraoperative findings were consistent with a perforated ulcer located at the gastrojejunal anastomosis and a distended gastric remnant caused by a pancreatic mass invading and obstructing the second portion of the duodenum. The gastrojejunal perforation was repaired using an omental patch. A gastrostomy for decompression of the remnant was also performed. The patient had a satisfactory postoperative period and was discharged on day 7. Discussion. Perforation of the gastrojejunal anastomosis after Roux-en-Y gastric bypass is an unusual complication. There is no correlation between the perforation and the presence of pancreatic cancer. They represent two different conditions that coexisted. The presence of a gastrojejunal perforation made the surgeon aware of the advanced stage of the pancreatic cancer.

  18. Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying Pancreatic Cancer: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Omar Bellorin

    2015-01-01

    Full Text Available Introduction. We describe a case of gastrojejunal anastomosis perforation after gastric bypass on a patient with underlying pancreatic cancer. Case Description. A 54-year-old female with past surgical history of gastric bypass for morbid obesity and recent diagnosis of unresectable pancreatic cancer presents with abdominal pain, peritonitis, and sepsis. Computerized axial tomography scan shows large amount of intraperitoneal free air. The gastric remnant is markedly distended and a large pancreatic head mass is seen. Intraoperative findings were consistent with a perforated ulcer located at the gastrojejunal anastomosis and a distended gastric remnant caused by a pancreatic mass invading and obstructing the second portion of the duodenum. The gastrojejunal perforation was repaired using an omental patch. A gastrostomy for decompression of the remnant was also performed. The patient had a satisfactory postoperative period and was discharged on day 7. Discussion. Perforation of the gastrojejunal anastomosis after Roux-en-Y gastric bypass is an unusual complication. There is no correlation between the perforation and the presence of pancreatic cancer. They represent two different conditions that coexisted. The presence of a gastrojejunal perforation made the surgeon aware of the advanced stage of the pancreatic cancer.

  19. Efficacy of Intravenous Acetaminophen after Coronary Artery Bypass Graft Surgery

    OpenAIRE

    Leick AM; Ratliff PD; Shely RN; Lester WC; Short MR

    2015-01-01

    In recent years, a multimodal approach to post-operative pain control consisting of opioid and non-opioid agents administered simultaneously has been used to provide synergistic effects and reduce opioid-related adverse effects. This is a retrospective, cohort study involving coronary artery bypass graft surgery patients who received scheduled intravenous IV acetaminophen 1gm every 6 hours for 4 doses starting at surgery end time with opioids administered as needed versus opioids as monother...

  20. Effects of Deep Breathing Exercises after Coronary Artery Bypass Surgery

    OpenAIRE

    Westerdahl, Elisabeth

    2004-01-01

    Deep breathing exercises are widely used in the postoperative care to prevent or reduce pulmonary complications, but no scientific evidence for the efficacy has been found after coronary artery bypass grafting (CABG) surgery. The aim of the thesis was to describe postoperative pulmonary function and to evaluate the efficacy of deep breathing exercises performed with or without a blow bottle device for positive expiratory pressure (PEP) 10 cmH2O or an inspiratory resistance-positive expirator...

  1. Early chest tube removal after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Mohsen Mirmohammad-Sadeghi

    2009-01-01

    Full Text Available Background: There is no clear data about the optimum time for chest tube removal after coronary artery bypass surgery. Aim: The aim of this study was to assess the impact of the chest tube removal time following coronary artery bypass grafting surgery on the clinical outcome of the patients. Material and Methods: An analysis of data from 307 patients was performed. The patients were randomized into two groups: in group 1 (N=107 chest tubes were removed within the first 24 hours after surgery, whereas in group 2 (N=200, chest tubes were removed in the second 24 hours after surgery. Demographics, lactate and pH at the beginning, during and after the operation, creatinine, left ventricular ejection fraction, inotropic drugs administration, length of ICU stay, and mortality data were collected. Respiratory rate and pain level was assessed. Results: In these surgeries, the mean± standard deviation for the aortic clamping time was 49.18±17.59 minutes and cardiopulmonary bypass time was 78.39±25.12 minutes. The amount of heparin consumed by the second group was higher (P <0.001 which could be considered as an important factor in increasing the drainage time after the surgery (P =0.047. The pain level evaluated 24 hours post-operation was lower in the first group, and the difference in the pain level between the 2 groups evaluated 30 hours post-operation was significant (P=0.016. The mean time of intensive care unit stay was longer in the second group but it was not statistically significant. Conclusion: Early extracting of chest tubes after coronary artery bypass graft surgery when there is no significant drainage can lead to pain reduction and consuming oxygen is an effective measure after surgery toward healing; it doesn′t increase the risk of creation of plural effusion and pericardial effusion.

  2. Heart bypass surgery

    Science.gov (United States)

    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 - ...

  3. Long-term internal thoracic artery bypass graft patency and geometry assessed by multidetector computed tomography

    DEFF Research Database (Denmark)

    Zacho, Mette; Lilleoer, Nikolaj Thomas; Kelbaek, Henning;

    2012-01-01

    The left internal thoracic artery (LITA) undergoes vascular remodelling when used for coronary artery bypass grafting. In this study we tested the hypothesis that the extent of the LITA remodelling late after coronary artery bypass grafting assessed by multidetector computed tomography is related...... to the severity of stenosis in the native coronary vessel. One hundred and forty-two patients who had undergone coronary artery bypass grafting including implantation of LITA as conduit to the left anterior descending artery were studied 5 years after surgery. Arterial graft patency and geometry was assessed...

  4. Graft Flow Unaffected by Full Occlusion of Left Anterior Descending Artery during Coronary Artery Bypass Grafting in a Porcine Model

    DEFF Research Database (Denmark)

    Torstensson, Gustav Nils Johannes; Torp, Thomas Lee; Rasuli-Oskuii, Nader;

    2013-01-01

    Background: We investigated in a porcine model whether measuring both the flow distal to an anastomosis and the graft transit time flow (TTF) gives a more accurate picture of the true blood flow in the left anterior descending artery (LAD) than graft TTF measurement alone.Methods: We performed off-pump...... anastomosis, despite a fully occluded LAD. This result suggests that graft TTF measurement alone is not sufficient when performing CABG, and measurement of flow distal to the anastomosis is also necessary to determine the true blood flow in the LAD....

  5. Coronary bypass revascularization with radial artery and internal mammary artery grafts

    Institute of Scientific and Technical Information of China (English)

    甄文俊; 佟宏峰; 王永忠; 孙耀光; 黄文; 马玉健; 田家政; 吴良洪

    2002-01-01

    Objective To evaluate radial artery (RA) and internal mammary artery (IMA) grafts in coronary artery bypass and the use of color Doppler ultrasound in the peri-operative evaluation of IMA and radial-ulnar collateral circulation.Methods From June 1998 to June 2000, sixty cases of coronary bypass revascularization with RA and IMA were performed. Preoperatively, the radial-ulnar collateral circulation was evaluated with the modified Allen's test, color Doppler ultrasound and noninvasive oxygen saturation measurement. The IMA lumen and blood flow were measured at the first intercostal space with color Doppler ultrasound preoperatively and postoperatively.Results One patient (1.7%) died of serious cardiac arrhythmia on the fourth postoperative day. There were no arterial graft harvest related complications. Before harvesting, the ulnar artery blood flow was 30.78±9.71?ml/min, and it increased to 43.36±13.98?ml/min (40.87% increase, P0.05), but the systolic/diastolic flow ratio markedly decreased from 8.57±3.98?ml/min to 3.41±4.87?ml/min (P<0.01).Conclusions Arterial grafts can be safely used for coronary bypass revascularization with good results. The ulnar artery blood flow can increase compensatively after RA harvesting. The diastolic blood flow of grafted IMA markedly increased postoperatively. Color Doppler ultrasound was very helpful both in evaluating the radial-ulnar collateral circulation before RA harvesting and in assessing the patency of the grafted IMA after coronary artery bypass grafting (CABG).

  6. Risk Factors for Ventilator Dependency Following Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Qiang Ji, Qianglin Duan, Xisheng Wang, Jianzhi Cai, Yongxin Zhou, Jing Feng, Yunqing Mei

    2012-01-01

    Full Text Available Background: Ventilator dependency following coronary artery bypass grafting (CABG is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for ventilator dependency following CABG. This study aimed to evaluate the independent risk factors for ventilator dependency following coronary artery bypass grafting (CABG. Methods: The relevant pre-, intra- and post-operative data of patients without a history of chronic obstructive pulmonary disease undergoing isolated CABG from January 2003 to December 2008 in our center were retrospectively analyzed. Elapsed time between CABG and extubation of more than 48 hours was defined as postoperative ventilator dependency (PVD. Results: The incidence of PVD was 13.8% (81/588. The in-hospital mortality in the PVD group was significantly higher than that in the non-PVD group (8.6% versus 2.4%, p=0.0092. Besides the length of ICU and hospital stay, PVD correlated with negative respiratory outcomes. The independent risk factors for PVD were preoperative congestive heart failure (OR=2.456, 95%CI 1.426-6.879, preoperative hypoalbuminemia (OR=1.353, 95%CI 1.125-3.232, preoperative arterial oxygen partial pressure (PO2 (OR=0.462, 95%CI 0.235-0.783 and postoperative anaemia (OR=1.541, 95%CI 1.231-3.783. Conclusions: Preoperative congestive heart failure, preoperative hypoalbuminemia, low preoperative PO2 and postoperative anaemia were identified as four independent risk factors for ventilator dependency following CABG.

  7. Improvement of C peptide zero BMI 24-34 diabetic patients after tailored one anastomosis gastric bypass (BAGUA).

    Science.gov (United States)

    Garciacaballero, M; Martínez-Moreno, J M; Toval, J A; Miralles, F; Mínguez, A; Osorio, D; Mata, J M; Reyes-Ortiz, A

    2013-03-01

    Introducción: Aunque la cirugía bariátrica ha demostrado ser un método muy eficaz en el tratamiento de pacientes diabéticos cuyo páncreas aún es capaz de producir insulina (diabetes tipo 2), así como del síndrome metabólico y las complicaciones relacionadas con la diabetes, no hay información sobre el efecto de este tipo de cirugía en pacientes IMC 24-34 cuando el páncreas no produce insulina en absoluto (tipo 1, tipo LADA y diabetes tipo 2 de larga evolución, entre otros). Métodos: Presentamos datos preliminares de una serie de 11 pacientes todos con valores de Péptido C insulina, tanto de insulina rápida (de 40,6 ± 12,8 a 0 U/día) como de insulina retardada (41,27 ± 7,3 U/día a 15,2 ± 3,3 U/día). Se resolvieron el 100% de las comorbilidades estudiadas y se mejoraron algunas complicaciones graves derivadas de la diabetes como retinopatía o nefropatía. Conclusiones: El bypass gástrico de una anastomosis adaptado a pacientes diabéticos IMC24-34 con péptido C cero elimina el uso de insulina de acción rápida, reduce a una sola inyección diaria la insulina retardada y mejora el control glucémico. Tras la cirugía desaparecen el síndrome metabólico y los episodios severos de hipoglucemia, y mejora significativamente la retinopatía, neuropatía, nefropatía, vasculopatía periférica y cardiopatía.

  8. [DESCRIPTION OF A RETROPERITONEAL ACCESS ROUTE TO THE VESSELS OF THE SPLEEN FOR SPLENORENAL ARTERIAL AND VENOUS ANASTOMOSIS].

    Science.gov (United States)

    Gil-Vernet Vila, José María

    2014-01-01

    To perform arterial or venous spleno-renal anastomoses, surgeons have so far systematically used the transperitoneal way whic is burdened by a high mortality an morbility percentage. On the basis of anatomo-surgical considerations, a retroperitoneal approach has been found reaching the hilus of the spleen via the lumbar region; the first arterial spleno-renal anastomosis by this way was performed in 1972 and the first venous spleno-renal anastomosis due to portal hipertension also by this way was performed in 1974, the alter proving to be the least aggresive by avoiding damaging the páncreas, the most surgical and direct for reaching the splenic vessels thereby enabling a better exposure and an easier performing of the anastomoses. By being retroperitoneal, the loss or infección of the ascitic liquid in the cirrhotic patient is prevented.

  9. Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease

    Science.gov (United States)

    Samak, Mostafa; Fatullayev, Javid; Sabashnikov, Anton; Zeriouh, Mohamed; Schmack, Bastian; Ruhparwar, Arjang; Karck, Matthias; Popov, Aron-Frederik; Dohmen, Pascal M.; Weymann, Alexander

    2016-01-01

    Total arterial revascularization is the leading trend in coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD). Adding to its superiority to vein conduits, arteries allow for a high degree of versatility and long-term patency, while minimizing the need for reintervention. This is especially important for patients with multi-vessel coronary artery disease, as well as young patients. However, arterial revascularization has come a long way before being widely appreciated, with some yet unresolved debates, and advances that never cease to impress. In this review, we discuss the evolution of this surgical technique and its clinical success, as well as its most conspicuous limitations in light of accumulated published date from decades of experience. PMID:27698339

  10. Heparin responsiveness during off-pump coronary artery bypass graft surgery: predictors and clinical implications

    Institute of Scientific and Technical Information of China (English)

    Duk-hee CHUN; Seong-wan BAIK; So Yeon KIM; Jae Kwang SHIM; Jong Chan KIM; Young Lan KWAK

    2011-01-01

    Aim: To evaluate the clinical impact of reduced heparin responsiveness (HRreduced) on the incidence of myocardial infarction (MI) following off-pump coronary artery bypass graft surgery (OPCAB),and to identify the predictors of HRreduced.Methods: A total of 199 patients scheduled for elective OPCAB were prospectively enrolled. During anastomosis,150 U/kg of heparin was injected to achieve an activated clotting time (ACT) of ≥300 s,and the heparin sensitivity index (HSI) was calculated. HSIs below 1.0 were considered reduced (HRreduced).The relationships between the HSI and postoperative MI,cardiac enzyme levels and preoperative risk factors of HRreduced were investigated.Results: There was no significant relationship between the HSI and cardiac enzyme levels after OPCAB. The incidence of MI after OPCAB was not higher in HRreduced patients. HRreduced occurred more frequently in patients with low plasma albumin concentrations and high platelet counts.Conclusion: HRreduced was not associated with adverse ischemic outcomes during the perioperative period in OPCAB patients,which seemed to be attributable to a tight prospective protocol for obtaining a target ACT regardless of the presence of HRreduced.

  11. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

    Directory of Open Access Journals (Sweden)

    Toischer Karl

    2009-09-01

    Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

  12. Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery

    NARCIS (Netherlands)

    Vriens, Bianca H. R.; Pol, Robert A.; Hulsebos, Robin G.; van Det, Rob J.; van der Palen, Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    2015-01-01

    BACKGROUND: To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. METHODS: Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inl

  13. Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery

    NARCIS (Netherlands)

    Vriens, Bianca H.R.; Pol, Robert A.; Hulsebos, Robin G.; Det, van Rob J.; Palen, van der Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    2015-01-01

    Background To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. Methods Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inla

  14. ANGIOGRAPHIC STUDY ON THE PATENCY OF SINGLE VERSUS SEQUENTIAL VENOUS GRAFT BEFORE REDO CORONARY ARTERY BYPASS SURGERY

    Institute of Scientific and Technical Information of China (English)

    陈长志; 陆佩中

    2003-01-01

    Objective To compare the long term patency and longevity of the single and sequential venous graft.MethodsThe coronary arterial angiographic data for 300 redo coronary bypass grafting (CABG) were collected. Among them 106 cases had both single (159) and sequential (118) grafts.ResultsThe occlusive and narrowness rate for the single grafts versus sequential grafts were: 1 year, 2% vs 2%; 5 years, 3% vs 4%; 10 years, 18% vs 19%; 15 years, 60% vs 68%; and 23 years, 76% vs 81%, respectively. The differences were not significant in general.ConclusionSequential anastomosis itself does not has any adverse affects on short term and long term patency of the venous graft and its longevity in CABG operations in general.

  15. Coronary artery bypass surgery in the diabetic patient.

    LENUS (Irish Health Repository)

    Maher, M

    2012-02-03

    Coronary artery and peripheral occlusive arterial disease frequently complicate diabetes mellitus, with death due to atherosclerotic coronary artery disease being three times more likely in diabetic compared to non-diabetic patients. The profile of 32 diabetic patients and 32 matched controls who underwent coronary artery bypass (CABG) is studied and their early and late postoperative outcomes are described. The mean age was 61 +\\/- 1 year in both groups. The diabetic group comprised 26 non-insulin dependent and 6 insulin dependent diabetics, who had a mean duration of diabetes of 8.5 years (range 2 months--35 years). The median number of grafts per patient performed in the diabetic group and the control group was 3.5 and 3 respectively. There was no mortality in the series, however considerably greater wound morbidity rates were encountered in the diabetic group when compared to matched controls. One renal transplant patient in the diabetic group suffered irreversible acute tubular necrosis and became dialysis dependent post-operatively. Longterm follow-up showed no longterm mortality in either group, with full relief of angina achieved in 75% of diabetic patients compared with 87.5% of matched controls. In addition diabetic patients suffered greater longterm cardiac morbidity than the control group (21.8% versus 12.5%). The results of this study suggest that CABG is a safe operation for the diabetic patient. Diabetic patients receive satisfactory symptomatic relief of angina, but suffer increased perioperative wound complications and greater incidence of longterm cardiac morbidity.

  16. Effects of topical hypothermia on postoperative inflammatory markers in patients undergoing coronary artery bypass surgery

    OpenAIRE

    Kadan, Murat; Erol, Gokhan; Savas Oz, Bilgehan; Arslan, Mehmet

    2014-01-01

    Summary Background We aimed to examine the effects of topical hypothermia on inflammatory markers in patients undergoing coronary artery bypass surgery. Methods Fifty patients undergoing isolated coronary artery bypass surgery were included the study. They were randomised to two groups. Mild hypothermic cardiopulmonary bypass (28–32°C) was performed on both groups using standardised anaesthesiology and surgical techniques. Furthermore, topical cooling with 4°C saline was performed on patients...

  17. Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Da-Bing Zhao; Jie-Sheng Qian; Hong Shan; Zai-Bo Jiang; Ming-Sheng Huang; Kang-Shun Zhu; Gui-Hua Chen; Xiao-Chun Meng; Shou-Hai Guan; Zheng-Ran Li

    2007-01-01

    AIM: To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver transplantation (OLT)-associated hepatic artery stenosis (HAS) and non-anastomosis bile duct stricture.METHODS: Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty (PTA) was performed in four HAS cases, and expectant treatment in other five HAS cases; percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases.RESULTS: Diffuse intra- and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/ follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases.CONCLUSION: Progressive, non-anastomosis, and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

  18. Giant serpentine aneurysm arising from the middle cerebral artery successfully treated with trapping and anastomosis: case report.

    Science.gov (United States)

    Abiko, Masaru; Ikawa, Fusao; Ohbayashi, Naohiko; Mitsuhara, Takafumi; Nosaka, Ryo; Inagawa, Tetsuji

    2009-02-01

    A 56-year-old man presented with a giant serpentine aneurysm arising from the middle cerebral artery (MCA) manifesting as right hemiparesis and motor aphasia. Magnetic resonance imaging and digital subtraction angiography identified the giant serpentine aneurysm arising from the MCA. The patient was treated surgically. Temporary clipping of the distal channel induced thrombosis in the vascular channel, and the thrombosis was aspirated with an ultrasonic suction device after superficial temporal artery-MCA anastomosis. This case shows that initial occlusion of the distal channel is effective to treat giant serpentine aneurysm. PMID:19246869

  19. Long-term patency of superficial temporal artery to middle cerebral artery bypass for cerebral atherosclerotic disease: factors determining the bypass patent.

    Science.gov (United States)

    Matano, Fumihiro; Murai, Yasuo; Tateyama, Kojiro; Tamaki, Tomonori; Mizunari, Takayuki; Matsukawa, Hideoshi; Teramoto, Akira; Morita, Akio

    2016-10-01

    Long-term patency of superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery for atherosclerotic disease and associated risk factors for loss of patency have rarely been discussed. We retrospectively analyzed long-term patency following STA-MCA bypass and evaluated various demographic and clinical factors to identify the ones predictive of postsurgical loss of patency using records of 84 revascularization procedures (58 patients, 45 males; mean age at surgery 63.6 years, range 31-78 years). Bypass patency was diagnosed based on magnetic resonance angiography or three-dimensional computed tomography. The mean follow-up period was 24.7 months (range 6-63 months). Decreased bypass patency was observed in 4 of 58 patients (6.9 %) who collectively underwent 6 bypasses (7.1 %) of 84. All cases of decreased bypass patency were first detected within 6 months of surgery. Bypass patency was not correlated with age, sex, number of anastomoses, postoperative cerebral infarction, or control of postoperative diabetes mellitus. We found a significant association of bypass patency with hyperperfusion (p = 0.01) and postoperative smoking (p = 0.0036). Furthermore, we found a significant association of hyperperfusion with STA diameter (p bypass patency in cerebral atherosclerotic disease patients. Careful monitoring of patency to prevent hyperperfusion and cessation of smoking are recommended, particularly within 6 months of the surgery.

  20. MYCTOIC ANEURYSM OF POPLITEAL ARTERY AND AORTOFEMORAL BYPASS GRAFT

    Directory of Open Access Journals (Sweden)

    A. Sohrabi

    1979-11-01

    Full Text Available Mycotic aneurysm could be divided into three types according to their etiology: septic-embolic, cryptogenic and traumatic type. During the period from 1972 to 1974 two cases of mycotic aneurysms have been seen at the Ohio Valley Medical Center - one following a sub acute bacterial endocarditic and another one was two years following surgery for aortofemoral bypass graft. The clinical course of both patients is discussed. The prognosis of mycotic aneurysm is always fatal without surgical intervention. Mycotic aneurysm is a rare entity which is occasionally reported in the literatures. As far as these case reports go the pathology could be divided into three categories according to their etiology, even though the pathology is essentially the same. 1. The septic-embolic or primary mycotic aneurysm in which the aneurysm is secondary to the sepsis which settles in the wall of the artery and destroys the lamina media and finally developing an aneurysm. This type of mycotic aneurysm is, usually seen in any type of septicemia. 2. The cryptogenic or secondary, mycotic aneurysm in which the sepsis takes place in the pra-existing aneurysm of the arterial wall usually due to arteriosclerosis disease. 3. Traumatic or mixed type mycotic aneurysm in which the sepsis and arterial wall damage takes place at the same time.

  1. Anesthesia for off-pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

  2. Do Statins Reduce Atrial Fibrillation After Coronary Artery Bypass Grafting?

    Directory of Open Access Journals (Sweden)

    Anil Paturi MD

    2011-07-01

    Full Text Available Background Atrial Fibrillation (AF is a common postoperative complication after coronary artery bypass grafting. There is contradictory evidence as to whether pre-operative statin use lowers the incidence of postoperative AF. This study aimed to assess whether pre operative statin therapy prevents the post-operative AF. Methods In this retrospective cohort study we used a propensity score–matching analysis to evaluate the effect of preoperative treatment with statins on postoperative atrial fibrillation. There were 427 matched pairs of patients. Primary outcome was the incidence of postoperative AF. Secondary outcomes were 30 day mortality, stroke, myocardial infarction and length of hospital stay Results The incidence of postoperative AF was not different in the statin users compared with the nonusers (123, 28.1%, versus 127, 29.7%, respectively; p = 0.764. The 30 day mortality (6, 1.4%, versus 8, 1.9%; p = 0.590, stroke (10, 2.3%, versus 8, 1.9%; p = 0.634, myocardial infarction (2, 0.5%, versus 0, 0.0%; p = 0.499 and length of hospital stay in days (11.8 ± 9.0, versus 11.9 ± 9.3; p = 0.544 did not differ significantly between the two groups. Conclusions In a propensity-matched cohort of patients undergoing coronary bypass surgery, we could not demonstrate that preoperative statins were protective for the development of post operative atrial fibrillation.

  3. Depression following coronary artery bypass grafting surgery revisited.

    Science.gov (United States)

    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

  4. End tidal CO2 versus arterial CO2 monitoring in patients undergoing coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Hassani E

    2009-12-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Measuring end tidal carbon dioxide (ETCo2 is one of the methods used for estimating arterial carbon dioxide (PaCo2 during general anesthesia. ETCo2 measurements maybe obviate the need for repeating arterial puncture for determination of arterial PaCo2. This study performed to determine the accuracy of ETCo2 levels as a measure of PaCo2 levels in patients undergoing coronary artery bypass graft and also to evaluate variation of the gradient between PaCo2 and ETCo2, peri- cardiopulmonary bypass operation."n"nMethods: In a prospective, cross-sectional study, a total of 40 patients with age 57±11 (35-73 years old undergoing coronary artery bypass graft were enrolled. ETCo2 levels (mmHg were recorded using side stream capnography at the time of arterial blood gas sampling, before (T0 and after (T1 cardiopulmonary bypass."n"nResults: Mean P(a-ETCo2 at T0 was 4.3±4.4mmHg, with the mean PaCo2, 33±6mmHg and mean ETCo2, 29±5mmHg and these values at T1 were 4.5±4.1mmHg, 33±5mmHg and 29±2mmHg respectively. There was no variation of the mean gradient (PaCo2-PETCo2 during, before and after cardiopulmonary bypass (p>0.870. Significant correlation was found between ETCo2 and PaCo2 at T0 and T1 (r=0.754 and 0

  5. Surgical treatment of 82 patients with diabetic lower limb ischemia by distal arterial bypass

    Institute of Scientific and Technical Information of China (English)

    GU Yong-quan; WANG Zhong-gao; ZHANG Jian; QI Li-xing; YU Heng-xi; LI Jian-xin; LI Xue-feng; GUO Lian-rui; LUO Tao; CUI Shi-jun

    2007-01-01

    Background Diabetic lower limb ischemia is a serious complication of diabetes mellitus.This study was conducted to investigate the effectiveness of distal arterial bypass treatment in diabetic patients with lower limb ischemia. Methods From July 2000 to July 2004, 96 lower limbs of 82 diabetic patients (type 2) with severe lower limb ischemia were treated in Xuan Wu Hospital. Arterial bypass with femoro-popliteal polytetrafluoroethylene (PTFE) and graft-tibial autologous grafts was performed on 311 limbs (32.3%). Popliteal-tibial artery bypass alone was performed on 22 limbs (22.9%). Combined iliac artery stenting, femoro-popliteal artery PTFE graft bypass, and graft-tibial artery autologous graft bypass was performed on 12 limbs (12.5%), and femoro-tibial artery graft bypass was performed on 10 limbs (10.4%). Popliteal-tibial-pedal artery graft bypass was performed on 7 limbs (7.3%). Results Arterial grafts in 92 limbs of 79 patients were patent on discharge. Three patients with 4 ischemic limbs (3.7%)died of respiratory failure 12 hours, 3 days and 7 days after operation respectively. Early operation success rate was 96.3% (79/82). Graft patency rate of patients on discharge was 95.8% (92/96). The short-term total effectiveness rate was 83.3% (80/96). Foot ulcer healing rate was 35.7% (10/28). 97.4% (75/77) patients were followed up for a mean of 13.5 months. The long-term total effective rate was 80.7% (71/88). The total amputation rate was 4.5% (4/88). Mortality was 4.5%. The total graft patency rate was 90.9% (80/88).Conclusion In the treatment of diabetic foot, distal lower limb arterial bypass can help to avoid amputation or lower the amputation level, and may promote foot ulcer healing and improve patient's quality of life.

  6. Hemodynamics Simulation of Stenosed Coronary Bypass Graft

    Institute of Scientific and Technical Information of China (English)

    LIU You-jun; QIAO Aike; DU Jian-jun

    2005-01-01

    By means of FEM, the physiological blood flow in coronary bypass graft is simulated. The stenosis in coronary artery is involved in the graft model,and the deformation of graft end to allow the surgical suture with a smaller diameter coronary is taken into consideration. The flow pattern, secondary flow and wall shear stress in the vicinity of anastomosis are analyzed. It is shown that a zone of low wall stress and high wall stress gradient exists downstream the toe. The floor opposed to the anastomosis is an area of high wall stress and high wall stress gradient. Both the toe downstream and the anastomosis bottom floor are prone to intimal hyperplasia.

  7. Early Introduction of Everolimus Immunosuppressive Regimen in Liver Transplantation with Extra-Anatomic Aortoiliac-Hepatic Arterial Graft Anastomosis

    Directory of Open Access Journals (Sweden)

    Emanuele Felli

    2014-01-01

    Full Text Available Liver transplantation is the treatment of choice for patients with acute and chronic end-stage liver disease, when no other medical treatment is possible. Despite high rates of 1- to 5-year survival, long-term adverse effects of immunosuppressant agents remain of major concern. Current research and clinical efforts are made to develop immunosuppressant agents that minimize adverse effects along with a low rate of graft rejection. Tailoring immunosuppressive therapy to individual patients by the use of proliferation signal inhibitors seems to be the best way to minimize toxicity and increase efficacy. Recently everolimus has been introduced in clinical practice; among its adverse effects an increased incidence of arterial graft thrombosis in renal transplants, vascular anastomosis leakage, impaired wound healing, and thrombotic microangiopathy have been reported. We present the case of a 54-year-old patient submitted to liver transplantation for end-stage liver disease treated by an extra-anatomic aortoiliac-hepatic arterial graft anastomosis and early postoperative introduction of everolimus for acute renal failure. Postoperative period was characterized by two abdominal collections and reactivation of cytomegalovirus infection that were treated by percutaneous drainage and antiviral therapy, respectively; the patient is well after 8-month followup with patency of the arterial conduit and no leakage.

  8. Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; QI Dan-ni; GU Cheng-xiong

    2010-01-01

    @@ Currently coronary artery bypass grafting (CABG) is the most commonly used procedure for revascularization of coronary heart disease. However it may not be suitable for the patients with diffuse coronary artery diseases. Under this circumstance, retrograde perfusion via cardiac venous system, namely retrograde coronary venous bypass graft (CVBG), may be the proper therapeutic selection.1 The idea of myocardial revascularization by means of grafting the coronary venous system is more than a century old. However, few clinical trials and long-term outcome data have been presented. The use of venous arterialization has not been widely used. We report the use of a sequential saphenous vein graft from the aorta to middle cardiac vein in a patient with diffuse lesions in right coronary artery during off-pump coronary artery bypass surgery (OPCAB).

  9. Does Previous Transradial Catheterization Preclude Use of the Radial Artery as a Conduit in Coronary Artery Bypass Surgery?

    Science.gov (United States)

    Mounsey, Craig A; Mawhinney, Jamie A; Werner, Raphael S; Taggart, David P

    2016-08-30

    The radial artery (RA) is a commonly used conduit for coronary artery bypass grafting, and recent studies have demonstrated that it provides superior long-term patency rates to the saphenous vein in most situations. In addition, the RA is also being used with increasing frequency as the access point for coronary angiography and percutaneous coronary interventions. However, there has been concern for many years that these transradial procedures may have a detrimental impact on the function of RA grafts used in coronary artery bypass grafting, and there is now comprehensive evidence that such interventions cause morphologic and functional damage to the artery in situ. Despite this, there remain remarkably few studies investigating the use of previously cannulated RAs as grafts in coronary artery bypass surgery, and there are no clear guidelines on the use of the RA in coronary artery bypass grafting after its catheterization. This article will review concisely the evidence that transradial procedures cause damage to the RA, and discuss the impact this could have on previously cannulated RAs used as coronary artery bypass grafting conduits. On the basis of the evidence assessed, we make a number of recommendations to both surgeons and cardiologists regarding use of the RA in cardiovascular procedures. PMID:27572880

  10. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting

    NARCIS (Netherlands)

    Gu, YJ; Mariani, MA; van Oeveren, W; Grandjean, JG; Boonstra, PW

    1998-01-01

    Background. The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.

  11. Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013

    OpenAIRE

    Schumer, Erin M.; Chaney, John H.; Trivedi, Jaimin R.; Linsky, Paul L.; Williams, Matthew L.; Slaughter, Mark S

    2016-01-01

    Emergency coronary artery bypass grafting (CABG) is associated with increased in-hospital mortality rates and adverse events. This study retrospectively evaluated indications and outcomes in patients who underwent emergency CABG.

  12. Posttraumatic growth in post-surgical coronary artery bypass graft patients

    Directory of Open Access Journals (Sweden)

    Catherine A Waight

    2015-02-01

    Full Text Available Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.

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

    OpenAIRE

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

    2012-01-01

    There have been several reports of gas embolism occurring during off-pump coronary artery bypass graft (OPCAB) surgery. However, all these cases of air embolism were associated with the repair of venous circulation, using a CO2 blower. In this report, we describe a rare case of air embolism in the coronary arteries associated with the use of a CO2 blower during OPCAB. There was no injury to the veins during OPCAB. The air embolism was treated successfully with cardiopulmonary bypass.

  14. Outcome of Coronary Artery Bypass Grafts: Comparison between on Pump and off Pump

    OpenAIRE

    Rasoul Ibrahim Abdulrahman; Rezayat Parvizi

    2010-01-01

    The present study was undertaken to compare the in hospital results of coronary artery bypass graft (CABG) with (on pump) or without (off pump) cardiopulmonary bypass (CPB). Data were collected on all first-time isolated CABGs with saphenous vein and/or artery grafts at Shahid Madani Hospital in Tabriz-Iran, between 2006 and 2009. Age and clinical profile were marched between on pump and off pump group patients. Patients with concomitant cardiac operations or beating pump technique were exclu...

  15. Decline in Health-Related Quality of Life 6 Months After Coronary Artery Bypass Graft Surgery

    DEFF Research Database (Denmark)

    El Baz, Noha; Pedersen, Susanne S.; van Dijk, Jitse P;

    2013-01-01

    Although coronary artery bypass graft (CABG) is known to improve health-related quality of life (HRQoL), this improvement does not seem to be realized in all patients who had undergone CABG surgery.......Although coronary artery bypass graft (CABG) is known to improve health-related quality of life (HRQoL), this improvement does not seem to be realized in all patients who had undergone CABG surgery....

  16. Effects of different PEEP levels on respiratory mechanics and oxygenation after coronary artery bypass grafting

    OpenAIRE

    Daniel Lago Borges; Vinícius José da Silva Nina; Marina de Albuquerque Gonçalves Costa; Thiago Eduardo Pereira Baldez; Natália Pereira dos Santos; Ilka Mendes Lima; Eduardo Durans Figuerêdo; Josimary Lima da Silva Lula

    2013-01-01

    OBJECTIVE: To compare the effects of different levels of positive end-expiratory pressure on respiratory mechanics and oxygenation indexes in the immediate postoperative period of coronary artery bypass grafting. METHODS: Randomized clinical trial in which 136 patients underwent coronary artery bypass grafting between January 2011 and March 2012 were divided into three groups and admitted to mechanical ventilation with different positive end-expiratory pressure levels: Group A, 5 cmH2O (n=44)...

  17. Off-pump versus on-pump coronary artery bypass surgery for the treatment of left main with triple coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Zhibing Qiu; Xin Chen; Ming Xu; Kaihu Shi; Yinshuo Jiang; Liqiong Xiao

    2008-01-01

    Objective:To obtain early results of off-pump coronary artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery(CCAB). Methods:Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January I999 and May 2006. Non-randomized, retrospective data analysis included demographic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results: The number of distal anastomosis and grafts varied from 3 to 6. The average number per patient was similar in the two groups (OPCAB group:3.76±0.98, CCAB group:3.81±1.02). Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance (P>0.05). The frequency of atrial fibrillation (AF), IABP usage, mediastinitis,re-operation for bleeding (or tamponade) were similar in the two groups (P>0.05). Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in thc OPCAB group compared with CCAB group(P<0.05).Conclusion: Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.

  18. Hyperhomocysteinemia and mortality after coronary artery bypass grafting.

    Directory of Open Access Journals (Sweden)

    Domenico Girelli

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

  19. Effect of Incentive Spirometry on Oxygenation in Patients after Coronary Artery Bypass Graft Surgery

    OpenAIRE

    H Dehghani; MH Zahmatkesh; MH Abdullahi; A Dehghani

    2014-01-01

    Introduction: Arterial hypoxemia is one of the main pulmonary complications after coronary artery bypass graft surgery. Therefore, several proceedings have been recommended to reduce the complications, and to improve arterial hypoxemia as well as arterial blood gas parameters such as incentive spirometry. This study intended to investigate the effect of incentive spirometry on patients´ oxygenation. Methods: In this randomized clinical trial, a sample size of 70 patients undergoing corona...

  20. Efficacy of Intravenous Acetaminophen after Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Leick AM

    2015-12-01

    Full Text Available In recent years, a multimodal approach to post-operative pain control consisting of opioid and non-opioid agents administered simultaneously has been used to provide synergistic effects and reduce opioid-related adverse effects. This is a retrospective, cohort study involving coronary artery bypass graft surgery patients who received scheduled intravenous IV acetaminophen 1gm every 6 hours for 4 doses starting at surgery end time with opioids administered as needed versus opioids as monotherapy for postoperative pain control. The primary endpoint assessed was total morphine equivalents administered post-operatively in each group with a secondary focus on degree of pain control, total length of stay, ICU length of stay, and time to first bowel movement. The study concludes that the addition of IV acetaminophen to opioids for postoperative pain relief did not produce an opioid sparing effect and paradoxically led to an increase in opioid use. Clinical outcomes including pain control, total length of stay, and ICU length of stay were unaffected by the addition of IV acetaminophen.

  1. Predictors of post coronary artery bypass grafting atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Tongtong Shen; Qijun Shan; Biao Yuan; Bing Yang; Chun Chen; Dongjie Xu; Minglong Chen; Jiangang Zou; Kejiang Cao

    2007-01-01

    Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results: 103/312(33.01%) patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age (≥ 70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement ( ≥40 mm), a history of AF, prolonged p-wave duration ( ≥ 120 ms) and increased number of grafts (≥3). Multivariate logistic regression analysis showed that advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm) and a history of AF were highly related to post-CABG AF. Conclusion: The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of β-blockers,hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF.

  2. Mental Health and Depression after Coronary Artery Bypass Graft

    Directory of Open Access Journals (Sweden)

    Hassan Farrashbandi

    2014-08-01

    Full Text Available Background: Mental health of those with ischemic heart disease (IHD has been a focus of attention of researchers since it has always been considered as a psychosomatic disorder. The present study was designed to investigate mental health status of a group of patients before and after coronary artery bypass graft (CABG. Materials and Methods: In this longitudinal descriptive study 63 candidates for CABG, referred by cardiologist and cardiac surgeon in a 6 month period were asked to take part in the study if they didn't have any exclusion criteria. The patients were the out-patients of cardiac clinics in Shiraz, Iran. The patients were assessed by general health questionnaire (GHQ-28 and beck depression inventory (BDI at 3 phases, before surgery, 1 month after surgery and three months after surgery. Results: The analysis did not show significant statistical change in GHQ-28 and BDI measures before and after CABG. There were statistically significant differences in the mentioned measures between male and female participants in initial assessment, i.e., women scores were higher than men in distress scores measured by GHQ-28 and BDI. Conclusion: In our study, we observed no statistically significant differences between pre and post operation in general health and depression scales. However women showed higher degrees of depressed mood at any step of assessment.

  3. Evaluation of retrospectively ECG-gated 4-row multidetector CT in patients planned for minimal invasive coronary artery bypass grafting

    International Nuclear Information System (INIS)

    Purpose: Minimal invasive direct coronary artery bypass grafting (MIDCAB) or off-pump coronary artery bypass grafting (OPCAB) on the beating heart with full or mini-sternotomy are becoming more common in coronary bypass surgery of the left anterior descending (LAD). In the decision, which surgical approach (MIDCAB, OPCAB or conventional surgery with cardiopulmonary bypass) will be best used, knowledge of the anatomical field is of major importance. The aim of the study was to evaluate retrospective ECG-gated 4-row multidetector CT (MDCT) in patients planned for MIDCAB as additional imaging to coronary angiography. Material and methods: The study included 25 consecutive patients. MSCT was performed as unenhanced (collimation 4 x 2.5 mm) and contrast-enhanced examination (140-170 ml, 300 mg Iodine/ml, collimation 4 x 1 mm). The evaluation included presence of LAD calcifications, distance of LAD and left internal mammarian artery (LIMA), coursek of LAD and LIMA, the presence or absence of bridging through myocardium or epicardial fat and the presence of pleural fibrosis. The MDCT results were correlated with intra-operative findings. Results: All MDCTs could be assessed with reference to the demands. In 20/25 operations, MDCT had direct influence as to the selection of the surgical approach (11 MIDCAB, 7 OPCAB with mini-sternotomy and 5 with full sternotomy, 2 conventional surgeries). The distance of LAD and LIMA varied from 0.9 to 4.5 cm in MDCT. As to calcifications, 3/25 correlated patients had calcifications and 10 patients had no calcifications in the middle LAD. Seven patients had intraoperative fibrosis of the vessel wall without calcification of the middle LAD, which could not be detected with MDCT. Another 5 patients had single calcified plaques in the middle LAD, 4 of these had a fibrosis of the vessel and 1 had a normal vessel at surgery. In these cases, the anastomosis was done between the calcified plaques. No myocardial bridging was detected by MDCT and

  4. On-pump versus off-pump coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Houlind, Kim Christian

    2013-01-01

    Off pump coronary artery bypass surgery has been purported to be safer than conventional coronary artery bypass surgery performed using cardiopulmonary bypass. This theory was supported by a number of early series, but failed to be confirmed by a number of small, randomized controlled trials...... . Conversely, it has been suggested that revascularization after off pump surgery is associated with fewer grafts and lower graft patency, potentially leading to a higher risk of cardiovascular morbidity and need for repeated, coronary interventions. Since 2009, three major randomized controlled trials have...

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

    LENUS (Irish Health Repository)

    Flynn, Michael J

    2012-02-03

    OBJECTIVE: Vasoactive agents and inotropes influence conduit-coronary blood flow following coronary artery bypass grafting (CABG). It was hypothesized that dopexamine hydrochloride, a dopamine A-1 (DA-1) and beta(2) agonist would increase conduit-coronary blood flow. A prospective randomized double blind clinical trial was carried out to test this hypothesis. DA-1 receptors have previously been localized to human left ventricle. METHODS: Twenty-six American Society of Anaesthesiology class 2-3 elective coronary artery bypass graft patients who did not require inotropic support on separation from cardiopulmonary bypass (CPB) were studied. According to a randomized allocation patients received either dopexamine (1 microg\\/kg per min) or placebo (saline) by intravenous infusion for 15 min. Immediately prior to and at 5,10 and 15 min of infusion, blood flow through the internal mammary and vein grafts (Transit time flow probes, Transonic Ltd.), heart rate, cardiac index, mean arterial pressure and pulmonary haemodynamics were noted. The data were analysed using multivariate analysis of variance. RESULTS: Low-dose dopexamine (1 microg\\/kg per min) caused a significant increase in mammary graft blood flow compared to placebo at 15 min of infusion (P=0.028, dopexamine group left internal mammary artery (LIMA) flow of 43.3+\\/-14.2 ml\\/min, placebo group LIMA flow at 26.1+\\/-16.3 ml\\/min). Dopexamine recipients demonstrated a non-significant trend to increased saphenous vein graft flow (P=0.059). Increased heart rate was the only haemodynamic change induced by dopexamine (P=0.004, dopexamine group at 85.2+\\/-9.6 beats\\/min and placebo group at 71.1+\\/-7.6 beats\\/min after 15 min of infusion). CONCLUSION: This study demonstrates that administration of dopexamine (1 microg\\/kg per min) was associated with a significant increase in internal mammary artery graft blood flow with mild increase in heart rate being the only haemodynamic change. Low-dose dopexamine may

  6. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting

    DEFF Research Database (Denmark)

    Møller, Christian H; Steinbrüchel, Daniel A

    2014-01-01

    Coronary artery bypass grafting (CABG) remains the preferred treatment in patients with complex coronary artery disease. However, whether the procedure should be performed with or without the use of cardiopulmonary bypass, referred to as off-pump and on-pump CABG, is still up for debate....... Intuitively, avoidance of cardiopulmonary bypass seems beneficial as the systemic inflammatory response from extracorporeal circulation is omitted, but no single randomized trial has been able to prove off-pump CABG superior to on-pump CABG as regards the hard outcomes death, stroke or myocardial infarction....... In contrast, off-pump CABG is technically more challenging and may be associated with increased risk of incomplete revascularization. The purpose of the review is to summarize the current literature comparing outcomes of off-pump versus on-pump coronary artery bypass surgery....

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

    OpenAIRE

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

    2015-01-01

    Background This study aimed to investigate sternal healing over time and the incidence of poor sternal healing in patients undergoing coronary artery bypass graft (CABG) surgery using bilateral internal thoracic arteries. Methods This study enrolled 197 patients who underwent isolated CABG using skeletonized bilateral internal thoracic arteries (sBITA) from 2006 through 2009. Postoperative computed tomography (CT) angiography was performed on all patients at monthly intervals for three to six...

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

    OpenAIRE

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

    2015-01-01

    Background: It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD). Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD. Methods: From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeo...

  9. In situ cephalic vein bypasses from axillary to the brachial artery after catheterization injuries.

    Science.gov (United States)

    Hudorovic, Narcis; Lovricevic, Ivo; Ahel, Zaky

    2010-07-01

    The need to bypass to the brachial artery is rare. Over a five-year period, 16 patients had suffered iatrogenic post-catheterization injuries of the upper extremity. We have performed 16 bypasses, in 16 patients, mean age was 65 years (range 47-75), to the brachial artery originating from an artery proximal to the shoulder joint. In all cases, the axillary artery was the donor artery. All bypasses were created by using the cephalic vein with the in situ technique and distal anastomoses were made to a distance-free section of brachial artery. No operative mortality, neurological complications or major upper-extremity amputation was associated with the procedure. Life-long-conduit analysis showed 75% patency in the five-year period. After iatrogenic post-catheterization trauma of arterial system of upper extremity, bypasses from axillary to brachial artery with the cephalic vein with the in situ technique is a safe operation with satisfactory long-term patency. PMID:20395248

  10. Early Coronary Artery Bypass Grafting Following Life-Saving Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Kerem Yay

    2013-10-01

    Full Text Available Aim: Percutaneous coronary intervention is usually the initial treatment option for treatment of emergent and severe coronary atherosclerosis with suitable coronary arteries. We aimed to investigate the clinical features, morbidity and mortality rates of coronary artery bypass grafting performed following life-saving stent procedures and patency rates of these stents. Material and Method: Between January 2005 and December 2008, we performed coronary artery bypass grafting on 23 patients who had previous percutaneous coronary intervention to the culprit artery for acute myocardial infarction. Early postoperative coronary angiography was obtained for evaluation of stent patency. Results: In-hospital mortality occurred in five patients (21.7%. Coronary angiographic examination of the remaining patients revealed severe stenosis or occlusion at 16 out 20 stents (80%. The mean time interval between percutaneous coronary intervention and coronary artery bypass grafting was found to be statistically significant regarding stent patency (p=0.007. Discussion: Bypass grafting to a previously stented coronary artery may be the relevant approach even if the angiographic findings are normal, because intraoperative manipulation and systemic effects of cardiopulmonary bypass if used will result in deformity or occlusion of the stent.

  11. Coronary artery bypass graft (CABG) patency: Assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography (MDCT) versus coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Anders, Katharina [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany)]. E-mail: katharina.anders@idr.imed.uni-erlangen.de; Baum, Ulrich [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Schmid, Michael [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Ropers, Dieter [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Schmid, Axel [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Pohle, Karsten [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Daniel, Werner G. [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Bautz, Werner [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Achenbach, Stephan [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany)

    2006-03-15

    Purpose: To investigate the ability of 16-slice multidetector-row computed tomography (MDCT) to visualize coronary artery bypass graft (CABG) patency and to detect bypass stenoses. Materials and methods: Thirty-two patients with 94 grafts (20 mammary artery grafts, 74 venous grafts) were investigated by 16-slice MDCT using a scan protocol with 12 x 0.75 mm slice collimation (pitch 0.3), 420 ms rotation time and simultaneous electrocardiogram (ECG)-registration. One hundred milliliters iodinated contrast agent were injected with a delay according to the individually determined contrast agent transit time. Patients with heart rates above 60 bpm received oral beta-blockade. Cross-sectional images with a slice width of 1.0 mm (0.5 mm increment) were reconstructed using an ECG-gated half-scan reconstruction or a multisegment reconstruction algorithm depending on the heart rate. Bypass grafts were evaluated concerning patency and presence of stenoses {>=}50% diameter reduction on cross-sectional images, multiplanar reformations and maximum intensity projections by two independent observers. Results were compared to coronary bypass angiography. Results: Sixteen-slice MDCT results were compared to those of invasive coronary angiography concerning absence or presence of bypass graft occlusion or relevant stenosis {>=}50% lumen reduction. Coronary CT angiography (CTA) permitted detection of bypass occlusion with 100% sensitivity (28/28) and 98% specificity (64/65). Seventy-eight percent (observer 1) and 84% (observer 2) of all patent grafts were found to be evaluable concerning presence or absence of stenosis. In 34 of 40 (observer 1) and 38 of 43 (observer 2) bypass grafts, high-grade stenoses were correctly ruled out (specificity 85% versus 88%, sensitivity 80% and 82%). Yet, if all patients with either unevaluable grafts/graft anastomosis or relevant graft stenosis were excluded, only 8/32 patients (25%) had fully diagnostic 'negative' graft-CTA. According to

  12. Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

    Institute of Scientific and Technical Information of China (English)

    Xiang HU; Qiang ZHAO

    2011-01-01

    Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left antetior descending coronary arteries is unclear.This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library.Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years,there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right intemal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery

  13. Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting:which is better in patients with chronic obstructive pulmonary disease?

    Institute of Scientific and Technical Information of China (English)

    朱亚彬; 许建屏; 刘志勇; 杨丹宁; 李旭东; 李鸿雁

    2004-01-01

    To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

  14. Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

    Institute of Scientific and Technical Information of China (English)

    朱亚彬; 许建屏; 刘志勇; 杨丹宁; 李旭东; 李鸿雁

    2004-01-01

    To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

  15. Premature coronary artery disease in systemic lupus erythematosus with extensive reocclusion following coronary artery bypass surgery.

    Science.gov (United States)

    D Agate, David J; Kokolis, Spyros; Belilos, Elise; Carsons, Steven; Andrieni, Julia; Argyros, Thomas; Glasser, Lynne A; Dangas, George

    2003-03-01

    A 21-year-old woman with a history of systemic lupus erythematosus (SLE) presented to the emergency room with a chief complaint of substernal chest pain and palpitations. She had undergone a four-vessel coronary artery bypass graft operation with separate saphenous vein grafts to the left anterior descending (LAD), obtuse marginal (OM) 1 and 2, and distal right coronary arteries (RCA) 8 months prior to admission. The patient underwent angiography of the coronary vessels, which showed severe diffuse disease with a long, 90% narrowing of the vein graft to the LAD and closed vein grafts to OM1 and OM2. The RCA graft showed mild diffuse disease. An intervention was done in which the LAD was stented twice with subsequent TIMI 3 flow. Advances in medical therapy and a better understanding of the disease have contributed to a dramatic improvement in the long-term survival of patients with SLE. However, despite the overall long-term improvement, coronary artery disease remains a major cause of morbidity and mortality with an incidence of approximately nine-fold greater than would be expected for this population. PMID:12612393

  16. Efficacy of Endoscopically Created Bypass Anastomosis in Treatment of Afferent Limb Syndrome: A Single-Center Study.

    Science.gov (United States)

    Rodrigues-Pinto, Eduardo; Grimm, Ian S; Baron, Todd H

    2016-04-01

    Afferent limb syndrome is a postoperative complication of gastrointestinal surgery, resulting from obstruction of a biliary-enteric limb. Surgery has been the cornerstone of treatment for this condition, but advances in endoscopic and percutaneous techniques could offer less-invasive options. Creation of an internal endoscopic anastomosis between the obstructed afferent limb and an adjacent gastrointestinal lumen can relieve symptoms and might provide a long-term solution. We report the efficacy of endoscopic treatment of afferent limb syndrome using lumen-apposing self-expandable metal stents to create 3 types of enteric anastomoses: a jejunojejunostomy, 2 gastrojejunostomies, and a duodenuojejunostomy in patients who developed afferent limb obstruction following a resection for pancreaticobiliary cancer. PMID:26674590

  17. Anesthetic considerations for the patients with off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    New surgical techniques for coronary artery bypass graft (CABG) have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgical expertise can perform the procedures in some high-risk patients such as poor left ventricular function, redo CABG, advanced age and renal dysfunction etc. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. It is a quite challenge to anesthetist in managing the intraoperative patient.

  18. Prediction of Carotid Artery Stenosis in Candidates of Coronary Artery Bypasses Surgery by A Scoring System.

    Directory of Open Access Journals (Sweden)

    Sh. Shirani

    2007-05-01

    Full Text Available Background and Objective: Up to 9% of coronary ar-tery bypass grafting (CABG patients suffer from stroke after the surgery. Although post CABG stroke has multiple etiologies, stenosis of cervical carotid arteries is an important factor. Many studies have evaluated carotid artery stenosis in CABG. Carotid stenosis and its related factors and a new scoring sys-tem for selection of CABG patients for Doppler study are introduced. Materials and methods: 1721 consecutive cases of non-urgent CABG were evaluated for presence of significant carotid stenosis (> 50% stenosis. The asso-ciation of age, sex, hypertension, smoking, diabetes, dislipidemia and left main coronary stenosis with ca-rotid stenosis was evaluated. For introducing a scor-ing method, absence of each related factor was scored by 1 and its presence by 2. The score range for each patient was from 5 (none of related factors up to 10 (all of related factors. Results: 7% of patients suffered from significant stenosis. Female gender, age more than 55 years old, hypertension, diabetes, and stenosis of left main coronary artery were the related risk factors in uni-variate analysis. A step type analysis revealed patients with score 5 have 98.3% negative predictive value (NPV for significant stenosis with 96.2% sensitivity and 13.9% specificity. Patients with score 10 have 93.9% NPV for significant stenosis with 99.9% speci-ficity. Conclusion: This scoring system may help for better selection of patients for Doppler study before CABG.

  19. Comparison of Coronary Artery Bypass Grafting with Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease

    OpenAIRE

    Kawecki, Damian; Morawiec, Beata; Fudal, Marcin; Milejski, Wojciech; Jacheć, Wojciech; Nowalany-Kozielska, Ewa

    2011-01-01

    Purpose Coronary artery bypass grafting (CABG) is the optimal treatment option for left main coronary artery disease (LMCAD). However, LMCAD remains a constant topic of discussion between cardiac surgeons and interventional cardiologists. The aim of this study was to assess the efficacy of LMCAD treatments by comparing the mid-term outcomes of CABG and percutaneous coronary intervention (PCI) using bare metal stents or drug-eluting stents (DESs). Materials and Methods The study population was...

  20. Monitoring diastolic dysfunction using a simplified algorithm in patients undergoing off-pump coronary artery bypass grafting surgery

    Science.gov (United States)

    Borde, Deepak Prakash; Asegaonkar, Balaji; Apsingekar, Pramod; Khade, Sujeet; Futane, Savni; Khodve, Bapu; Kedar, Mahesh; Deodhar, Anand; Takalkar, Unmesh; George, Antony; Joshi, Shreedhar

    2016-01-01

    Context: Left ventricle diastolic dysfunction (LVDD) is gaining importance as useful marker of mortality and morbidity in cardiac surgical patients. Different algorithms have been proposed for the intraoperative grading of DD. Knowledge of the particular grade of DD has clinical implications with the potential to modify therapy, but there is a paucity of literature on the role of diastolic function evaluation during off-pump coronary artery bypass grafting (OPCABG) surgery. Aims: The aim of this study was to monitor changes in LVDD using simplified algorithm proposed by Swaminathan et al. in patients undergoing OPCABG. Settings and Design: The study was conducted in a tertiary care level hospital; this was a prospective, observational study. Subjects and Methods: Fifty consecutive patients undergoing OPCABG were enrolled. Hemodynamic and echocardiographic parameters were measured at 6 stages in every patient namely after anesthetic induction (baseline), during left internal mammary artery (LIMA) to left anterior descending (LAD) grafting (LIMA → LAD), saphenous vein graft (SVG) to obtuse marginal (OM) grafting (SVG → OM), SVG to posterior descending artery (PDA) grafting (SVG → PDA), during proximal anastomosis of SVG to aorta, and postprotamine. The patients were classified in grades of LVDD as per simplified algorithm proposed by Swaminathan et al. using only intraoperatively measured E and E’. Results: The success rate of measurement and classification of LVDD was 98.92% (277 out of 280 measurements). The grades of LVDD varied significantly as per surgical steps with maximum downgrading occurring during OM and LAD grafting. During OM grafting, none of the patients had normal diastolic function while 29% of patients exhibited restrictive pattern (Grade 3 LVDD). Patients with normal baseline LV diastolic function also exhibited downgrading during OM and LAD grafting. Postprotamine, 37% of patients with normal baseline diastolic function continued to

  1. Perioperative risk factors for prolonged mechanical ventilation and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Zahra S Faritous

    2011-01-01

    Full Text Available Background: Prolonged mechanical ventilation is an important recognized complication occurring during cardiovascular surgery procedures. This study was done to assess the perioperative risk factors related to postoperative pulmonary complications and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass. Methods: It was a retrospective study on 5,497 patients, including 31 patients with prolonged ventilatory support and 5,466 patients without it; from the latter group, 350 patients with normal condition (extubated in 6-8 hours without any complication were selected randomly. Possible perioperative risk factors were compared between the two groups using a binary logistic regression model. Results: Among the 5,497 women undergoing coronary artery bypass graft (CABG, 31 women needed prolonged mechanical ventilation (PMV, and 15 underwent tracheostomy. After logistic regression, 7 factors were determined as being independent perioperative risk factors for PMV. Discussion: Age ≥70 years old, left ventricular ejection fraction (LVEF ≤30%, preexisting respiratory or renal disease, emergency or re-do operation and use of preoperative inotropic agents are the main risk factors determined in this study on women undergoing CABG.

  2. Blood flow modeling for patient-specific bypass surgery in lower-limb arteries

    OpenAIRE

    Willemet, Marie

    2012-01-01

    Every day in Belgium, at least one or two people will undergo a bypass surgery in the lower-limb arteries. This medical procedure consists of replacing an occluded section of the leg arteries with an artificial vessel, in order to allow blood to flow downwards of this blockage. Even though this intervention is very common, failure of this treatment within five years reaches up to 60%. In order to improve our understanding of the causes of bypass failure, one approach is to study the local hem...

  3. Patency rates and the role of newer grafts in coronary artery bypass grafting.

    Science.gov (United States)

    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.

  4. DOES TRANEXAMIC ACID REDUCE BLOOD LOSS IN OFF-PUMP CORONARY ARTERY BYPASS?

    OpenAIRE

    A. Mehr-Aein; M. Sadeghi M. Madani-Civi

    2006-01-01

    Tranexamic acid is now used on a routine basis for on-pump coronary artery bypass grafting (CABG). We assessed the hemostatic effects of tranexamic acid to decrease bleeding tendency and transfusion requirements in patients undergoing off-pump coronary artery bypass surgery (OPCAB). A total of 66 patients were enrolled to elective OPCAB in a double-blind, prospective randomized study. Of these, 33 patients received tranexamic acid (15 mg/kg before the infusion of heparin and 15 mg/kg after pr...

  5. Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Thorsteinsson, Kristinn; Andreasen, Jan Jesper; Torp-Pedersen, Christian;

    2015-01-01

    O5 Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: A nationwide cohort study Kristinn Thorsteinsson, Jan Jesper Andreasen, Christian Torp Pedersen, Kirsten Fonager, Rikke Nørmark Mortensen, Kristian Kragholm, Gunnar Gislason, Lars Køber....... Aalborg, Denmark Background: Data on nursing home admission in patients >80 years of age after isolated coronary artery bypass grafting (CABG) are scarce. Aim: The purpose of this study was to evaluate longevity and subsequent admission to nursing home stratified by age in a nationwide CABG cohort...

  6. One anastomosis gastric bypass: a simple, safe and efficient surgical procedure for treating morbid obesity El bypass gástrico de una anastómosis: un procedimiento simple, seguro y eficaz para tratar la obesidad mórbida

    Directory of Open Access Journals (Sweden)

    M. García-Caballero

    2004-11-01

    Full Text Available The One Anastomosis Gastric Bypass has been developed from the Mini Gastric Bypass procedure as originally described by Robert Rutledge. The modification of the original procedure consists of making a latero-lateral gastro-jejunal anastomosis instead of a termino-lateral anastomosis, as is carried out as described in the original procedure. The rationale for these changes is to try to reduce exposure of the gastric mucosa to biliopancreatic secretions because of their potentially carcinogenic effects with longer term exposure, which is the major criticism of the original technique. If we fix the jejunal loop to the gastric pouch some centimetres up to the gastro-jejunal anastomosis the biliopancreatic secretions have less possibility of coming into the gastric cavity (gravity force. Furthermore, if the anastomosis is latero-lateral this possibility is reduced even more. In addition, the intestinal loop reinforces the staple line against disruption, and also the gastric pouch against dilatation.El Bypass Gástrico de Una Anastomosis se ha desarrollado a partir del Mini Bypass Gástrico descrito por Robert Rutledge. La modificación del procedimiento original consiste en hacer una anastomosis latero-lateral en lugar de termino-lateral como se hace en la técnica original. Este cambio intenta reducir la exposición de la mucosa gástrica a la secreción bilio-pancreática, evitando así el posible efecto carcinogénico de la exposición crónica que constituye la más importante crítica del procedimiento original. Al fijar el asa de yeyuno a la nueva bolsa gástrica unos centímetros por encima de la anastomosis gastro-yeyunal, la secreción bilio-pancreática tiene menos posibilidades de entrar en la cavidad gástrica (fuerza de gravedad. Al ser la anastomosis latero-lateral esta posibilidad se reduce aún más. Además, el asa de yeyuno refuerza la línea de grapas contra su disrupción y previene la posible dilatación de la bolsa gástrica.

  7. Factors associated with delayed intracerebral hemorrhage after superficial temporal artery-middle cerebral artery bypass in stenoocclusive cerebrovascular diseases

    Institute of Scientific and Technical Information of China (English)

    Mao Zhiqi; Li Meng; William A.Li; Yu Xinguang

    2014-01-01

    Background Intra-cerebral hemorrhage (ICH) is a devastating complication that can result from superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients undergoing treatment for steno-occlusive cerebrovascular disease (CVD).There is a clinical need to find the possible risk factors to prevent ICH,as it is a significant cause of mortality and morbidity.The aim of the study was to investigate the factors associated with delayed ICH after STA-MCA bypass in patients with steno-occlusive CVDs.Methods We retrospectively analyzed the records of 163 patients seen from 2002 to 2011 with STA-MCA bypass for steno-occlusive cerebrovascular diseases at the Department of Neurosurgery,Xuan Wu Hospital,Beijing.Demographic and clinical data,including age,gender,vascular risk factors,preoperative syndrome,preoperative National Institutes of Health Stroke Scale (NIHSS),ipsilateral ischemic lesions,classification of steno-occlusive CVDs,donor branches of STA,graft patency,postoperative hypertension,and postoperative-increased MCA velocity were recorded and analyzed.Binary Logistic regression served to identify factors associated with delayed ICH after STA-MCA bypass.Results We identified 8 (4.9%) patients with delayed ICH after STA-MCA bypass.Patients with hypertension,preoperative stroke,ipsilateral ischemic lesions,postoperative hypertension and postoperative-increased MCA velocity were significantly more prone to experiencing delayed ICH after STA-MCA bypass.Logistic regression analysis shows ipsilateral ischemic lesions,postoperative hypertension,and postoperative-increased MCA velocity remained independent predictors for delayed ICH after STA-MCA bypass.Conclusion Despite the varied associated factors in patients with steno-occlusive CVDs,ipsilateral ischemic lesions,postoperative hypertension,and postoperative-increased MCA velocity could be associated with delayed ICH after STAMCA bypass.

  8. COMBINED INTRAOPERATIVE ILIAC ARTERY STENTS AND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

    Institute of Scientific and Technical Information of China (English)

    刘昌伟; 管珩; 李拥军; 郑曰宏; 刘卫

    2001-01-01

    Objective. To review our preliminary experience and evaluate our early results of a combined intraoperative iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease.``Methods. From July 1999 to April 2000, intraoperative iliac angioplasty and stenting combined with simultaneous femoro-popliteal bypass were performed on 12 lower extremities of 10 patients suffering from multilevel atherosclerotic occlusive disease. There were 8 men and 2 women, average 72 years. The indications for procedures included disabling claudication in 3 and rest pain in 7 patients.``Results. Eleven iliac angioplasty and stent procedures combined with simultaneous 9 femoro-popliteal bypass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stent placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femorofemoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 ~ 10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patency rate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% ( 11 /11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectively. The amputation rate was 8.3%(1/12).``Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively performed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a prtable C arm fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditional surgical intervention, and also, any

  9. COMBINED INTRAOPERATIVE ILIAC ARTERY STENTSAND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

    Institute of Scientific and Technical Information of China (English)

    刘昌伟; 管珩; 李拥军; 郑曰宏; 刘卫

    2001-01-01

    Objective. To review our preliminary experience and evaluate our early results of a combined intraopemtive iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease. Methods. From July 1999 to April 2000, intraoperative iliac angiOplasty and stenting combined with simultaneous femoro-pepliteal bypass were pedormed on 12 lower extremities of 10 patients suffering from multilevel athemsclemtic occlusive disease. There were 8 men and 2 women, average 72 years. The indicationsf or procedures included disabling claudication in 3 and rest pain in 7 patients. Results. Eleven iliac angioplasty and stem procedures combined with simultaneous 9 femoro-popliteal by-pass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stem placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femoro-femoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 -10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patencyrate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% (11/11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectivdy. The amputation rate was 8. 3%(1/12). Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively pedormed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a portable C ann fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditionalsurgical intervention, and also, any angioplasty and

  10. Awake off-pump coronary artery bypass surgery in 25 patients

    Institute of Scientific and Technical Information of China (English)

    GUO Huiming(郭惠明); Murali Chakravarthy; Vivek Jawali; K Jayaprakash; NV Shivananda

    2003-01-01

    Objectives To test the fea-sibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Results The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotony. There was no mortality. Mean length of stay in the intensive care tnit was 16.2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypassesin conscious patients without endotracheal general an esthesia.

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

    DEFF Research Database (Denmark)

    Wiberg, Sebastian; Schoos, Mikkel; Sillesen, Henrik;

    2015-01-01

    OBJECTIVES: Carotid artery stenosis (CAS) and vertebral artery stenosis (VAS) are associated with cerebral infarction after coronary artery bypass graft surgery (CABG). It remains unclear whether this association is causal. We investigated the associations between neurologically asymptomatic CAS...... association between the presence of cerebral vessel stenosis and acute cerebral infarction (67% vs. 27%, p = 0.047). However none of the patients with stenosis had isolated cerebral lesions in the ipsilateral vascular territory. CONCLUSION: Asymptomatic CAS and VAS is common in CABG patients and is associated...

  12. An uncommon cause of myocardial ischemia after coronary artery bypass grafting: "the dangerous drainage".

    Science.gov (United States)

    Beiras-Fernandez, Andres; Möhnle, Patrick; Kopf, Carsten; Vicol, Calin; Kur, Felix; Reichart, Bruno

    2011-06-01

    The most common causes of myocardial ischemia and myocardial infarction early after coronary artery bypass grafting surgery are early graft occlusion/thrombosis or occlusion/ thrombosis of coronary arteries due to advanced coronary heart disease. We describe a case of postoperative myocardial ischemia due to an uncommon and quickly reversible cause: mechanical compression of a vein graft by a 19F flexible silicone mediastinal drainage tube.

  13. Diet and exercise interventions following coronary artery bypass graft surgery: a review and call to action

    OpenAIRE

    Coyan, Garrett N.; Reeder, K. M.; Vacek, James L.

    2014-01-01

    Coronary artery bypass graft surgery (CABG) has been used for the treatment of coronary artery disease (CAD) for nearly 50 years, and has been performed for millions of people worldwide. However, little is known about the impact of lifestyle changes, including diet and exercise, on long-term outcomes in patients who have had CABG surgery. While clinical practice guidelines on post-CABG surgery management have been available for nearly 2 decades, evidence regarding secondary prevention behavio...

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

    OpenAIRE

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

    2015-01-01

    Background Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE. Methods This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After fo...

  15. T-Bar Utilization for Concomitant Coronary Artery Bypass Graft Operation and Left Upper Lobectomy.

    Science.gov (United States)

    Mitropoulos, Fotios; Kanakis, Meletios A; Apostolou, Anastasios; Chatzis, Andrew; Contrafouris, Constantinos; Apostolidis, Christos; Lioulias, Achilleas

    2016-01-01

    Management in patients with coexisting coronary artery disease and lung carcinoma is usually a two-stage operation, with the cardiac surgery procedure followed by pulmonary resection at a later time. Delayed tumor resection on the other hand may be detrimental. Off-pump coronary artery bypass grafting could facilitate concomitant lung resection at one stage via median sternotomy. T-bar retractor may be a useful tool in the surgical approach of this combined operation.

  16. T-Bar Utilization for Concomitant Coronary Artery Bypass Graft Operation and Left Upper Lobectomy

    Directory of Open Access Journals (Sweden)

    Fotios Mitropoulos

    2016-01-01

    Full Text Available Management in patients with coexisting coronary artery disease and lung carcinoma is usually a two-stage operation, with the cardiac surgery procedure followed by pulmonary resection at a later time. Delayed tumor resection on the other hand may be detrimental. Off-pump coronary artery bypass grafting could facilitate concomitant lung resection at one stage via median sternotomy. T-bar retractor may be a useful tool in the surgical approach of this combined operation.

  17. Use of Janke-Barron retractor for exposure of the arteries during bypass surgery.

    Science.gov (United States)

    Bridges, K G; Tomasello, D N; Hoffman, W S; MacVaugh, H

    1982-09-01

    The Janke-Barron heart support was used successfully on 1500 patients who required coronary artery bypass surgery to at least two vessels. The significant advantages it provided were improved exposure and access to all coronary arteries, elimination of damage caused by an assistant holding the heart, provision of a dryer operating field, and allowance for a smaller incision without compromising exposure of the heart.

  18. Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients.

    Science.gov (United States)

    Abla, Adib A; McDougall, Cameron M; Breshears, Jonathan D; Lawton, Michael T

    2016-05-01

    OBJECT Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. METHODS Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. RESULTS During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. CONCLUSIONS PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one

  19. 磁压榨吻合技术快速无缝线吻合犬股动脉%Rapid and effective sutureless anastomosis of femoral artery by magnetic compression anastomosis technique

    Institute of Scientific and Technical Information of China (English)

    刘仕琪; 雷鹏; 吕毅; 高睿; 关正; 王善佩; 史建华; 刘艳奎

    2015-01-01

    Objective To investigate the magnetic pinned-ring device for non-suture vascular anastomosis.Methods Twelve adult mongrel dogs of either gender were randomly divided for femoral artery in situ end-to-end anastomosis,one side of the femoral artery was anastomosised with MCA,and the other side of the femoral artery was anastomosised by hand suturing in each dog.Operation time and stoma errhysis were recorded during operation.Patency and stoma stenosis was confirmed via color Doppler ultrasound scans and X-ray cholangiography at different time points as late as 6 weeks after surgery.Results The time required to perform the vascular anastomosis was significantly shorter for the magnetic device than hand sewing[(3.89 ± 1.16) min vs.(14.16 ± 3.72) min,P =0.000].There were 6 patients who happened stoma errhysis during femoral artery hand-sewing anastomosis,and needed to be repaired.Vascular X-ray angiography and color Doppler ultrasound found blood flow magnetic anastomosis group normal with 100% patency rate and there wasn't stoma stenosis,but one stoma occlusive and four stoma stenosis in the manual suture groups.Conclusion The magnetic pinned-ring device offers a simple,fast,reliable,and efficacious technique for non-suture artery anastomosis.Application of the MCA technique can effectively reduce the complication caused by operation technique,resulting in smooth operation and improved prognosis.%目的 利用磁性压榨式吻合(MCA)技术自制新型磁性吻合环,探讨其快速无缝线吻合血管的可行性.方法 西安近郊杂种犬12只,雌雄不限,6~8月龄,体质量(16.5±3.6) kg.每只的犬左、右侧股动脉分别行MCA与手工缝合,观察并比较两种缝合技术吻合股动脉耗时、术中渗漏血情况,术后6周行超声心动图与血管X线造影检查吻合口血流及并发症情况.结果 MCA血管吻合耗时(3.89±1.16) min,手工缝合(14.16±3.72) min,两者差异有统计学意义(P =0.000).MCA术中吻合口无

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

    Science.gov (United States)

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

    2011-05-01

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

  1. The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS)

    DEFF Research Database (Denmark)

    Houlind, Kim; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard;

    2009-01-01

    BACKGROUND: Coronary Artery Bypass Graft operation for ischemic heart disease provides improved quality of life and, in some patients, prolonged survival. Concern has, however, been raised about complications that may be related to the use of cardiopulmonary by-pass (CPB) and aortic cross......-clamping. It has been hypothesized that when coronary artery by-pass grafting is performed without the use of CPB, the rate of serious complications is reduced. METHODS/DESIGN: The trial is designed as an open, randomized, controlled, clinical trial with blinded assessment of end-points. Patients at or above 70...... years of age, referred for surgical myocardial revascularisation, are included and randomised to receive coronary artery by-pass grafting either with or without the use of CPB and aortic cross-clamping. Follow-up is performed by clinical, biochemical, electrocardiographic, and angiographic data...

  2. Off-pump Y-graft coronary artery bypass in a patient with situs inversus totalis

    NARCIS (Netherlands)

    Arrigoni, Sara Camilla; Oosterhof, Richard; Mariani, Massimo Alessandro

    2010-01-01

    Situs inversus is the mirror image of situs solitus. Situs inversus with dextrocardia is termed 'situs inversus totalis'. Since situs inversus totalis is a rare condition, there are a only a few reports about off-pump coronary artery bypass (OPCAB) in these patients. A 67-year-old man with a diagnos

  3. Transfusion practice in coronary artery bypass surgeri in Denmark: a multicenter audit

    DEFF Research Database (Denmark)

    Andreasen, Jan J.; Westen, Mikkel; Pallesen, Peter A.;

    2007-01-01

    Transfusion rates in coronary artery bypass grafting (CABG) continue to vary substantially, although guidelines for allogeneic transfusion have been developed. In order to evaluate ongoing transfusion practices, we performed a multicenter audit in four Danish hospitals regarding the use of alloge...

  4. Removal of thrombus from aortocoronary bypass grafts and coronary arteries using the 6Fr hydrolyser

    NARCIS (Netherlands)

    vanOmmen, VG; vandenBos, AA; Pieper, M; denHeyer, P; Thomas, MR; Ozbeck, S; Bar, FW; Wellens, HJJ

    1997-01-01

    This study evaluates the feasibility and safety of a 6Fr hydrodynamic thrombectomy catheter, the Hydrolyser, in native coronary arteries and aortocoronory bypass grafts. With use of a conventional contrast injector, saline solution is injected into the narrow lumen of the catheter which makes a 180

  5. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery

    NARCIS (Netherlands)

    D.J. Cohen (David J.); B.A. van Hout (Ben); P.W.J.C. Serruys (Patrick); F.W. Mohr (Friedrich); C.M. Miguel (Carlos); P. den Heijer (Peter); M.M. Vrakking (M. M.); K.K. Wang (Kenneth); E.M. Mahoney (Elizabeth M.); S. Audi (Salma); K. Leadly (Katrin); K.D. Dawkins (Keith); A.P. Kappetein (Arie Pieter)

    2011-01-01

    textabstractBACKGROUND: Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in

  6. Risk of stroke after coronary artery bypass grafting: effect of age and comorbidities

    DEFF Research Database (Denmark)

    Mérie, Charlotte; Køber, Lars; Olsen, Peter Skov;

    2012-01-01

    The risk of stroke after coronary artery bypass grafting (CABG) is known to increase dramatically with age. During recent years, the age of patients operated on has increased and concomitant therapy has changed. Therefore, we have re-evaluated the risk of stroke after CABG....

  7. Prolonged ischemic heart disease and coronary artery bypass - relation to contractile reserve

    DEFF Research Database (Denmark)

    Kofoed, Klaus F; Bangsgaard, Regitze; Carstensen, Steen;

    2002-01-01

    OBJECTIVE: A major effect of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and impaired left ventricular (LV) contractile function is believed to be an improvement in LV function due to recovery of dysfunctional, but viable myocardium. However, recent studies have...

  8. Arterial pressure during cardiopulmonary bypass is not associated with acute kidney injury

    DEFF Research Database (Denmark)

    Kandler, K; Jensen, M E; Nilsson, J C;

    2015-01-01

    BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is common and is associated with increased mortality. We wanted to investigate if the arterial pressure or the use of norepinephrine during cardiopulmonary bypass were associated with AKI. METHODS: A retrospective analysis of patients who...

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

    Science.gov (United States)

    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.

  10. The hemodynamic behavior of arterial anastomosis using fibrin sealant: experimental study in swine.

    Science.gov (United States)

    Rocha, Eduardo A V; de Souza, Cláudio

    2008-11-01

    The wide use of biological sealants as a reinforcement for arterial sutures and the small experimental base in literature motivated this study. Our aim was to evaluate the flow, tear pressure, and the need of reinforcement stitches in sutured arteries after a cross-section. This research project complied with the Helsinki convention. The Tissucol (Baxter) fibrin sealant was used in all experiments. The femoral and carotid arteries of 17 swine from the same breed (weighing from 15 to 20 kg) were cross-sectioned after heparinization and subjected to anastomoses using a single continuous plane of 7-0 prolene. We worked with 68 artery samples, 34 in the treatment group and 34 in the control group. For each animal, one carotid and one femoral artery randomly received fibrin sealant with the contralateral side being used as a control. The need and the number of reinforcement stitches were recorded. Ten minutes after protamine infusion, the animals were sacrificed and the arteries were catheterized respecting 1 cm proximal and distal. The arteries were measured and placed on a flow meter to evaluate the flow rate of 10 mL of 0.9% NaCl in a 50 cm high column. The arteries were then subjected to air infusion at increasingly higher pressures (stepwise increases of 25 mm Hg), the grafts were dipped in 0.9% NaCl solution, the first air leakage was observed, and the tear pressure recorded. Data was analyzed with EpiInfo 6 data manager. The external diameters and thickness of the arteries were similar in both the treatment and control group. There was no significant difference between the groups regarding the tear pressure (P = 0.329), flow rate (P = 0.943), and the number of samples with a tear pressure above 200 mm Hg. However, the sealant reduced the number of reinforcement stitches necessary (P = 0.029). We conclude that fibrin sealant reduces the need of additional stitches; however, it does not change the tear pressure nor significantly reduces the flow. PMID:18959674

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

    Directory of Open Access Journals (Sweden)

    Mahdi Haddadzadeh

    2015-01-01

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

  12. Agenesis of the internal carotid artery with a trans-sellar anastomosis: CT and MRI findings in late-onset congenital hypopituitarism

    Energy Technology Data Exchange (ETDEWEB)

    Mellado, J.M.; Merino, X.; Ramos, A.; Salvado, E.; Sauri, A. [Inst. de Diagnostic per la Imatge, Centre de Ressonancia Magnetica de Tarragona (Spain)

    2001-03-01

    A 29-year-old woman with a history of hypothyroidism since early childhood developed hypopituitarism. CT and MRI revealed anterior pituitary hypoplasia, an ectopic posterior lobe, a Chiari I malformation and agenesis of the right internal carotid artery with a trans-sellar anastomosis. This constellation of findings constitutes a previously unreported association in congenital hypopituitarism of late onset. The usefulness of imaging modalities and the pathogenic implications are also discussed. (orig.)

  13. Comparative study of graft flow between on-pump and off-pump coronary bypass surgery for patients with multivessel coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Xin Chen; Ming Xu; Zhibing Qiu; Yinshuo Jiang; Liming Wang; Liqiong Xiao

    2006-01-01

    Objective: To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods: The grafts flow was studied in 100 patients of OPCAB and compared with100 cases of CCABG by means of Medi-Stim Butterfly Flowmeter measurement intraoperatively. Results: The mean number of the distal anastomosis was 3.78+ 1.11 in CCABG group, and 3.83 + 0.93 in OPCAB group. The index of completeness of revascularization in CCABG group was 1.01 + 0.08, and 1.10+ 0.09 in OPCAB group. The flow of grafts was satisfied in all patients. The PI values were all under 5. There was no significant difference in the mean graft flow and PI value between two groups.Conclusion: OPCAB can provide the same grafts flow and similar completeness of revascularization when compared with CCABG which indicates the similar anastomosis quality of grafts in OPCAB and CCABG groups.

  14. Effects of massage therapy on sleep quality after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Flavia Baggio Nerbass

    2010-01-01

    Full Text Available INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0, during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3 using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5%, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m² were randomized into control (n = 20 and massage therapy (n = 20 groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006 and Day 2 (p=0.028 in addition, they reported a more effective sleep during all three days (p=0.019 when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

  15. Iodine-123 IMP SPECT before and after by-pass surgery in a patient with occlusion of left anterior and middle cerebral arteries with basal abnormal telangiectasis (unilateral Moyamoya disease)

    Energy Technology Data Exchange (ETDEWEB)

    Honda, Norinari; Machida, Kikuo; Takishima, Teruo; Kaizu, Hiroyuki; Sugimoto, Eiichi

    1987-09-01

    A case of left anterior and middle cerebral arterial occlusion with angiographic features similar to Moyamoya disease was reported. IMP SPECT of the patient revealed the success of by-pass surgery clearly. The patient complained of transient right hemiparesis with aphasia 4 times. The cerebral arteriography disclosed occlusions of left anterior and middle cerebral arteries at their proximal portions. Right internal carotid and its branches were normal. I-123 IMP SPECT study showed hypoperfusion in left temporal lobe, basal ganglia with incomplete reperfusion on the delayed (4 hours after injection) SPECT images. After the superficial temporal-middle cerebral artery anastomosis, I-123 IMP SPECT showed improvement of the brain blood flow. I-123 IMP SPECT was very useful in detecting the ischemic areas and evaluating the revascularizing surgery in this case.

  16. Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass.

    Science.gov (United States)

    Lansen, T A; Kasoff, S S; Arguelles, J H

    1989-07-01

    Saccular intracranial aneurysms occur infrequently in children, and the incidence of pediatric giant aneurysms is statistically in the same proportion as in adults. The management of these giant aneurysms can be treacherous. This paper presents a case of a 9-year-old boy with a giant aneurysm of the right middle cerebral artery that was successfully managed by ligation of the middle cerebral artery using a Drake tourniquet with the patient awake and by augmentation of the middle cerebral artery circulation with superficial temporal artery-middle cerebral artery anastomosis without excision of the lesion.

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

    Directory of Open Access Journals (Sweden)

    Shahzad G. Raja

    2013-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  19. Frequent change of procedure during coronary artery bypass surgery suggests insufficient preoperative diagnostic strategy

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Thayssen, Per;

    2007-01-01

    We sought to evaluate how often and in what way surgeons change peroperatively their preoperative coronary artery bypass grafting strategy and to what degree these changes affect postoperative graft patency. A series of 109 patients with stable angina pectoris and at least one occluded coronary...... artery participated. The surgeon filled in a questionnaire pertaining to the planned localization and number of grafts. These estimates were compared to procedures actually performed and with the angiographic outcome six months after bypass surgery. Planned and actually inserted grafts disclosed...... a discrepancy in 22% of the patients, resulting in a lower or higher number of grafts than pre-operatively estimated. The difference in shift rates between the three sites, left anterior descending, left circumflex, and right coronary artery, was significant (P=0.014). Patency rates were highest when only...

  20. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ... distributing blood supply to. He the went for heart catheterization, which revealed him to have 100 percent ... the artery on the front surface of the heart. And his left anterior descending, which is really ...

  1. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ... 59:44 CHRIS MCCARTY, MD: Yeah. Okay. Thankfully technology keeps working with us, so we have this ... artery. Now we're going to use new technology that we were one of the first to ...

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

    Directory of Open Access Journals (Sweden)

    Hafiz Abdul Moiz Fakih

    2016-02-01

    Full Text Available 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.

  3. Super obese behave different from simple and morbid obese patients in the changes of body composition after tailored one anastomosis gastric bypass (BAGUA

    Directory of Open Access Journals (Sweden)

    M. Garciacaballero

    2014-05-01

    Full Text Available Introduction: Super obese patients behave different from simple and morbid obese patients when they reach final changes of body composition (BC after bariatric surgery. This has led us to tailor One Anastomosis Gastric Bypass (BAGUA to achieve better results in this group of patients. Patients and Methods: We studied 83 (37 diabetic and 46 nondiabetic BMI 30 and up patients who completed all evaluation appointment (preoperative, 10 days, 1, 3, 6 and 12 months after tailored BAGUA for diabesity. We used the Tanita body composition analyzer BC-420 MA by the method of single frequency impedance to analyze the evolution of BC in patients classified by BMI 30 - 34,9, 35 - 50, and >50. Results: While preoperative excess weight presented dramatic decreases after tailored BAGUA in all the groups, super obese have different final BC. Diabetics retained more fat mass and visceral fat, where super obese have double (14 kg that simple obese patients (6 kg, they lost more muscle mass, and have higher basal metabolism. The final BC is altered in all parameters if diabetes is added. Conclusions: The reduction of the preoperative excess weight is motivated largely by the tailored effect of BAGUA. Patients BMI 30-50 behaved homogeneous in BC after surgery while patients BMI >50 behave different. Super obese lose less weight, retained more fat mass, visceral fat, bone mass, and total water. This effect should be treated by more aggressive surgery by measuring the entire small intestine to make a proper exclusion (tailored to achieve homogeneous effects.

  4. Off-pump Coronary Endarterectomy and Bypass Grafting in Patients With Diffuse Coronary Artery Disease

    Institute of Scientific and Technical Information of China (English)

    Chen Xin; Xu Ming; Jiang Yinshuo; Sui Kaihu; Qiu Zhibing; Wang Liming; Liu Peisheng

    2006-01-01

    Objectives To summarize our preliminary experience on off-pump coronary endarterectomy and bypass grafting in patients with diffuse coronary artery disease. Methods Over a 3-year period, 53 patients (41 male) with diffuse coronary artery disease underwent off-pump coronary endarterectomy and bypass grafting at our institution.Patients' age ranged from 55 to 79 years. Prior to surgery, 70% of patients were in CCS angina class 2 (n=5) or 3 (n=32), and nearly half of them (26/53) had history of myocardial infarction. Most patients (n=50) had triple vessel lesions, with left main stem involvement in 9. Their left ventricular ejection fraction ranged from 26% to 65% (mean 52%). At the end of operation, a flow-meter was routinely applied to measure the perfusion flow of each postendarterectomy graft. Results In total, 70 endarterectomies were performed in 53 patients, including 38 in left anterior descending artery (LAD), 8 in circumflex artery and 24 in right coronary artery. Four operations were emergency or urgent in nature. Five patients received on-lay venous patch after endarterectomy in LAD, followed by left internal mammary artery (LIMA) grafting on the patch. The graft conduits included 53 LIMAs and 2 radial arteries,and saphenous veins in others. Mean number of grafts per patient was 3.75. The overall index of completeness of revascularization reached 1.03±0.07. There was no death in this group of patients during their post-operative hospital stay (mean duration = 9 days).Intra-operatively, 63 (90%) out of the 70 grafts after coronary endarterectomy showed satisfactory flow. Two patients had perioperative myocardial infarctions but neither experienced significant hemodynamic deteriations. Conclusions Off-pump coronary endarterectomy with bypass grafting is technically feasible and can be performed safely in patients with diffuse coronary artery disease. This strategy may help to improve the completeness of myocardial revascularization.

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

    Science.gov (United States)

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

    1980-01-01

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

  6. Is it necessary to stent renal artery stenosis patients before cardiopulmonary bypass procedures?

    Institute of Scientific and Technical Information of China (English)

    ZHENG Bin; YAN Hong-bing; LIU Rui-fang; CHENG Shu-juan; WANG Jian; ZHAO Han-jun; SONG Li

    2011-01-01

    Background Acute kidney injury (AKI) is associated with poor prognosis after cardiopulmonary bypass. The aim of this retrospective study was to investigate whether stent implantation before cardiopulmonary bypass has beneficial effect on development of AKI in renal artery stenosis (RAS) patients.Methods In this retrospective study, patients with abnormal baseline serum creatinine (SCr, >106 μmol/L) were not included. Included patients (n=69) were divided into two groups. Group 1 included 31 RAS patients receiving no stent implantation before cardiopulmonary bypass. Group 2 included 38 RAS patients having received stent implantation just before cardiopulmonary bypass. To assess AKI after cardiopulmonary bypass, serum urea nitrogen, SCr and creatinine clearance were recorded at baseline, at the end of operation, during the first and second postoperative 24 hours.Results Baseline characteristics were similar between groups. Serum urea nitrogen, SCr, creatinine clearance before and after cardiopulmonary bypass were also similar class groups. Incidence of AKI in group 1 was not significantly different from group 2. In group 1, AKI defined by RIFLE between occurred in 7 (22.6%) patients: 5 (16.1%) with RIFLE-R,2 (6.5%) with RIFLE-I, and no patients with RIFLE-F. In group 2, 10 patients (26.3%) had an episode of AKI during hospitalization: 6 (15.8%) had RIFLE-R, 4 (10.5%) had RIFLE-I, and no patients had RIFLE-F.Conclusions There are no data suggesting that it is necessary to stent RAS patients with normal SCr before cardiopulmonary bypass. However, it cannot be concluded that RAS is not associated with AKI after cardiopulmonary bypass.

  7. Anterior ischemic optic neuropathy after conventional coronary artery bypass graft surgery

    Science.gov (United States)

    Dorecka, Mariola; Miniewicz-Kurkowska, Joanna; Romaniuk, Dorota; Gajdzik-Gajdecka, Urszula; Wójcik-Niklewska, Bogumiła

    2011-01-01

    Summary Background Perioperative optic neuropathy is a disease which can lead to serious, irreversible damage of vision. This complication could be the result of non-ocular surgery, for example, cardiac or spinal procedures. We present a case of anterior ischemic neuropathy (AION) which occurred following a conventional coronary artery bypass graft procedure. Case Report A 57-year-old man, 4 days after Conventional Coronary Artery Bypass Graft surgery as result of multi-vessel stabile coronary artery disease and history of anterolateral wall myocardial infarction, was admitted to the Eye Clinic due to significant loss of vision in his right eye. The patient had hypertension and was a heavy smoker. On admission, the slit lamp examination revealed a relative afferent pupillary defect in the right eye. The fundus examination showed optic disc edema with the presence of flame hemorrhages. Best corrected visual acuity (BCVA) was 0.02. The results of eye examination and fluorescein angiography confirmed the diagnosis of AION. Anti-aggregation and antithrombotic treatment was continued with steroids and vasodilators. After 7 days of this treatment we noticed the improvement of BCVA to 0.2. At 6-month follow-up, the vision was stable, and fundus examination revealed optic disc atrophy. Conclusions After cardiac surgical operations, such as coronary artery bypass graft procedures, anterior ischemic optic neuropathy may occur. In those cases, close cooperation between the various specialists is necessary. PMID:21629193

  8. The effect of cardiopulmonary bypass in coronary artery bypass surgeries (on-pump versus off-pump) on erectile function and endothelium-derived nitric oxide levels

    OpenAIRE

    Onder Canguven; Selami Albayrak; Ahmet Selimoglu; Muhsin Balaban; Ahmet Sasmazel; Ayse Baysal

    2011-01-01

    PURPOSE: To investigate the effects of on-pump and off-pump coronary artery bypass grafting (CABG) on the erectile function and endothelium-derived nitric oxide (eNO) levels. MATERIALS AND METHODS: Twenty-eight consecutive patients were randomized into two groups depending on use of cardiopulmonary bypass in CABG surgery. The erectile function was evaluated by using the IIEF-5 questionnaire. The plasma eNO levels were determined at baseline and after reactive hyperemia before and after surger...

  9. Use of pulmonary artery catheter in coronary artery bypass graft. Costs and long-term outcomes.

    Directory of Open Access Journals (Sweden)

    Fei Xu

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

  10. The effects of fenoldopam on coronary conduit blood flow after coronary artery bypass graft surgery.

    LENUS (Irish Health Repository)

    Halpenny, M

    2012-02-03

    OBJECTIVE: To quantify the effects of fenoldopam, 0.1 microg\\/kg\\/min, on left internal mammary artery (LIMA) and saphenous vein blood flow after coronary anastomosis. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: University teaching hospital, single institution. PARTICIPANTS: Thirty-one American Society of Anesthesiologists III patients undergoing elective coronary revascularization. INTERVENTIONS: A perivascular ultrasonic flow probe (Linton Instrumentation, Norfolk, UK) was placed around the LIMA and saphenous vein graft after coronary anastomosis. MEASUREMENTS AND MAIN RESULTS: Immediately before and at 5-minute intervals for 15 minutes after starting the infusion, blood flow was measured in the LIMA and one saphenous vein graft using a transit time ultrasonic flow probe. Heart rate, blood pressure, and central venous pressure were documented at these time points. Administration of fenoldopam, 0.1 microg\\/kg\\/min, did not alter heart rate or blood pressure. A small, nonsignificant increase in LIMA blood flow occurred during the 15-minute study period (30 +\\/- 12 to 35 +\\/- 10 mL\\/min) in patients who received fenoldopam. No significant changes occurred in the placebo group. CONCLUSIONS: The findings indicate that fenoldopam, 0.1 microg\\/kg\\/min, did not influence coronary conduit blood flow to a clinically significant extent. The small increase in LIMA blood flow may be of greater importance in high-risk patients or in the prevention of coronary arterial spasm.

  11. Intraoperative conversion to on-pump coronary artery bypass grafting is independently associated with higher mortality in patients undergoing off-pump coronary artery bypass grafting: A propensity-matched analysis

    OpenAIRE

    Deepak Prakash Borde; Balaji Asegaonkar; Pramod Apsingekar; Sujeet Khade; Savni Futane; Bapu Khodve; Ajita Annachhatre; Manish Puranik; Sayaji Sargar; Yogesh Belapurkar; Anand Deodhar; Antony George; Shreedhar Joshi

    2016-01-01

    Context: One of the main limitations of off-pump coronary artery bypass grafting (OPCAB) is the occasional need for intraoperative conversion (IOC) to on-pump coronary artery bypass grafting. IOC is associated with a significantly increased risk of mortality and postoperative morbidity. The impact of IOC on outcome cannot be assessed by a randomized control design. Aims: The objective of this study was to analyze the incidence, risk factors, and impact of IOC on the outcome in patients underg...

  12. Post re-anastomosis demonstration of regain in function in non-visualized upper half of kidney in a dual arterial allogenic renal graft on renal scintigraphy

    International Nuclear Information System (INIS)

    A young male patient with end stage renal disease underwent renal allograft having dual arterial supply. Immediate post-operative urine output dropped, an urgent Technetium-99m-mercaptoacetyltriglycine (99mTc-MAG3) renogram revealed non-visualized upper-half and the preserved perfusion and parenchymal function of the small transplant kidney. Patient was re-explored and re-anastomosis was performed. A renogram at 24h post re-anastomosis revealed increase in the size of renal allograft, with preserved perfusion to the upper-half of transplant. Transplant kidney biopsy of the Upper-half showed acute tubular necrosis. 99mTc-MAG3renogram at 10 days post re-vascularization remains unchanged with persistent improvement at 2 months follow-up. We conclude that early recognition of renal functional loss allows early management and the high probability of salvaging the renal function

  13. Effects of angiotensin-converting enzyme inhibition in low-risk patients early after coronary artery bypass surgery

    NARCIS (Netherlands)

    Rouleau, Jean L.; Warnica, Wayne J.; Baillot, Richard; Block, Pierre J.; Chocron, Sidney; Johnstone, David; Myers, Martin G.; Calciu, Cristina-Dana; Dalle-Ave, Sonia; Martineau, Pierre; Mormont, Christine; van Gilst, Wiek H.

    2008-01-01

    Background-Early after coronary artery bypass surgery (CABG), activation of numerous neurohumoral and endogenous vasodilator systems occurs that could be influenced favorably by angiotensin-converting enzyme inhibitors. Methods and Results-The Ischemia Management with Accupril post -bypass Graft via

  14. To ventilate or not after minimally invasive direct coronary artery bypass surgery : The role of epidural anesthesia

    NARCIS (Netherlands)

    de Vries, AJ; Mariani, MA; van der Maaten, JMAA; Loef, BG; Lip, H

    2002-01-01

    Objective: To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia. Design: Randomized prospective study. Setting: University hospital, single inst

  15. [Stented dilated or varicose veins as arterial bypass transplants: experimental and initial clinical results].

    Science.gov (United States)

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

    1991-01-01

    Dilated and varicose veins are usually not used as arterial bypass-grafts despite they are lined with functional endothelium. External support by a constrictive mesh tube could conform these veins into evenly calibrated bypass-grafts. Ovine jugular veins could be constricted from 15 to 6 mm diameter without forming folds on the inner flow surface. 6 months after implantation of 5 cm long jugular vein segments into the carotid arteries of 7 sheep the inner diameter was 19.5 +/- 3.3 mm for native veins (n = 4) and 7.6 +/- 0.8 mm for constricted veins (n = 10). Intimal hyperplasia was reduced from 0.4 +/- 0.2 mm in native to 0.23 +/- 0.07 mm in reinforced veins (p = 0.03). Mesh tube constricted varicose veins were used as bypass material in 11 infrainguinal reconstructions. All grafts were well calibrated at control angiography. External constriction by mesh tubes is a means to convert varicose veins into suitable bypass grafts. PMID:1950138

  16. CK-MB release following coronary artery bypass grafting in the absence of myocardial infarction.

    Science.gov (United States)

    Lee, M E; Sethna, D H; Conklin, C M; Shell, W E; Matloff, J M; Gray, R J

    1983-03-01

    Elevation of levels of the myocardial-specific isoenzyme of creatine kinase (CK-MB) in the immediate postoperative period in patients undergoing coronary artery bypass grafting is usually associated with myocardial necrosis. However, mean isoenzyme elevations of 18 +/- 2 IU/L (standard error of the mean) were recently observed in 6 patients in the absence of electrocardiographic or scintigraphic (technetium 99m stannous pyrophosphate) evidence of perioperative myocardial infarction. To test the hypothesis that surgical trauma of the atrium and aorta during cannulation for cardiopulmonary bypass might contribute to elevated CK-MB levels, biopsy of the right atrial appendage and aorta of 7 patients was done at operation, the tissue samples were assayed for total creatine kinase (CK) activity using the Rosalki technique, and for CK-MB using column chromatography. The results indicate that the human atrium is a rich source of CK, with the proportion of CK-MB similar to that present in the ventricle (20%). In addition, technical considerations inherent in the performance of coronary bypass surgery may result in release of CK-MB, causing elevated serum enzyme levels in the post-coronary artery bypass patient in the absence of myocardial infarction.

  17. Neuropsychological dynamics in patients with type 2 diabetes mellitus undergone coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Ol'ga Aleksandrovna Trubnikova

    2012-12-01

    Full Text Available Aim. The study was aimed at evaluation of hospital neuropsychological dynamics in ischemic heart disease patients with comorbid type 2 diabetes mellitus (T2DM undergone on-pump coronary artery bypass grafting.Materials and methods. 14 from a total of 37 examined patients had T2DM. Diabetic patients were found to have lower attention parameters prior to the intervention in comparison to non-diabetic controls. At days 7-10 after the surgery all patients demonstrated deterioration of cognitive functions.Results. We observed deeper deterioration in diabetic patients, regarding attention, memory, sensorimotor speed and quantity of erroneous test responses, as measured against individuals with normal glucose tolerance.Conclusion. Diabetic patients undergone coronary artery bypass surgery show lower cognitive characteristics when compared to controls without T2DM, suggesting this cohort to be a high-risk group for further cognitive decline.

  18. Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Nygård, Eigil; Sørensen, Lars H; Hviid, Lamia B;

    2004-01-01

    OBJECTIVE: This study was designed to assess the effects of a perioperative dosing regimen of amiodarone administration, high thoracic epidural anesthesia (TEA), or a combination of the 2 regimens on atrial fibrillation (AF) after coronary artery bypass grafting (CABG). DESIGN AND SETTING......: The study was prospective, controlled, and randomized and was performed in a tertiary health care center associated with a university. PARTICIPANTS: One hundred sixty-three patients scheduled for coronary artery bypass graft surgery. INTERVENTIONS: In this 2 x 2 factorial-designed study the patients were...... randomized to 1 of 4 regimens in which group E had perioperative TEA, group E+A had TEA and amiodarone, group A had amiodarone, and group C served as control. The epidural catheter was inserted at T1-3 the day before surgery. TEA groups received TEA for 96 hours. The amiodarone regimen consisted of a single...

  19. Compromised Cardiopulmonary Exercise Capacity in Patients Early After Endoscopic Atraumatic Coronary Artery Bypass Graft: Implications for Rehabilitation

    OpenAIRE

    Hansen, Dominique; Roijackers, Ruben; Jackmaert, Lore; Robic, Boris; Hendrikx, Marc; Yilmaz, Alaaddin; Frederix, Ines; Rosseel, Michael; DENDALE, PAUL

    2016-01-01

    Objective: The purpose of this work was to test the hypothesis that cardiopulmonary exercise tolerance is better preserved early after endoscopic atraumatic coronary artery bypass graft (endo-ACAB) surgery versus coronary artery bypass graft (CABG) surgery. Design: Twenty endo-ACAB surgery patients, 20 CABG surgery patients, and 15 healthy subjects executed a maximal cardiopulmonary exercise test, with assessment and comparison of cycling power output, O2 uptake, CO2 output, respiratory ...

  20. Anastomose mamária-coronária: análise de 2923 casos Mammary-coronary artery anastomosis: analysis of 2923 cases

    Directory of Open Access Journals (Sweden)

    Jarbas J Dinkhuysen

    1987-04-01

    ção entre 5 a 10 anos, apenas com mamária isolada, em 55 reestudos constataram-se 94,4% (50 de mamárias permeáveis e 5,6% (3 de ocluidas. A mortalidade intra-hospitalar, nos 2923 casos, foi de 3,45%.At the Instituto Dante Pazzanese de Cardiollogia, the use of mammary-coronary anastomosis was iniciated in 1972, isolated or with saphenous vein by-pass or other procedure. Initially only left internal mammary artery LAD anastomosis was employed in a few (57 cases. In 1973/1974, the aplication of this technique was intensified-386 cases. The method was practically descontinued between 1975 to 1982 - only 43 cases were performed. Since then, its use increased steadily and the right internal mammary artery has been used as well. In 1984, studying 177 patients, we observed that this technique does not influence the incidence of external dehiscence on the reoperation for bleeding; but in 25% occurred an elevation of hemolateral diaphragm, in 17% atelectasis, and in 27.6% pleural effusion. In 654 patients with mammary-coronary anastomoses and saphenous vein grafts followed up to nine years; patency was 91.5% for mammaries and 70.6% for saphenous veins. In another group of 102 patients with isolated mammarycoronary anastomosis patency was 94.4% in a period between 5 and 10 years. The mortality rate of all 2923 cases was 3.45%.

  1. Comparison of Treatment Outcomes in Off-pump Coronary Artery Bypass Graft and Medical Therapy in Patients with Triple-vessel Coronary Artery Disease and Severe Ventricular Dysfunction

    OpenAIRE

    Feridoun Sabzi; Hossein Karim; Shahrokh Chaghazardi; Atefeh Asadmobini

    2016-01-01

    Introduction: Heart failure is a major hazard for public health. Despite recent advance in medical therapy, there is not enough information on the outcome of off-pump coronary artery bypass (OPCAB) and medical therapy on the patients with severe ventricular dysfunction and triple-vessel (CAD). This study aimed to compare treatment outcomes and mortality rate in patients undergoing off-pump coronary artery bypass (OPCAB) surgery and medical therapy who presented with severe ventricular dysfunc...

  2. To Pace Or Not To Pace! – Prevention Of Atrial Fibrillation After Coronary Artery Bypass Surgery

    OpenAIRE

    Vora, Amit

    2005-01-01

    Atrial fibrillation (AF) is a very undesirable, but unfortunately a common arrhythmia following coronary artery bypass graft (CABG) surgery, occurring in up to 40% of patients. There is an increase in hospital stay and adds to the overall cost of the surgery. Atrial fibrillation occurrence may identify a subset of patients with reduced survival. Prevention of AF therefore would have a significant positive impact on patients undergoing CABG surgery. Based on the mechanism of postoperative AF, ...

  3. Factors Associated with Early Adverse Events after Coronary Artery Bypass Grafting Subsequent to Percutaneous Coronary Intervention

    OpenAIRE

    Kamal, Yasser Ali; Mubarak, Yasser Shaban; Alshorbagy, Ashraf Ali

    2016-01-01

    Background A previous percutaneous coronary intervention (PCI) may affect the outcomes of patients who undergo coronary artery bypass grafting (CABG). The objective of this study was to compare the early in-hospital postoperative outcomes between patients who underwent CABG with or without previous PCI. Methods The present study included 160 patients who underwent isolated elective on-pump CABG at the department of cardiothoracic surgery, Minia University Hospital from January 2010 to Decembe...

  4. Screening Preoperative Peptide Biomarkers for Predicting Postoperative Myocardial Infarction after Coronary Artery Bypass Grafting

    OpenAIRE

    Zhibin Jiang; Ping Hu; Jianxin Liu; Dianjun Wang; Longyu Jin; Chao Hong

    2014-01-01

    Postoperative myocardial infarction (PMI) is one of the most serious complications of cardiac surgeries. No preoperative biomarker is currently available for predicting PMI after cardiac surgeries. In the present study, we used a phage display peptide library to screen potential preoperative peptide biomarkers for predicting PMI after coronary artery bypass grafting (CABG) surgery. Twenty patients who developed PMI after CABG and 20 age-, sex-, and body mass index-matched patients without PMI...

  5. Perioperative optic neuropathy in patients undergoing off-pump coronary artery bypass graft surgery

    OpenAIRE

    Rajani Battu; Apoorva Prasad; Muralidhar Kanchi

    2014-01-01

    Aims and Objectives: Perioperative optic neuropathy (PON) is a rare, but devastating complication following coronary artery bypass graft surgery (CABG). We performed a retrospective study of PON associated with off-pump CABG (OPCABG) to identify possible risk factors. Materials and Methods: 1442 patients underwent OPCABG over a 10-month period from October 2008 to August 2009; PON was identified in four (0.28%) patients. A retrospective review of the charts was done to identify the patient ch...

  6. Bispectral index-guided anaesthesia for off-pump coronary artery bypass grafting

    OpenAIRE

    Muralidhar Kanchi; Banakal Sanjay; Murthy Keshav; Garg Rajneesh; Rani G; Dinesh R

    2008-01-01

    Bispectral index (BIS) monitoring may assist reduction in utilisation of anaesthetic agents during general surgical procedures. This study was designed to test whether the use of BIS monitoring reduces the anaesthetic requirements during off-pump coronary artery bypass grafting (CABG). This prospective - clinical trial was conducted on 40 adult patients undergoing elective off-pump CABG. Patients received either isoflurane or propofol anaesthesia. BIS monitoring, which guided the dose of anae...

  7. Open Surgical Bypass for Superficial Femoral Artery Occlusion Caused by Blunt Trauma

    OpenAIRE

    Ikeda, Akihiko; Kudo, Yohei; Maeda, Michihiro; Tochiki, Aito; Ichimura, Haruto; Uesugi, Masafumi; Jikuya, Tomoaki

    2015-01-01

    Blunt vascular trauma of the lower extremities brings about a high amputation rate, because other organ injuries disturb revascularization. We experienced a case of a superficial femoral artery occlusion caused by blunt trauma. The patient also had a femoral bone fracture and a large skin defect with deep muscular injuries of the thigh. We performed a femoropopliteal (FP) bypass using a saphenous vein which was routed through the contaminated wound. Postoperative vacuum-assisted closure thera...

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

    OpenAIRE

    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 un...

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

    OpenAIRE

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

    2012-01-01

    BACKGROUND: Cardiovascular disorders are an important public health problem worldwide. They are also the leading cause of mortality and morbidity. Therefore, American Heart Association proposed cardiac rehabilitation program as an essential part of care for cardiac patients to improve functional capacity. The aim of this study was to evaluate the effectiveness of cardiac rehabilitation program on functional status and some hemodynamic responses in patients after coronary artery bypass graft (...

  10. Effects of Cardiac Rehabilitation Program on Right Ventricular Function after Coronary Artery Bypass Graft Surgery

    OpenAIRE

    Akram Sardari; Seyed Kianoosh Hosseini; Ali Taherian; Arezoo Zoroufian; Mehrdad Sheikhvatan

    2012-01-01

    Background: Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery (CABG). However, the effect of this program on right ventricular function following CABG is unclear. The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular (RV) function in a cohort of patients who underwent ...

  11. Cardiac rehabilitation for patients after coronary artery bypass graft surgery Nursing Interventions

    OpenAIRE

    Tsaloglidou A.; Lavdaniti M.; Ioannidis T.

    2010-01-01

    Purpose: To describe the way by which the rehabilitation of the patients that have undergone cardiac surgery is performed, to present the content of the cardiac rehabilitation programs and to determine the nursing role in the whole process. Methodology: Literature review of the relevant articles in the databases pubmed and scopus. Results: The patients with coronary heart disease usually face a lot of problems in their everyday life. Coronary artery bypass graft surgery (CABG) is commonly per...

  12. Early mobilization and exercise in elderly patients after coronary artery bypass grafting

    OpenAIRE

    Almeida, Klebson; Novo, André; Carneiro, Saul Rassy; Preto, Leonel; Mendes, Eugénia

    2015-01-01

    Coronary Artery Bypass Grafting (CABG) is one of the most commonly performed surgical procedures. During the postoperative period, the prolonged bed rest increases the possible occurrence of systemic complications, resulting from immobilization. Aim: This quasi-experimental study aims to analyze the hemodynamic variables and the peak expiratory flow (peak flow) during the application of two different exercise protocols (with and without passive exercise peddler) compared with the traditional ...

  13. Vasoplegic Syndrome after Off-Pump Coronary Artery Bypass Surgery: An Unusual Complication

    OpenAIRE

    Raja, MRCS, Shahzad G.; Dreyfus, Gilles D.

    2004-01-01

    We report the case of a 65-year-old man who developed norepinephrine-resistant vasoplegic syndrome after elective off-pump coronary artery bypass surgery (OPCAB). The failure of norepinephrine to improve the patient's hemodynamics prompted us to start treatment with vasopressin; within 30 minutes, the hemodynamics began to improve. After 12 hours, the patient was stable enough to be weaned from the vasopressin. He was discharged from the hospital on the 10th postoperative day. To our knowledg...

  14. Ischemia monitoring in off-pump coronary artery bypass surgery using intravascular near-infrared spectroscopy

    Directory of Open Access Journals (Sweden)

    Zerkowski Hans-Reinhard

    2006-05-01

    Full Text Available Abstract Background In off-pump coronary artery bypass surgery, manipulations on the beating heart can lead to transient interruptions of myocardial oxygen supply, which can generate an accumulation of oxygen-dependent metabolites in coronary venous blood. The objective of this study was to evaluate the reliability of intravascular near-infrared spectroscopy as a monitoring method to detect possible ischemic events in off-pump coronary artery bypass procedures. Methods In 15 elective patients undergoing off-pump myocardial revascularization, intravascular near-infrared spectroscopic analysis of coronary venous blood was performed. NIR signals were transferred through a fiberoptic catheter for signal emission and collection. For data analysis and processing, a miniature spectrophotometer with multivariate statistical package was used. Signal acquisition and analysis were performed before and after revascularization. Spectroscopic data were compared with hemodynamic parameters, electrocardiogram, transesophageal echocardiography and laboratory findings. Results A conversion to extracorporeal circulation was not necessary. The mean number of grafts per patient was 3.1 ± 0.6. An intraoperative myocardial ischemia was not evident, as indicated by electrocardiogram and transesophageal echocardiography. Continuous spectroscopic analysis showed reproducible absorption spectra of coronary sinus blood. Due to uneventful intraoperative courses, clear ischemia-related changes could be detected in none of the patients. Conclusion Our initial results show that intravascular near-infrared spectroscopy can reliably be used for an online intraoperative ischemia monitoring in off-pump coronary artery bypass surgery. However, the method has to be further evaluated and standardized to determine the role of spectroscopy in off-pump coronary artery bypass surgery.

  15. Repair of left ventricular aneurysm during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; GU Cheng-xiong; WEI Hua; LIU Rui; CHEN Chang-cheng; FANG Ying

    2005-01-01

    Background Acute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery.Methods From January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejection fraction was 26%±9%. The mean left ventricular, end diastolic diameter was (57.5±7.1) mm. The ventricular preoperative and postoperative performances were compared. χ2 test and Student's t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.Results Hospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P<0.001). The mean left ventricular, end diastolic diameter decreased significantly (P<0.001). Conclusions Surgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.

  16. Coronary artery bypass surgery in a patient with Kartagener syndrome: a case report and literature review

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    Bougioukas Ioannis

    2010-08-01

    Full Text Available Abstract Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener syndrome was reffered to our department due to 3-vessel coronary disease. An off-pump coronary artery bypass operation was performed using both internal thoracic arteries and a saphenous vein graft. We performed a literature review for cases with Kartagener syndrome, coronary surgery and dextrocardia. Although a few cases of dextrocardia were found in the literature, no case of Kartagener syndrome was mentioned.

  17. Off-pump and on-pump coronary artery bypass surgery:time to move on

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja

    2004-01-01

    @@ To the editor: Chen and colleagues,1 and the editorial staff of the Chinese Medical Journal, deserve much credit for carrying out and publishing a prospective comparative study of on-pump and off-pump coronary artery bypass (OPCAB) surgery in 300 patients with triple-vessel coronary artery disease. Although this study is limited by non-randomization and selection bias yet contrary to the previously published prospective, randomized studies by Van Dijk et al,2 and Ascione et al,3 the patient population of this study is more representative of current coronary artery surgery practices. Even more important is the conclusion that OPCAB can be applied to patients with triple-vessel coronary artery disease and "in experienced hands" can achieve similar completeness of revascularization and similar early surgical results.

  18. "Ultrasonographic Screening for Abdominal Aortic Aneurysm in Iranian Candidates of Coronary Artery Bypass Graft"

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    Sh. Shirani

    2007-07-01

    Full Text Available Background/Objective: To evaluate the prevalence of abdominal aortic aneurysm (AAA in Iranian candidates of coronary artery bypass graft and its associated factors. Patients and Methods: 1,647 consecutive candidates of coronary artery bypass graft underwent abdominal aorta sonography. The relation of AAA with gender, age, smoking, dyslipidemia, hypertension, diabetes mellitus, carotid and coronary stenosis was evaluated. Results: The prevalence of AAA was 3.7% in men and 1% in women. The prevalence was 5.2% in men older than 65 years. The largest diameter f AAA was 51 mm. Gender, age, smoking and carotid stenosis were associated factors of AAA. Conclusion: The prevalence of AAA is lower in Iran comparing with western studies (p<0.0001. The mean diameter of aneurysm was lesser in our study too (p<0.0001. The associated factors of AAA in our study were similar with previous reports. Screening of AAA is not recommended in Iranian candidates of coronary artery bypass graft.

  19. Assessment of Myocardial Perfusion and Systolic Function in Patients with Coronary Artery Disease after Coronary Artery Bypass Surgery by Myocardial Contrast Echocardiography and Two-dimensional Strain Echocardiography

    Institute of Scientific and Technical Information of China (English)

    Rong LIU; Youbin DENG; Xiaojun BI; Yani LIU; Li XIONG; Liuping CHEN

    2009-01-01

    The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echo-cardiography (RT-MCE) combined with two-dimensional strain echocardiography was assessed.Twenty patients underwent intravenous RT-MCE by intravenous injections of Sono Vue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months af-ter coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu-dinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78±5.91)% vs (-10.45±8.31)%, P0.05]. It was con-cluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of re-gional systolic function. The combination of myocardial perfusion with two-dimensional strain echocar-diography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

  20. Off - Pump Coronary Artery Bypass Graft Surgery: A Safe Method For Complete Revascularization

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    Mirkhani S. H

    2002-07-01

    Full Text Available In recent years off-pump coronary artery bypass surgery (OPCAB has emerged as preferred method for revascularization of coronary arteries in relatively selected group of patients. Considering patients receiving incomplete revascularization need significantly higher postoperative catheterization and re-intervention (PTCA or CABG, we performed this study to identify safety and feasibility of this technique for total revascularization in nearly all patients requiring coronary artery graft surgery."nMaterials and Methods: In this study, 150 consecutive patients underwent OPCAB by one surgeon. Octopus device used for regional wall stabilization. Vascular control achieved by ethibond loops, occluder, and shunts. Situations such as cardiomegaly, poor ventricular function, advanced age, hemodynamic instability, and small coronary arteries were not considered contraindications to OPCAB."nResults: Of 150 OPCAB cases, 146 (97.3 percent were completely off-pump. The mean number of grafts per patient was 4.1 (range, 2 to 6. Total 595 distal grafts anastomosed to LAD (140 diagonals (140, right coronary artery (145, left circumflex (164. Thirty-day mortality and myocardial infarction were 0.6 percent and 3.3 percent respectively OPCAB patient experienced lesser postoperative bleeding had shorter stay at surgical intensive care unit and extubated earlier. Conduits used were left internal mammary artery, radial artery and greater saphenous vein."nConclusion: OPCAB is a safe method for complete revascularization in nearly all patients. The OPCAB patients experience less complications, have shorter hospital stay, absolute contraindication for OPCAB other than severe, diffuse coronary artery disease with poor run-off which is better treated by cardiopulmonary bypass.

  1. Experimental laparoscopic aortobifemoral bypass.

    Science.gov (United States)

    Dion, Y M; Chin, A K; Thompson, T A

    1995-08-01

    The goal of the present study is to develop a technique for laparoscopic aortobifemoral bypass. Piglets weighing between 60 and 78 kg were anesthetized with halothane. The lateral retroperitoneal approach was preferred to the more familiar anterior transperitoneal approach and was successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four other trocars were placed in the retroperitoneum after balloon inflation had allowed creation of a space which permitted visualization of the aorta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained using an abdominal lift device and a retractor. Using this approach, we performed four aorto-bifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less than 4 h. Blood loss did not exceed 250 ml and the hematocrit remained stable. Postmortem evaluation of the grafts revealed they were positioned as in a conventional bypass, their limbs having followed in the created retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that this first performed series of totally retroperitoneal laparoscopic aortobifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region.

  2. Predicting Blood Transfusion Factors in Coronary Artery Bypass Surgery

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    L. Kasraian

    2007-04-01

    Full Text Available Introduction & Objective: The ability to predict the use of blood components during bypass surgery will improve the blood banks ability to provide efficient service.Materials and Methods: This is a retrospective cross-sectional study that was carried out on patients that underwent CABG in Shiraz Namazi hospital in 2004. The sample size was 480 and we did systematic random sampling, and a questionnaire contained factors that effect on blood need was filling out. Independent t-test, multivariate logistic regression and Poason correlation were used for data analysis.Results: The average age of patients was 59.15±10.6 years, 69.2% were male and the mean Hct before surgery was 39.86±6.38% and after operation was 32.68±5.84% and the duration of surgery was 2 hours and 48 minutes. The average of pack cell was 5.76±1.52 unit and average of FFP was 2.82±7.72 unit. There was not significant correlation between ages, weighs, Hct before and after, sex and pack cell use (P> 0.05. The use of pack cell and FFP were more in urgent surgery in diabetic patients and vascular disease (P< 0.05.Conclusion: It seems that the rate of blood demanding in proportion to blood use is logical but the rate of blood usage is more than blood usage in other countries with considering of immunological and non-immunological complication of blood products, the heart surgeons must do special concern about the making decision for blood use.

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

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    Reijane Oliveira Lima

    2015-08-01

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

  4. Index finger radial digital proper artery transfer and sleeve anastomosis to treat thumb digital artery defect%食指桡侧指固有动脉转位套入法治疗拇指断指

    Institute of Scientific and Technical Information of China (English)

    姚阳; 李崇杰

    2014-01-01

    Objective To investigate the effect of index finger radial digital proper artery transfer and sleeve anastomosis on treatment of thumb digital artery defect. Methods 10 cases of complete or incomplete thumb amputation with digital artery defect, but without tendon or nerve defect, were replanted by index finger radial digital proper artery transfer and sleeve anastomosis to thumb ulnar digital proper artery. Results All of 10 cases survived after operation, finger pulp was plump, color and lustre was florid. The patients were followed up for 10 months to 2 years, the hand function has obtained satisfactory recovery, and extrinsic feature was natural. Conclusion Index finger radial digital proper artery transfer and sleeve anastomosis is especially adaptive to the treatment of thumb digital artery defect.%目的:探讨食指桡侧指固有动脉转位套入法治疗拇指断指的疗效。方法对10例指动脉缺损而无肌腱神经缺损的拇指完全或不完全离断病例,采用食指桡侧指固有动脉转位与拇指尺侧指固有动脉行套入吻合法修复动脉,再植拇指。结果本组10例再植拇指均成活,指腹饱满,色泽红润,经6~24个月随访,患者手部功能恢复满意,外观自然,2例出现虎口狭窄,经手术改善。结论食指桡侧指固有动脉转位套入法适用于单纯拇指指动脉缺损的再植治疗。

  5. Clinical outcome of patients with familial hypercholesterolemia and coronary artery disease undergoing partial ileal bypass surgery

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    Jaqueline Scholz Issa

    2000-07-01

    Full Text Available Familial hypercholesterolemia is characterized by high serum levels of total cholesterol and LDL-cholesterol. It may be homozygous or heterozygous. In homozygous patients, LDL-cholesterol levels range from 500 to 1000mg/dL and coronary artery disease is precocious, usually manifesting itself between the 2nd and 3rd decades of life. The diagnosis is often made by the presence of xanthoma tuberosum and tendinous xanthomas that appear between the 1st and 2nd decades of life. The use of high doses of statins or even unusual procedures (apheresis, partial ileal bypass surgery, liver transplantation, gene therapy, or both, is necessary for increasing survival and improving quality of life, because a reduction in cholesterol levels is essential for stabilizing the coronary artery disease and reducing xanthomas. We report our experience with 3 patients with xanthomatous familial hypercholesterolemia and coronary artery disease, who underwent partial ileal bypass surgery. Their follow-up over the years (approximately 8 years showed a mean 30% reduction in total cholesterol, with a significant reduction in the xanthomas and stabilization of the coronary artery disease.

  6. Fusiform superior cerebellar artery aneurysm treated with STA-SCA bypass and trapping

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    Fabricio C Lamis

    2014-01-01

    Full Text Available Background: Fusiform aneurysms of cerebellar arteries are rare. Different surgical techniques to address these challenging lesions have been described, and their application depends on whether the goal is to maintain the flow in the parent vessel or to occlude it. Case Description: The authors reported a case of a fusiform aneurysm located in the lateral pontomesencephalic segment of the superior cerebellar artery (SCA in a 32-year-old man who presented with subarachnoid hemorrhage. The patient was subjected to aneurysm trapping followed by a bypass between the superficial temporal artery (STA and SCA and had an uneventful recovery. Conclusions: Although only a few cases of fusiform aneurysms in the supracerebellar artery have been reported in the literature, the treatment strategies adopted were diverse. In selected cases of patients in good neurological condition with ruptured fusiform aneurysms at the proximal segments of SCA and who have poor evidence of collateral supply, the possibility of a STA-SCA bypass with aneurysm trapping must be considered. A review of the current treatment modalities of this pathology is also presented.

  7. Intraoperative angiography after coronary bypass grafting in a patient presenting with a single coronary artery: a case report.

    Science.gov (United States)

    Bigdeli, Amir K; Kilian, Eckehard; Beiras-Fernandez, Andres; Vogt, Ferdinand; Reichart, Bruno; Kur, Felix

    2010-06-01

    Among coronary artery anomalies, single coronary artery is one of the rarest anomalies. Pulmonary origins of the coronary arteries, coronary artery fistulae, and anomalous aortic origins of the coronary arteries are the most common anomalies requiring surgical intervention. In this case, we describe the performance of bypass grafting after unsuccessful attempts at percutaneous coronary intervention in a 72-year old male patient with single coronary artery arising from the right sinus of Valsalva and with associated diffuse coronary atherosclerosis. Intraoperative angiography was performed to evaluate the revascularization of this anomalous coronary system. The patient remains symptom free 6 months after the operation.

  8. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    Minimally invasive direct coronary artery bypass; MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery ... doctor may recommend a minimally invasive coronary artery bypass if you have a blockage in one or ...

  9. What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study

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    S. Neragi-Miandoab

    2014-01-01

    Full Text Available Objective. Bilateral internal thoracic artery (BITA grafting provides improved graft patency and potential survival advantage in selected patients as compared to single left internal thoracic artery (LITA revascularization. The ideal functional BITA configuration remains controversial. Methods. Patients undergoing planned BITA revascularization with greater than 75% stenosis in both the left anterior descending artery (LAD and in a circumflex branch were prospectively randomized to one of two proximal free right internal thoracic artery (RITA connections directly off the aorta (Ao (n=12 or as a “t” graft off the LITA (t (n=12. The LITA was placed to the LAD in all cases, and the RITA was placed to a single lateral wall vessel. Intraoperative transit time flow measurements of all arterial grafts were performed, and RITA fractional flow parameters were compared between the 2 groups. Results. There were no differences in preoperative patient variables between the two groups. Cross-clamp times (91.5+15.3 versus 68.0+12.5 minutes, P<0.01 and total cardiopulmonary bypass times (109.0+16.2 versus 85.0+15.1 minutes, P<0.01 were shorter in the t group. The Ao group demonstrated significantly higher mean RITA flow (38.3±13.5 versus 22.1±9.5, P<0.01, mean RITA conductance (flow/mean arterial pressure (0.45±0.16 versus 0.28±0.11, P<0.01, RITA fractional flow (0.52 ± 0.15 versus 0.36 ± 0.11, P<0.01, and RITA fractional conductance (0.51 ± 0.15 versus 0.36 ± 0.11, P<0.01 than the “t” grafted patients. Thirty-day mortality and wound infection were 0% for each group. Over an average of 42.8+6.6 months of followup there were no mortalities in either group. Repeat angiography were performed in 4 patients (33% in the Ao group and 2 patients in the t group (16%. One occluded RITA graft and one ostial RITA stenosis were detected in the Ao group. Conclusions. Acute flow measurements indicate that the free RITA anastomosed to the aorta

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

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    Li-Qun Chi

    2015-01-01

    Full Text Available Background: It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD. Coronary endarterectomy (CE offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG was discussed in the treatment for the diffused CAD. Methods: From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE + CABG were performed, which was about 17.2% (38/221 of the cohort. All these patients were divided into two groups: CE + CABG group (Group A and CABG alone group (Group B. All clinical data were compared between the two groups, and postoperative complications and in-hospital mortality were analyzed. The categorical and continuous variables were analyzed by Chi-square test and Student′s t-test respectively. Results: Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was performed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A (3/38, which was more often than that in Group B (3/183. At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent (50/50. There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions: Coronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.

  11. Minimally invasive direct coronary artery bypass plus coronary stent for acute coronary syndrome: a case report

    Institute of Scientific and Technical Information of China (English)

    Caiyi Lu; Gang Wang; Qi Zhou; Jinwen Tian; Lei Gao; Shenhua Zhou; Jinyue Zhai; Rui Chen; Zhongren Zhao; Cangqing Gao; Shiwen Wang; Yuxiao Zhang; Ming Yang; Qiao Xue; Cangsong Xiao; Wei Gao; Yang Wu

    2008-01-01

    A 69-year old female patient was admitted because of 3 days of worsened chest pain.Coronary angiography showed60% stenosis of distal left main stem,chronic total occlusion of left anterior descending (LAD),70% stenosis at the ostium of a smallleft circumflex,70-90%stenosis at the paroxysmal and middle part of a dominant fight coronary artery (RCA),and a normal left internalmammary artery (LIMA) with normal origination and orientation.Percutaneous intervention was attempted but failed on the occludedlesion of LAD.The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davincirobot.Eleven days later,the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously.Then thepatient was discharged uneventfully after 3 days hospitalization.Our experience suggests that two stop shops of hybrid technique befeasible and safe in the treatment of elderly patient with multiple coronary diseases.

  12. Effects of different PEEP levels on respiratory mechanics and oxygenation after coronary artery bypass grafting

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    Daniel Lago Borges

    2013-09-01

    Full Text Available OBJECTIVE: To compare the effects of different levels of positive end-expiratory pressure on respiratory mechanics and oxygenation indexes in the immediate postoperative period of coronary artery bypass grafting. METHODS: Randomized clinical trial in which 136 patients underwent coronary artery bypass grafting between January 2011 and March 2012 were divided into three groups and admitted to mechanical ventilation with different positive end-expiratory pressure levels: Group A, 5 cmH2O (n=44, Group B, 8 cmH2O (n=47 and Group C, 10 cmH2O (n=45. Data about respiratory mechanics were obtained from mechanical ventilator monitor and oxygenation indexes from arterial blood gas samples, collected twenty minutes after intensive care unit admission. Patients with chronic obstructive pulmonary disease and patients submitted to off-pump, emergency or combined operations were not included. For statistical analysis, we used Kruskal-Wallis, G and Chi-square tests, considering results significant when P<0.05. RESULTS: Groups were homogeneous in terms of demographic, clinical and surgical variables. Patients ventilated with positive end-expiratory pressure of 10 cmH2O (Group C had best compliance (P=0.04 and airway resistance values, this, however, without statistical significance. They also had best oxygenation indexes, with statistical difference in all analyzed variables, and lower frequency of hypoxemia (P=0.03. CONCLUSION: Higher levels of positive end-expiratory pressure in immediate postoperative period of coronary artery bypass grafting improved pulmonary compliance values and increased oxygenation indexes, resulting in lower frequency of hypoxemia.

  13. MR IMAGING OF CORONARY ARTERY BYPASS GRAFT:A PRELIMINARY STUDY

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. To make a preliminary investigation of the patency and function of coronary artery bypass grafts(CABG) by magnetic resonance(MR) images and to establish a suitable method for follow-up study after CABG operation among Chinese.Methods. MR imaging was performed with a Toshiba 1.5-T unit in 27 patients with 74 grafts. All patients were examined with a breath-hold ECG-gated two-dimensional fast field echo (FFE) sequence to evaluate the patency of bypass grafts, among them 16 patients with 42 grafts were further examined with a phase shift magnetic resonance angiography flow (PSMRAflow) sequence to evaluate the grafts patency as well as the flow velocity and flow volume vs. time.Results. The results showed that 66 of the 74 grafts in the patients of the present series studied with FFE were patent with a patency rate of 89.2%. The results evaluated both with FFE and PSMRAflow remained the same except that two grafts were patent with FFE and the results with PSMRAflow were uncertain. Diastolic perfusion pattern curves were found in 25 of the 32 grafts in patients of the present series. Comparing the flow curves of the grafted left internal mammary artery with those of the native right internal mammary artery in 7 patients, the systolic peak velocity value(SPV) of the grafted arteries was significantly lower than that of the ungrafted ones, whereas the diastolic peak velocity value(DPV) and the ratio of DPV to SPV were significantly greater than that of the ungrafed ones.Conclusion. The FFE and PSMRAflow sequences were efficient in evaluating patency and obtaining the curves of flow velocity and volume of the bypass grafts. Therefore, they may offer a non-invasive screening method for follow-up study in patients after CABG surgery, although its accuracy should be further evaluated in more patients and comparatively studied with other methods.

  14. Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

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    Elayne Kelen de Oliveira

    2013-09-01

    Full Text Available INTRODUCTION: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality. OBJECTIVE: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards. METHODS: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P 3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17 and smoking (OR=4.07 were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10 was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction 24 hours for the intensive care unit and presence of infection for the ward.

  15. Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

    NARCIS (Netherlands)

    Drenth, Derk Jan

    2005-01-01

    This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

  16. Assessment of right ventricular function by pressure-volume loops in off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    ZHAO Hong-wei; YUE Yun; WU An-shi; LIU Yu; RUI Yan; WU Di; LIU Juan; ZHAO Qiu-hua; GUO Shu-rong; ZHANG Yong-qian

    2008-01-01

    Background Right ventricular function plays an important role in the hemodynamic derangement during off-pump coronary artery bypass (OPCAB) surgery. Pressure-volume loops have been shown to provide load-independent information of cardiac function. Therefore, the aim of this study was to investigate the feasibility of construction of right ventricular pressure-volume loops with pressure and volume data measured by a volumetric pulmonary artery catheter (PAC) and to evaluate right ventricular systolic and diastolic function by end-systolic elastance (EEs) and end-diastolic stiffness (EED) in OPCAB surgery.Methods Twenty-eight patients who underwent OPCAB surgery were included. After anesthesia induction, a volumetric PAC was placed via the right internal jugular vein. Data were recorded at: anesthesia steady-state before skin incision (T1); 5 minutes after the stabilizer device was placed for anastomosis on the heart's anterior wall (T2), lateral wall (T3),posterior wall (T4), respectively; after sternal closure (T5). Three sets of data were collected at each time point: first,hemodynamic variables were measured; second, right ventricular EES and EED were calculated; third, right ventricular pressure-volume loops were constructed with pressure and volume data measured from end-diastole point,end-isovolumic systole point, peak-ejection point, end-systole point and end-isovolumic diastole point.Results Right ventricular pressure-volume loops generally shifted to the left during OPCAB surgery. Especially, the end-diastolic point shifted upward and to the left at T2-T5 compared with that at T1. Decrease in right ventricular ejection fraction, stroke volume index and end-diastolic volume index occurred (P<0.05) at T4 compared with values at T1. Pulmonary vascular resistance index at T4 increased relatively compared with that at T2 and T3. The change of EES was not statistically significant during operation. Right atrial pressure increased only during coronary

  17. Diagnostic Accuracy of 64-Slice Multislice Computed Tomography in Assessment of Coronary Artery Bypass Grafts

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    A. Arjmand Shabestari

    2007-05-01

    Full Text Available Background and Objective: Nowadays 64-slice mul-tislice computed tomography (MSCT has gained a wide acceptance as a non-invasive diagnostic imaging modality in native coronary arteries. This study was performed to determine the diagnostic accuracy of 64-slice MSCT in assessment of coronary artery by-pass grafting (CABG patency. Materials and Methods: 73 patients underwent both coronary CT-angiography (CTA using 64-slice MSCT scanner and quantitative coronary angiography (QCA were studied. Arterial and venous CABG patency was graded as: a-normal, b-patent with non-significant (<50% diameter reduction stenosis, c-patent with significant (≥50% diameter reduction stenosis or d-totally occluded. The results of CTA and QCA were compared. Results: Totally, 236 CABG were assessed, including 49 arterial and 187 venous grafts. Sensitivity, specific-ity, positive predictive value (PPV and negative pre-dictive value (NPV in detecting normal patency of arterial grafts were 100%, 85%, 95% and 100%, re-spectively and those in finding normal patency of ve-nous grafts all were 100%. The above-mentioned fig-ures for non-significant stenosis were 67% (2 out of 3 patients, 100%, 100% and 98% in arterial and 95%, 100%, 100% and 99% in venous grafts, respectively. Regarding to the significant stenosis, the results were 67% (2 out of 3 patients, 100%, 100% and 98% in arterial and 100%, 99%, 94% and 100% in venous grafts, respectively. All of these numerals were meas-ured being 100% for total occlusion of both arterial and venous grafts. Conclusion: Diagnostic accuracy of 64-slice MSCT in detecting normal patency, non-significant stenosis, significant stenosis and total occlusion of arterial and particularly venous CABG is extremely high so that QCA may be eventually substituted by CTA in a near future.

  18. Effects of Cardiopulmonary Bypass on Mediastinal Drainage and the Use of Blood Products in the Intensive Care Unit in 60- to 80-Year-Old Patients Who Have Undergone Coronary Artery Bypass Grafting

    OpenAIRE

    Fatih Aygün; Mehmet Özülkü; Murat Günday

    2015-01-01

    ABSTRACT OBJECTIVE: The present study consisted of patients who underwent on-pump coronary artery bypass grafting (CABG) and off-pump CABG and investigated effect of using cardiopulmonary bypass (CPB) on the amount of postoperative drainage and blood products, red blood cell (RBC), free frozen plasma (FFP) given in the intensive care unit in 60-80-year-old patients who underwent CABG. METHODS: The present study comprises a total of 174 patients who have undergone coronary artery bypass graf...

  19. A case report and brief review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Trethowan Brian A

    2011-11-01

    Full Text Available Abstract Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION, posterior ischaemic optic neuropathy (PION, and central retinal artery occlusion (CRAO. These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass; general surgery; urology; gynaecology; liposuction; liver transplantation and duration of surgery. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone, alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.

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

    Directory of Open Access Journals (Sweden)

    Rajeeva Rivikath Pieris

    2014-05-01

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

  1. Total intravenous anesthesia using propofol and alfentanil for coronary artery bypass surgery.

    Science.gov (United States)

    Gordon, P C; Morrell, D F; Pamm, J D

    1994-06-01

    Total intravenous anesthesia (TIVA) using alfentanil and propofol was used in 10 patients undergoing coronary artery bypass grafting. In an attempt to diminish unwanted side effects, lower doses were chosen than if either drug had been used alone. Anesthesia was induced with alfentanil, 75 micrograms/kg, followed by a sleep dose of propofol (mean dose 0.5 mg/kg). Maintenance in the precardiopulmonary bypass (CPB) period was achieved by infusions of propofol (6 mg/kg/h) and alfentanil (100 micrograms/kg/h). These were decreased by two thirds on commencement of CPB, and increased to half the initial rate on rewarming to 32 degrees C. Additional boluses of alfentanil were used to control breakthrough hypertension. The mean arterial pressure (MAP) and left ventricular stroke work index (LVSWI) fell significantly on induction. MAP but not LVSWI returned to baseline levels at skin incision. The cardiac index (CI) was maintained. A degree of myocardial depression was suggested by a fall in LVSWI despite maintaining preload, and by the failure of CI to increase in the presence of a reduced SVR. Anesthesia was satisfactory in all but one patient who developed breakthrough hypertension on sternotomy with transient ST segment depression, and awareness after CPB despite a plasma alfentanil concentration of 450 ng/mL. Mean time to wakening was 55 minutes. The study indicated that TIVA using propofol and alfentanil in the dosages described provides satisfactory basal anesthesia for coronary artery bypass surgery in patients with good left ventricular function, but requires additional pharmacologic manipulation, particularly with boluses of alfentanil, to control breakthrough hypertension. PMID:8061261

  2. Oxygenator Exhaust Capnography for Prediction of Arterial Carbon Dioxide Tension During Hypothermic Cardiopulmonary Bypass

    OpenAIRE

    Baraka, Anis; El-Khatib, Mohamad; Muallem, Eva; Jamal, Salim; Haroun-Bizri, Sania; Aouad, Marie

    2005-01-01

    Continuous monitoring and control of arterial carbon dioxide tension (PaCO2) during cardiopulmonary bypass (CPB) is essential. A reliable, accurate, and inexpensive system is not currently available. This study was undertaken to assess whether the continuous monitoring of oxygenator exhaust carbon dioxide tension (PexCO2) can be used to reflect PaCO2 during CPB. A total of 33 patients undergoing CPB for cardiac surgery were included in the study. During normothermia (37°C) and stable hypother...

  3. Off-pump coronary artery bypass in poland syndrome with dextrocardia: case report

    Directory of Open Access Journals (Sweden)

    More Ranjit

    2011-05-01

    Full Text Available Abstract Poland Syndrome is a congenital disorder characterised by hypoplasia of the pectoral muscles along with upper extremity deformities. We encountered a patient with Poland syndrome associated with dextrocardia and also failed pectus excavatum repairs who presented to us with symptomatic ischaemic heart disease requiring intervention. He underwent successful off-pump coronary artery bypass surgery (OPCABG. As far as we are aware, this is the first case report of OPCABG in a case of Poland syndrome with dextrocardia. We describe here the management of this complex patient and wish to emphasise that the off-pump option is feasible in dextrocardia with some technical modifications.

  4. Guillain–Barré Syndrome after Coronary Artery Bypass Graft Surgery:a Case Report

    OpenAIRE

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

    2016-01-01

    Guillain-Barre syndrome is a neurologic disorder that may appear after infection or major surgery.  Guillian-Barre syndrome following cardiac surgery is rare and only based on case reports, and we review all of the published cases. A 52-year-old man after 5 months suffering from chest pain was referred to our hospital and underwent coronary artery bypass graft for 3 vessel disease. The patient was discharged without complication on the 5th postoperative day. He presented Guillain- Barre syndr...

  5. Sudden cardiovascular collapse caused by carbon dioxide embolism during endoscopic saphenectomy for coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin-chun; TANG Xiao-yang; JIANG Yi-fan; PAN Yan-bing; FU Cheng-zhang

    2006-01-01

    @@ Endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) has gained increasing acceptance as a less invasive alternative to conventional open vein harvesting. With this procedure, carbon dioxide (CO2) is insufflated to create a subcutaneous tunnel to facilitate the harvest of the great saphenous vein. The technique seems to be safe because there are no adverse hemodynamic consequences or systemic CO2 absorption during EVH.1,2 We report a case of massive right heart gas embolism which occurred during a routine EVH performance of the saphenous vein.

  6. Rate of Urgent Coronary Artery Bypass Grafting in Elective Percutaneous Coronary Intervention (PCI)

    OpenAIRE

    Yonos Nozari; Seyed Amir Kassaei

    2008-01-01

    Background: Latest research shows that about 0.5% of percutaneous coronary intervention (PCI) patients will need urgent coronary artery bypass grafting (CABG) because of coronary accidents. The ACC/AHA guidelines regard on-site cardiac surgery back-up obligatory for PCI centers. It seems the need for urgent CABG in some Iranian PCI centers is less than 0.5%, which may affect decision-making for performing PCI without on-site surgical back-up in the same condition in Iran.Methods: This retrosp...

  7. Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

    Directory of Open Access Journals (Sweden)

    Wasmuth Hermann E

    2011-06-01

    Full Text Available Abstract Background Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage. Case presentation In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient. Conclusion Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

  8. Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico Endoscopic dilation of gastrojejunal anastomosis after gastric bypass

    Directory of Open Access Journals (Sweden)

    Josemberg Marins Campos

    2012-12-01

    Full Text Available INTRODUÇÃO: Bypass gástrico em Y-de-Roux pode resultar em estenose de anastomose gastrojejunal. Não há protocolo de tratamento bem definido para essa complicação. OBJETIVO: Analisar os resultados da dilatação endoscópica em pacientes com estenose, através de revisão sistemática, incluindo complicações e taxa de sucesso. MÉTODOS: Foi realizada busca dos estudos relevantes publicados de 1988 a 2010 na base de dados do PubMed, sendo identificados 23 estudos para análise. Apenas os que descreviam o tratamento de estenose de anastomose após bypass gástrico em Y-de-Roux foram incluídos e relatos de caso que apresentavam menos de três pacientes foram excluídos. RESULTADOS: A idade média da população foi de 42,3 anos e o índice de massa corpórea pré-operatório médio foi de 48,8 kg/m². No total, 760 pacientes (81% feminino foram submetidos a 1298 procedimentos, sendo realizadas 1,7 dilatações por paciente. Balões Through-the-scope foram utilizados em 16 estudos (69,5% e dilatador de Savary-Gilliard em quatro. Apenas 2% dos pacientes necessitaram revisão cirúrgica após a dilatação; a taxa de complicações reportada foi de 2,5% (n=19. A taxa de sucesso anual foi maior que 98% nos anos 1992 a 2010, exceto por uma de 73% em 2004. Sete estudos relataram complicações, sendo perfuração a mais comum, relatada em 14 pacientes (1,82%, necessitando operação imediata em dois pacientes. Outras complicações foram também relatadas: um hematoma esofágico, uma lesão de Mallory-Weiss, um caso grave de náusea e vômito, e dois casos de dor abdominal importante. CONCLUSÃO: Tratamento endoscópico de estenose é seguro e eficaz; entretanto, mais estudos controlados randomizados devem ser realizados a fim de confirmar esses achados.INTRODUCTION: Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication. AIM: Through

  9. Oxidative Stress and Homocysteine Metabolism Following Coronary Artery Bypass Grafting by On-pump and Off-pump Techniques

    OpenAIRE

    Susan Hassanzadeh Salmasi; Mohammad Rahbani Noubar; Rezayat Parvizi

    2007-01-01

    Background: It is well documented that coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) causes ischemia and oxidative stress of the whole body. To compare the effect of on – pump and off –pump CABG on the induction of the oxidative stress and the metabolism of homocysteine which is involved in the synthesis of glutathione was investigated in the CABG patients during the early postoperative period.Methods: Plasma homocysteine, folate total antioxidant capacity (TAC) and...

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

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    Ziadi Jalel

    2014-01-01

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

  11. Coronary angiographies of patients with recurrent acute coronary syndrome following coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    JIA Yu-he; YANG Yue-jin; WEI Yi-zhen; YAO Min; HU Sheng-shou

    2005-01-01

    @@ Coronary artery bypass grafting (CABG) is considered as a more complete means of revascularization than percutaneous coronary intervention (PCI). However, acute coronary syndrome (ACS) can still occur after CABG. The culprit vessel can be the graft vessel or the native vessel. Many questions remain unanswered in the Chinese literature regarding this topic: what are the short- and long-term pathological changes that induce ACS? Is there any difference between arterial and venous grafts with respect to the frequency of restenosis? Are there any patterns of ACS-related vessels in different periods after CABG? We aim to answer these fundamental questions by analyzing coronary angiographies of patients with recurrent ACS following CABG and provide evidence for reducing post-CABG restenosis.

  12. Pulmonary artery perfusion versus no pulmonary perfusion during cardiopulmonary bypass in patients with COPD

    DEFF Research Database (Denmark)

    Buggeskov, Katrine B; Sundskard, Martin M; Jonassen, Thomas;

    2016-01-01

    INTRODUCTION: Absence of pulmonary perfusion during cardiopulmonary bypass (CPB) may be associated with reduced postoperative oxygenation. Effects of active pulmonary artery perfusion were explored in patients with chronic obstructive pulmonary disease (COPD) undergoing cardiac surgery. METHODS: 90...... starting CPB and longitudinally in a mixed-effects model (MEM). Secondary outcomes were tracheal intubation time, serious adverse events, mortality, days alive outside the intensive care unit (ICU) and outside the hospital. RESULTS: 21 hours after starting CPB patients receiving pulmonary artery perfusion...... with normothermic oxygenated blood had a higher oxygenation index compared with no pulmonary perfusion (mean difference (MD) 0.94; 95% CI 0.05 to 1.83; p=0.04). The blood group had also a higher oxygenation index both longitudinally (MEM, p=0.009) and at 21 hours (MD 0.99; CI 0.29 to 1.69; p=0.007) compared...

  13. Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Carranza, Christian L; Ballegaard, Martin; Werner, Mads U;

    2014-01-01

    the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year...... postoperatively.We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the radial artery. The trial also aims to show if there is any patency difference between mammario-radial compared...

  14. The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery

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    Boonstra Piet W

    2007-12-01

    Full Text Available Abstract Background Intensive insulin therapy to maintain normoglycemia after cardiac surgery reduces morbidity and mortality. We investigated the magnitude and duration of hyperglycemia caused by dexamethasone administered after cardiopulmonary bypass. Methods A single-center before-after cohort study was performed. All consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass during a 6-month period were included. Insulin administration was guided by a sliding scale protocol. Halfway the observation period, the dexamethasone protocol was changed. The single dose (1D group received a pre-operative dose of dexamethasone of 1 mg/kg. The double dose group (2D received an additional dose of 0.5 mg/kg of dexamethasone post-operatively at ICU admission. Results We included 116 patients in the 1D group and 158 patients in the 2D group. There were no significant baseline differences between the groups. Median Euroscore was 5. In univariable analysis, the glucose level was different between groups 1D and 2D at 4, 6, 9, 12 and 24 hours after ICU admission (all p Conclusion Dexamethasone exerts a hyperglycemic effect in cardiac surgery patients. Patients receiving high-dose corticosteroid therapy should be monitored and treated more intensively for hyperglycemic episodes.

  15. Role magnesium in preventing post-operative atrial fibrillation after coronary artery bypass surgery

    International Nuclear Information System (INIS)

    To assess the role of 3 days of magnesium infusion after coronary artery bypass graft (CABG) surgery in preventing postoperative atrial fibrillation (AF). Prospective, randomized, non-blinded. All patients undergoing isolated, initial CABG surgery, and having sinus rhythm before surgery were alternatively randomized into the study or the control group. The exclusion criteria included: history of AF, implanted pacemaker, myocardial infarction postoperatively, use of left ventricular assist devices and renal failure. The patients in the study group received 10 mmol of magnesium sulphate (2.47 gm) dissolved in 100 ml of saline solution infused intravenously over 4 hours, for 3 days. The end point was development of AF for at least 15 minutes or more, or if an episode of AF had to be treated because of symptoms. A total of 220 patients were included in the study, 110 in each group. The incidence of AF was 9% in patients who received the three days of magnesium infusion. The patients without magnesium had an AF incidence of 23% (p<0.001). The hospital stay was also less in the treated group (p=0.055). A 3-days postoperative infusion of magnesium is safe and effective in reduction of possibly life-threatening AF, in patients undergoing primary coronary artery Bypass surgery. (author)

  16. DOES TRANEXAMIC ACID REDUCE BLOOD LOSS IN OFF-PUMP CORONARY ARTERY BYPASS?

    Directory of Open Access Journals (Sweden)

    A. Mehr-Aein

    2006-09-01

    Full Text Available Tranexamic acid is now used on a routine basis for on-pump coronary artery bypass grafting (CABG. We assessed the hemostatic effects of tranexamic acid to decrease bleeding tendency and transfusion requirements in patients undergoing off-pump coronary artery bypass surgery (OPCAB. A total of 66 patients were enrolled to elective OPCAB in a double-blind, prospective randomized study. Of these, 33 patients received tranexamic acid (15 mg/kg before the infusion of heparin and 15 mg/kg after protamin infusion, and 33 patients received only saline. Preoperative hematologic variables, postoperative bleeding and allogeneic transfusions were considered. D-dimer plasma levels were also evaluated to monitor the activation of fibrinolysis. Postoperative bleeding was significantly lower in the tranexamic acid group compared with the control group (320 ± 38 mL vs. 480 ± 75 mL at 12 hour, P < 0.001. The tranexamic acid group had significantly lesser need for allogeneic blood products (0.46 units/patients vs. 0.94 units/patients, P < 0.001. They had also lower post-operative D-dimer plasma levels. No postoperative thrombotic complications were observed in either group. The defective hemostasis occurs even in the OPCABG. Tranexamic acid effectively reduces postoperative blood loss and the need for allogeneic blood products after OPCAB is decreased.

  17. Ventricular function following coronary artery bypass grafting: comparison between Gated SPECT and cardiac magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mesquita, Claudio Tinoco [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear; Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Pessoa, Maria Carolina Pinheiro [Pro-Echo Hospital Samaritano, Rio de Janeiro, RJ (Brazil); Vasconcelos, Paulo Pontes [Centro de Diagnostico por Imagens (CDPI), Rio de Janeiro, RJ (Brazil); Oliveira Junior, Amarino Carvalho [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil). Servico de Radiologia; Dohmann, Hans Fernando Rocha [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil). Servico de Radiologia; Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Reis, Adair Gomes dos [Nuclear Diagnosticos, SP (Brazil); Fonseca, Lea Mirian Barbosa da [Pro-Echo Hospital Samaritano, Rio de Janeiro, RJ (Brazil); Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil)

    2009-04-15

    Background: The assessment of left ventricular function may be impaired by the abnormal interventricular septal motion frequently found after coronary artery bypass grafting (CABG). Studies on the validation of gated SPECT as a tool for the assessment of left ventricular function in this patient group are scarce. Objective: We investigated the agreement and correlation between left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV) as obtained using electrocardiogram-gated myocardial perfusion scintigraphy (gated SPECT) and cardiac magnetic resonance imaging in 20 patients undergoing coronary artery bypass grafting. Methods: Correlation was measured using Spearman's correlation coefficient ({rho}). Agreement was assessed using Bland-Altman analysis. Results: A good correlation was found between gated SPECT and cardiac magnetic resonance imaging in patients after CABG with regard to left ventricular ejection fraction ({rho} = 0.85; p =0.0001), moderate correlation for end-diastolic volume ({rho} = 0.51; p = 0.02), and non-significant correlation for end-diastolic volume ({rho} = 0.13; p = 0.5). Agreement ranges for LVEF, ESV and EDV were: -20% to 12%; -38 to 54 ml and; -96 to 100 ml, respectively. Conclusion: A reliable correlation was found for left ventricular ejection fraction as obtained by gated SPECT and magnetic resonance imaging in patients undergoing CABG. For ventricular volumes, however, the correlation is not adequate. (author)

  18. Intraoperative perfusion contrast echocardiography. Initial experience during coronary artery bypass grafting.

    Science.gov (United States)

    Kabas, J S; Kisslo, J; Flick, C L; Johnson, S H; Craig, D M; Stanley, T E; Smith, P K

    1990-03-01

    Intraoperative evaluation of the effectiveness of myocardial revascularization has been limited by an inability to assess regional myocardial perfusion. Microbubbles of sonicated diatrizoate sodium and diatrizoate meglumine (Renografin) have been an effective echocardiographic contrast agent and have been employed clinically during cardiac catheterization. This recent development in contrast-enhanced two-dimensional echocardiography permits real-time imaging of transmural myocardial blood flow but has not been evaluated in the operating room. This study represents the initial surgical application of this directed technique and was designed to evaluate the safety and efficacy of intraoperative perfusion contrast echocardiography in assessing the results of coronary artery bypass grafting. Twenty men with significant coronary artery disease ranging in age from 49 to 73 years were studied. Direct contrast agent injection into completed saphenous vein bypass grafts caused the myocardium supplied by each graft to be well delineated and provided a tomographic view of contrast distribution. The enhanced region was well correlated with the size and distribution of the native vessel. Rapid contrast washout (less than 20 seconds) indicated satisfactory regional perfusion. Contrast echocardiography prolonged the operation less than 10 minutes and did not result in any perioperative complications.

  19. Pulmonary artery perfusion with HTK solution prevents lung injury in infants after cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    LI Jian-an; LIU Ying-long; LIU Jin-ping; LI Xiao-feng

    2010-01-01

    Background Pulmonary artery perfusion during cardiopulmonary bypass (CPB) is a novel adjunctive method, which can minimize the lung ischemic-reperfusion injury and inflammatory response. This study evaluated the protective effect of pulmonary perfusion with hypothermic HTK solution in corrections of congenital heart defects with pulmonary hypertension.Methods Between June 2009 and December 2009, 24 consecutive infants with congenital heart defects and pulmonary hypertension were randomly divided into perfused group (n=12) and control group (n=12). Oxygen index, alveolar-arterial O2gradient, serum levels of malondialchehyche (MDA), interleukin (IL)-6, -8, -10, soluble intercellular adhesion molecule-1(slCAM-1), and P-selectin were measured before commencement and serially for 48 hours after termination of bypass.Results Oxygenation values were better preserved in the perfused group than in the control group. The serum levels of IL-6 increased immediately after CPB in both groups and returned to baseline at 48 hours after CPB, but it was restored faster and earlier in the perfused group. The serum levels of IL-8, slCAM-1, and MDA remained at baseline at each point after CPB in the perfused group and elevated significantly immediately after CPB in the control group, except for sICAM-1.The serum level of IL-10 increased immediately after CPB and decreased to baseline at 48 hours after CPB in both groups, but the IL-10 level in the perfused group was significantly higher than in the control group at 12 hours after CPB.The serum P-selectin levels in the control group immediately after CPB were significantly higher than prebypass levels.Moreover, there were no significant differences in postoperative clinical characters, except for the intubated time.Conclusion In infants with congenital heart defects, pulmonary perfusion with hypothermic HTK solution during cardiopulmonary bypass could ameliorate lung function and reduce the inflammatory response.

  20. Fast simulations of patient-specific haemodynamics of coronary artery bypass grafts based on a POD-Galerkin method and a vascular shape parametrization

    Science.gov (United States)

    Ballarin, Francesco; Faggiano, Elena; Ippolito, Sonia; Manzoni, Andrea; Quarteroni, Alfio; Rozza, Gianluigi; Scrofani, Roberto

    2016-06-01

    In this work a reduced-order computational framework for the study of haemodynamics in three-dimensional patient-specific configurations of coronary artery bypass grafts dealing with a wide range of scenarios is proposed. We combine several efficient algorithms to face at the same time both the geometrical complexity involved in the description of the vascular network and the huge computational cost entailed by time dependent patient-specific flow simulations. Medical imaging procedures allow to reconstruct patient-specific configurations from clinical data. A centerlines-based parametrization is proposed to efficiently handle geometrical variations. POD-Galerkin reduced-order models are employed to cut down large computational costs. This computational framework allows to characterize blood flows for different physical and geometrical variations relevant in the clinical practice, such as stenosis factors and anastomosis variations, in a rapid and reliable way. Several numerical results are discussed, highlighting the computational performance of the proposed framework, as well as its capability to carry out sensitivity analysis studies, so far out of reach. In particular, a reduced-order simulation takes only a few minutes to run, resulting in computational savings of 99% of CPU time with respect to the full-order discretization. Moreover, the error between full-order and reduced-order solutions is also studied, and it is numerically found to be less than 1% for reduced-order solutions obtained with just O(100) online degrees of freedom.

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

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

    Science.gov (United States)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Marano, Riccardo; Storto, Maria L. [G. d' Annunzio University, SS. Annunziata Hospital, Department of Clinical Sciences and Bioimaging-Section of Radiology, Chieti (Italy); Liguori, Carlo; Rinaldi, Pierluigi; Savino, Giancarlo; Bonomo, Lorenzo [Catholic University, A. Gemelli Hospital, Department of Bioimaging and Radiological Sciences, Rome (Italy); Politi, Marco A. [Casa Sollievo della Sofferenza-Interventional Radiology, San Giovanni Rotondo (Italy)

    2007-12-15

    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. (orig.)

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Alexandre Gonçalves de Sousa

    2015-02-01

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

  6. Gender and Diabetes Mellitus Relevance on Outcomes of Coronary Artery Bypass Grafting. A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Sergiu C. BATÂR

    2010-06-01

    Full Text Available Purpose: For the group of patients with coronary artery disease (CAD, referred to coronary artery bypass surgery, we sought to asses the relevance of gender and presence of Diabetes Mellitus upon survival rates, within the first 3 years after surgery. Methods: At “Nicolae Stancioiu” Heart Institute, a number of 110 patients were followed up from September 2003 to February 2008, for the following events: ischemia, restenosis, atrial fibrillation, ventricular arrhythmias, heart failure, other events and complications. Ages, gender, presence of Diabetes Mellitus were noted. For the diabetic/non-diabetic (45 diabetic, 65 non-diabetic groups and male/female groups (27 female, 83 male, we applied in the SPSS program the Logrank and Wilcoxon tests, for quantifying the differences in the survival rates between the groups. Results: No significant differences were found in the survival rates between the groups (diabetic/non-diabetic Logrank test, p=0.71, Wilcoxon test, p=0.86; female/male Logrank test, p=0.7, Wilcoxon test, p=0.95. Also for the subgroup of patients which had in-graft restenosis (46 patients no significant differences were found between the diabetic/non-diabetic (Logrank test, p=0.36 and gender groups (Logrank test, p=0.4. Mean age for the whole group is 59.2 (61.9 for female and 58.3 for male. Conclusion: Diabetes Mellitus or sex is not significant factors for lower survival rates, in the first 3 years after coronary artery bypass.

  7. Evaluation of early coronary graft patency after coronary artery bypass graft surgery using multislice computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Raissi Kamal

    2009-12-01

    Full Text Available Abstract Background Coronary artery bypass graft (CABG surgery is the standard of care in the treatment of advanced coronary artery disease, and its long-term results are affected by the failure of bypass grafts. The aim of the present study was to evaluate the early patency rate in coronary bypass grafts. Methods A total of 107 consecutive patients who underwent CABG were included in this study. Early graft patency was evaluated via computed tomography (CT angiography in the first week after surgery. Results There were a total of 366 grafts, comprised of 250 venous grafts and 116 arterial grafts. Multi-slice CT detected acute graft occlusions in 32 (8.7% of all the grafts, including 26 (10% of the 250 venous grafts and 6 (5% of the 116 arterial grafts. The patency rates obtained were 97.3% for the left internal mammary (IMA grafts, 50% for the radial artery grafts, and 50% for the right IMA grafts. Additionally, 107 (96.4% grafts to the left anterior descending artery (LAD were classified as patent, whereas 1 (30% of the 3 grafts in the left circumflex (LCX region and 1 (50% of the 2 grafts in the right coronary artery (RCA territory were found to be occluded. In the venous category, 8 (13.7% of the 58 grafts to LAD were found to be occluded. In the LCX region, 9 (8.5% of the 106 grafts were classified as occluded, while the remaining 97 (91.5% grafts were patent. The venous grafts to RCA were occluded in 9 (10.4% of the 86 grafts. Amongst the multiple preoperative, intraoperative, and postoperative factors, pump time was significantly longer in the patients with occluded grafts than in those with patent grafts (P = 0.04. Conclusion The IMA grafts had the highest early patency rate amongst the coronary bypass grafts. However, the other arterial grafts were associated with a high rate of acute occlusions.

  8. Uncalibrated pulse power analysis fails to reliably measure cardiac output in patients undergoing coronary artery bypass surgery

    OpenAIRE

    Broch, Ole; Renner, Jochen; Höcker, Jan; Gruenewald, Matthias; Meybohm, Patrick; Schöttler, Jan; Steinfath, Markus; Bein, Berthold

    2011-01-01

    Introduction Uncalibrated arterial pulse power analysis has been recently introduced for continuous monitoring of cardiac index (CI). The aim of the present study was to compare the accuracy of arterial pulse power analysis with intermittent transpulmonary thermodilution (TPTD) before and after cardiopulmonary bypass (CPB). Methods Forty-two patients scheduled for elective coronary surgery were studied after induction of anaesthesia, before and after CPB respectively. Each patient was monitor...

  9. Indications and Outcomes of Prophylactic and Therapeutic Extracranial-to-intracranial Arterial Bypass for Cerebral Revascularization

    Directory of Open Access Journals (Sweden)

    Emre Gazyakan, MD, MSc

    2015-04-01

    Conclusions: The collaboration of neurosurgeons and plastic surgeons in performing EC-IC bypass can result in excellent outcomes with a high bypass patency rate and few complications, particularly for prophylactic EC-IC bypass.

  10. Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

    OpenAIRE

    Tonga Nfor; Kambiz Shetabi; Wael Hassan; Quinta Nfor; Jayant Khitha; Anjan Gupta; Tanvir Bajwa; Suhail Allaqaband

    2015-01-01

    Purpose: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD. Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS)-predicted operative mortality >...

  11. Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Diabetics with Multivessel Coronary Artery Disease: The Korean Multicenter Revascularization Registry (KORR)

    OpenAIRE

    Gwon, Hyeon-Cheol; Choi, Seung Hee; Choi, Byung-Il William; Cho, Seung Yun; Ro, Young Moo; Lee, Won Ro; ,

    2005-01-01

    This study was designed to assess the relative merits of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD), particularly for Korean diabetics. Among 3,279 patients with MVCAD who were recommended for revascularization were enrolled from nine centers in Korea, 2,154 were selected after statistical adjustments for the disparities between two groups. Survival rates were not significantly different for three years be...

  12. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease and Diabetic Nephropathy: A Single Center Experience

    OpenAIRE

    Bae, Ki Sun; Park, Hyeong Cheon; Kang, Byung Seung; Park, Jong Won; Chon, Nu Ri; Oh, Kyung Jin; Yoon, Young Won; Hong, You Sun; Ha, Sung Kyu

    2007-01-01

    Background Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD. Methods The clinical and angiographic records of DN patients with CAD ...

  13. Coronary artery bypass grafting and sensorineural hearing loss, a cohort study

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    Ashraf Omer

    2005-12-01

    Full Text Available Abstract Background Sudden sensorineural hearing loss is routinely encountered by the otologist. The etiology is varied and often identifiable. One of the relatively less frequent causes is surgery. Apart from being an established entity with otological surgeries, sensorineural hearing loss has also been known to occur after non-otological procedures under general anesthesia. Commonest amongst these procedures is cardiopulmonary bypass, an association that has long been recognized. However, despite the proposition of diverse hypotheses in the past, the pathophysiology remains unclear. Methods The study is a prospective matched cohort study that will be carried out in Aga Khan University Hospital, Karachi, Pakistan. Participants among exposed would include all those patients who would be undergoing coronary artery bypass surgery in the hospital who fall under the criteria for inclusion. Unexposed group would comprise of patients undergoing a non-bypass procedure of similar duration under the same type of anesthesia who meet the selection criteria. Both these groups will undergo audiometric testing at our hospital on three different occasions during the course of this study. Initially before the procedure to test the baseline hearing capacity; then one week after the procedure to assess any changes in hearing ability following the surgery; and finally a third audiogram at six weeks follow-up to assess further changes in any hearing deficits noted during the second phase of testing. Certain variables including the subjects' demographics and those concerning the procedure itself will be noted and used later for risk factors analysis. A detailed past medical and surgical history will also be obtained. Data analysis would include calculation of relative risk and significance of the results, by running the chi-square test. Other statistical tests like Fisher exact test may then be employed to facilitate data interpretation. Continuous scale may then be

  14. Perioperative optic neuropathy in patients undergoing off-pump coronary artery bypass graft surgery

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    Rajani Battu

    2014-01-01

    Full Text Available Aims and Objectives: Perioperative optic neuropathy (PON is a rare, but devastating complication following coronary artery bypass graft surgery (CABG. We performed a retrospective study of PON associated with off-pump CABG (OPCABG to identify possible risk factors. Materials and Methods: 1442 patients underwent OPCABG over a 10-month period from October 2008 to August 2009; PON was identified in four (0.28% patients. A retrospective review of the charts was done to identify the patient characteristics, pre-operative status, intra-operative details, and ophthalmic examination details. Friedman test was used to compare the hematocrit (Hct and the mean arterial pressure (MAP values across the three time periods: Pre-, intra- and post-operative periods. Results: All four patients were male, diabetic, and in the age range 51-69 years. All patients noted unilateral or bilateral severe visual loss in the immediate post-operative period, which was permanent. All the four patients had statistically significant decrease in the Hct (P < 0.039 and mean arterial blood pressure (P < 0.018 in the intraoperative and post-operative period when compared to pre-operative value. Conclusions : PON is a rare but definite possibility in patients undergoing OPCABG. Diabetes mellitus may be a risk factor. Perioperative hemodynamic abnormalities like decrease in MAP and anemia may play a role in the development of PON in OPCABG.

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

    NARCIS (Netherlands)

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

    2010-01-01

    Background/Objectives. We aimed to investigate the incidence and clinical outcome of coronary artery bypass grafting (CABG) performed in contemporary patients with ST-elevation myocardial infarction (STEMI) within 30 days after presentation. Methods. All 1071 patients enrolled in the Thrombus Aspira

  16. No benefit of intraoperative whole blood sequestration and autotransfusion during coronary artery bypass grafting : results of a randomized clinical trial

    NARCIS (Netherlands)

    Ramnath, A N; Naber, H R; de Boer, A; Leusink, J A

    2003-01-01

    OBJECTIVES: In a randomized clinical trial of patients undergoing elective coronary artery bypass grafting, we evaluated the effect of intraoperative whole blood sequestration and autotransfusion on postoperative blood loss and the use of allogeneic blood products. METHODS: Male patients were includ

  17. PREOPERATIVE THERAPY OF LOW-DOSE ASPIRIN IN INTERNAL MAMMARY ARTERY BYPASS OPERATIONS WITH AND WITHOUT LOW-DOSE APROTININ

    NARCIS (Netherlands)

    SCHONBERGER, JPAM; BREDEE, JJ; VANOEVEREN, W; VANZUNDERT, AAJ; VERKROOST, M; TERWOORST, J; BAVINCK, JH; BERREKLOUW, E; WILDEVUUR, CRH

    1993-01-01

    The effect of preoperative low-dose aspirin (1 mg/kg of body weight) and intraoperative low-dose aprotinin (2 million kallikrein inactivator units) treatment on perioperative blood loss and blood requirements in patients who undergo internal mammary artery bypass operations is unknown. Therefore, we

  18. Vitamin C in prevention of atrial fibrillation after coronary artery bypass graft: double blind randomized clinical trial

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    Mahmoodreza Sarzaeem

    2014-03-01

    Conclusion: Vitamin C is relatively safe, inexpensive, well tolerated and has a low complication. According to the 44% reduction in the incidence of atrial fibrillation in vitamin C patients undergoing coronary artery bypass grafting surgery, this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation.

  19. Sustained postoperative anaemia is associated with an impaired outcome after coronary artery bypass graft surgery : insights from the IMAGINE trial

    NARCIS (Netherlands)

    Westenbrink, B. Daan; Kleijn, Lennaert; de Boer, Rudolf A.; Tijssen, Jan G.; Warnica, Wayne J.; Baillot, Richard; Rouleau, Jean L.; van Gilst, Wiek H.

    2011-01-01

    Objective To investigate the association between sustained postoperative anaemia and outcome after coronary artery bypass graft (CABG) surgery. Design Retrospective analysis of the IMAGINE trial, which tested the effect of the ACE inhibitor quinapril on cardiovascular events after CABG. Setting Thor

  20. Perioperative Changes of Plasma Endothelin-1 in Patients Undergoing Coronary Artery bypass Grafting and the Effect of Nitroglycerin

    Institute of Scientific and Technical Information of China (English)

    陈鑫; 蒋英硕; 徐明; 陈振强; 郭子黄

    2002-01-01

    Objectioe To observe the dynamic changes of the plasma ET-1 and the effect of low dose nitroglycerin in patients with coronary artery bypass surgery. Methods Forty patravenous nitroglycerin 1 μg @ kg-1 @ rain-1 perioperatively. RIA was used to assay the plasma ET-1 lev-el. All the hemodynamie parameters were recorded by the Swan-Ganze catheter. Results The preoperative plasma ET-1 level in patients with coronary artery disease was significantly higher than the normal level. Five minutes after cardiopalmouary bypass in these patients the plasma ET-1 level was increased significantly until 6 to 8 h after operation. The increasing plasma ET-1 level in group B was less intense than that in group A. There was a positive correlation between the plasma ET-1 level and the mean pulmonary artery pressure in group A 2 and 8 h after operation. Conclusion In patients undergoing coronary artery bypass surgery, the increased plasma ET-1 level may be due to the influence of cardiopulmonary bypass partly. Low dose nitroglycerin is beneficial to these patients.

  1. Feasibility study of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    孙立新

    2014-01-01

    Objective To investigate the feasibility of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting(OPCABG).Methods Upon the approval of institutional Ethics Committee and informed consent,forty patients ASAⅡorⅢaged 52-77 yr with BMI(body mass index)<30

  2. The relationship between oxygenator exhaust P(CO2) and arterial P(CO2) during hypothermic cardiopulmonary bypass.

    Science.gov (United States)

    Graham, J M; Gibbs, N M; Weightman, W M; Sheminant, M R

    2005-08-01

    During cardiopulmonary bypass the partial pressure of carbon dioxide in oxygenator arterial blood (P(a)CO2) can be estimated from the partial pressure of gas exhausting from the oxygenator (P(E)CO2). Our hypothesis is that P(E)CO2 may be used to estimate P(a)CO2 with limits of agreement within 7 mmHg above and below the bias. (This is the reported relationship between arterial and end-tidal carbon dioxide during positive pressure ventilation in supine patients.) During hypothermic (28-32 degrees C) cardiopulmonary bypass using a Terumo Capiox SX membrane oxygenator, 80 oxygenator arterial blood samples were collected from 32 patients during cooling, stable hypothermia, and rewarming as per our usual clinical care. The P(a)CO2 of oxygenator arterial blood at actual patient blood temperature was estimated by temperature correction of the oxygenator arterial blood sample measured in the laboratory at 37 degrees C. P(E)CO2 was measured by connecting a capnograph end-to-side to the oxygenator exhaust outlet. We used an alpha-stat approach to cardiopulmonary bypass management. The mean difference between P(E)CO2 and P(a)CO2 was 0.6 mmHg, with limits of agreement (+/-2 SD) between -5 to +6 mmHg. P(E)CO2 tended to underestimate P(a)CO2 at low arterial temperatures, and overestimate at high arterial temperatures. We have demonstrated that P(E)CO2 can be used to estimate P(a)CO2 during hypothermic cardiopulmonary bypass using a Terumo Capiox SX oxygenator with a degree of accuracy similar to that associated with the use of end-tidal carbon dioxide measurement during positive pressure ventilation in anaesthetized, supine patients. PMID:16119486

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    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

  5. Amiodarone cost effectiveness in preventing atrial fibrillation after coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Zebis, Lars R; Christensen, Thomas D; Hjortdal, Vibeke E;

    2008-01-01

    was based on a randomized, controlled, double-blind trial (the RASCABG study) using avoidance of atrial fibrillation as the measure of benefit at the Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark. Two hundred and fifty eligible consecutively enrolled CABG......BACKGROUND: The purpose of this study was to estimate the costs and health benefits of routinely administered postoperative amiodarone as prevention of atrial fibrillation for patients undergoing coronary artery bypass grafting (CABG) for stable angina. METHODS: This cost-effectiveness study...... patients were included to receive either 300 mg amiodarone or placebo (5% aqueous dextrose solution) administered intravenously over 20 minutes followed by 600 mg amiodarone/placebo orally twice a day (8 am and 8 pm) for the first 5 postoperative days. RESULTS: In the amiodarone group, there were 14 cases...

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

    Directory of Open Access Journals (Sweden)

    Deepak Borde

    2013-01-01

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

  7. Guillain–Barré Syndrome after Coronary Artery Bypass Graft Surgery:a Case Report

    Directory of Open Access Journals (Sweden)

    Manouchehr Hekmat

    2016-01-01

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

  8. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review

    Institute of Scientific and Technical Information of China (English)

    Phillip J Tully; Robert A Baker

    2012-01-01

    Research to date indicates that the number of coronary artery bypass graft (CABG) surgery patients affected by depression (i.e., major, minor, dysthymia) approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsychological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.

  9. The effect of education on the stress levels in patients undergoing coronary artery bypass graft surgery

    International Nuclear Information System (INIS)

    Objectives: To investigate the effect of education on the stress levels associated with Coronary Artery Bypass Graft (CABG) surgery in the week after CABG surgery. Methodology: The study used a quasi-experimental design. Patients were selected through convenience sampling at a university hospital in Turkey. There were 60 patients in the study; 30 in the experimental group and another 30 in the control group. Data were collected using the Stressors Scale associated with CABG on the third day of the post-operative period. Results: Cronbach's alpha of the scale was 0.89. Alpha coefficients ranged from 0.82 to 0.79.The difference between the score averages of the experimental and control group was p = 0.002 for the illness-related sub scale, p=0.031 for the hospital-related sub scale, and p = 0.006 in total. Conclusion: Education was effective for reduction of stress associated with CABG surgery. (author)

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

    Science.gov (United States)

    LaPar, Damien J.; Stukenborg, George J.; Guyer, Richard A.; Stone, Matthew L.; Bhamidipati, Castigliano M.; Lau, Christine L.; Kron, Irving L.; Ailawadi, Gorav

    2012-01-01

    Background Medicaid and Uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes following coronary artery bypass grafting (CABG) in the United States is dependent upon primary payer status. Methods From 2003–2007, 1,250,619 isolated CABG operations were evaluated using the Nationwide Inpatient Sample (NIS) database. Patients were stratified by primary payer status: Medicare, Medicaid, Uninsured, and Private Insurance. Hierarchical multiple regression models were applied to assess the effect of primary payer status on postoperative outcomes. Results Unadjusted mortality for Medicare (3.3%), Medicaid (2.4%) and Uninsured (1.9%) patients were higher compared to Private Insurance patients (1.1%, p<0.001). Unadjusted length of stay was longest for Medicaid patients (10.9±0.04 days) and shortest for Private Insurance patients (8.0±0.01 days, p<0.001). Medicaid patients accrued the highest unadjusted total costs ($113,380±386, p<0.001). Importantly, after controlling for patient risk factors, income, hospital features, and operative volume, Medicaid (OR=1.82, p<0.001) and Uninsured (OR=1.62, p<0.001) payer status independently conferred the highest adjusted odds of in-hospital mortality. In addition, Medicaid payer status was associated with the longest adjusted length of stay and highest adjusted total costs (p<0.001). Conclusions Medicaid and Uninsured payer status confers increased risk adjusted in-hospital mortality for patients undergoing coronary artery bypass grafting operations. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors. Possible explanations include delays in access to care or disparate differences in health maintenance. PMID:22965973

  11. Geographic Variability in Potentially Discretionary Red Blood Cell Transfusions After Coronary Artery Bypass Grafting Surgery

    Science.gov (United States)

    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 [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 [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 triggers and anemia management, may contribute to variability in RBC transfusion rates. PMID:25227699

  12. Adenosine Preconditioning versus Ischemic Preconditioning in Patients undergoing Off-Pump Coronary Artery Bypass (OPCAB

    Directory of Open Access Journals (Sweden)

    SeyedKhalil Forouzannia

    2015-10-01

    Full Text Available Background: During off-pump coronary artery bypass (OPCAB, the heart is subjected to ischemic and reperfusion injury. Preconditioning is a mechanism that permits the heart to tolerate myocardial ischemia. The aim of this study was to compare the effects of Adenosine preconditioning with ischemic preconditioning on the global ejection fraction (EF in patients undergoing OPCAB.Methods: In this single-blind, randomized controlled trial, sixty patients undergoing OPCAB were allocated into three equally-numbered groups through simple randomization: Adenosine group, ischemic group, and control group. The patients in the Adenosine group received an infusion of Adenosine. In the ischemic group, ischemic preconditioning was induced by the temporary occlusion of the left anterior descending coronary artery twice for a 2-minute period, followed by 3-minute reperfusion before bypass grafting of the first coronary vessel. The control group received an intravenous infusion of 0.9% saline. Blood samples at different times were sent for the measurement of creatine kinase isoenzyme MB (CK-MB and cardiac troponin I (cTnI. We also recorded electrocardiographic indices and clinical parameters, including postoperative use of inotropic drugs and preoperative and postoperative EF.Results: History of myocardial infarction, hyperlipidemia, diabetes mellitus, kidney disease, preoperative arrhythmias, and utilization of postoperative inotrope was the same between the three groups. The incidence of postoperative arrhythmias was not significant between the three groups. Also, there were no significant differences in preoperative and postoperative EF and the serum levels of enzymes (cTnI and CK-MB between the groups.Conclusion: Based on the findings of this study, there was no significant difference in the postoperative EF between the groups. Although the incidence of arrhythmias was higher in the ischemic preconditioning group than in the other groups, the difference

  13. Meta-analysis of concomitant mitral valve repair and coronary artery bypass surgery versus isolated coronary artery bypass surgery in patients with moderate ischaemic mitral regurgitation.

    Science.gov (United States)

    Kopjar, Tomislav; Gasparovic, Hrvoje; Mestres, Carlos A; Milicic, Davor; Biocina, Bojan

    2016-08-01

    Ischaemic mitral regurgitation (IMR) is a complication of coronary artery disease with normal chordal and leaflet morphology. Controversy surrounds the issue of appropriate surgical management of moderate IMR. With the present meta-analysis, we aimed to determine whether the addition of mitral valve (MV) repair to coronary artery bypass grafting (CABG) improved clinical outcome over CABG alone in patients with moderate IMR. Databases were searched for studies reporting on clinical outcomes after CABG and MV repair or CABG alone for moderate IMR. Clinical end-points were operative mortality, survival, New York Heart Association (NYHA) class ≥2 and MR grade ≥2 at last follow-up. A total of five observational and four randomized controlled trials (RCTs) were identified. The mean follow-up was 2.7 years. An analysis of all studies revealed increased operative risk in the concomitant CABG and MV repair group {risk ratio [RR] 2.02 [95% confidence interval (CI) 1.15, 3.56], P = 0.01, I(2) = 0%}. However, an analysis of RCTs only showed that the operative risk was equivalent [RR 1.05 (95% CI 0.34, 3.30), P = 0.93, I(2) = 0%]. Pooled hazard ratio (HR) on survival did not favour either procedure [all studies: HR 1.08 (95% CI 0.77, 1.50), P = 0.66, I(2) = 0%; RCTs only: HR 0.89 (95% CI 0.47, 1.70), P = 0.73, I(2) = 0%]. The incidence of exercise intolerance quantified as NYHA class ≥2 was similar between groups (all studies: RR 0.72 (95% CI 0.42, 1.24), P = 0.24, I(2) = 77%; RCTs only: RR 0.61 (95% CI 0.24, 1.55), P = 0.30, I(2) = 83%]. Risk of residual MR grade ≥2 was higher in the CABG only group [all studies: RR 0.30 (95% CI 0.16, 0.60), P < 0.001, I(2) = 83%; RCTs only: RR 0.20 (95% CI 0.04, 0.90), P = 0.04, I(2) = 72%]. There is neither increased operative mortality nor survival benefit associated with concomitant CABG and MV repair for IMR of moderate degree over CABG alone. Further studies with long-term follow-up data and sub-group analyses of current data are

  14. Postoperative neuropsychological change and its underlying mechanism in patients undergoing coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    YIN Yi-qing; LUO Ai-lun; GUO Xiang-yang; LI Li-huan; HUANG Yu-guang

    2007-01-01

    Background The high incidence of neuropsychologic deficits after cardiac surgery, including cognitive dysfunction and mood status, has significantly influenced the prognosis, outcome of treatment and long-term quality of life of patients. With a circadian secretion pattern, melatonin and cortisol are capable of modulating the human physiological processes and neuropsychological status, whereas disorder of their secretion pattern may lead to many diseases. However, it is unclear whether neuroendocrine variations are related to the neuropsychologic status in patients undergoing coronary artery bypass grafting (CABG). Methods Forty male patients scheduled for CABG with hypothermic cardiopulmonary bypass (CPB) (n=20) or off-pump coronary artery bypass (OPCAB) (n=20) were studied. Blood samples were taken intraoperatively at specific time-points and every 3 hours within the first postoperative 24 hours to determine plasma concentrations of melatonin and cortisol. A neuropsychologic test battery including depression and anxiety was administered preoperatively and 7 to 10 days postoperatively. Statistical methods included the nonparametric analysis, multiple linear regression and cosinor analysis. Results The patients in the CPB group exhibited more severe neuropsychologic deficits and more anxious than those in the OPCAB group after surgery. In both groups, patients were more depressed postoperatively than preoperatively and recovered 3 months after surgery. Depression and anxiety were correlated with some factors of cognitive dysfunctions. In the postoperative 24 hours, 2 patients in the CPB group, and 6 patients in the OPCAB group showed a circadian rhythm of melatonin secretion. As for cortisol secretion, there were 3 patients in the CPB group and 7 in the OPCAB group respectively. Parameters of circadian rhythm of melatonin in the CPB group and those of secretion rhythm of cortisol in both groups were correlated with depression and some neuropsychologic tests

  15. [Coronary artery bypass surgery: methods of performance monitoring and quality control].

    Science.gov (United States)

    Albert, A; Sergeant, P; Ennker, J

    2009-10-01

    , the special advantages of the procedure can be utilised to reach a nearly complete avoidance of postoperative stroke through combining the procedure with aorta no-touch technique. The long-term success of the bypass operation depends on the type of bypass material in additions to many other factors. Both internal mammary arteries are considered the most durable.Using an operation preparation check contributes to the operative success.

  16. Bronchopulmonary arterial anastomosis at the precapillary level in human lung. Visualization using CT angiography compared with microangiography of autopsied lung

    International Nuclear Information System (INIS)

    To investigate the interrelationships between the bronchial and pulmonary circulations including the existence of precapillary bronchopulmonary arterial anastomoses, CT of bronchial arteriography (BAG-CT) was performed in 10 patients and BAG-CT during a pulmonary artery block test (PA-block) in 5 patients with lung cancer. Bronchial and pulmonary circulations were evaluated in 5 autopsied normal lungs by injecting silicone rubber with different colors into the bronchial and pulmonary arteries. BAG-CT correlated well with the findings at silicone rubber injection into lung autopsy samples. BAG-CT demonstrated inflow of contrast medium into the pulmonary artery during PA-block in all cases, while no inflow was observed before and following reversal of PA-block. Mixed silicone rubber was observed in the lobar to subsubsegmental bronchial arteries in all cases and in the subsubsegmental pulmonary artery in one case. Precapillary bronchopulmonary arterial anastomoses may exist at the level of the lobar bronchi to the periphery. If either the pulmonary or bronchial circulation is disturbed, flow occurs inside the anastomoses to supplement the other flow, especially flow from the bronchial to the pulmonary arteries via the anastomoses, which occurs within 30 min

  17. Bronchopulmonary arterial anastomosis at the precapillary level in human lung. Visualization using CT angiography compared with microangiography of autopsied lung

    International Nuclear Information System (INIS)

    Purpose: To investigate the interrelationships between the bronchial and pulmonary circulations including the existence of precapillary bronchopulmonary arterial anastomoses. Material and Methods: CT of bronchial arteriography (BAG-CT) was performed in 10 patients and BAG-CT during a pulmonary artery block test (PA-block) in 5 patients with lung cancer. Bronchial and pulmonary circulations were evaluated in 5 autopsied normal lungs by injecting silicone rubber with different colors into the bronchial and pulmonary arteries. Results: BAG-CT correlated well with the findings at silicone rubber injection into lung autopsy samples. BAG-CT demonstrated inflow of contrast medium into the pulmonary artery during PA-block in all cases, while no inflow was observed before and following reversal of PA-block. Mixed silicone rubber was observed in the lobar to subsubsegmental bronchial arteries in all cases and in the subsubsegmental pulmonary artery in one case. Conclusion: Precapillary bronchopulmonary arterial anastomoses may exist at the level of the lobar bronchi to the periphery. If either the pulmonary or bronchial circulation is disturbed, flow occurs inside the anastomoses to supplement the other flow, especially flow from the bronchial to the pulmonary arteries via the anastomoses, which occurs within 30 min. (orig.)

  18. The Evaluation of the Graft Vessels after Coronary Artery Bypasses Graft with the Distal Angiography of DSCT%DSCT数字化血管成像对冠状动脉搭桥术后桥血管的评价

    Institute of Scientific and Technical Information of China (English)

    汪春荣; 沈比先; 高德宏; 刘远健; 谭四平; 陈胜基

    2012-01-01

    Objective: To evaluate the performance of Dual Source CT (DSCT) in the follow up of coronarvartery bypass grafts. Methods: 16 patients with coronary bypass grafts underwent the DSCT coronary angiography(CTA) in Siemens SOMATOM Definition. The proximal and distal anastomosis, the bypass graft itself, and the run-off vessel detected in CTA images were evaluated for every coronary bypass graft, and the native coronary artery segments were evaluated too. The reliability of the DSCT detecting stenoses of the bypass grafts and the native coronary segments would be evaluated. Results: There were 42 bypass grafts in 16 patients with coronary bypass grafts underwent the DSCT coronary angiography(CTA) ,6 bypass grafts of the cases were blocked. All 42 bypass grafts were assessable. Twenty-five bypass grafts of the cases were flowing freely. Nine bypass grafts with insignificant stenosis(≤50%) and 8 bypass grafts with significant stenosis could be dearly displayed(>50%). 36 of 42 coronary bypass grafts including IMA patency in 88.9 (8 / 9), RA in 85.7(6/7) and SVG in 76.9 (20 / 26) were patient. The overall patient rate was 85.7%. Conclusion: Noninvasive evaluating the bypass grafts with DSCT has great potential value in the follow-up.%目的:探讨DSCT数字化血管成像对冠状动脉搭桥术后随访应用价值.方法:采用西门子DSCT(Siemens SOMATOM Definition)对16例行冠状动脉搭桥术后患者行DSCT冠状动脉检查,分别评价CT图像桥血管近远端吻合口、桥血管本身有无狭窄、钙化和吻合口远端引流血管的图像质量及冠状动脉图像质量,评价双源CT诊断桥血管通畅性和冠状动脉是否存在狭窄.结果:DSCT显示16例患者共发现桥血管42根,其中6根闭塞,所有桥血管均可评价.42支桥血管中,25支未见狭窄,9支桥血管狭窄程度≤50%,8支桥血管狭窄程度>50%.搭桥血管通畅率为85.7%(36/42),乳内动脉桥通畅率较高,为88.9%(8/9),肱动脉次之,为85.7%(6/7),大隐

  19. Triage for coronary artery bypass graft surgery in Canada: Do patients agree on who should come first?

    Directory of Open Access Journals (Sweden)

    Chong Alice

    2007-07-01

    Full Text Available Abstract Background The extent to which clinical and non-clinical factors impact on the waiting-list prioritization preferences of patients in the queue is unknown. Using a series of hypothetical scenarios, the objective of this study was to examine the extent to which clinical and non-clinical factors impacted on how patients would prioritize others relative to themselves in the coronary artery bypass surgical queue. Methods Ninety-one consecutive eligible patients awaiting coronary artery bypass grafting surgery at Sunnybrook Health Sciences Centre (median waiting-time duration prior to survey of 8 weeks were given a self-administered survey consisting of nine scenarios in which clinical and non-clinical characteristic profiles of hypothetical patients (also awaiting coronary artery bypass surgery were varied. For each scenario, patients were asked where in the queue such hypothetical patients should be placed relative to themselves. Results The eligible response rate was 65% (59/91. Most respondents put themselves marginally ahead of a hypothetical patient with identical clinical and non-clinical characteristics as themselves. There was a strong tendency for respondents to place patients of higher clinical acuity ahead of themselves in the queue (P Conclusion While patient perceptions generally reaffirmed a bypass surgical triage process based on principals of equity and clinical acuity, the valuation of social independence may justify further debate with regard to the inclusion of non-clinical factors in waiting-list prioritization management systems in Canada, as elsewhere.

  20. Progress on Complications of Direct Bypass for Moyamoya Disease.

    Science.gov (United States)

    Yu, Jinlu; Shi, Lei; Guo, Yunbao; Xu, Baofeng; Xu, Kan

    2016-01-01

    Moyamoya disease (MMD) involves progressive occlusion of the intracranial internal carotid artery resulting in formation of moyamoya-like vessels at the base of the brain. It can be characterized by hemorrhage or ischemia. Direct vascular bypass is the main and most effective treatment of MMD. However, patients with MMD differ from those with normal cerebral vessels. MMD patients have unstable intracranial artery hemodynamics and a poor blood flow reserve; therefore, during the direct bypass of superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, perioperative risk factors and anesthesia can affect the hemodynamics of these patients. When brain tissue cannot tolerate a high blood flow rate, it becomes prone to hyperperfusion syndrome, which leads to neurological function defects and can even cause intracranial hemorrhage in severe cases. The brain tissue is prone to infarction when hemodynamic equilibrium is affected. In addition, bypass vessels become susceptible to occlusion or atrophy when blood resistance increases. Even compression of the temporalis affects bypass vessels. Because the STA is used in MMD surgery, the scalp becomes ischemic and is likely to develop necrosis and infection. These complications of MMD surgery are difficult to manage and are not well understood. To date, no systematic studies of the complications that occur after direct bypass in MMD have been performed, and reported complications are hidden among various case studies; therefore, this paper presents a review and summary of the literature in PubMed on the complications of direct bypass in MMD.

  1. Assessment of regional quantitative analysis by ECG-gated myocardial SPECT after coronary artery bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Higuchi, Takahiro; Taki, Junichi; Nakajima, Kenichi; Tsuji, Sirou; Yoneyama, Tatsuya; Kinuya, Seigo; Tonami, Norihisa; Kawasuji, Michio [Kanazawa Univ. (Japan). School of Medicine

    1999-12-01

    ECG-gated myocardial SPECT (G-SPECT) was performed before and after coronary artery bypass surgery (CABG) to investigate how this operation would affect the assessment of regional quantitative analyses. Nineteen patients with coronary artery disease underwent G-SPECT before and 1 month after uncomplicated CABG. {sup 99m}Tc-MIBI 740 MBq was injected at rest, then G-SPECT was performed 60 min later. Regional ejection fraction (rEF), wall motion (WM), systolic was thickening (WT) and % tracer uptake were evaluated by quantitative gated SPECT program (QGS). Parameters were obtained quantitatively in 16 segments based on the functional bull's eye map. Percent tracer uptake increased in septum from 75{+-}11% to 78{+-}11% (p<0.001), while WT did not change (40{+-}19% to 41{+-}20%) after CABG. However, in septum rEF decreased from 17{+-}13% to 6{+-}9% (p<0.001) and WM decreased in septum from 1.6{+-}1.1 mm to 0.6{+-}0.9 mm (p<0.001). Significant reduction of rEF and WM despite of no deterioration of WT and % tracer uptake suggested that rEF and WM were affected by pseudoparadoxical asynergy after uncomplicated CABG. For the evaluation of regional function after CABG by G-SPECT, WT might be the preferred parameter. (author)

  2. Gender Differences in In-Hospital Outcomes After Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Swaminathan, Rajesh V; Feldman, Dmitriy N; Pashun, Raymond A; Patil, Rupa K; Shah, Tara; Geleris, Joshua D; Wong, Shing-Chiu; Girardi, Leonard N; Gaudino, Mario; Minutello, Robert M; Singh, Harsimran S; Bergman, Geoffrey; Kim, Luke K

    2016-08-01

    Women historically have a greater risk of operative mortality than men after coronary artery bypass grafting (CABG). There is paucity of contemporary data in gender outcomes of surgical revascularization and understanding modifiable factors that contribute to gender differences are critical for quality improvement and practice change. We, therefore, sought to examine whether the gender gap in CABG outcomes is closing in the contemporary era by conducting a retrospective analysis from the Nationwide Inpatient Sample database from 2003 to 2012. We included all patients who underwent isolated CABG surgery (n = 2,272,998; female n = 623,423 [27.4%]; male n = 1,649,575 [72.6%]). The annual rate of CABG surgeries decreased by 53.7% in men and 57.8% in women over the 10-year study period. Although internal mammary artery use in women was less frequent than in men in 2003 (77.4% vs 81.9%, p gap by 2012 (86.2% vs 87.0%, ptrend 0.003). Overall, unadjusted in-hospital mortality was greater in women (3.2% vs 1.8%, p gap is slowly closing. PMID:27269585

  3. Cell layer-electrospun mesh composites for coronary artery bypass grafts.

    Science.gov (United States)

    Erndt-Marino, Josh D; Becerra-Bayona, Silvia; McMahon, Rebecca E; Goldstein, Aaron S; Hahn, Mariah S

    2016-09-01

    This work investigates the potential of cell layer-electrospun mesh constructs as coronary artery bypass grafts. These cell-mesh constructs were generated by first culturing a confluent layer of 10T½ smooth muscle progenitor cells on a high strength electrospun mesh with uniaxially aligned fibers. Cell-laden mesh sheets were then wrapped around a cylindrical mandrel such that the mesh fibers were aligned circumferentially. The resulting multi-layered constructs were then cultured for 4 wks in media supplemented with TGF-β1 and ascorbic acid to support 10T½ differentiation toward a smooth muscle cell-like fate as well as to support elastin and collagen production. The underlying hypothesis of this work was that extracellular matrix (ECM) deposited by the cell layers would act as an adhesive agent between the individual mesh layers, providing strength to the construct as well as a source for structural elasticity at low strains. In addition, the structural anisotropy of the mesh would inherently guide desired circumferential cell and ECM alignment. Results demonstrate that the cell-mesh constructs exhibited a J-shaped circumferential stress-strain response similar to that of native coronary artery, while also displaying acceptable tensile strength. Furthermore, associated 10T½ cells and deposited collagen fibers showed a high degree of circumferential alignment. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2200-2209, 2016. PMID:27101019

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

    Directory of Open Access Journals (Sweden)

    Elder dos Santos Cavalcante

    2014-11-01

    Full Text Available 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.

  5. Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

    Directory of Open Access Journals (Sweden)

    Burgess SN

    2015-06-01

    Full Text Available Sonya N Burgess,1 John J Edmond,2 Craig P Juergens,1 John K French11Department of Cardiology, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; 2Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials. Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG and PCI, with particular reference to the landmark trials that inform practice guidelines. Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era. Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the

  6. Axillobifemoral bypass grafting

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2004-01-01

    occlusion was reported in four patients. As the cause of occlusion, the progression of occlusive disease of receptive artery was identified in three patients, while anastomotic neointimae hyperplasia of recipient artery was identified in one patient. Three patients died during the follow up period. As the cause of death, CVI was reported in two patients and malignancy of the urinary tract was fpund in one patient. The other complications were - artery angulation on the level of proximal anastomosis in one patient (Figure 1, false aneurysm in one patient, perigraft seroma in one patient and graft infection in three patients. Life table method has shown that cumulative rate of late graft patency is 80.39% after five years (Graph 1. DISCUSSION Our results were analyzed and compared with the results of the study on 283 patients who had undergone aortobifemoral bypass (AFF operation due to the aortoiliac occlusive disease. This study was completed in 1995 (18. The results showed that there was no statistically significant differences between AxFF and AFF group (p>0.05, considering early mortality rate and late graft patency (Graph 2. The review of mortality and late patency rate after AxFF bypass grafting in a world well known studies has shown the similar results (Table 1. CONCLUSION The authors suggest that axilobifemoral bypass is indicated when there are contraindications or difficulties to perform anatomic reconstruction due to the abdomen condition (infection, adhesion, comorbidity as well as in high risk patients with low life expectancy.

  7. Short-term clinical outcomes after hybrid coronary revascularization versus off-pump coronary artery bypass for the treatment of multivessel or left main coronary artery disease: a meta-analysis

    OpenAIRE

    Hu, Fang-Bin; Cui, Lian-Qun

    2015-01-01

    Background Hybrid coronary revascularization (HCR) and off-pump coronary artery bypass grafting (OPCABG) are both feasible, less invasive techniques for coronary revascularization. Although both techniques utilize the left internal mammary artery to left anterior descending artery graft, HCR uses drug-eluting stents instead of saphenous vein bypass. It remains unclear whether HCR is equal to, better or worse than OPCABG. Methods and results A meta-analysis was carried out using a random-effec...

  8. Impact of Isolated Coronary Artery Bypass Grafting on Non-Organic Tricuspid Regurgitation Severity

    Directory of Open Access Journals (Sweden)

    Mahmood Sheikhfathollahi

    2009-12-01

    Full Text Available Background: Moderate non-organic tricuspid regurgitation (TR concomitant with coronary artery disease is not uncommon. Whether or not TR improves after pure coronary artery bypass grafting (CABG, however, is unclear. The aim of this study was to evaluate the effect of isolated CABG on moderate non-organic TR.Methods: This study recruited 50 patients (40% female, mean age: 65.38±8.01 years, mean left ventricular ejection fraction (LVEF: 45.74±13.05% with moderate non-organic TR who underwent isolated CABG. TR severity before and after CABG was compared. Pulmonary arterial systolic pressure (PAPs>30mmHg and LVEF<50% were considered elevated PAPs (EPAPs and LV systolic dysfunction, respectively. Presence of Q-wave in leads II, III, and aVF was considered inferior myocardial infarction (inf. MI.Results: Pre-operatively, 81.5% of the patients had EPAPs, 16% right ventricle (RV dilation, and 50% left ventricle (LV and 16% RV systolic dysfunction. TR severity improved in 64% after CABG, whereas it remained unchanged or even worsened in others (P value<0.001. Patients with inf. MI showed no improvement in TR, while patients without inf. MI had significant TR regression after CABG (P value=0.050. Improvement of TR severity after CABG was not related to pre-operative RV size and function, LV systolic function, or PAPs reduction.Conclusion: Although TR severity decreased remarkably after isolated CABG, a considerable number of the patients had no TR regression. In addition, only absence of inf. MI was significantly correlated to TR improvement after CABG. Further prospective studies with long-term follow-up are needed to determine the other factors predicting TR regression after isolated CABG.

  9. Distinct alterations in sublingual microcirculatory blood flow and hemoglobin oxygenation in on-pump and off-pump coronary artery bypass graft surgery

    NARCIS (Netherlands)

    B. Atasever; C. Boer; P. Goedhart; J. Biervliet; J. Seyffert; R. Speekenbrink; L. Schwarte; B. de Mol; C. Ince

    2011-01-01

    The authors hypothesized that cardiopulmonary bypass (CPB) (on-pump) is associated with more severe changes in the microcirculatory blood flow and tissue oxygenation as compared with off-pump coronary artery bypass surgery. An observational study. A university hospital and teaching hospital. Patient

  10. Oral Ascorbic Acid in Combination with Beta-Blockers Is More Effective than Beta-Blockers Alone in the Prevention of Atrial Fibrillation after Coronary Artery Bypass Grafting

    OpenAIRE

    Eslami, Masoud; Badkoubeh, Roya Sattarzadeh; Mousavi, Mehdi; Radmehr, Hassan; Salehi, Mehrdad; Tavakoli, Nafiseh; Avadi, Mohamad Reza

    2007-01-01

    Because adrenergic beta antagonists are not sufficient to prevent atrial fibrillation after coronary artery bypass grafting, this prospective, randomized trial was designed to evaluate the effects of ascorbic acid as an adjunct to β-blockers.

  11. Early physical training and psycho-educational intervention for patients undergoing coronary artery bypass grafting. The SheppHeart randomized 2 × 2 factorial clinical pilot trial

    DEFF Research Database (Denmark)

    Højskov, Ida E; Moons, Philip; Hansen, Niels V;

    2015-01-01

    BACKGROUND: Patients undergoing coronary artery bypass graft surgery often experience a range of problems and symptoms such as immobility, pain and insufficient sleep. Results from trials investigating testing in-hospital physical exercise or psychological intervention have been promising. However...

  12. The influence of stenosis degrees and graft suture position on local hemodynamics of coronary bypass

    Science.gov (United States)

    Totorean, A. F.; Bernad, S. I.; Susan-Resiga, R. F.

    2016-06-01

    Bypass graft failure is mainly caused by intimal hyperplasia (IH) that occurs at the graft anastomosis after coronary artery bypass grafting (CABG) surgery. It has been shown that local hemodynamics influences the process of IH initiation and progression. A main concern at this type of surgery is to increase the graft patency, respectively to improve the local hemodynamics. This paper analyzes the influence of different degree of stenosis severity and graft suture position on graft patency, taking into consideration the local hemodynamics. Bypass configurations with anastomosis angle of 45° were numerically investigated, with respect to wall shear stress and pressure variation. We can assume that in the conditions of our study, different stenosis degrees and position of the graft suture influence the local blood flow conditions, and, nevertheless, the graft patency.

  13. Coronary artery bypass surgery or coronary stenting in diabetic patients: too soon to make a statement?

    International Nuclear Information System (INIS)

    Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. However, almost simultaneously with this data, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in adverse cardiac events compared to 1st generation DES in patients with diabetes. In this editorial we review the old and new randomized data in diabetic patients and conclude that there are many unresolved issues to make a definitive statement regarding which is the best revascularization preference in diabetic patients and the measured final efficacy of PCI and CABG will not be reached until the arrival of RCT using next generation DES, including complete absorbable scaffolds. - Highlights: • Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. • In recent years, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in

  14. Coronary artery bypass surgery or coronary stenting in diabetic patients: too soon to make a statement?

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, Alfredo E., E-mail: arodriguez@centroceci.com.ar

    2014-11-15

    Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. However, almost simultaneously with this data, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in adverse cardiac events compared to 1st generation DES in patients with diabetes. In this editorial we review the old and new randomized data in diabetic patients and conclude that there are many unresolved issues to make a definitive statement regarding which is the best revascularization preference in diabetic patients and the measured final efficacy of PCI and CABG will not be reached until the arrival of RCT using next generation DES, including complete absorbable scaffolds. - Highlights: • Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. • In recent years, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in

  15. The effectiveness of the program kinesitherapy men aged 45-65 years after coronary artery bypass graft (CABG.

    Directory of Open Access Journals (Sweden)

    Iermakov S.S.

    2011-01-01

    Full Text Available The purpose of research is the effectiveness of the training program in cardiac rehabilitation of 11 men at the age between 45 and 65 years undergoing coronary artery bypass grafting. The study used the reports of electrocardiographic exercise stress test, performed before and after training cycle each of the patient. In order to analyze the training loads were also used medical records, including diagnosis, prescribing doctor and ordered treatments. Training loads used in the training program in the rehabilitation of men undergoing coronary artery bypass graft allowed for effective implementation of the objectives pursued. The analysis of training loads and effectiveness of the rehabilitation program to the conclusion that the basis for the achievement of rehabilitation is to develop general fitness and aerobic endurance. Optimally balanced training loads, taking into account the individual needs of patients, is the key to success in the process of recovery after cardiac incident.

  16. Drug-eluting stents:is it the beginning of the end for coronary artery bypass surgery?

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja

    2004-01-01

    @@ Myocardial revascularization therapy of coronary artery disease is one of the most important medical advances of the past 50 years.1 Coronary revascularization by either bypass surgery or coronary angioplasty relieves angina and may improve the prognosis in patients with coronary artery disease.2,3 Randomized comparisons reveal no difference in survival free from myocardial infarction (MI) between surgery and balloon angioplasty.4,5 Stenting significantly improved the long-term outcome, while surgery is still associated with fewer reinterventions during follow-up.6-10 However, subsequent improvements in both percutaneous and surgical techniques may now limit the validity of any conclusions that have been drawn from the earlier studies. In fact, the lines of demarcation for patients suited for bypass or angioplasty are becoming blurry with each passing day.

  17. Comparison Between Effects of Home Based Cardiac Rehabilitation Programs Versus Usual Care on the Patients’ Health Related Quality of Life After Coronary Artery Bypass Graft

    OpenAIRE

    Salavati, Mohsen; Falahinia, Gholamhossein; Vardanjani, Ali Esmaeili; Rafiei, Hossein; Moosavi, Saeid; Torkamani, Mehdi

    2015-01-01

    Background & Aim: To compare home-based cardiac rehabilitation with usual care on the patients’ Health Related Quality of Life (HRQoL) after coronary artery bypass graft in patients with coronary artery bypass graft (CABG) surgery. Methods: In a randomized controlled clinical conducted from March 2013 to June 2013, 110 patients with CABG surgery were randomly assigned into two groups. While patients in group I, were received usual care and patients in group II, in addition to the usual care w...

  18. Impact of repeated percutaneous coronary intervention on long-term survival after subsequent coronary artery bypass surgery

    OpenAIRE

    Komiya Tatsuhiko; Shimamoto Takeshi; Sakaguchi Genichi

    2011-01-01

    Abstract (Background) In the current stent era, aggressive repeated percutaneous coronary intervention (PCI) has become more common. The aim of this study was to investigate the impact of previous repeated PCI on the subsequent coronary artery bypass grafting (CABG). (Methods) Between January 1990 and January 2008, a total of 894 patients underwent first-time isolated elective CABG. Among the 894 patients, 515 patients had had no PCI (group A), 179 patients had had single PCI (Group B), and 2...

  19. Cardioprotective Effect of Extended Remote Ischemic Preconditioning in Patients Coronary Artery Bypass Grafting Undergoing: A Randomized Clinical Trial

    OpenAIRE

    Ali Karami; Mohamad Bagher Khosravi; Masih Shafa; Simin Azemati; Saeed Khademi; Seyed Hedayatalla Akhlagh; Behzad Maghsodi

    2016-01-01

    Background: The cardioprotective effect of ischemic preconditioning has been known for many years. Since the temporary ischemia in the heart may cause lethal cardiac effects, the idea of creating ischemia in organs far from the heart such as limbs was raised as remote ischemic preconditioning (RIPC). We hypothesized that the extension of RIPC has more cardioprotective effect in patients undergoing coronary artery bypass graft (CABG) surgeries. Methods: In this triple-blind randomized clini...

  20. Neurocognitive impairment after off-pump and on-pump coronary artery bypass graft surgery – an Iranian experience

    OpenAIRE

    Mehdi Farhoudi; Kaveh Mehrvar; Abbas Afrasiabi; et al

    2010-01-01

    Mehdi Farhoudi1, Kaveh Mehrvar2, Abbas Afrasiabi3, Rezayat Parvizi3, Ahmad Ali Khalili3, Babak Nasiri3, Khosrow Hashemzadeh3, Kamyar Ghabili41Neurosciences Research Center, Imam Reza Hospital, 2Razi Hospital, 3Cardiovascular Research Center, 4Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Coronary artery bypass graft (CABG) surgery is one of the most commonly performed surgical procedures worldwide, and it may be accompanied by po...

  1. Neurocognitive impairment after off-pump and on-pump coronary artery bypass graft surgery – an Iranian experience

    OpenAIRE

    Ghabili, Kamyar

    2010-01-01

    Mehdi Farhoudi1, Kaveh Mehrvar2, Abbas Afrasiabi3, Rezayat Parvizi3, Ahmad Ali Khalili3, Babak Nasiri3, Khosrow Hashemzadeh3, Kamyar Ghabili41Neurosciences Research Center, Imam Reza Hospital, 2Razi Hospital, 3Cardiovascular Research Center, 4Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Coronary artery bypass graft (CABG) surgery is one of the most commonly performed surgical procedures worldwide, and it may be accompanied by po...

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

    OpenAIRE

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

    2015-01-01

    The most common type of arrhythmia following coronary artery bypass graft (CABG) is atrial fibrillation (AF) with an incidence rate of 20-30%. Pericardial effusion is one of the etiologic factors of atrial fibrillation occurring after CABG. Posterior pericardiotomy (PP) causes the drainage of blood and fluids from the pericardial space into the pleural space leading to a decreased pericardial effusion. Most of the studies dealing with the occurrence of AF in the surgical operation of CABG hav...

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

    OpenAIRE

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

    2007-01-01

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

  4. Release of soluble vascular endothelial growth factor receptor-1 (sFlt-1) during coronary artery bypass surgery

    OpenAIRE

    Orsel Isabelle; Laskar Marc; Cornu Elisabeth; Leguyader Alexandre; Denizot Yves; Vincent Christelle; Nathan Nathalie

    2007-01-01

    Abstract Background This study was conducted to follow plasma concentrations of sFlt-1 and sKDR, two soluble forms of the vascular endothelial growth factor (VEGF) receptor in patients undergoing coronary artery bypass graft (CABG) surgery with extracorporeal circulation (ECC). Methods Plasma samples were obtained before, during and after surgery in 15 patients scheduled to undergo CABG. Levels of sFlt-1 and KDR levels were investigated using specific ELISA. Results A 75-fold increase of sFlt...

  5. Poor Sleep Quality in Patients after Coronary Artery Bypass Graft Surgery: An Intervention Study Using the PRECEDE-PROCEED Model

    OpenAIRE

    Soheila Ranjbaran; Tahereh Dehdari; Khosro Sadeghniiat- Haghighi; Mahmood Mahmoodi-Majdabadi

    2015-01-01

    Background: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG.Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifest...

  6. THE EFFECTIVENESS OF THE PROGRAM KINESITHERAPY MEN AGED 45-65 YEARS AFTER CORONARY ARTERY BYPASS GRAFT (CABG)

    OpenAIRE

    Iermakov S.S.; Prusik Krz.; Bielawa L.; Stankiewicz B.

    2011-01-01

    The purpose of research is the effectiveness of the training program in cardiac rehabilitation of 11 men at the age between 45 and 65 years undergoing coronary artery bypass grafting. The study used the reports of electrocardiographic exercise stress test, performed before and after training cycle each of the patient. In order to analyze the training loads were also used medical records, including diagnosis, prescribing doctor and ordered treatments. Training loads used in the training progra...

  7. Effect of Cardiac Rehabilitation Program on Heart Rate Recovery after Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting

    OpenAIRE

    Ali Abbasi; Mostafa Nejatian; Seyed Hesameddin Abbasi; Mehrab Marzban; Saeed Davoodi; Abbasali Karimi; Seyed Ebrahim Kassaian; Mojtaba Salarifar; Mohammad Alidoosti; Abbas Soleimani

    2008-01-01

    Background: The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery (HRR) in patients who received percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods: Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program (phase 2) after PCI (n=62) or CABG (n=178) at the rehabilitation department of Tehran Heart Center were included in the present study. Demogra...

  8. The Effects of Exercise Cardiac Rehabilitation on Anxiety, Depression and Quality of Life in Coronary Artery Bypass Grafting Patients

    OpenAIRE

    A. Yalfani; F. Nazem; R. Safiarian; M. Jargeh

    2012-01-01

    Introduction & Objective: Despite advancement in technology such as coronary artery bypasses grafting (CABG) prevalence of anxiety and depression remain high after cardiac events, which have been found to influence recovery process, recurrent cardiac events and patients’ quality of life. Cardiac Rehabilitation (CR) as part of secondary prevention aims to improve patients’ physical, psychological and quality of life (QoL) status. As there is lack of study in this area in Iran, the present stud...

  9. The effects of cardiac tertiary prevention program after coronary artery bypass graft surgery on health and quality of life

    OpenAIRE

    Azam Mosayebi; Shaghayegh Haghjooy Javanmard; Mohsen Mirmohamadsadeghi; Reza Rajabi; Samaneh Mostafavi; Marjan Mansourian

    2011-01-01

    Objectives: Cardiac tertiary prevention programs intend to support the recovery course following coronary artery bypass grafting (CABG). We investigated the effects of attendance at cardiac rehabilitation (CR) programs following CABG on patients′ mortality, morbidity and health related quality of life. Methods: Eighty patients who underwent CABG were selected in a way that half of them had attended a cardiac rehabilitation program and the other half had not. Health related quality of life ...

  10. A 7-year, single-center research and long term follow-up of graft patency of robotic total arterial off-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Guo-peng LIU

    2016-06-01

    Full Text Available Objective  The aim of the study was to explore the long-term benefits of coronary artery bypass grafting (CABG. Methods  From January 2007 to November 2014, 240 patients (187 males and 53 females, average age 59 years received robotic off-pump CABG assisted with da Vinci Surgical System (Intuitive Surgical, USA in our center. Totally endoscopic coronary artery bypass (totally robot-assisted TECAB, n=100 or mini-thoracotomy direct coronary artery bypass (free of internal mammary artery, IMA, by robot, MIDCAB, n=140 grafting was performed. Patients were followed-up regularly, and their graft patency was assessed every 6 months by coronary angiography or 64-multi-slide CT angiography. Results  All the procedures were completed successfully without conversion to median sternotomy or cardiopulmonary bypass , there was no operative mortality. 237 unilateral IMA grafts (98.7% and 3 bilateral IMA grafts (1.3% were used. Hybrid revascularization of non-left anterior descending vessels was performed in 24 patients (10%. In the follow-up of 41.1±12.9 months, no death, stroke or myocardial infarction occurred. All grafts were patent before discharge. The IMA graft patency was 97.1% in TECAB and 96.4 % in MIDCAB over 3 years (up to 91 months after surgery. Conclusions  Robotic off-pump CABG using IMA grafts is a safe and effective surgery method in selected patients. The long-term outcome and patency of IMA grafts are excellent. DOI: 10.11855/j.issn.0577-7402.2016.06.15

  11. New Replacement of a Thrombosed Mitral Valve via Right Anterolateral Thoracotomy in a Patient with Coronary Artery By-Pass Graft and Functioning Internal Mammary Artery Graft

    OpenAIRE

    CEVİZ, Münacettin

    2007-01-01

    A 49-year-old male, who had undergone mitral valve replacement with mechanical cardiac valve and coronary arterial by-pass grafting six years previously, was admitted to our hospital with acute dyspnea. Transesophageal echocardiography revealed that one of the leaflets of the prosthetic valve was entirely immobilized in the closed position, and an immobile soft tissue mass was detected on the ventricular side of the obstructed leaflet. We performed re-replacement using a 29-mm mechanical pros...

  12. Acute Respiratory Distress Syndrome diagnosis after coronary artery bypass: comparison between diagnostic criteria and clinical picture.

    Directory of Open Access Journals (Sweden)

    Manzar Vakili

    2015-01-01

    Full Text Available Acute Respiratory Distress Syndrome (ARDS is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2 less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2≤200mmHg and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 % in the 24 hours and 4 (1.33% patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937 and sex (P

  13. Off-pump minimally invasive direct coronary artery bypass in patients with cosmetic prosthesis for pectus excavatum.

    Science.gov (United States)

    Massi, Francesco; Manca, Mario; Muretti, Mirko; Portoghese, Michele

    2016-08-01

    Pectus excavatum can be associated with coronary artery diseases that can become difficult to manage in urgent situations. We describe the use of an off-pump minimally invasive direct coronary artery bypass (MIDCAB) through the fourth intercostal space incision in a patient with pectus excavatum and acute coronary syndrome who previously underwent a cosmetic prosthesis implantation. The patient refused any surgical procedure that could compromise the integrity of his cosmetic prosthesis and a left mini-thoracotomy was a good option to avoid the removal of the prosthesis. The preservation of the integrity of the thoracic cage enhanced chest wall stability and pulmonary function and permitted avoidance of inadvertent cardiac structure iatrogenic injuries. MIDCAB was optimal for the exposure of the left internal thoracic artery and the left anterior descending artery. The deformity of the chest should not be considered as an absolute contraindication to off-pump MIDCAB when other surgical options are not viable, even in emergency situations. PMID:27170745

  14. Effect of different dosages of nitroglycerin infusion on arterial blood gas tensions in patients undergoing on- pump coronary artery bypass graft surgery

    OpenAIRE

    Gholamreza Masoumi; Evaz Hidar Pour; Ali Sadeghpour; Mohsen Ziayeefard; Mostapha Alavi; Sanam Javid Anbardan; Shahin shirani

    2012-01-01

    Background: On-pump coronary artery bypass graft (CABG) surgery impairs gas exchange in the early postoperative period. The main object on this study was evaluation of changes in arterial blood gas values in patients underwent on pump CABG surgery receiving different dose of intravenous nitroglycerin (NTG). Materials and Methods: sixty-seven consecutive patients undergoing elective on-pump CABG randomly enrolled into three groups receiving NTG 50 μg/min (Group N1, n =67), 100 μg/min (Group N2...

  15. Evaluation of the graft flow reserve after coronary artery bypass grafting by stress {sup 201}Tl myocardial SPECT. Comparison between arterial grafts and venous grafts

    Energy Technology Data Exchange (ETDEWEB)

    Ichikawa, Akihiro; Taki, Junichi; Nakajima, Kenichi; Kawasuji, Michio; Tonami, Norihisa [Kanazawa Univ. (Japan). School of Medicine

    1997-01-01

    We performed stress {sup 201}Tl myocardial SPECT to evaluate ischemia and perfusion reserve after coronary artery bypass grafting (CABG). A total of 103 patients was performed stress {sup 201}Tl myocardial SPECT one month after CABG. Each patient`s myocardium was divided into 9 segments and visually evaluated using five grade scoring system (0=defect, 1=severe decrease, 2=moderate decrease, 3=mild decrease, 4=normal uptake). Eleven of 133 (8.27%) segments covered by patent venous grafts showed reversible {sup 201}Tl defect, however, 36 of 117 (30.8%) segments which covered by patent arterial grafts showed reversible {sup 201}Tl defect. This finding was observed more significantly in arterial grafts than in venous grafts (p<0.001). These finding suggests that arterial grafts have lower flow capacity than venous grafts at peak exercise. (author)

  16. Gastroepiploic artery as an in situ coronary artery bypass graft: evaluation of MRI and colour Doppler ultrasound in follow-up.

    Science.gov (United States)

    Vanninen, R L; Vainio, P A; Manninen, H I; Suhonen, M; Jaakola, P

    1995-01-01

    The right gastroepiploic artery, increasingly used as an in situ coronary artery bypass graft, has good long-term patency. This study aimed to assess the accuracy and limitations of magnetic resonance imaging (MRI) and colour Doppler ultrasound (US) in postoperative follow-up of such cases. In eight consecutive patients (6 men, 2 women, mean age 57 years), conventional angiography, MRI and US were performed to evaluate graft patency. Colour Doppler US, performed within a week of the operation, correctly detected flow in three patent grafts. MRI (1.5 tesla) was performed c. 17 months after surgery, using a spine coil and a coronal two-dimensional Flash-type imaging sequence. At angiography six of the eight gastroepiploic artery grafts were patent, and two were occluded. The sensitivity and specificity of MRI were 100%. This accuracy makes MRI a promising method for noninvasive post-operative evaluation of right gastroepiploic artery graft patency. PMID:7644909

  17. The Effects of Regular Physical Activity at Home on Patients' Quality of Life after Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Zeinab Amirian

    2013-04-01

    Full Text Available Introduction: Chronic diseases such as heart diseases have adverse effects on the physical, psychological, social performance, and overall quality of life of patients. This study aimed to determine the effect of regular physical activity at home on the quality of life in patients undergoing coronary artery bypass surgery. Methods: This Quasi-experimental study was carried out on patients who had undergone coronary artery bypass surgeries. 58 patients from Urmia Syedolshoheda hospital were selected randomly and then allocated into two intervention and control groups randomly. Data collected with using MacNew quality of life questionnaire. Patients in intervention group were trained with combined exercises at least three times a week and performed this exercises for 12 week at home. Data were analyzed using Chi-sqaure, Mann-Whitney and Wilcoxon testes. Results: Findings of the study showed promotion in quality of life domains in physical, emotional and social after performance of regular physical activity at home in intervention group (P=0.001. A significant difference was observed between patients quality of life after regular physical activity in intervention and the control groups (P=0.001. Conclusion: Regular physical activity at home has important effects on patients' promotion of quality of life after coronary artery bypass surgeries. Therefore, it is suggested that after CABG patients be trained with regular physical activity at home.

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

    Directory of Open Access Journals (Sweden)

    Kaneez Fatima

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Margarete Diprat Trevisan

    2015-12-01

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

  20. Osteopontin in relation to Prognosis following Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Eftihia Sbarouni

    2016-01-01

    Full Text Available Cardiovascular events may occur even after complete revascularization in patients with coronary artery disease. We measured preoperative osteopontin (OPN levels in 131 consecutive patients (66.5±10 years old, 117 men and 14 women with left ventricular ejection fraction of 50.7±9.2% and low logistic EuroScore (3.5±3.2% undergoing elective Coronary Artery Bypass Grafting (CABG surgery. Patients were prospectively followed up for a median of 12 months (range 11–24. The primary study endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, need for repeat revascularization, and hospitalization for cardiovascular events. Pre-op OPN plasma levels were 77.9 (49.5, 150.9. Patients with prior acute myocardial infarction (AMI had significantly higher OPN levels compared to those without [131.5 (52.2, 219 versus 73.3 (45.1, 125, p=0.007]. OPN levels were positively related to EuroScore (r=0.2, p=0.031. Pre-op OPN levels did not differ between patients who had a major adverse event during follow-up compared to those with no event (p=0.209 and had no effect on the hazard of future adverse cardiac events [HR (95% CI: 1.48 (0.43–4.99, p=0.527]. The history of AMI was associated with increased risk of subsequent cardiovascular events at follow-up (p=0.02. OPN is associated with preoperative risk assessment prior to low-risk CABG but did not independently predict outcome.

  1. Diabetes patients show different time-course of myocardial perfusion improvement after coronary artery bypass grafting

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J. J.; Seok, J. W.; Eo, J. S. [Seoul National University Hospital, Seoul (Korea, Republic of)] (and others)

    2005-07-01

    Diabetes mellitus is an independent risk factor of cardiovascular disease. Diabetes is known to cause microangiopathy. The microangiopathy is hardly detectable on the coronary angiography. Myocardial perfusion imaging shows the resultant perfusion status which reflects the microangiopathy. For patients who underwent revascularization, the microangiopathy could affect the myocardial perfusion improvement. Diabetes patients probably experience the different myocardial perfusion improvement as compared to the non-diabetes patients although they have similar angiographic findings. The aim of this study is to find out whether there is a time-course difference of perfusion improvement between the diabetes and non diabetes patients who showed patent angiographic findings after coronary artery grafting surgery (CABG). A total of 129 patients who underwent coronary artery bypass grafting surgery were enrolled in this study. Myocardial SPECTs performed at previous, short-term (3 month), and mid-term (1 year) to CABG. One-year follow up angiography was done 411{+-}121 days after surgery. Graft patency was determined according to the FitzGibbon et al. Segments were assigned to vascular territories using a 20 segment model. The segments of excellent patency were included in this study. Time course differences of concerned segments were analyzed using RMANOVA. The number of segments enrolled was 764 of diabetes and 1083 of non-diabetes. At short-term follow up, reversibility score was 2.8{+-}8.1% in diabetes and 0.3{+-}7.5% in non-diabetes. At long-term follow up, reversibility score was 1.8{+-}8.0% in diabetes and 0.1{+-}7.3% in non-diabetes. The time-course of reversibility score was significantly different between the diabetes and non diabetes (p<0.001) Diabetic segments showed high residual reversibility score than non-diabetic segments after CABG although the angiographic finding was patent in both groups. This result is maybe attributable to microangiopathy induced by

  2. The value of semi-quantitative myocardial metabolic-perfusion scores in coronary artery bypasses grafting

    International Nuclear Information System (INIS)

    Objective: Coronary artery bypass grafting (CABG) is the preferred method of coronary revascularization in the coronary artery disease (CAD) patients with multi-vessel involvement. The study was aimed to evaluate the role of semi-quantitative assessment of myocardial viability scores using PET in CABG. Methods: Twenty-one consecutive patients with multi-vessel CAD were recruited from the department of cardiac/thoracic surgery. All patients underwent gated myocardial perfusion imaging (G-MPI) and 18F-fluorodeoxyglucose (FDG) myocardial PET imaging to assess the extent and severity of ischemia as well as the myocardial viability. The images were interpreted according to the semi-quantitative method issued by American Society of Nuclear Cardiology (ASNC) imaging guidelines using a 20-segment nomenclature. Summed rest score (SRS) and summed difference score (SDS) were calculated accordingly. All patients were scheduled for CABG within 2 weeks after the radionuclide myocardial imaging. The follow-up G-MPI was performed in all patients in the 3rd month after the surgery. Results: Out of the total 420 segments, 164 segments had abnormal myocardial perfusion by preoperative G-MPI. Among them, 93 segments were identified as non-viable (with difference score≥0) and the remaining 71 viable (with difference score <0). Based on their SDS, the patients were divided into 3 groups: group A (SDS≥0, n=5), group B (-5≤SDS<0, n8) and group C (SDS < -5, n=8). The mean change of global left ventricular ejection fraction (LVEF) after CABG in the three groups were -3.6%, 3.38% and 6.88% respectively. Conclusion: Assessment of myocardial viability by PET imaging is valuable in predicting whether the CAD patients may benefit from CABG. (authors)

  3. [Use of microstream capnography and alveolar recruitment during off-pump coronary artery bypass grafting].

    Science.gov (United States)

    Suborov, E V; Postnikova, E A; Kapinos, A A; Kuz'kov, V V; Smetkin, A A; Kirov, M Iu

    2009-01-01

    The aim of the study was to investigate changes in EtCO2 and its correlation with PaCO2, and cardiac function during off-pump coronary artery bypass grafting (OPCAB) and to evaluate whether the recruitment maneuver was effective in improving gas exchange after OPCAB. Twenty adult patients scheduled for elective OPCAB were enrolled in a prospective randomized study. Anesthesia was maintained with midazolam, propofol, and fentanyl. After OPCAB the patients were randomized to a control group receiving conventional ventilation (n=10) or to a RM group (n=10) having ventilation and RM. RM was performed at min 15 after transfer to an ICU, by increasing airway pressure to 40 cm H2O for 40 sec subsequently adjusting PEEP to a level of 2 cm H2O above the lower inflection point of the pressure-volume curve. The measurements included hemodynamics, microstream capnography, respiratory parameters, and blood gasses. The baseline EtCO2 correlated with PaCO2 and cardiac index in both group (r = 0.7 and 0.81, respectively; p recruitment, EtCO, increased transiently whereas PaO2/FiO2 return to the baseline level. There was a moderate correlation between EtCO2 and PaCO2 before and after RM (r = 0.7 and 0.8, respectively; p < 0.05). The Bland-Altman analysis has shown that the difference between PaCO2 an EtCO2 was 1.9 +/- 11.4 mm Hg (M +/- 2SD). Thus, during OPCAB, EtCO2 measured by microstream capnography cor related well with PaCO2 and cardiac function. The use of RM after OPCAB increases CO2 elimination and improve arterial oxygenation. PMID:19824412

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

    Directory of Open Access Journals (Sweden)

    Al Aloul Basel

    2012-08-01

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

  5. Electrocardiographic Changes in Certain Cardiovascular Physiological and Pathological Settings. Impact on Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Dimitar Simov

    2016-03-01

    Full Text Available Review on electrocardiographic changes provoked by aging, diagnostic tests, cardiac surgery, hemodialysis, diabetes, etc., is the objective of the current material. Several electrocardiographic (ECG parameters that are well known risk markers of arrhythmias, incidental heart failure and sudden cardiac death (SCD are discussed: QRS amplitude, QRS morphology, QRS duration, QRS alternans, T-wave amplitude, T-wave morphology, T-wave alternans, negative T-waves, 3D-spatial angle between maximal QRS and T vectors of the vectorcardiographic loops, ST-segment elevation, QT-interval dispersion, and heart rate. All reviewed parameters are compared with the results on the ECG-alterations, induced by coronary artery bypass grafting (CABG surgery. Two parameters showed an improvement in the patients' condition: QRS-T angle and cardiac autonomic innervation while two others (T-wave alternans and heart rate indicated deterioration. We tend to assume that the deterioration in this early post-operative period is an effect of the post-surgery trauma. We speculate that this effect will fade away in a period of a month and more after surgery, and we intend to conduct such a research in the future. The analysis of ECG's changes will help to better assess the impact of the CABG surgery.

  6. Predictors of atrial fibrillation after coronary artery bypass graft: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Liang Yin; Zhi-Nong Wang; Yi-Feng Wang; Wen-Tao Wang; Guang-Yu Ji; Xin-Wei Yang; Zhi-Yun Xu

    2009-01-01

    Objectives Postoperative atrial fibrillation (AF) has been associated with less favorable outcomes in patients undergoing coronary artery bypass graft surgery (CABG) and may result in increased post-operative morbidity and mortality. A systematic review and meta-analysis of published studies was conducted to examine the risk factors of occurrence AF after CABG. Methods Using the Medline database, the Cochrane clinical trials database and online clinical trial databases, we reviewed all randomized controlled trials (RCTs) and observational studies examining the risk factors of occurrence of AF after CABG. We searched for literature published April 2009 or earlier. Results Our review identified 8 studies (observational studies), involving 14548 patients, that examined the risk factors of occurrence of AF after CABG. Although studies provide conflicting results, the overall outcomes suggests that advanced age, previous hypertension, numbers of bridge vessels may increase the occurrence of AF after CABG, while no significant difference of diabetes, preoperative myocardial infarction, and preoperative medication of 13 -Blocker have been observed between the AF patients and no-AF patiens. Conclusions Patients with advanced age, previous hypertension and more numbers of bridge vessels had higher risk for the occurrence of AF after CABG, and perioperative medication and care must be intensified to decrease the postoperative occurrence of AF.

  7. Physical therapy for post coronary artery bypass grafting complications -A Case Report

    Directory of Open Access Journals (Sweden)

    Anitha Kumari Abbina

    2013-04-01

    Full Text Available Background:This case report describes about the female patient who came with cough, breathlessness and neck pain after one month following coronary artery bypass grafting to the cardiology department. Chest radiograph was taken and diagnosed it as pleural effusion with atelectasis of left lower lobe. Later therapeutic thoracentesis was done to aspirate the fluid and referred the case to physiotherapy. Thorough physical examination showed reduced neck mobility due to trigger points and spasm of the neck muscles which are causing pain, and also breathlessness on walking, on percussion dull note on left lower lobe, on auscultation crackles are heard with diminished breath sounds over the left lower lobe, altered chest symmetry reduced chest expansion of the lower chest. To reduce neck pain and improve neck mobility she was treated with cryostretches,trigger point release technique, myofascial release and muscle energy techniques. She was treated with positioning, chest percussion, vibration and shaking, deep breathing exercises, thoracic expansion exercises, segmental breathing to lower lobes, incentive spirometry every one hour ten times, trunk and thoracic mobilityexercises were done twice in a day to reduce breathlessness. After 15 days again x-ray was taken where lung was re-expanded and also there are free movements of the neck without pain.

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

    Science.gov (United States)

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

    2015-01-01

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

  9. Cardiac rehabilitation for patients after coronary artery bypass graft surgery Nursing Interventions

    Directory of Open Access Journals (Sweden)

    Tsaloglidou A.

    2010-07-01

    Full Text Available Purpose: To describe the way by which the rehabilitation of the patients that have undergone cardiac surgery is performed, to present the content of the cardiac rehabilitation programs and to determine the nursing role in the whole process. Methodology: Literature review of the relevant articles in the databases pubmed and scopus. Results: The patients with coronary heart disease usually face a lot of problems in their everyday life. Coronary artery bypass graft surgery (CABG is commonly performed to improve the quality of patients’ life and to extend their survival. Ιn order for the positive results of the surgery to be maintained and the quality of patients’ life to be improved, it is essential that the patients participate after the surgery in programs of cardiac rehabilitation. The cardiac rehabilitation programs are usually consisted of four phases and they involve a variety of interventions including exercise training, suitable drug therapy, psychological input, risk factor education, as well as teaching for the rules of a healthy diet. Conclusions: Nurses and other health care professionals have to inform the patients of the existing rehabilitation programs and instruct to participate in them as well as to return in the daily life activities.

  10. How Older Female Spouses Cope with Partners’ Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Suzanne Marnocha

    2013-01-01

    Full Text Available This research sought to better understand how older female spouses cope with a partner’s coronary artery bypass graft surgery and to explore coping’s relationships with life-change stress, cognitive appraisal, resilience, social support, and aspects of spouse’s surgery. A sample of 96 women, aged from 55 to 81 years, completed surveys after their partner’s surgery. Folkman and Lazarus’ ways of coping (WCQ scales yielded two factors in this sample—reactive coping and adaptive coping. Reactive coping, including more emotion-focused ways of coping from the WCQ, was associated only with more time spent anticipating spouses’ surgeries. Women described the greatest use of ways of coping labeled adaptive, which in turn had significant relationships with greater resilience, social support, and positive appraisal of the surgical experience. Stepwise multiple regression found greater resilience, more frequent religious participation, and fewer children to be distinct predictors of adaptive coping. Nursing staff are encouraged to accept and normalize reactive coping, while facilitating adaptive coping with surgical stresses.

  11. Preoperative statin is associated with decreased operative mortality in high risk coronary artery bypass patients

    Directory of Open Access Journals (Sweden)

    Maher Thomas D

    2010-02-01

    Full Text Available Abstract Background Statins are widely prescribed to patients with atherosclerosis. A retrospective database analysis was used to examine the role of preoperative statin use in hospital mortality, for patients undergoing isolated coronary artery bypass grafting (CABG. Methods The study population comprised 2377 patients who had isolated CABG at Allegheny General Hospital between 2000 and 2004. Mean age of the patients was 65 ± 11 years (range 27 to 92 years. 1594 (67% were male, 5% had previous open heart procedures, and 4% had emergency surgery. 1004 patients (42% were being treated with a statin at the time of admission. Univariate, bivariate (Chi2, Fisher's Exact and Student's t-tests and multivariate (stepwise linear regression analyses were used to evaluate the association of statin use with mortality following CABG. Results Annual prevalence of preoperative statin use was similar over the study period and averaged 40%. Preoperative clinical risk assessment demonstrated a 2% risk of mortality in both the statin and non-statin groups. Operative mortality was 2.4% for all patients, 1.7% for statin users and 2.8% for non-statin users (p Conclusions Between 2000 and 2004 less than 50% of patients at this institution were receiving statins before admission for isolated CABG. A retrospective analysis of this cohort provides evidence that preoperative statin use is associated with lower operative mortality in high-risk patients.

  12. Local anaesthetic toxicity after bilateral thoracic paravertebral block in patients undergoing coronary artery bypass surgery.

    Science.gov (United States)

    Ho, A M-H; Karmakar, M K; Ng, S K; Wan, S; Ng, C S H; Wong, R H L; Chan, S K C; Joynt, G M

    2016-09-01

    We conducted a small pilot observational study of the effects of bilateral thoracic paravertebral block (BTPB) as an adjunct to perioperative analgesia in coronary artery bypass surgery patients. The initial ropivacaine dose prior to induction of general anaesthesia was 3 mg/kg, which was followed at the end of the surgery by infusion of ropivacaine 0.25% 0.1 ml/kg/hour on each side (e.g. total 35 mg/hour for a 70 kg person). The BTPB did not eliminate the need for supplemental opioids after CABG in the eight patients studied. Moreover, in spite of boluses that were within the manufacturer's recommendation for epidural and major nerve blocks, and an infusion rate that was only slightly higher than what appeared to be safe for epidural infusion, potentially toxic total plasma ropivacaine concentrations were common. We also could not exclude the possibility that the high ropivacaine concentrations were contributing to postoperative mental state changes in the postoperative period. Also, one patient developed local anaesthetic toxicity after the bilateral paravertebral dose. As a result, the study was terminated early after four days. The question of whether paravertebral block confers benefits in cardiac surgery remains unanswered. However, we believe that the bolus dosage and the injection rate we used for BTPB were both too high, and caution other clinicians against the use of these doses. Future studies on the use of BTPB in cardiac surgery patients should include reduced ropivacaine doses injected over longer periods.

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

    Science.gov (United States)

    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 rehabilitation group: 22.0 ± 3.8 days; control group: 29.1 ± 4.6 days, P ICU stay (early rehabilitation group: 11.7 ± 3.2 days; control group: 18.3 ± 4.2 days, P rehabilitation group were larger than that in the control group after 7 days of rehabilitation therapy (logrank test: P rehabilitation therapy in patients requiring prolonged mechanical ventilation after CABG. PMID:26973269

  14. The risk of arrhythmias following coronary artery bypass surgery: do smokers have a paradox effect?

    LENUS (Irish Health Repository)

    Al-Sarraf, Nael

    2010-11-01

    Smoking is reported to increase the risk of arrhythmias. However, there are limited data on its effects on arrhythmias following coronary artery bypass graft (CABG). This is a retrospective review of a prospective database of all CABG patients over an eight-year period. Our cohort (n=2813) was subdivided into: current (n=1169), former (n=837), and non-smokers (n=807). Predictors of arrhythmias following CABG in relation to smoking status were analysed. Atrial arrhythmias occurred in 942 patients (33%). Ventricular arrhythmias occurred in 48 patients (2%) and high-grade atrioventricular block occurred in five patients (0.2%). Arrhythmias were lower in current smokers than former and non-smokers (29% vs. 40% vs. 39%, respectively P<0.001). Logistic regression analysis showed 30% arrhythmia risk reduction in smokers compared to non-smokers [odds ratio (OR) 0.7, 95% confidence intervals (CI) 0.5-0.8] and this effect persisted after accounting for potential confounders while former smokers had the same risk as non-smokers (OR 1.04, CI 0.9-1.3). There were no significant differences in mortality. Smokers are less prone to develop arrhythmias following CABG. This paradox effect is lost in former smokers. This effect is possibly due to a lower state of hyper adrenergic stimulation observed in smokers than non-smokers following the stress of surgery.

  15. On-Pump Beating Coronary Artery Bypass in High Risk Coronary Patients

    Directory of Open Access Journals (Sweden)

    Abbas Afrasiabirad

    2015-01-01

    Full Text Available Background: There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG in coronary high-risk patients in comparison with the conventional methods. Methods: In a prospective research study, 3000 off-pump CABG patients were considered during June 2003 to December 2011. Among these, 157 patients with one or more of the following risk factors were included for OPBCABG; severe left main stenosis, early post-acute myocardial infarction with ongoing chest pain, unstable angina, intractable ventricular arrhythmia, post complicated coronary intervention and severe left ventricular dysfunction. These patients were compared with 157 similar patients undergone CCABG with aortic cross clamp before 2003. Results: Preoperative patient characteristics revealed no significant differences between the two groups. The patients’ mean age and number of grafts were 57 years and 3 per patient respectively. Hospital mortality was 3.2% and 9% in OPBCABG and CCABG groups, respectively (P<0.001. Preoperative myocardial infarction, requirement of inotropic agents and intraaortic balloon pump, renal dysfunction and prolonged ventilation time were significantly higher in CCABG group. Conclusion: Our results suggest that OPBCABG is effective in coronary high-risk patients and significantly reduces mortality and the incidence of perioperative MI and other major complications.

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

    Directory of Open Access Journals (Sweden)

    Nooredin Mohammadi

    2015-12-01

    Full Text Available 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.

  17. The effect of weight loss on the outcome after coronary artery bypass grafting in obese patients

    Directory of Open Access Journals (Sweden)

    Remez Kocz

    2012-01-01

    Full Text Available The role of body mass index (BMI in the setting of coronary artery bypass graft (CABG surgery has been a focus of past studies. However, the effects of postoperative weight loss in patients after CABG is yet to be known. We performed a retrospective study of 899 patients who underwent CABG at our institution. Perioperative patient information was collected from an onsite electronic record system. Patients were grouped into four BMI categories: normal controls, overweight, obese and morbidly obese. Based on the postoperative BMI changes, patients were then grouped into three categories: gainers, no change and losers. Statistical analyses were performed using analysis of variance and linear regression to establish an association among the data. Hazard ratios (HR and cumulative survival were obtained by the Cox-Mantel and Kaplan-Meier analyses, respectively. The normal controls exhibited a markedly higher mortality postoperatively, at 27.9%, especially when compared with the obese individuals (16.1%. Patients who lost weight faced a significantly increased risk of mortality than those who experienced no changes or gained weight after surgery. This trend was especially salient among the obese patients, who more than tripled their mortality risk (HR = 3.24 versus individuals who gained weight, and more than doubled their risk (HR = 2.87 versus those who had no changes. We conclude that obesity confers a survival advantage in the setting of the CABG surgery. Weight loss among all BMI categories of patients studied results in an adverse effect on postoperative survival.

  18. Lung cancer resection with concurrent off-pump coronary artery bypasses: safety and efficiency

    Science.gov (United States)

    Ma, Xuchen; Huang, Fangjiong; Zhang, Zhitai; Song, Feiqiang

    2016-01-01

    Background To assess the safety and efficacy of combined surgery for patients with concurrent lung cancer and severe coronary heart disease (CHD). Methods Between 2003 and 2014, 34 patients with stage I or II lung cancer and simultaneous severe CHD underwent combined off-pump coronary artery bypass (OPCAB) grafting and lung resection. Surgically, myocardial revascularization was performed first and followed by lobectomies through the same or a second incision. Video-assisted thoracoscopes were used in some cases. Five patients also received chemotherapy before or after combined surgery in an effort to improve the long-term survival. Results All patients survived the operation and no new myocardial infarctions (MIs) occurred in the perioperative period. The most frequent complications were cardiac arrhythmias (5 cases), atelectasis (4 cases), and pulmonary infections (2 cases). All patients were followed up for 5–60 months. Within this period, 6 patients (17.6%) died due to cancer recurrence. The 3- and 5-year survivals were 75% and 67% for these lung cancer patients, respectively. Conclusions Combined OPCAB and pulmonary resection for early stage lung cancer patients with concurrent severe CHD is a relatively safe and effective treatment with satisfactory long-term survival rates, especially for those patients with three-vessel disease who are not usually candidates for percutaneous coronary intervention (PCI) before open surgery.

  19. A bypass case due to an acute inferior myocardial infarction caused by vascular occlusion of the left subclavian artery and left anterior descending artery

    Directory of Open Access Journals (Sweden)

    Altas Y

    2016-07-01

    Full Text Available Yakup Altas, Ali Veysel Ulugg Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey Abstract: ST segment elevation is the most common electrocardiographic finding in acute myocardial infarction. ST elevation in chest leads generally represents left anterior descending artery occlusion, while elevation in DII and III, and aVF represents right coronary and circumflex artery occlusion. A female patient aged 66 years was admitted to our emergency service with ST elevation in leads DIII and aVF. A diagnosis of acute inferior myocardial infarction was made. The patient’s history included coronary artery bypass graft involving the left internal mammary artery to the left anterior descending coronary artery and aorta to the right coronary artery. The patient was taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention and a lesion in the left anterior descending artery was identified. Additionally, the left subclavian artery was totally occluded. Following intervention to the lesion, the patient was discharged on day 4 of admission. Keywords: electrocardiography, myocardial infarction, coronary circulation

  20. Heparin Therapy during Extracorporeal Circulation: Deriving an Optimal Activated Clotting Time during Cardiopulmonary Bypass for Isolated Coronary Artery Bypass Grafting

    OpenAIRE

    Palmer, Kenneth; Ridgway, Tim; Al-Rawi, Omar; Poullis, Michael

    2012-01-01

    Bull’s seminal work on heparin therapy during cardiopulmonary bypass (CPB) was carried out over 30 years ago and has not been updated in the modern era. No correlation with postoperative blood loss was performed. The optimal activated clotting time (ACT) with regard to blood loss has not been established for patients undergoing CPB. A minimum ACT of 400 is based on the lack of visible formation of clots in the CPB circuit. The effect of heparin dose, sensitivity, metabolism, patient size, ele...

  1. Evaluation of retrospectively ECG-gated 4-row multidetector CT in patients planned for minimal invasive coronary artery bypass grafting; Die EKG-getriggerte 4-Zeilen-Spiral-CT des Herzens in der praeoperativen Bildgebung vor minimalinvasiver koronarer Bypass-Operation

    Energy Technology Data Exchange (ETDEWEB)

    Begemann, P.G.C.; Ittrich, H.; Koops, A.; Adam, G.; Weber, C. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Radiologisches Zentrum, Universitaetsklinikum, Hamburg (Germany); Arnold, M.; Detter, C.; Boehm, D.H.; Reichenspurner, H. [Universitaetsklinikum Hamburg-Eppendorf, Herzzentrum, Herz und Gefaesschirurgie, Hamburg (Germany)

    2005-08-01

    Purpose: Minimal invasive direct coronary artery bypass grafting (MIDCAB) or off-pump coronary artery bypass grafting (OPCAB) on the beating heart with full or mini-sternotomy are becoming more common in coronary bypass surgery of the left anterior descending (LAD). In the decision, which surgical approach (MIDCAB, OPCAB or conventional surgery with cardiopulmonary bypass) will be best used, knowledge of the anatomical field is of major importance. The aim of the study was to evaluate retrospective ECG-gated 4-row multidetector CT (MDCT) in patients planned for MIDCAB as additional imaging to coronary angiography. Material and methods: The study included 25 consecutive patients. MSCT was performed as unenhanced (collimation 4 x 2.5 mm) and contrast-enhanced examination (140-170 ml, 300 mg Iodine/ml, collimation 4 x 1 mm). The evaluation included presence of LAD calcifications, distance of LAD and left internal mammarian artery (LIMA), coursek of LAD and LIMA, the presence or absence of bridging through myocardium or epicardial fat and the presence of pleural fibrosis. The MDCT results were correlated with intra-operative findings. Results: All MDCTs could be assessed with reference to the demands. In 20/25 operations, MDCT had direct influence as to the selection of the surgical approach (11 MIDCAB, 7 OPCAB with mini-sternotomy and 5 with full sternotomy, 2 conventional surgeries). The distance of LAD and LIMA varied from 0.9 to 4.5 cm in MDCT. As to calcifications, 3/25 correlated patients had calcifications and 10 patients had no calcifications in the middle LAD. Seven patients had intraoperative fibrosis of the vessel wall without calcification of the middle LAD, which could not be detected with MDCT. Another 5 patients had single calcified plaques in the middle LAD, 4 of these had a fibrosis of the vessel and 1 had a normal vessel at surgery. In these cases, the anastomosis was done between the calcified plaques. No myocardial bridging was detected by MDCT and

  2. Off-Pump Triple Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Case Presentation and a Brief Review of the Brazilian and the International Experiences

    Science.gov (United States)

    Karigyo, Carlos Junior Toshiyuki; Batalini, Felipe; Murakami, Alexandre Noboru; Teruya, Rogério Toshio; Gregori Júnior, Francisco

    2016-01-01

    A 76-year-old man with situs inversus totalis underwent a successful off-pump three-vessel coronary artery bypass surgery. The postoperative course was uneventful, and the patient was discharged 8 days later. At 9-month follow-up a coronary computed tomography angiography confirmed the viability of all of the grafts, and one year after the operation the patient remained asymptomatic. It comprises the fifth Brazilian case of a coronary surgery in a patient with situs inversus totalis and the first one of the country of a coronary artery bypass surgery without the use of the cardiopulmonary bypass in this condition. PMID:27556323

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

    Science.gov (United States)

    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

  4. Does patency after a vein collar and PTFE-bypass depend on sex and age?

    DEFF Research Database (Denmark)

    Lundgren, F; Schroeder, Torben Veith

    2012-01-01

    Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect...... on patency nor on limb salvage after bypass to below-knee arteries. However, the Scandinavian patients were a decade older and predominately female compared to the British patients. Can this explain the conflicting result?...

  5. A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Stephen M McHugh

    2016-01-01

    Full Text Available Background and Aims: Tranexamic acid (TA is used for prophylactic antifibrinolysis in coronary artery bypass surgeries to reduce bleeding. We evaluated the efficacy of two different doses of TA for prophylactic antifibrinolysis in patients undergoing primary coronary artery bypass grafting (CABG surgery in this retrospective cohort study at a tertiary care referral centre. Methods: One-hundred eighty-four patients who underwent primary CABG with cardiopulmonary bypass (CPB via sternotomy between January 2009 and June 2011 were evaluated. Pre-operative patient characteristics, intraoperative data, post-operative bleeding, transfusions, organ dysfunction and 30-day mortality were compared between high-dose TA (30 mg/kg loading dose followed by infusion of 15 mg/kg/h until the end of surgery along with 2 mg/kg priming dose in the bypass circuit and low-dose TA (15 mg/kg loading dose followed by infusion of 6 mg/kg/h until the end of surgery along with 1 mg/kg priming dose in the bypass circuit groups. Univariate comparative analysis of all categorical and continuous variables was performed between the two groups by appropriate statistical tests. Linear and logistic regression analyses were performed to control for the effect of confounding on the outcome variables. Results: Chest tube output, perioperative transfusion of blood products and incidence of re-exploration for bleeding did not differ significantly (P> 0.05 between groups. Post-operative complications and 30-day mortality were comparable between the groups. The presence of cardiogenic shock and increased pre-operative creatinine were found to be associated with increased chest tube output on the post-operative day 2 by multivariable linear regression model. Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB.

  6. Correlation of atherosclerotic changes in peripheral arteries with pathological involvement of aortic arch in coronary bypass patients

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    Eshraghi N

    2010-10-01

    Full Text Available "nBackground: A correlation between coronary artery disease (CAD and atherosclerosis of peripheral arteries and the determination of noninvasive indexes for its existence and extent have been sought by many researchers. Some studies report that the intima-media thickness (IMT of peripheral arteries could play this role. This study evaluated the correlation between the IMTs of common carotid and common femoral arteries and the degree of atherosclerosis in aortic arch and to evaluate the severity of CAD in candidates of coronary artery bypass grafting (CABG."n "nMethods: In a cross-sectional analytic-descriptive study, The severity of CAD, the grade of atherosclerosis of the aortic arch, and the IMTs of the common carotid and common femoral arteries were determined."n "nResults: There was a significant weak positive correlation between the IMT of common carotid artery (ρ = 0.193, p = 0.039 and common femoral artery (ρ = 0.206, p = 0.028 with the number of involved carotid vessels; the mean of these two parameters was not significantly different between the three CAD groups. There was not any significant relation between the IMTs of common carotid and common femoral arteries with the severity of atherosclerosis in the aortic arch too. There was not any significant relation between the presences of atherosclerotic plaque in the common carotid or the common femoral arteries with the severity of CAD. The severe atherosclerosis of the aortic arch was significantly higher in patients with three vessel disease."n "nConclusion: According to our results, the IMTs of common carotid and/or common femoral arteries may increase with the severity of CAD; however, these parameters are not a surrogate for predicting the CAD severity.

  7. Meta-analysis of randomized trials comparing the effectiveness of on-pump and off-pump coronary artery bypass

    Institute of Scientific and Technical Information of China (English)

    CHEN Yong-bing; SHU Jian; YANG Wen-tao; SHI Li; GUO Xu-feng; WANG Fei-ge; QIAN Yong-yue

    2012-01-01

    Background The growing enthusiasm for coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is emerging,but the role of off-pump coronary artery bypass (OPCAB) in clinical practice remains controversial.The purpose of this study was to assess differences in the incidences of stroke,atrial fibrillation (AF),and myocardial infarction (MI) between OPCAB and conventional coronary artery bypass grafting (CCABG) by meta-analyses of randomized clinical trials.Methods A literature search for the period before March 2010 supplemented with manual bibliographic review was performed for all Chinese or English publications in Medline,the Science Citation Index Expanded,the Cochrane Central Register of Controlled Trials (CENTRAL) and CBMdisc.A systematic overview (meta-analyses) of randomized clinical trials was conducted to evaluate the differences between OPCAB and CCABG in the incidences of stroke,AF,and MI.The meta-analysis was performed using RevMan 5 software.Results Forty-three randomized clinical trials were selected for meta-analysis after screening a total of 356 references,with 8104 patients in the OPCAB group and 8724 cases in the CCABG group.The meta-analyses of these trials showed no significant difference between OPCAB and CCABG in the incidences of stroke (odds ratio (OR)=0.80,95% confidence interval (CI)=0.52-1.22,P=0.30) and MI (OR=0.73,95%CI=0.52-1.02,P=0.06).However,we found a significantly reduced risk of AF (OR=0.65,95%CI =0.52-0.82,P=0.0002)in off-pump patients.Conclusions Our meta-analyses suggest that OPCAB reduces the risk of postoperative AF compared with CCABG,but there is no significant difference in the incidences of stroke and MI between OPCAB and CCABG.

  8. Biological artificial vessel graft in distal arterial bypass for treating diabetic lower limb ischemia: a case report

    Institute of Scientific and Technical Information of China (English)

    GU Yong-quan; WU Ying-feng; QI Li-xing; GUO Lian-ri; LI Xue-feng; CUI Shi-jun; TONG Zhu; GUO Jian-ming; ZHANG Jian

    2011-01-01

    A 68-year-old female patient was treated for unhealed ulcer in the fourth toe of the left foot. Clinical examinations identified severe stenosis of the proximal segment and occlusion of the distal segment of the left anterior tibial artery, and occlusion of the left posterior tibial artery and the peroneal artery. The proximal stenotic segment of the left anterior tibial artery was dilated, but the distal occlusive part failed to be re-canalized. Left anterior tibial artery to dorsal pedal artery bypass was performed on the patient with an epoxide-crosslinked, special radicals antigen-sealed, porcine-derived biological graft; debridement of the left 4th digiti pedis was also performed. Postoperation course was uneventful. The pulse of the left dorsal pedal artery was strong. The ankle brachial index (ABI) increased from 0.60 to 1.09. Warfarin and two antiplatelet drugs were given after the operation. Six months after operation, computed tomographic angiogram (CTA)identified the patent graft.

  9. Perioperative pentoxifylline therapy attenuates early postoperative neuro-cognitive decline in patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass

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    Sambhunath Das

    2015-01-01

    Full Text Available Background: Postoperative cognitive decline (POCD after coronary artery bypass grafting (CABG is a common problem. Studies show that pentoxifylline administration reduces inflammation induced by cardiopulmonary bypass and brain injury after ischaemia. Hence the perioperative use of pentoxifylline in attenuating POCD was evaluated in the study. Materials and Methods: Eighty patients were divided randomly into two groups from 106 patients scheduled for CABG surgery. The study group was administered pentoxifylline 400 mg twice daily orally from day of admission to 7th day after surgery, whereas the control group patients received placebo. Neurocognitive assessment was assessed by an independent clinical psychologist one day after admission to hospital and again on 7th postoperative day. The data was analyzed and a P < 0.05 was considered significant results. Results: Pentoxifylline-treated group showed no statistically significant difference in animal naming test scores (10.3 ± 2.2 versus 9.4 ± 2.5, P = 0.07, digit symbol substitution test (26.1 ± 7.47 vs 22.2 ± 6.07, P = 0.09 and 8 subtests of Post Graduate Institute-memory scale. The control group had significant POCD as detected by animal naming test (10.5 ± 3.7 versus 8.6 ± 3.9, P = 0.008, digit symbol substitution test (20.2 ± 8.2 versus 14.7 ± 8.9, P = 0.008 and five subtests of memory scale (P = 0.01, 0.04, 0.003, 0.005 and 0.02. The incidence of POCD was 50% in placebo-treated group compared to 22.5% in pentoxifylline group. Conclusions: The perioperative use of pentoxifylline attenuates the early postoperative neurocognitive decline after CABG using cardiopulmonary bypass.

  10. Staged endovascular treatment with selective EC-IC bypass for symptomatic large-giant aneurysms in the cavernous portion of the internal carotid artery

    International Nuclear Information System (INIS)

    For the treatment of symptomatic large-giant aneurysm in the cavernous portion of the internal carotid artery (ICA), it is often necessary to occlude the ICA with or without extracranial-intracranial (EC-IC) bypass surgery. We report 11 patients with such symptomatic lesions treated between January 2004 and June 2008 by staged endovascular trapping of the aneurysm with detachable coils following selective EC-IC bypass placement. The necessity of the bypass was determined according to neurological conditions and radiological findings during the preoperative balloon test occlusion (BTO) of the ICA. When ischemic symptoms occurred during BTO, high-flow bypass was selected. Otherwise, findings on single-photon emission computed tomography were used for the bypass selection. Following completion of the bypass, dual antiplatelet therapy was induced. Then the confirmative BTO and endovascular ICA occlusion (ICA-O) under local anesthesia were planned several days after the bypass placement. A total of 4 high-flow bypasses with radial artery graft were placed before ICA-O, while 7 patients underwent endovascular ICA-O without bypass surgery. There were no perioperative complications related to the procedures in 10 cases, but 1 developed cerebral infarction 7 days after bypass placement possibly due to distal embolism from intraaneurysmal thrombus. No patients showed postoperative symptoms according to insufficient ipsilateral cerebral blood flow, and cranial nerve palsies improved in all patients. Favorable outcomes can be expected for patients with such aneurysms by staged endovascular ICA-O with selective EC-IC bypass. Although endovascular ICA-O can be safe and useful, understanding of adequate antithrombotic therapy and treatment timing are especially important in cases with bypass placement. (author)

  11. The study of neuropsychological alterations following coronary artery bypass operation as predicted by computed tomography scan of the brain

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    Iguchi, Atsushi; Sato, Kiyoharu (Sendai Tokushu-kai Hospital (Japan)); Sadahiro, Mitsuaki; Endo, Masato; Yokoyama, Hitoshi; Ohmi, Mikio

    1993-01-01

    The objective of this clinical study is to provide information regarding the association between coexistent cerebrovascular disease and neuropsychological abnormalities after coronary artery bypass operations. Computed tomography scan of the brain was performed in 104 patients pre-operatively, and their post-operative neuropsychological functions were evaluated. The patients were categorized as follows according to the CT findings. Seventy-three patients showed normal or slight cerebral cortical atrophy which usually seen in patients over fifty of age (group A). Sixteen showed moderate or severe cortical atrophy (group B). Fifteen patients demonstrated the characteristic findings of Binswanger type; severe white matter hypodensity especially in frontal horns and dilated ventricles (group C). Overt neuropsychological dysfunction was not observed in patients in groups A and B. Six patients in group C showed a combination of dementia, bizarre behavior, disorientation and gait dyspraxia following bypass operations. The pseudobulbar signs were also found in 3 patients. These clinical abnormalities persisted for six days to three weeks, and were most often reversible. Although the underlying mechanism of these deleterious alterations is not elucidated, the ischemic nature of the characteristic white matter lesions was highly suspected. The arteriosclerotic changes of the arteriole of the cerebral cortex and hypoperfusion during cardio-pulmonary bypass were supposed to be responsible. Therefore it was concluded that special attention should be focused on neurological evaluation for bypass surgery in group C patients. (author).

  12. Complicated type B aortic dissection causing ischemia in the celiac and inferior mesenteric artery distribution despite patent superior mesenteric artery bypass.

    Science.gov (United States)

    Afifi, Rana O; Zhu, Youwei; Leake, Samuel S; Kott, Amy; Azizzadeh, Ali; Estrera, Anthony L; Safi, Hazim J; Charlton-Ouw, Kristofer M

    2015-08-01

    Mortality rates associated with acute type B aortic dissection (ABAD) complicated by malperfusion remains significant. Optimal management of patients with ABAD is still debatable. We present a case report of a 50-year-old man who was admitted due to ABAD. He was treated medically with his pain resolved and he was discharged on oral antihypertensive medications. One month after initial diagnosis, he was readmitted with abdominal pain, nausea, vomiting, and diarrhea. On imaging, an extension of the aortic dissection into the visceral arteries with occlusion of the celiac and superior mesenteric arteries (SMA) was noted. He underwent thoracic endovascular aortic repair (TEVAR) and bypass grafting to the SMA. Despite the intervention, the patient developed large bowel, liver, and gastric ischemia and underwent bowel resection. He died from multi-organ failure. In selected cases of uncomplicated ABAD, TEVAR should be considered and when TEVAR fails and visceral malperfusion develops, an aggressive revascularization of multiple visceral arteries should be attempted.

  13. Myocardial protection during elective coronary artery bypasses grafting by pretreatment with omega-3 polyunsaturated fatty acids

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    Veljović Milić

    2013-01-01

    Full Text Available Background/Aim. Despite recent advances in coronary artery bypass grafting (CABG, cardioplegic cardiac arrest and cardiopulmonary bypass (CPB are still associated with myocardial injury. Accordingly, the efforts have been made lately to improve the outcome of CPB by glucose-insulinpotassium, adenosine, Ca2+-channel antagonists, L-arginine, N-acetylcysteine, coenzyme Q10, diazoxide, Na+/H+ exchange inhibitors, but with an unequal results. Since omega-3 polyunsatutated fatty acids (PUFAs have shown remarkable cardioprotection in preclinical researches, the aim of our study was to check their effects in prevention of ischemia reperfusion injury in patients with CPB. Methods. This prospective, randomized, placebo-controlled study was performed with parallel groups. The patients undergoing elective CABG were randomized to receive preoperative intravenous omega-3 PUFAs infusion (n = 20 or the same volume of 0.9% saline solution infusion (n = 20. Blood samples were collected simultaneously from the radial artery and the coronary sinus before starting CPB and at 10, 20 and 30 min after the release of the aortic cross clamp. Lactate extraction/excretion and myocardial oxygen extraction were calculated and compared between the two groups. The levels of troponin I (TnT and creatine kinase-myocardial band (CK-MB were determined before starting CPB and 4 and 24 h postoperatively. Results. Demographic and operative characteristics, including CPB and aortic cross-clamp time, were similar between the two groups of patients. The level of lactate extraction 10 and 20 min after aortic cross-clamp time has shown negative values in the control group, but positive values in the PUFAs group with statistically significant differences (-19.6% vs 7.9%; p < 0.0001 and -19.9% vs 8.2%; p < 0.0008, respectively. The level of lactate extraction 30 minutes after reperfusion was not statistically different between the two groups (6.9% vs 4.2%; p < 0.54. Oxygen extraction in the

  14. ECG-based prediction of atrial fibrillation development following coronary artery bypass grafting

    International Nuclear Information System (INIS)

    In patients undergoing coronary artery bypass grafting (CABG) surgery, post-operative atrial fibrillation (AF) occurs with a prevalence of up to 40%. The highest incidence is seen between the second and third day after the operation. Following cardiac surgery AF may cause various complications such as hemodynamic instability, heart attack and cerebral or other thromboembolisms. AF increases morbidity, duration and expense of medical treatments. This study aims at identifying patients at high risk of post-operative AF. Early prediction of AF would provide timely prophylactic treatment and would reduce the incidence of arrhythmia. Patients at low risk of post-operative AF could be excluded on the basis of the contraindications of anti-arrhythmic drugs. The study included 50 patients in whom lead II electrocardiograms were continuously recorded for 48 h following CABG. Univariate statistical analysis was used in the search for signal features that could predict AF. The most promising ones identified were P wave duration, RR interval duration and PQ segment level. On the basis of these, a nonlinear multivariate prediction model was made by deploying a classification tree. The prediction accuracy was found to increase over time. At 48 h following CABG, the measured best smoothed sensitivity was 84.8% and the specificity 85.4%. The positive and negative predictive values were 72.7% and 92.8%, respectively, and the overall accuracy was 85.3%. With regard to the prediction accuracy, the risk assessment and prediction of post-operative AF is optimal in the period between 24 and 48 h following CABG

  15. EFFECT OF N - ACETYLCYSTEINE ON OXIDATIVE STRESS IN PATIENTS UNDERGOING OFF PUMP CORONARY ARTERY BYPASS GRAFTING

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    Jalakandan

    2015-09-01

    Full Text Available OBJECTIVE: Increasingly used Off Pump Coronary Artery Bypass Grafting (OPCABG has significantly reduced the oxidative stress and decreased the inflammatory response associated with the use of Cardiopulmonary by Pass (CPB. However, OPCABG is associated with signific ant oxidative stress and its associated complications. This present study is a prospective, randomized, double blind investigating the effects of N - acetylcysteine (NAC, a potent anti - oxidant on oxidative stress in patients undergoing OPCABG. METHODS: Fift y patients undergoing elective OPCABG were randomized into two groups. Group A (n=25, the control group received 200ml of Normal saline immediately following induction, whereas Group B (n=25, the study group received 150mg/kg of NAC in 200ml of Normal sa line at the corresponding time. At the end of surgery, all the patients were shifted to intensive care unit (ICU and were extubated at the earliest possible time. Malondialdehyde (MDA, a marker of free radical injury and Glutathione (GSH Levels were ass ayed from the 2 blood samples obtained ( F irst sample immediately following induction and the second immediately after shifting to ICU. RESULTS: Demographic profile, pre - incision clinical and biochemical values were comparable in both the groups. At the en d of surgery, MDA levels were significantly raised in control group (p<0.001 whereas its levels were maintained in study group (p<0.569. GSH levels were significantly decreased in control group (p<0.001 whereas its levels were significantly increased in study group (p<0.001. CONCLUSION: These results revealed that OPCABG was associated with significant oxidative response and the administration of N - Acetylcysteine attenuates this stress response by replenishing the Glutathione stores.

  16. Endothelial Injury Associated with Cold or Warm Blood Cardioplegia during Coronary Artery Bypass Graft Surgery

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    Elmar W. Kuhn

    2015-01-01

    Full Text Available The aim of this investigation was to analyze the impact of intermittent cold blood cardioplegia (ICC and intermittent warm blood cardioplegia (IWC on endothelial injury in patients referred to elective on-pump coronary artery bypass graft (CABG surgery. Patients undergoing CABG procedures were randomized to either ICC or IWC. Myocardial injury was assessed by CK-MB and cardiac troponin T (cTnT. Endothelial injury was quantified by circulating endothelial cells (CECs, von Willebrand factor (vWF, and soluble thrombomodulin (sTM. Perioperative myocardial injury (PMI and major adverse cardiac events (MACE were recorded. Demographic data and preoperative risk profile of included patients (ICC: n=32, IWC: n=36 were comparable. No deaths, PMI, or MACE were observed. Levels of CK-MB and cTnT did not show intergroup differences. Concentrations of CECs peaked at 6 h postoperatively with significantly higher values for IWC-patients at 1 h (ICC: 10.1 ± 3.9/mL; IWC: 18.4 ± 4.1/mL; P=0.012 and 6 h (ICC: 19.3 ± 6.2/mL; IWC: 29.2 ± 6.7/mL; P<0.001. Concentrations of vWF (ICC: 178.4 ± 73.2 U/dL; IWC: 258.2 ± 89.7 U/dL; P<0.001 and sTM (ICC: 3.2 ± 2.1 ng/mL; IWC: 5.2 ± 2.4 ng/mL; P=0.011 were significantly elevated in IWC-group at 1 h postoperatively. This study shows that the use of IWC is associated with a higher extent of endothelial injury compared to ICC without differences in clinical endpoints.

  17. Bispectral index-guided anaesthesia for off-pump coronary artery bypass grafting

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    Muralidhar Kanchi

    2008-01-01

    Full Text Available Bispectral index (BIS monitoring may assist reduction in utilisation of anaesthetic agents during general surgical procedures. This study was designed to test whether the use of BIS monitoring reduces the anaesthetic requirements during off-pump coronary artery bypass grafting (CABG. This prospective - clinical trial was conducted on 40 adult patients undergoing elective off-pump CABG. Patients received either isoflurane or propofol anaesthesia. BIS monitoring, which guided the dose of anaesthetic, was carried out in 50 percent of the patients. The amount of anaesthetic agent (isoflurane or propofol administered from the start of anaesthesia to the end of surgical procedure was calculated and were compared in four groups of patients - namely Group A (I-no BIS received isoflurane; end tidal concentration was maintained at 1-1.2% in a low flow technique throughout the procedure, Group B (I-BIS received isoflurane in a low flow technique; inspired concentration was dictated by BIS value maintained at 50; Group C (P-no BIS received propofol at a dose range of 4-8 mg/kg/hr and in Group D(P-BIS the propofol infusion rate was dictated by BIS value maintained at 50. The quantity of isoflurane was significantly less for Group B (I-BIS as compared with Group A (I-no BIS (37 ± 4 vs. 24 ± 4 ml; p< 0.05 and similarly the amount of propofol infused was significantly less in Group D (P-BIS as compared with Group C (P-no BIS (176 ± 9 vs. 120 ± 6 ml; p< 0.05. BIS guided anaesthesia reduces the anaesthetic agent required for the performance of off-pump CABG. This can be extrapolated in terms of saving agent and reduced cardiac depression during off-pump CABG.

  18. Effect of Cardiac Rehabilitation on Strength and Balance in Patients after Coronary Artery Bypass Graft

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    Nahid Nazari

    Full Text Available Background: The most common method for improving the quality of life especially in chronic heart disease is rehabilitation. For increasing the level of knowledge about effect of rehabilitation and its' impression on improving the quality of life in patients. This study evaluates effect of one month cardiac rehabilitation on lower limb strength and the static and dynamic balance of CABG patients. Materials and Methods: This study is based on clinical trial before and after rehabilitation. the exercise protocol lasted for one month, three times per week, each session lasting 1 hour, on 30 male patients in two groups in control (N=15 and experimental group (N=15 after CABG in the centre of rehabilitation in Javad-Alaeme Heart Hospital, Mashhad. The strength of lower limb by chair standing test, the static balance by standing on one leg and dynamic balance by time up and go (TUG test, was evaluated before and after 1 month rehabilitation in training group and detraining in control group. Data were analyzed with SPSS-16 and used t-test analysis (p≤0.05.Results: The strength of lower limb (p=0.001, static balance (p=0.023 and dynamic balance (p=0.037 increased significantly after one month of cardiac rehabilitation.Conclusion: The result of this study indicates that cardiac rehabilitation after coronary artery bypass surgery causes significant increase in strength of lower limb and balance in patients, the more muscle strength is associated with an increase in ability of performing daily activities and so it causes improved quality of life.

  19. Effect of Cardiac Rehabilitation on Strength and Balance in Patients after Coronary Artery Bypass Graft

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    Nahid Nazari

    2014-01-01

    Full Text Available Background: The most common method for improving the quality of life especially in chronic heart disease is rehabilitation. For increasing the level of knowledge about effect of rehabilitation and its' impression on improving the quality of life in patients. This study evaluates effect of one month cardiac rehabilitation on lower limb strength and the static and dynamic balance of CABG patients. Materials and Methods: This study is based on clinical trial before and after rehabilitation. the exercise protocol lasted for one month, three times per week, each session lasting 1 hour, on 30 male patients in two groups in control (N=15 and experimental group (N=15 after CABG in the centre of rehabilitation in Javad-Alaeme Heart Hospital, Mashhad. The strength of lower limb by chair standing test, the static balance by standing on one leg and dynamic balance by time up and go (TUG test, was evaluated before and after 1 month rehabilitation in training group and detraining in control group. Data were analyzed with SPSS-16 and used t-test analysis (p≤0.054T. Results: The strength of lower limb (p=0.001, static balance (p=0.023 and dynamic balance (p=0.037 increased significantly after one month of cardiac rehabilitation4T. Conclusion: The result of this study indicates that cardiac rehabilitation after coronary artery bypass surgery causes significant increase in strength of lower limb and balance in patients, the more muscle strength is associated with an increase in ability of performing daily activities and so it causes improved quality of life4T.

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

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    Scheinin Harry

    2011-05-01

    Full Text Available Abstract 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 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 was carried out in 1994-1997 and was thus not registered.

  1. Comparison of levosimendan and nitroglycerine in patients undergoing coronary artery bypass graft surgery

    Science.gov (United States)

    Sahu, Manoj K.; Das, Anupam; Malik, Vishwas; Subramanian, Arun; Singh, Sarvesh Pal; Hote, Milind

    2016-01-01

    Background: Levosimendan a calcium ion sensitizer improves both systolic and diastolic functions. This novel lusitropic drug has predictable antiischemic properties which are mediated via the opening of mitochondrial adenosine triphosphate-sensitive potassium channels. This action of levosimendan is beneficial in cardiac surgical patients as it improves myocardial contractility, decreases systemic vascular resistance (SVR), and increases cardiac index (CI) and is thought to be cardioprotective. We decided to study whether levosimendan has any impact on the outcomes such as the duration of ventilation, the length of Intensive Care Unit (ICU) stay, and the hospital stay when compared with the nitroglycerine (NTG), which is the current standard of care at our center. Materials and Methods: Forty-seven patients undergoing elective coronary artery bypass surgery were randomly assigned to two groups receiving either levosimendan or NTG. The medications were started before starting surgery and continued until 24 h in the postoperative period. Baseline hemodynamic parameters were evaluated before beginning of the operation and then postoperatively at 3 different time intervals. N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) levels were also measured in both groups. Results: In comparison to the NTG group, the duration of ventilation and length of ICU stay were significantly less in levosimendan group (P < 0.05, P = 0.02). NT-proBNP level analysis showed a slow rising pattern in both groups and a statistically significant rise in the levels was observed in NTG group (P = 0.03, P = 0.02) in postoperative period when compared to levosimendan group of patients. Conclusion: Levosimendan treatment in patients undergoing surgical revascularization resulted in improved CI, decreased SVR and lower heart rate. And, thereby the duration of ventilation and length of ICU stay were significantly less in this group of patients when compared with NTG group. PMID:26750674

  2. Gabapentin May Relieve Post-Coronary Artery Bypass Graft Pain: A Double Blind Randomized Clinical Trial

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    MSoltanzadeh

    2011-09-01

    Full Text Available Background: One of the most common complaints after coronary artery bypass graft (CABG is post-operative pain. Gabapentin is an anticonvulsant and antineuralgic agent. Objective: To evaluate the analgesic effect of preemptive gabapentin on post-operative pain and morphine consumption after cardiac surgery. Methods: A double-blind randomized clinical trial was conducted on 60 male candidates for CABG. The patients were divided into two groups—the gabapentin (n=30 and the control group (n=30. The test group received 800 mg gabapentin orally two hours before the surgery followed by 400 mg of the drug two hours post-extubation. The control group received placebo instead. Then severity of pain was recorded according to an 11-point visual analog pain scale. The amount of morphine consumed, its side effects and hemodynamic changes were also recorded during and at 2, 6, 12, 18 and 24 hours after extubation. Results: The mean±SD cumulative morphine consumption at the first 24 hours after extubation in gabapentin group was 0.9±1.5 mg while it was 1.5±4 mg for the control group. Therefore, gabapentin group consumed 38% less than the control group (P=0.01. The pain scores during rest and coughing at 2, 6, and 12 hours after extubation were also significantly lower in the gabapentin group compared with the control group (P=0.02. The mean±SD mechanical ventilation time was 5.4±1.7 hours for gabapentin group and 1.6±4.4 hours for the control group (P=0.035. The other variables including hemodynamic changes (HR, SBP and DBP, and incidence of nausea, vomiting and respiratory depression showed no significant difference between the studied groups within 24 hours after extubation. Conclusion: Oral pre-medication with gabapentin before CABG significantly reduces post-operative pain and morphine consumption in adult cardiac surgery.

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

    Science.gov (United States)

    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.

  4. Preliminary results of combined carotid endarterectomy and off-pump coronary artery bypass grafting in patients with coexistent carotid and coronary artery diseases

    Institute of Scientific and Technical Information of China (English)

    CHEN Xu-jun; CHEN Xin; XIE Dong-hua; SHI Kai-hu; XU Ming

    2009-01-01

    Background Coexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery.The aim of this study was to investigate the effect of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) in patients with coexistent carotid and coronary artery diseases.Methods Between January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out. Results A total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was (25.5±7.0) minutes. The mean number of distal grafts per patient was 3.30±0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was (11.3±5.4) hours, (2.1 ±0.9) days, and (12.5±6.1) days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients (92.16%) with a mean follow-up of (39.5±12.5) months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred.Conclusion Combined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.

  5. Resolution of diabetes mellitus and metabolic syndrome in normal weight 24-29 BMI patients with one anastomosis gastric bypass Resolución de la diabetes mellitus y del síndrome metabólico

    Directory of Open Access Journals (Sweden)

    M. García-Caballero

    2012-04-01

    Full Text Available Introduction: Diabetes mellitus type 2 (DMT2 is a major cause of death in the world. The medical therapy for this disease has had enormous progress, but it still leaves many patients exposed to the complications developed from the disease. It is well known the beneficial effects of bariatric surgery in obese diabetic patients, however it is important to investigate if the same principles of bariatric surgery that improve diabetes in obese patients, could be applied to non obese normal weight diabetics. Material and methods: Thirteen diabetic patients operated by One Anastomosis Gastric Bypass (BAGUA, were evaluated in the preoperative period and 1,3 and 6 months after surgery. Body weight and composition, Fasting Plasma Glucose, HbA1c levels, blood pressure and serum lipids levels were analyzed, as well as the monitoring of the immediate postoperative treatment necessities for Diabetes and other metabolic syndrome comorbidities. Results: After the surgery the 77% of the patients resolves its T2DM, 46% from surgery, and rest noted an significant improvement of the disease in spite of having a C peptide level near to zero some of the patients. The comorbidities, mainly hypertension and lipid abnormalities experience improvement early. All patients reduce their weight and the amount of fat mass until values consistent with their age and height. Conclusions: The One Anastomosis Gastric Bypass leads to resolution or improvement of T2DM in non obese normal weight patients. The best results are obtained in patients with few years of diabetes, without or short term use of insulin treatment and high C-peptide levels.Introducción: La diabetes mellitus de tipo 2 (DMT2 es una causa principal de muerte a escala mundial. El tratamiento médico de esta enfermedad ha progresado tremendamente pero sigue dejando a muchos pacientes expuestos a las complicaciones derivadas de la enfermedad. Son bien conocidos los efectos beneficiosos de la cirugía bariátrica en

  6. Persistent carotid-vertebrobasilar anastomosis: radiologic findings

    International Nuclear Information System (INIS)

    To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. Thirteen pateints with fourteen cases of carotid-vertebrobasilar anastomosis collected from January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography were cerebral infarction (n=3D3), intracranial hemorrhage (n=3D2), subarachnoid hemorrhage (n=3D1), brain tumor (n=3D3), arteriovenous malformation (n=3D3) and trigeminal neuralgia (n=3D1). Cerebral angiograms and clinical symptoms were retrospectively analyzed. The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases of persistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminal arteries were associated with anterior communicating artery aneurysm(n=3D1), posterior fossa arteriovenous malformation(n=3D2) and persistent trigeminal artery variant(n=3D5). Type I proatantal intersegmental arteries were associated with hypoplastic vertebral arteries(n=3D2): only proximal segment in one, and proximal and distal segments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosis which was trigeminal neuralgia. Knowledge of the anatomical and radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovascular disease and prevent possible complications during surgical and interventional procedures.=20

  7. Persistent carotid-vertebrobasilar anastomosis: radiologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Il; Kim, Dong Ik; Jun, Pyoung; Yoon, Pyeong Ho; Hwang, Geum Ju; Cheon, Young Jik; Lim, Joon Seok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-11-01

    To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. Thirteen pateints with fourteen cases of carotid-vertebrobasilar anastomosis collected from January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography were cerebral infarction (n=3D3), intracranial hemorrhage (n=3D2), subarachnoid hemorrhage (n=3D1), brain tumor (n=3D3), arteriovenous malformation (n=3D3) and trigeminal neuralgia (n=3D1). Cerebral angiograms and clinical symptoms were retrospectively analyzed. The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases of persistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminal arteries were associated with anterior communicating artery aneurysm(n=3D1), posterior fossa arteriovenous malformation(n=3D2) and persistent trigeminal artery variant(n=3D5). Type I proatantal intersegmental arteries were associated with hypoplastic vertebral arteries(n=3D2): only proximal segment in one, and proximal and distal segments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosis which was trigeminal neuralgia. Knowledge of the anatomical and radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovascular disease and prevent possible complications during surgical and interventional procedures.=20.

  8. Development of an instrument to indirectly monitor arterial pCO2 during cardiopulmonary bypass.

    Science.gov (United States)

    Høgetveit, Jan Olav; Kristiansen, Frode; Pedersen, Thore H

    2006-01-01

    Arterial blood carbon dioxide tension (PaCO2) during cardiopulmonary bypass (CBP) is important to the conduct of perfusion with alpha-stat or pH-stat strategy. Temperature changes during CBP complicate any attempts to monitor carbon dioxide tension in the exhaust outlet of an oxygenator (PexCO2) because CO2 becomes more soluble with decreasing temperatures. Normally, this would have been the obvious and easy choice of method to indirectly measure the patient's PaCO2. Several tests have been performed with ordinary capnographs modified to measure pCO2 at the oxygenator exhaust gas port. These tests have shown varying degrees of precision (Br I Anaesth 1999; 82(6): 843-46; 1 Extra-Corpor Technol 2003; 35(3): 218-23; Br JAnaesth 2000; 84: 536; J Extra-Corpor Technol 1994; 26: 64-67). Some of the best results have been achieved by Potger et al. (JExtra-Corpor Technol 2003; 35(3): 218-23), who found a strong correlation between the arterial temperature-corrected PexCO2 when using a standard capnograph monitoring the PaCO2 measured from a blood gas analyser (PbCO2). Our group has developed a new instrument, especially designed for oxygenator gas exhaust monitoring. The new instrument has automatic temperature correction, enabling it to show both original and corrected pCO2 values, simultaneously. Ordinary capnograph functions, such as zeroing, flow control and calibration routines, are included. The solution consists of a pCO2 sensor module, a temperature sensor, a water trap and a dedicated PC mounted on a heart-lung machine. Since the heart-lung machine was already equipped with a computer for data logging and a temperature sensor, only a box containing the pCO2 sensor module and the water trap had to be added. The PC uses a specially written program designed to collect data, make the necessary calculations and display the results on the computer screen. A temperature correction was developed based on a linear regression analysis for a data-set of 15 patients, assuming

  9. A propensity matched comparison of return to work and quality of life after stenting or coronary artery bypass surgery

    OpenAIRE

    Maznyczka, Annette M; Howard, James P; Banning, Amerjeet S.; Gershlick, Anthony H.

    2016-01-01

    Objectives We sought to determine (1) return to work (RTW) rates, (2) long-term employment (>12 months postprocedure), (3) time taken to RTW, and (4) quality of life (QoL), in patients treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods Questionnaires regarding RTW were sent to 689 PCI and 169 CABG patients who underwent PCI or CABG at University Hospitals of Leicester Trust, UK, from May 2012 to May 2013. QoL was also measured using the Eu...

  10. Effect of Cardiac Rehabilitation Program on Exercise Capacity in Women Undergoing Coronary Artery Bypass Graft in Hamadan-Iran

    OpenAIRE

    Ramin Shabani; Abas A Gaeini; Nikoo, Mohamad R.; Hojatollah Nikbackt; Majid Sadegifar

    2010-01-01

    Objectives: The purpose of this study was to determine the effects of cardiac rehabilitation program (CRP) on exercise capacity and rate pressure product (RPP) in Iranian female patients undergoing coronary artery bypass grafting (CABG) in Hamadan, Iran. Methods: Sixty women after CABG were assigned into an exer-cise group (n = 30, mean age 58.5 ± 10.8 years), who performed physical training for 12 weeks, or a control group (n = 30, mean age 59.3 ± 8.6 years) who received usual care. Funct...

  11. Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm.

    Science.gov (United States)

    Bowers, Christian A; Taussky, Philip; Park, Min S; Neil, Jayson A; Couldwell, William T

    2015-12-01

    We report the microsurgical rescue and removal of a Pipeline stent embolization of a giant internal carotid artery terminus aneurysm. After the initial placement of a Pipeline Embolization Device (PED), it migrated proximally to the cavernous carotid with the distal end free in the middle of the aneurysm, resulting in only partial aneurysm neck coverage. The patient underwent microsurgical rescue with trapping, bypass, and opening of the aneurysm with PED removal. The vessel remained patent in the proximal segment previously covered by the Pipeline stent. Microsurgical rescue for definitive aneurysm treatment with PED removal can be safe and effective for aneurysms unsuccessfully treated with PED.

  12. Off-pump coronary artery bypass surgery is associated with fewer gene expression changes in the human myocardium in comparison with on-pump surgery

    OpenAIRE

    Ghorbel, Mohamed T.; Cherif, Myriam; Mokhtari, Amir; Bruno, Vito Domenico; Caputo, Massimo; Angelini, Gianni D

    2010-01-01

    Off-pump coronary artery bypass surgery reduces the myocardial injury associated with on pump surgery with cardiopulmonary bypass (CPB) and ischemic-cardioplegic arrest (CA). We sought to find a mechanistic explanation for this by comparing the transcriptomic changes in the myocardium of patients undergoing on- and off-pump surgery. Transcriptomic analyses were performed on left ventricular biopsies obtained from patients prior to (pre-op) and after completion of all coronary anastomoses (pos...

  13. Comparison of the centrifugal and roller pump in elective coronary artery bypass surgery--a prospective, randomized study with special emphasis upon platelet activation.

    Science.gov (United States)

    Andersen, Knut S; Nygreen, Else L; Grong, Ketil; Leirvaag, Beryl; Holmsen, Holm

    2003-12-01

    Objective--Evaluation of the centrifugal pump vs roller pump concerning effects upon platelet function, hemolysis and clinical outcome in elective coronary artery bypass surgery. Design--Thirty-four patients were randomized to centrifugal or roller pump. Platelet activation was studied by flow cytometry before, during and up to 3 days after bypass. Results--Duration of bypass, ischemic period, peripheral anastomoses, hospital stay and mortality did not differ. In roller pump patients, platelet aggregates increased by 250% between end of bypass and 3 h postoperatively (p centrifugal pump group, these changes were not significant. Hemolysis increased (20%) at end of bypass and 3 h postoperatively (p centrifugal pump patients, indicating higher susceptibility to postoperative thrombotic complications with the roller pump. Otherwise, there was no clinical evidence for superiority of the centrifugal pump.

  14. Factors Affecting the Quality and Quantity of Sleep in Coronary Artery Bypass Graft Patients

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    H Esmaily

    2008-10-01

    Full Text Available Introduction: Sleep disturbance is common in patients undergoing Coronary Artery Bypass Graft surgery and has been recognized for more than 30 years. New literature suggests the importance of sleep and rest for restoration, protection and promotion of function and wellbeing of these patients. Because of the importance of the role of nurses in diagnosis and treatment of sleep disorders, this study was conducted to determine possible effective factors on sleep quality and sleep quantity of patients after CABG. Methods: This longitudinal, descriptive and correlational study was conducted on 91 patients admitted to Imam Reza Hospital in Mashad City in 2005-2006. Subjects were selected according to inclusion and exclusion criteria. Data was collected by interview in three stages: 24 hours before surgery, as well as 6 weeks and 10 weeks after surgery. Subjective sleep quality was measured with PSQI and sleep quantity was measured with sleep log. The first two interviews were done at the hospital clinic and the last via telephone. Data was analyzed in SPSS using student T test, Pearson correlation coefficient and General Linear Model. Results: According to Univariable analysis, variables such as age (p=0.03, aorta clamp time (p=0.003, mechanical ventilation time (p=0.01, staying time in hospital (p=0.04 can affect sleep quantity 10 weeks after surgery. Previous history of sleep disorder (p=0.005, diabetes (p=0.02, use of diuretic drugs before surgery (p=0.04 and ACEI drugs after surgery (p=0.01 can affect sleep quality 10 weeks after surgery. Conclusion: Sleep disorder history (p=0.01, use of diuretic drugs before surgery (p=0.04 and sleep quantity 6 weeks after surgery (p=0.01 have been the most effective factors on sleep quality 10 weeks after surgery, whereas quality of life 10 weeks after surgery (p=0.04 has been the most effective factor on sleep quantity 10 weeks after surgery. There is therefore a necessity for presenting approaches in order to

  15. Effects of Cardiac Rehabilitation Program on Right Ventricular Function After Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Akram Sardari

    2012-03-01

    Full Text Available Background: Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery (CABG. However, the effect of this program on right ventricular function following CABG is unclear. The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular (RV function in a cohort of patients who underwent CABG. Methods: A total of 28 patients who underwent CABG and participated consecutively in an 8-week cardiac rehabilitation program at Tehran Heart Center were studied. The control group consisted of 39 patients who refused to attend cardiac rehabilitation and only received postoperative medical treatment after registration in the Cardiac Rehabilitation Clinic. Two-dimensional and Doppler echocardiography was performed to assess the RV function in both groups at the three time points of before surgery, at the end of surgery, and at the end of the rehabilitation program. Results: Significant increase of RV function parameters were observed in both rehabilitation group (RG and control group (CG at the end of the rehabilitation program compared with post-CABG evaluation in terms of tricuspid annular plane systolic execution (RG: 12.50 mm to 14.18 mm; CG: 13.41 mm to 14.56 mm, tricuspid annular peak systolic velocity (RG: 8.55 cm/s to 9.14 cm/s; CG: 9.03 cm/s to 9.26 cm/s, and tricuspid annular late diastolic velocity (RG: 8.93 cm/s to 9.39 cm/s; CG: 9.26 cm/s to 9.60 cm/s.The parameters of the RV function did improve in both groups, but this improvement was not associated with participation in the complete cardiac rehabilitation program. Conclusion: The RV function parameters gradually improved after CABG; this progress, however, was independent of the exercise-based cardiac rehabilitation program.

  16. Health related quality of life trajectories and predictors following coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Worcester Marian UC

    2006-08-01

    Full Text Available Abstract Background Many studies have demonstrated that health related quality of life (HRQoL improves, on average, after coronary artery bypass graft surgery (CABGS. However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. Methods 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36, Profile of Mood States (POMS and the Everyday Functioning Questionnaire (EFQ. These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. Results For both the physical component summary scale (PCS and the mental component summary scale (MCS of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers. A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation. Conclusion It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of

  17. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Mehta Yatin

    2008-01-01

    Full Text Available Minimally invasive surgery with robotic assistance should elicit minimal pain. Regional analgesic techniques have shown excellent analgesia after thoracotomy. Thus the aim of this study was to compare thoracic epidural analgesia (TEA technique with paravertebral block (PVB technique in these patients with regard to quality of analgesia, complications, and haemodynamic and respiratory parameters. This was a prospective randomised study involving 36 patients undergoing elective robotic-assisted coronary artery bypass grafting (CABG. TEA or PVB were administered in these patients. The results revealed no significant differences with regard to demographics, haemodynamics, and arterial blood gases. Pulmonary functions were better maintained in PVB group postoperatively; however, this was statistically insignificant. The quality of analgesia was also comparable in both the groups. We conclude that PVB is a safe and effective technique for postoperative analgesia after robotic-assisted CABG and is comparable to TEA with regard to quality of analgesia.

  18. Angiography-based prediction of outcome after coronary artery bypass surgery versus changes in myocardial perfusion scintigraphy

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Haghfelt, Torben;

    2011-01-01

    The present study compared the clinical prediction of the effect of coronary artery bypass grafting (CABG) on coronary blood flow and left ventricular ejection fraction (LVEF) with changes in gated myocardial perfusion scintigraphy. A prospective group of 92 patients underwent myocardial perfusion...... predicted and observed regional changes in coronary blood flow and perfusion defects were poor. LVEF increased (by over five ejection fraction units) in almost half of the patients, but with no correlation between the predicted and the observed changes. Based on clinical and angiographic findings...... scintigraphy before and 6 months after CABG, the results being kept secret from the surgeon. Based on clinical and angiographic findings, the surgeons filled in a questionnaire indicating the predicted changes in coronary blood flow in each of the three coronary artery territories and in the LVEF. Symptomatic...

  19. 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.

    Science.gov (United States)

    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. PMID:24730632

  20. 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.

    Science.gov (United States)

    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.

  1. [A Case of Laparoscopic Surgery for Early Gastric Cancer that Occurred after Coronary Artery Bypass Grafting using the Right Gastroepiploic Artery].

    Science.gov (United States)

    Kusumoto, Eiji; Ota, Mitsuhiko; Tsutsumi, Norifumi; Hashimoto, Kenkichi; Egashira, Akinori; Sakaguchi, Yoshihisa; Kusumoto, Tetsuya; Ikejiri, Koji

    2015-10-01

    We herein report a case involving a 70-year-old man who was diagnosed with early gastric cancer that occurred after coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) for effort-induced angina. He was successfully treated by laparoscopic surgery. Preoperative cardiac three-dimensional computed tomography and coronary angiography showed an occlusion of the RGEA graft, which could lead to ligation of the RGEA to dissect the lymph nodes along the RGEA. The laparoscopic approach helps to identify and avoid injury to the RGEA graft because of its enlarged and precise viewing field compared with laparotomy followed by retractor placement. Laparoscopic surgery is a useful method in such cases to reduce perioperative complications risk.

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

    Science.gov (United States)

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

    2014-11-01

    Background: Coronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective: This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods: Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) - 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) - 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ≤ 0.05 were considered significant. Results: Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ≤ 0.01). Conclusion: Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.Fundamento: A cirurgia de revascularização miocárdica (CRM) é a opção cirúrgica padrão para pacientes com placas arteriais difusas e significativas. Tal procedimento, no entanto, não é desprovido de complicações pós-operatórias, especialmente distúrbios pulmonares e cognitivos. Objetivo: Comparar o impacto de duas abordagens fisioterap

  3. High volume practice proved the safety of off-pump coronary artery bypass surgery in left main coronary artery lesions:a two-year single center experience

    Institute of Scientific and Technical Information of China (English)

    LIU Tong; LU Chun-shan; LU Jia-kai; GAN Hui-li; ZHANG Jian-qun; HUANG Fang-jong; GU Cheng-xiong; KONG Qing-yu; CAO Xiang-rong; BO Ping

    2012-01-01

    Background Left main coronary artery (LMCA) stenosis has been recognized as a risk factor for early death among patients undergoing coronary artery bypass grafting (CABG).This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event (MACCE) after off-pump coronary artery bypass grafting (OPCABG),compared with non-left main coronary artery stenosis (non-mainstem disease).Methods From January 1,2009 to December 31,2010,4869 patients had a primary isolated OPCABG procedure at Beijing Anzhen Hospital.According to the pathology of LMCA lesions,they were retrospectively classified as a non-mainstem disease group (n=3933) or a LMCA group (n=936).Propensity scores were used to match the two groups,patients from the non-mainstem disease group (n=831) were also randomly selected to match patients from the LMCA group (n=831).Freedom from MACCE in the two groups was calculated using the Kaplan-Meier method.Results The difference in the mortality and the rate of MACCE during the first 30 days between the non-mainstem disease group and the LMCA group did not reach statistical significance (P=0.429,P=0.127 respectively).With a mean follow-up of (12.8±7.5) months and a cumulative follow-up of 1769.6 patient-years,the difference in the freedom from MACCEs between the two groups,calculated through Kaplan-Meier method,did not reach statistical significance (P=0.831).Conclusion Analysis of a high volume of OPCABG procedures proved that LMCA lesions do not pose additional early and mid-term risk to OPCABG.Therefore,a LMCA lesion is as safe as non-mainstem disease lesion during the OPCABG procedure.

  4. Pulsatile compared with nonpulsatile perfusion using a centrifugal pump for cardiopulmonary bypass during coronary artery bypass grafting. Effects on systemic haemodynamics, oxygenation, and inflammatory response parameters.

    Science.gov (United States)

    Driessen, J J; Dhaese, H; Fransen, G; Verrelst, P; Rondelez, L; Gevaert, L; van Becelaere, M; Schelstraete, E

    1995-01-01

    The present study investigated the influence of pulsatile or nonpulsatile flow delivery with a centrifugal pump for cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) in two randomized groups of 19 patients each. All patients received a standard anaesthetic and surgical protocol. Pulsatile perfusion during CPB was created by accelerating the baseline pump speed of the Sarns centrifugal pump at a rate of 50 cycles per minute. Measurements included perioperative systemic haemodynamics and oxygen exchange, total haemolytic complement (CH50), polymorphonuclear (neutrophil) granulocyte (PMN) count and plasma granulocyte elastase bound to alpha 1-proteinase inhibitor (E-alpha 1-PI). Laboratory measurements were corrected for haemodilution. During and after CPB there were only a few significant differences between the groups in systemic haemodynamics and oxygenation, i.e. a lower mean arterial blood pressure after the end of CPB in the nonpulsatile group (65 mmHg, SD = 11 vs 76 mmHg, SD = 11) and a lower SvO2 during rewarming on CPB in the nonpulsatile group (62%, SD = 8 vs 67%, SD = 8). The decrease in percentage of PMNs in the total white blood cell count during CPB was greater in the nonpulsatile group than in the pulsatile group (from 61 to 46% vs 63 to 53% of prebypass value). The steep increase of PMN count at the end of CPB and postoperatively was comparable in both groups. The maximal decrease of CH50 levels, occurring after surgery, was significantly higher in the nonpulsatile group (70% SD = 15 vs 79%, SD = 16, of baseline value), suggesting a greater complement activation. E-alpha 1-PI levels increased significantly in both groups during and after CPB with higher peak levels, obtained at one hour after admission to an intensive care unit, in the nonpulsatile group (316 micrograms/l, SD = 102) than in the pulsatile group (247 micrograms/l, SD = 106). There was a partly inverse correlation between the peak postoperative elastase levels and

  5. Comparison of the standard roller pump and a pulsatile centrifugal pump for extracorporeal circulation during routine coronary artery bypass grafting.

    Science.gov (United States)

    Driessen, J J; Fransen, G; Rondelez, L; Schelstraete, E; Gevaert, L

    1991-01-01

    The present prospective study compared the standard nonpulsatile twin roller pump with the Sarns centrifugal pump, in the pulsatile mode, as arterial pumps for extracorporeal circulation during coronary artery bypass grafting (CABG). The study was conducted in two consecutive groups of 25 patients receiving a standard anaesthetic and surgical protocol. The investigated parameters included haemodynamic profiles, oxygen exchange, blood gas and acid-base homeostasis, haematology, coagulation and complement consumption. With comparable settings for pump flow, gas flow and delivered oxygen concentrations, there was no difference between the groups in the main haemodynamic parameters during cardiopulmonary bypass (CPB). However, a tenfold lower dose of sodium nitroprusside was required to keep systemic vascular resistance within physiologic limits during CPB in the centrifugal group (C group) compared with the roller group (R group). During rewarming oxygen extraction was higher in the C group than in the R group. During the first eight hours after CPB no differences in haemodynamics, oxygenation parameters and pulmonary shunt between the groups were observed. During, as well as after, CPB there was no significant difference in blood gas and acid-base homeostasis between either group. Average postoperative blood loss via chest tubes, total transfusions of blood products, haemoglobin and coagulation did not differ between the two groups. However, the white blood cell count, corrected for changes in haematocrit, decreased during the early phase of CPB in the R group, but not in the C group.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Auler José

    2011-09-01

    Full Text Available Abstract Background The PEEP-ZEEP technique is previously described as a lung inflation through a positive pressure enhancement at the end of expiration (PEEP, followed by rapid lung deflation with an abrupt reduction in the PEEP to 0 cmH2O (ZEEP, associated to a manual bilateral thoracic compression. Aim To analyze PEEP-ZEEP technique's repercussions on the cardio-respiratory system in immediate postoperative artery graft bypass patients. Methods 15 patients submitted to a coronary artery bypass graft surgery (CABG were enrolled prospectively, before, 10 minutes and 30 minutes after the technique. Patients were curarized, intubated, and mechanically ventilated. To perform PEEP-ZEEP technique, saline solution was instilled into their orotracheal tube than the patient was reconnected to the ventilator. Afterwards, the PEEP was increased to 15 cmH2O throughout 5 ventilatory cycles and than the PEEP was rapidly reduced to 0 cmH2O along with manual bilateral thoracic compression. At the end of the procedure, tracheal suction was accomplished. Results The inspiratory peak and plateau pressures increased during the procedure (p Conclusion The PEEP-ZEEP technique seems to be safe, without alterations on hemodynamic variables, produces elevated expiratory flow and seems to be an alternative technique for the removal of bronchial secretions in patients submitted to a CABG.

  7. A comparison of urinary neutrophil gelatinase-associated lipocalin in patients undergoing on- versus off-pump coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Wagener, Gebhard; Gubitosa, Gina; Wang, Shuang;

    2009-01-01

    OBJECTIVE: The purpose of this study was to compare urinary neutrophil gelatinase-associated lipocalin (NGAL) levels in off-pump and on-pump coronary artery bypass graft (CABG) surgery. DESIGN: A matched cohort study. SETTING: A tertiary university hospital. PARTICIPANTS: Thirty adult patients...... undergoing CABG surgery without cardiopulmonary bypass (off-pump) matched to 30 patients with on-pump CABG surgery by age, preoperative serum creatinine, Parsonnet score, ejection fraction, body mass index, and number of coronary artery grafts. INTERVENTIONS: None, observational. MEASUREMENTS AND MAIN...

  8. Risk factors for neurological worsening and symptomatic watershed infarction in internal carotid artery aneurysm treated by extracranial-intracranial bypass using radial artery graft.

    Science.gov (United States)

    Matsukawa, Hidetoshi; Tanikawa, Rokuya; Kamiyama, Hiroyasu; Tsuboi, Toshiyuki; Noda, Kosumo; Ota, Nakao; Miyata, Shiro; Oda, Jumpei; Takeda, Rihee; Tokuda, Sadahisa; Kamada, Kyousuke

    2016-08-01

    OBJECT The revascularization technique, including bypass created using the external carotid artery (ECA), radial artery (RA), and M2 portion of middle cerebral artery (MCA), has remained indispensable for treatment of complex aneurysms. To date, it remains unknown whether diameters of the RA, superficial temporal artery (STA), and C2 portion of the internal carotid artery (ICA) and intraoperative MCA blood pressure have influences on the outcome and the symptomatic watershed infarction (WI). The aim of the present study was to evaluate the factors for the symptomatic WI and neurological worsening in patients treated by ECA-RA-M2 bypass for complex ICA aneurysm with therapeutic ICA occlusion. METHODS The authors measured the sizes of vessels (RA, C2, M2, and STA) and intraoperative MCA blood pressure (initial, after ICA occlusion, and after releasing the RA graft bypass) in 37 patients. Symptomatic WI was defined as presence of the following: postoperative new neurological deficits, WI on postoperative diffusion-weighted imaging, and ipsilateral cerebral blood flow reduction on SPECT. Neurological worsening was defined as the increase in 1 or more modified Rankin Scale scores. First, the authors performed receiver operating characteristic curve analysis for continuous variables and the binary end point of the symptomatic WI. The clinical, radiological, and physiological characteristics of patients with and without the symptomatic WI were compared using the log-rank test. Then, the authors compared the variables between patients with and without neurological worsening at discharge and at the 12-month follow-up examination or last hospital visit. RESULTS Symptomatic WI was observed in 2 (5.4%) patients. The mean MCA pressure after releasing the RA graft (< 55 mm Hg; p = 0.017), mean (MCA pressure after releasing the RA graft)/(initial MCA pressure) (< 0.70 mm Hg; p = 0.032), and mean cross-sectional area ratio ([RA/C2 diameter](2) < 0.40 mm [p < 0.0001] and [STA/C2

  9. Recent development of robotic coronary artery bypass graft%机器人冠状动脉旁路移植术研究进展

    Institute of Scientific and Technical Information of China (English)

    杨明

    2013-01-01

    As an evolutionary process, the robotic technology has been recently applied in the minimally invasive surgery. The robotic surgical system can provide cardiac surgeons with less invasive manner and dexterity manipulation in coronary artery bypass graft. The robotic minimally invasive coronary artery bypass graft usually includes robotic internal thoracic artery harvesting, robotic assistant coronary artery bypass graft and totally robotic coronary artery bypass graft.%机器人手术系统作为一种全新的手术工具已逐步应用于微创外科领域。机器人冠状动脉旁路移植术是微创冠状动脉搭桥的前沿技术,具有创伤小、操作精细等优点,常见的术式为:机器人下内乳动脉游离、机器人辅助下冠状动脉旁路移植术和全机器人冠状动脉旁路移植术。

  10. Techniques for colorectal anastomosis

    OpenAIRE

    Ho, Yik-Hong; Ashour, Mohamed Ahmed Tawfik

    2010-01-01

    Colorectal anastomotic leak remains one of the most feared post-operative complications, particularly after anterior resection of the rectum with, the shift from abdomino-peritoneal resections to total mesorectal excision and primary anastomosis. The literature fails to demonstrate superiority of stapled over hand-sewn techniques in colorectal anastomosis, regardless of the level of anastomosis, although a high stricture rate was noted in the former technique. Thus, improvements in safety asp...

  11. The Dutch experience in percutaneous transluminal angioplasty of narrowed saphenous veins used for aortocoronary arterial bypass

    NARCIS (Netherlands)

    W.H.T. Plokker; H.J. Meester (Hannie); P.W.J.C. Serruys (Patrick)

    1991-01-01

    textabstractOf 19,994 percutaneous transluminal coronary angioplasty procedures performed in The Netherlands between April 1980 and January 1989, the long-term follow-up of 454 patients who underwent angioplasty of greater than or equal to 1 saphenous vein bypass graft was reviewed. In 46% of patien

  12. Comparison of the effects of on-pump and off-pump coronary artery bypass surgery on cerebral oxygen saturation using near-infrared spectroscopy

    OpenAIRE

    Demir, Guray; Çukurova, Zafer; Eren, Gülay; Hergünsel, Oya

    2014-01-01

    Background Central nervous system complications are the most clinically important of those affecting mortality in patients undergoing coronary artery surgery. Newly developed sophisticated techniques and surgical interventions obviating the need for cardiopulmonary pumps have facilitated avoidance of these complications. In this study, we compared the impact of on-pump and off-pump coronary artery bypass surgery on cerebral oxygenation using near-infrared spectroscopy. Methods This study incl...

  13. Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

    OpenAIRE

    Solange Guizilini; Marcela Viceconte; Esperança, Gabriel Tavares da M.; Douglas W. Bolzan; Milena Vidotto; Rita Simone L Moreira; Andréia Azevedo Câncio; Gomes, Walter J.

    2014-01-01

    Objective: To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. Methods: A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27) - pleural drain in intercostal sp...

  14. Effects of home-based exercise rehabilitation on quality of life after coronary artery bypass graft and PCI early post-discharge

    OpenAIRE

    Shadi Moafi; Vahid Zolaktaf; Katayun Rabiei; Mohamad Hashemi; Hamed Tarmah

    2011-01-01

    Background: The barriers to participation in cardiac rehabilitation programs are individual and economic problems and limited availability and access of rehabilitation services. Because of the important role of rehabilitation, home based exercise rehabilitation is a new approach to participate in such programs. The purpose of this study was to evaluate the effects of home-based rehabilitation on quality of life (QoL) in patients with coronary artery disease after coronary artery bypass graft ...

  15. Coronary artery bypass grafting in a patient with history of esophagectomy, hypothyroidism, hypertension and type 2 diabetes mellitus: a case report

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yang-yang; YE Jiang-chuan; WEI Lei; ZHANG Shi-jiang

    2012-01-01

    Coronary artery bypass grafting (CABG) is a mature procedure in treating patients with coronary artery diseases.We report a patient undergoing CABG had history of esophageal cancer and multiple underlying diseases:hypothyroidism,type 2 diabetes mellitus and hypertension.A CABG with midline sternotomy was safely performed in the presence of thyroid replacement therapy and intensive control of blood pressure and blood glucose.The patient recovered postoperatively with supportive care.

  16. Exploration of Syndrome Differentiation Patterns in Coronary Heart Disease Patients during Peri-Operative Stage of Coronary Artery Bypass Graft

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG). Methods: One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre- or post-operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored. Results: In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri-operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation. Conclusion: TCM SD conducting in peri-operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri-operative complications and elevating success rate of operation.

  17. Preoperative Hba1c level in prediction of short-term morbidity and mortality outcomes following coronary artery bypass grafting surgery

    Directory of Open Access Journals (Sweden)

    Ümit Arslan

    2015-05-01

    Conclusion ― We concluded that in those diabetic patients that elective coronart artery bypass graft is applied, highly reactive HbA1c levels (HbA1c ≥7, may indicate morbitity in the early stages of post operation.

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

    Science.gov (United States)

    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.…

  19. PILOT STUDY RESULTS OF THE INFLUENCE OF CITICOLINE AND PIRIBEDIL ON COGNITIVE FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS SURGERY

    Directory of Open Access Journals (Sweden)

    M. M. Petrova

    2015-01-01

    Full Text Available Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30 were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32 had piribedil in addition to standard therapy. Patients of the control group (n=32 had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008, categorical association (p=0.002, clock drawing test (Wilcoxon test; p=0,005, while other indices were reduced in comparison with the initial ones.Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.

  20. beta-blocker Therapy is Not Associated with Reductions in Angina or Cardiovascular Events After Coronary Artery Bypass Graft Surgery : Insights from the IMAGINE Trial

    NARCIS (Netherlands)

    Booij, Harmen G.; Damman, Kevin; Warnica, J. Wayne; Rouleau, Jean L.; van Gilst, Wiek H.; Westenbrink, B. Daan

    2015-01-01

    To evaluate whether beta-blockers were associated with a reduction in cardiovascular events or angina after Coronary Artery Bypass Graft (CABG) surgery, in otherwise stable low-risk patients during a mid-term follow-up. We performed a post-hoc analysis of the IMAGINE (Ischemia Management with Accupr

  1. Decreased pre-surgical CD34+/CD144+ cell number in patients undergoing coronary artery bypass grafting compared to coronary artery disease-free valvular patients

    Directory of Open Access Journals (Sweden)

    Redondo Santiago

    2012-01-01

    Full Text Available Abstract Background Cardiovascular disease has been linked to endothelial progenitor cell (EPC depletion and functional impairment in atherosclerosis and aortic stenosis. EPCs may play a pivotal role in vascular grafting. However, the EPC depletion in coronary artery bypass grafting (CABG patients has not been compared to coronary artery disease-free valvular replacement patients with aortic stenosis. Methods We aimed to assess the basal number of CD34+/KDR+ and CD34+/CD144+ cells in CABG patients, compared to aortic stenosis valvular replacement patients. 100 patients (51 CABG and 49 valvular surgery ones were included in the present study. All CABG or valvular patients had angiographic demonstration of the presence or the absence of coronary artery disease, respectively. Numbers of CD34+/KDR+ and CD34+/CD144+ were assessed by flow cytometry of pre-surgical blood samples. Results We found a lower number of CD34+/CD144+ cells in CABG patients compared to valvular patients (0.21 ± 0.03% vs. 0.47 ± 0.08%, and this difference remained statistically significant after the P was adjusted for multiple comparisons (P = 0.01428. Both groups had more EPCs than healthy controls. Conclusions Pre-surgical CD34+/CD144+ numbers are decreased in CABG patients, compared to valvular patients with absence of coronary disease.

  2. Artéria femoral profunda: uma opção como origem de fluxo para derivações infrageniculares Deep femoral artery: an option as inflow site in infragenicular bypasses

    Directory of Open Access Journals (Sweden)

    Francisco Cardoso Brochado Neto

    2008-09-01

    critical limb ischemia presenting superficial artery occlusion and hostile groins. OBJECTIVE: To retrospectively assess the deep femoral artery as an inflow site for infragenicular bypass grafts. METHODS: From 2000 to 2005, 129 infragenicular bypass grafts with proximal anastomosis located in femoral arteries were performed. Forty were located in the common femoral artery (CFA, 72 in the superficial femoral artery (SFA and 17 in the deep femoral artery (DFA. Indications for using the DFA as inflow were hostile groin (six cases, limited arterial substitute length (six cases or both (five cases. Anastomosis site was located in the first or second portion in 12 cases, and in the third in five cases. The surgery was secondary in 47% of the cases, and the arterial substitutes used were arm veins (11, greater saphenous vein (five and lesser saphenous vein (one. RESULTS: Primary patency and limb salvage rates were 68.0 and 84.7%, respectively, with acceptable standard error (0.1 in 36 months. The results of patency divided by inflow artery were similar (CFA, 63.3%; SFA, 70.2%; DFA 64.7%; p = 0.63, as well as limb salvage rates (CFA, 83.1%; SFA, 82.4%; DFA 92.3%; p = 0.78. Analyzing the deep femoral group, no difference of patency rates was observed when the anastomotic site was compared (proximal vs. distal portions of the DFA or between patients with or without previous grafts. (p = 0.89 and 0.77, respectively. CONCLUSION: Deep femoral artery is a feasible and effective option as donor site for infragenicular bypass grafts, with satisfactory patency and limb salvage rates.

  3. Reduction in hospitalisation rates following simultaneous carotid endarterectomy and coronary artery bypass grafting; experience from a single centre.

    Science.gov (United States)

    Hudorović, Narcis

    2006-08-01

    The aim of this study was to compare hospital, clinical, and health care cost among patients undergoing reversed staged procedure coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG) first and carotid endarterectomy (CEA) second (control group), compared with patients who had simultaneous CEA and off-pump CABG (study group). From January 1, 2000 to December 31, 2004, 53 consecutive patients underwent combined operations at a single institution. Reversed staged procedures were used in the first 23 patients (January 2000-September 2003), and the next 30 patients (September 2003-September 2004) received the one-stage operations. The two groups were similar with respect to baseline characteristics. An internal control system was implemented at the University Clinic Cardiovascular Department (UCCD) in order to compare staged versus simultaneous CEA/OPCABG. The objectives of the internal control system were two-fold: (1) to collect clinical outcomes, resource utilization on patients undergoing reverse-staged or simultaneous OPCABG/CEA and (2) to compare reverse-staged OPCABG/CEA patients, to patients receiving simultaneous CEA/OPCABG in a UCCD. Study patients spent statistically significantly less time in the hospital than control patients (10 vs. 17.9 days). The difference in the mean annual cost of simultaneous versus staged surgery was estimated to be -11.417 Euros (9.619 vs. 21.028 Euros). PMID:17670595

  4. Genome-wide assessment for genetic variants associated with ventricular dysfunction after primary coronary artery bypass graft surgery.

    Directory of Open Access Journals (Sweden)

    Amanda A Fox

    Full Text Available BACKGROUND: Postoperative ventricular dysfunction (VnD occurs in 9-20% of coronary artery bypass graft (CABG surgical patients and is associated with increased postoperative morbidity and mortality. Understanding genetic causes of postoperative VnD should enhance patient risk stratification and improve treatment and prevention strategies. We aimed to determine if genetic variants associate with occurrence of in-hospital VnD after CABG surgery. METHODS: A genome-wide association study identified single nucleotide polymorphisms (SNPs associated with postoperative VnD in male subjects of European ancestry undergoing isolated primary CABG surgery with cardiopulmonary bypass. VnD was defined as the need for ≥2 inotropes or mechanical ventricular support after CABG surgery. Validated SNPs were assessed further in two replication CABG cohorts and meta-analysis was performed. RESULTS: Over 100 SNPs were associated with VnD (P2.1 of developing in-hospital VnD after CABG surgery. However, three genetic loci identified by meta-analysis were more modestly associated with development of postoperative VnD. Studies of larger cohorts to assess these loci as well as to define other genetic mechanisms and related biology that link genetic variants to postoperative ventricular dysfunction are warranted.

  5. Can preoperative myocardial perfusion scintigraphy predict changes in left ventricular perfusion and function after coronary artery bypass graft surgery?

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Johansen, Allan;

    2012-01-01

    OBJECTIVESWe wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG).METHODSNinety-two patients with stable angina......%. Before CABG, one patient had normal perfusion; in the rest of them the defects were classified as follows: reversible (60%), partly reversible (27%) and irreversible (12%). Following CABG, 33% had normal perfusion; in the rest the defects were reversible in 29%, partly reversible in 12% and irreversible...... in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects...

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

    Science.gov (United States)

    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.

  7. Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Abildstrøm, Steen Z; Hansen, Peter R;

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the clinical efficacy of clopidogrel treatment on death and recurrent myocardial infarction (MI) among MI patients revascularized by coronary artery bypass graft surgery (CABG). BACKGROUND: The benefit from post-operative clopidogrel in CABG......-treated MI patients is largely unknown. METHODS: All patients admitted with first-time MI between 2002 and 2006, treated with CABG within 180 days after admission, were identified by nationwide administrative registers. Clopidogrel treatment was determined by claimed prescriptions after discharge from...... surgery. Risk of death or recurrent MI, and of a combined end point of the 2, were assessed by cumulative incidence and Cox proportional hazards model. A propensity score-matched subgroup analysis was done. RESULTS: We included 3,545 patients, and of these, 957 (27.0%) were treated with clopidogrel after...

  8. Clinical Evaluation of Poly(2-methoxyethylacrylate) in Primary Coronary Artery Bypass Grafting

    OpenAIRE

    Vang, See N.; Brady, Chad P.; Christensen, Kevin A.; Isler, Jack R.; Allen, Keith R.

    2005-01-01

    In an attempt to make cardiopulmonary bypass (CPB) less traumatic for patients undergoing cardiac surgery, extracorporeal circuits (ECC) have been modified to achieve this goal. Poly(2-methoxyethylacrylate) (PMEA, X-coating™) is a new polymer coating used in the ECC. PMEA studies have shown excellent biocompatibility with the components of blood. In this evaluation, PMEA-coated ECC were compared with control (CTR) circuits with emphasis on hematological parameters, perioperative homologous bl...

  9. The real-world outcomes of off-pump coronary artery bypass surgery in a public health care system

    Science.gov (United States)

    Guru, Veena; Glasgow, Kevin W; Fremes, Stephen E; Austin, Peter C; Teoh, Kevin; Tu, Jack V

    2007-01-01

    BACKGROUND: The population-based results of off-pump coronary artery bypass surgery (OPCAB) in a public health care system have not been reported. OBJECTIVE: The study objective was to compare the one-year outcomes of OPCAB with those of the standard on-pump coronary artery bypass surgery (ONCAB) in the province of Ontario. METHODS: The present study was a retrospective, population-based study (n=15,172, with 1660 OPCAB patients) undertaken in fiscal years 2000 and 2001 using clinical and administrative data. Multivariate regression modelling for risk adjustment and propensity matching were used to compare OPCAB with ONCAB for one-year outcomes, including death, repeat revascularization and cardiac readmission. RESULTS: The rate of OPCAB was 11%, with institutional rates ranging from 3% to 51%. OPCAB patients were more likely to be female and older than 79 years of age, with peripheral vascular disease and higher socioeconomic status. OPCAB patients were less likely to have surgically significant coronary disease, poor left ventricular function, an urgent status, congestive heart failure and diabetes. The risk-adjusted one-year composite outcome was higher for OPCAB (11.8%, 95% CI 10.40% to 13.29%) than ONCAB (10.8%, 95% CI 10.23% to 11.27%); however, this difference was eliminated with propensity matching. OPCAB patients had shorter hospital lengths of stay and lower blood product transfusion rates than ONCAB patients. CONCLUSIONS: Despite the minimal use of OPCAB in Canada’s public health care system, outcome rates are similar to those of ONCAB. The benefits of OPCAB observed in randomized trials, including shorter hospital lengths of stay and lower transfusion rates, remained true in the investigators’ real-world experience. The results OPCAB were at least equivalent to those of ONCAB. PMID:17380221

  10. Multivariate Analysis of Factors Influencing Length of Hospital Stay after Coronary Artery Bypass Surgery in Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Amin Torabipour

    2016-03-01

    Full Text Available Length of hospital stay (LOS is a key indicator for hospital management. Reducing hospital stay is a priority for all health systems. We aimed to determine the length of hospital stay following Coronary Artery Bypass Surgery (CABG based on its clinical and non-clinical factors. A cross-sectional study of 649 consecutive patients who underwent coronary artery bypass graft surgery was conducted in Imam Khomeini and Shariati university hospitals, Tehran, Iran. Data was analyzed by using non-parametric univariate tests and multiple linier regression models. Thirty seven independent variables including pre-operative, intra-operative and post-operative variables were analyzed. Finally, an appropriate model was constructed based on the associated factors. The results showed that 70.3% of the patients were male, and the mean age of the patients was 59.3 ± 10.4 years. The Mean (±SD and median of the LOS were 11.7 ± 7.1 and 9 days, respectively. Of 37 investigated variables, 24 qualitative and quantitative variables were significantly associated with length of stay (p<0.05. Multiple linear regression analysis showed that independent variables including age, medical insurance type, body mass index, and prior myocardial infarction; admission day, admission season, Cross-clamp time, pump usage, admission type, the number of laboratory tests and the number of specialty consultation had more effect on the hospital stay. We concluded that some significant factors influencing hospital stay after CABG were predictable and modifiable by hospital managers and decision makers to manage hospital beds.

  11. 冠脉支架置入术与冠脉搭桥术治疗严重冠心病的对比研究——SYNTAX研究%Percutaneous Coronary Intervention Versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease: SYNTAX Study

    Institute of Scientific and Technical Information of China (English)

    柴仁杰; 张斌

    2009-01-01

    @@ 1 文献来源 Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease [J]. N Engl J Med, 2009,360(10):961- 972.

  12. Bypass flap reconstruction, a novel technique for distal revascularization: outcome of first 10 clinical cases.

    Science.gov (United States)

    Malikov, Serguei; Magnan, Pierre-Edouard; Casanova, Dominique; Lepantalo, Mauri; Valerio, Nicolas; Ayari, Raouf; Champsaur, Pierre; Branchereau, Alain

    2009-01-01

    Combined distal venous bypass grafting and free flap transfer can achieve successful treatment of soft tissue defects due to advanced leg ischemia. However, this combined approach is a complex technique involving multiple anastomoses on the same arterial axis with an increased risk of thrombosis. To reduce this risk, we have proposed a new bypass-flap (BF) reconstruction technique using an arterial graft and a free flap supplied by a collateral branch of the graft. The purpose of this report is to document the outcome in the first 10 patients treated using the BF reconstruction technique. From 2002 to 2004, a total of 10 patients with a mean age of 67 years (range 55-78) were treated using a BF. All patients presented critical ischemia with soft tissue defects resulting in exposure of tendons and muscles on the foot or ankle. Distal anastomosis was made between the distal branch of the BF and the pedal artery in five cases, the posterior tibial artery or plantar artery in four cases, and the peroneal artery in one case. In six cases proximal anastomosis was performed between the leg artery and arterial autograft. In the remaining four cases proximal anastomosis required extension of the bypass using a venous graft. The mean duration of hospitalization was 25 days. During the postoperative period, one patient died due to stercoral peritonitis and one patient required major amputation due to unrelenting sepsis. Bypass occlusion was not observed. Mean follow-up was 24 months (range 14-36). No patient was lost to follow-up and no patient died after the first 30 postoperative days. Follow-up examinations including clinical assessment and Doppler ultrasound imaging were performed at 3 months and every 6 months thereafter. Findings demonstrated bypass patency and healing of the covered defect in all cases. Outcome in this initial series demonstrates the clinical feasibility of the new BF reconstruction technique, which allows revascularization and coverage of tissue

  13. The Best Bypass Surgery Trial

    DEFF Research Database (Denmark)

    Møller, Christian H; Jensen, Birte Østergaard; Gluud, Christian;

    2007-01-01

    Recent trials suggest that off-pump coronary artery bypass grafting (OPCAB) reduces the risk of mortality and morbidity compared with conventional coronary artery bypass grafting (CCAB) using cardiopulmonary bypass. Patients with a moderate- to high-risk of complications after CCAB may have...

  14. Neurocognitive impairment after off-pump and on-pump coronary artery bypass graft surgery – an Iranian experience

    Directory of Open Access Journals (Sweden)

    Mehdi Farhoudi

    2010-11-01

    Full Text Available Mehdi Farhoudi1, Kaveh Mehrvar2, Abbas Afrasiabi3, Rezayat Parvizi3, Ahmad Ali Khalili3, Babak Nasiri3, Khosrow Hashemzadeh3, Kamyar Ghabili41Neurosciences Research Center, Imam Reza Hospital, 2Razi Hospital, 3Cardiovascular Research Center, 4Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Coronary artery bypass graft (CABG surgery is one of the most commonly performed surgical procedures worldwide, and it may be accompanied by postoperative neurocognitive impairment. Although this complication has been attributed to the use of cardiopulmonary bypass, it is still a matter of debate whether the switch from on-pump to off-pump technique affects the cognitive function.Objective: The aim of this study was to compare the impact of the on-pump and off-pump techniques on neurocognitive impairment in low-risk CABG surgery groups.Methods: In a descriptive and analytic study, 201 CABG patients with left-ventricular ejection fraction >30%, and without cardiac arrhythmia were enrolled. Before the elective operation, all patients underwent neurological examination and neurocognitive test, Mini-Mental State Examination (MMSE. Two months following the operation, both on- and off-pump, the patients were re-examined by MMSE to detect any neurocognitive impairment.Results: Out of 154 patients included in the study, 95 (61.6% and 59 (38.3% patients were in off-pump and on-pump groups, respectively. Mean age of the patients was 57.17 ± 9.82 years. A 2-month postoperative neurocognitive impairment was detected among 17 patients of on-pump group (28.8% and in 28 cases of off-pump group (29.4% (P = 0.54. The mean postoperative MMSE scores were not comparable between groups (25.01 ± 4.49 in off-pump group versus 23.73 ± 4.88 in on-pump group, P = 0.09.Conclusion: The present study revealed that in low-risk patients undergoing CABG surgery, either the techniques of on-pump or off-pump did not differ

  15. The effects of venous cannulation technique and cardioplegia type on plasma potassium concentration and arterial blood pressure during cardiopulmonary bypass.

    LENUS (Irish Health Repository)

    Coleman, E T

    2012-02-03

    The cannulation method and cardioplegia solution used during cardiopulmonary bypass (CPB) may both influence plasma potassium concentrations ([K+]) and mean arterial blood pressure (MAP). Bi-caval or right atrial cannulation methods are routinely used in conjunction with crystalloid or blood cardioplegia. We investigated the influence of cannulation method and cardioplegia solutions on plasma [K+] and MAP during cardiopulmonary bypass. Sixty consecutive patients undergoing elective coronary artery bypass grafting (CABG) using CPB were studied. They were randomly divided into three groups of 20 patients. Patients in Group A underwent bi-caval venous cannulation and received crystalloid cardioplegia. Group B patients underwent right atrial cannulation and received crystalloid cardioplegia. Group C patients underwent right atrial cannulation and received blood cardioplegia. In each case. cardioplegia was administered antegrade via the aortic root. Plasma [K+], MAP. and hemoglobin concentration (Hb) were measured over an 8-min period following cardioplegia administration (pilot studies indicated pressure changes occuring post cardioplegia administration up to this time). The combination of bi-caval cannulation and crystalloid cardioplegia (Group A) was associated with the least increase in plasma [K+] and no decrease in MAP. The maximum [K+] for this Group was 4.2 mmol\\/L (4.6% increase). The minimum mean pressure was 57 mmHg (13.6% increase). Both right atrial cannulation groups (B and C) showed a large rise in plasma [K+] and a decrease in MAP. Group B maximum [K+] was 5.2 mmol\\/L (27.5% increase). Group C was also 5.2 mmol\\/L (26.0% increase). Group C showed the largest pressure decrease, the minimum mean pressure was 45 mmHg (21.3% decrease). The Group B minimum mean pressure was 45 mmHg (8.7% decrease). Our results show that patients undergoing CPB operations who are deemed to be at increased risk of suffering adverse effects from hypotensive episodes may

  16. Intraoperative conversion to on-pump coronary artery bypass grafting is independently associated with higher mortality in patients undergoing off-pump coronary artery bypass grafting: A propensity-matched analysis

    Directory of Open Access Journals (Sweden)

    Deepak Prakash Borde

    2016-01-01

    Full Text Available Context: One of the main limitations of off-pump coronary artery bypass grafting (OPCAB is the occasional need for intraoperative conversion (IOC to on-pump coronary artery bypass grafting. IOC is associated with a significantly increased risk of mortality and postoperative morbidity. The impact of IOC on outcome cannot be assessed by a randomized control design. Aims: The objective of this study was to analyze the incidence, risk factors, and impact of IOC on the outcome in patients undergoing OPCAB. Settings and Design: Three tertiary care level hospitals; retrospective observational study. Subjects and Methods: This retrospective observational study included 1971 consecutive patients undergoing  OPCAB from January 2012 to October 2015 at three tertiary care level hospitals by four surgeons. The incidence, patient characteristics, cause of IOC, and its impact on outcome were studied. Statistical Analysis Used: The cohort was divided into two groups according to IOC. Univariate logistic regression was performed to describe the predictors of IOC. Variables that were found to be significant in univariate analysis were introduced into multivariate model, and adjusted odds ratio (OR was calculated. To further assess the independent effect of IOC on mortality, propensity score matching with a 5:1 ratio of non-IOC to IOC was performed. Results: The overall all-cause in-hospital mortality was 2.6%. IOC was needed in 128 (6.49% patients. The mortality in the IOC group was significantly higher than non-IOC group (21 of 128 [16.4%] vs. 31 of 1843 [1.7%], P = 0.0001. The most common cause for IOC was hemodynamic disturbances during grafting to the obtuse marginal artery (51/128; 40%. On multivariate logistic regression analysis, left main disease, pulmonary hypertension, and mitral regurgitation independently predicted IOC. We obtained a propensity-matched sample of 692 patients (No IOC 570; IOC 122, and IOC had OR of 16.26 (confidence interval 6

  17. Comparison of Long-Term Outcome After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Unprotected Left Main Coronary Artery Disease (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    OpenAIRE

    Shiomi, Hiroki; MORIMOTO, TAKESHI; Hayano, Mamoru; Furukawa, Yutaka; Nakagawa, Yoshihisa; Tazaki, Junichi; Imai, Masao; Yamaji, Kyohei; Tada, Tomohisa; Natsuaki, Masahiro; Saijo, Sayaka; Funakoshi, Shunsuke; Nagao, Kazuya; Hanazawa, Koji; Ehara, Natsuhiko

    2012-01-01

    The long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the...

  18. COMPOUNDING PHARMACIES' POTENTIAL TO CREATE Graft Storage Solutions for Bypass Surgeries.

    Science.gov (United States)

    Guth, Michael A S

    2015-01-01

    Several studies have addressed the optimal storage conditions for vascular grafts during bypass surgery. These studies have repeatedly shown that placing vascular graft conduits in isotonic saline solutions, and to a lesser extent in heparinized autologous blood, leads to a profound decline in endothelial cell viability. Endothelial damage to vein grafts can occur at multiple points during a coronary artery bypass graft surgery procedure: graft harvesting, handling, flushing, storage, anastomosis, and arterialization (e.g., damage caused by exposure to arterial blood pressure). This damage to endothelial cells causes the release of pro-inflammatory chemical signals that trigger thrombosis, intimal hyperplasia, and accelerated graft atherosclerosis, all of which ultimately contribute to graft failure. Cardiothoracic surgeons performing coronary artery bypass graft surgery and vascular surgeons performing peripheral artery bypass graft surgery have attempted to overcome the damage to the vascular grafts by using buffers to maintain the physiological pH of the storage solution. However, the endothelial layers in the grafts would benefit from having proper oxygenation and antioxidants added to the storage solution. Compounding pharmacies can perform a vital role in ensuring the patency of the vascular grafts by creating compounded flushing and storage solutions that have an optimal mix of nitric oxide substrates, antioxidants, and other nutrients for the endothelium. Maintaining structural and functional viability of the endothelia in grafts by using an appropriate vessel storage medium would lead to improved long-term graft patency.

  19. Can perioperative C-reactive protein and interleukin-6 levels predict atrial fibrillation after coronary artery bypass surgery?

    International Nuclear Information System (INIS)

    Objective was to examine the relationship between proinflammatory cytokines such as interleukin-6 (IL-6) and C-reactive protein (CRP) and atrial fibrillation and after on-pump coronary artery bypass grafting (CABG). Fifty-four patients with coronary artery disease undergoing elective CABG at the Mazandaran Medical University, Mazandaran, Iran were enrolled in our prospective study in the year 2007. Postoperatively, heart rate and rhythm were continuously monitored for 5 days. Fasting blood samples were taken from all patients to examine quantities of CRP and IL-6 the day before surgery and on the second postoperative day in the intensive care unit. From 54 patients, 11 patients (20.4%) developed atrial fibrillation (AF) after CABG. The median age of patients with AF was 51.45+/-10.74 compared with 57.28+/-9.04 for patients with sinus rhythm (p=0.072). Cardioplegic time, cross clamp time and pump time were higher in the AF group but there was no significant difference between the 2 groups. Preoperative CRP and IL-6 levels were higher in patients with AF. The CRP and IL-6 increased after CABG in all patients but it increased more in the AF group. There was a significant relationship between preoperative IL-6 and AF in patients who underwent on-pump CABG, but there was no relationship between CRP and AF. Therefore, administration of glucocordicoids which significantly reduce plasma levels of IL-6 can reduce the incidence of AF after on-pump CABG. (author)

  20. Endothelial nitric oxide synthase gene polymorphisms -786T >C and 894G >T in coronary artery bypass graft surgery patients

    Directory of Open Access Journals (Sweden)

    Ragia Georgia

    2010-08-01

    Full Text Available Abstract Polymorphisms in the endothelial nitric oxide synthase (eNOS gene (-786T >C and 894G >T enhance endo-thelial dysfunction and have been studied in relation to coronary artery disease (CAD. In the present study, we examined the association of the above polymorphisms with CAD, as well as with myocardial infarction (MI, hypertension, diabetes and smoking in CAD patients. Study subjects consisted of 154 consecutive coronary artery bypass graft (CABG patients and 155 non-CAD controls. eNOS -786T >C and 894G >T polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism. The estimated frequencies of the -786C and 894T alleles did not differ between the two groups (p = 0.46 and p = 0.84, respectively. The prevalence of eNOS polymorphisms was not associated with MI, hypertension or diabetes in CABG patients; however, we found that the 894TT genotype and 894T allele were significantly more frequent in current/past smoker CABG patients (16.7 per cent and 39.6 per cent, respectively compared with never smoker CABG patients (6.1 per cent and 24.4 per cent, respectively (p = 0.01 and p eNOS -786C and 894T variant alleles with CAD; however, within CABG patients, a gene-environment interaction was found between the eNOS 894T allele and smoking.

  1. Coronary artery bypass grafting in a patient with hemophilia B: continuous recombinant factor IX infusion as per the Japanese guidelines for replacement therapy.

    Science.gov (United States)

    Suzuki, Tomoyuki; Kawamoto, Shunsuke; Kumagai, Kiichiro; Adachi, Osamu; Kanda, Keisuke; Ishikawa, Masaaki; Okitsu, Yoko; Harigae, Hideo; Kurosawa, Shin; Saiki, Yoshikatsu

    2016-08-01

    We herein report our experience of successfully managing the hemostatic system by controlling serum factor IX levels throughout the perioperative period in a patient with hemophilia B. Coronary artery bypass grafting with cardiopulmonary bypass was planned for a 52-year-old man with moderate severity of hemophilia B. During surgery, recombinant factor IX (rFIX; BeneFIX(®) Pfizer Japan inc., Tokyo, Japan) was administered by bolus infusion followed by continuous infusion as per the guidelines of the Japanese Society on Thrombosis and Hemostasis. The operative course was uneventful without any considerable bleeding or complications. PMID:25523881

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

    Science.gov (United States)

    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.

  3. CLINICAL PROGRESS IN CORONARY ARTERY BYPASS GRAFT%冠状动脉搭桥术的临床应用进展

    Institute of Scientific and Technical Information of China (English)

    姚建民; 成杞润

    2001-01-01

    Conventional coronary artery bypass graft performed through median sternotomy with hypothermic extracorporeal circulation and saphenous vein grafts is both saft and effective.To reduce perioperative morbidity further,and promote earlier hospital discharge and long-term graft patency rate,great efforts have ben recently made in coronary surgery.we reviewed the literature relevent to clinical progress in minimally invasive coronary bypass graft,total arterial revascularization and coronary operation in advanced age,and discussed their surgical indications,operative techniques and clinical results.Studies about off pump,thoracoscope or axial flow pump-assisted myocardial revacularization have demonstrated favourable results such as reduced systemic inflammatory respones,avoiding ischemia-prefusion injury,lower cost and shorter hospital stay.Clinical practice also showed that patients who received two arterial graft or total arterial revascularization had decreased risk of death,reoperation and angioplasty,and that advanced age in and of itself should not be a contraindication to an coronary bypass operation,although morbidity,mortality and cost may be higher.

  4. Cirurgia coronária com condutos arteriais múltiplos sem circulação extracorpórea Off-pump coronary artery bypass with multiple arterial conduits

    Directory of Open Access Journals (Sweden)

    Daniel Navia

    2005-03-01

    circulação extracorpórea utilizando condutos arteriais para a doença de múltiplos vasos é factível com baixa morbimortalidade em 30 dias.OBJECTIVE: To analyze intra-hospital results in patients undergoing elective off-pump total arterial revascularization and identify morbidity and mortality predictors using this surgical strategy. METHOD: From May 1999 to February 2004, 203 myocardial revascularization procedures with total arterial revascularization without cardiopulmonary bypass (off-pump were carried out in patients with multivessel disease (three vessels 81.7 %, one vessel disease was excluded. We report pre-surgical variables and co-morbidities: average age 63.9 ± 9.13 years, men 182 (89.5%, hypertension 132 (65%, smokers 125 (61%, hypercholesterolemia 152 (74.8%, previous myocardial infarction (> 30 days 73 (35%, moderate to severe ventricular dysfunction 31 (15%, redo five (2.5%. Total arterial revascularization included T-grafts and sequential grafts with left internal mammary (100%, right internal mammary (56.6% and radial (63% arteries. The total number of distal anastomosis was 576 (mean of three grafts/patient, all carried out with external mechanical stabilizers. There were no proximal aortic anastomoses. Conversion to on-pump surgery occurred in three (1.5% patients; 90% of the patients was extubated in the operating room. The multiple logistic regression test was used for statistical analysis. RESULTS: The postoperative incidence of atrial fibrillation was 12.8% (26, oligoanuric renal failure 3% (six, dialysis 0.49% (one, postoperative myocardial infarction 1.47% (three, low cardiac output 4% (eight, Redo for bleeding 1.47% (three, mediastinitis 1.47% (three, stroke 1.47% (three. Intra-hospital mortality was 2.45% (five. The only independent 30 day morbidity predictor was age (p=0.033; OR 1.04; IC 95%: 1-1.08. CONCLUSION: Off-pump myocardial revascularization with arterial conduits for multiple vessel disease is feasible with a low 30-day morbidity

  5. Evaluation of severe stenosis of end-to-end and end-to-side anastomosis of transplant renal artery with color Doppler sonography%彩色多普勒超声对端-端与端-侧吻合移植肾动脉重度狭窄的对比研究

    Institute of Scientific and Technical Information of China (English)

    李建初; Robert J Min; Amelia Ng; David Trost; Michael Goldstein; Sandip Kupur; John Wang; David Serur; 姜玉新; 高敬; 张丽娜; 戴睛; 孟华; 蔡胜; 吕珂; 孝梦甦; 张一休

    2008-01-01

    目的 探讨两种吻合方式(端-端吻合与端-侧吻合)移植肾动脉重度狭窄(内径减少≥80%)的彩色多普勒超声诊断指标的差异.方法 回顾性分析彩色多普勒超声检查发现后并经数字减影血管造影(DSA)证实的38例移植肾动脉重度狭窄患者(端-端吻合和端-侧吻合各19例).超声测量髂动脉、移植肾动脉主干和吻合口峰值流速(PSV),肾内叶间动脉或段动脉PSV和加速时间(AT),计算狭窄处与狭窄近端PSV比值(简称PSV前比).结果 血管造影显示所有患者的动脉内径减少≥80%,狭窄部位位于髂动脉4例,吻合口20例和移植肾动脉14例.狭窄处PSV、髂动脉PSV及PSV前比在两种吻合方式之间差异均有统计学意义(P0.05).结论 两种吻合方式移植肾动脉重度狭窄患者的肾动脉血流动力学差异很可能是导致它们之间狭窄处PSV和PSV前比差异的主要原因.为了提高移植肾动脉重度狭窄的诊断准确性,应依据吻合方式来建立PSV前比的诊断阈值,而同-AT诊断阈值很可能适合两种吻合方式患者.%Objective To investigate differences in Doppler parameters between severe transplant renal artery stenosis (TRAS,arterial lumen reduction ≥80%) with end-to-end anastomosis and that with end-to-side anastomosis. Methods Color Doppler sonography(CDS) and digital subtraction angiography(DSA) images were reviewed retrospectively in 38 patients with severe TRAS (19 cases with end-to-end anastomosis and 19 cases with end-to-side anastomosis). All 38 cases with severe TRAS were initially diagnosed with CDS and confirmed by DSA afterwards. Doppler parameters,including the peak systolic velocity(PSV) in the renal, lilac, anastomosis site and segmental or interlobar artery, pre-PSV ratio (the ratio of the PSV at the stenotic site to that in the iliae artery), acceleration time(AT) in the intrarenal arteries, were measured or calculated. Results DSA demonstrated all patients with severe arterial

  6. Impact of repeated percutaneous coronary intervention on long-term survival after subsequent coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Komiya Tatsuhiko

    2011-09-01

    Full Text Available Abstract (Background In the current stent era, aggressive repeated percutaneous coronary intervention (PCI has become more common. The aim of this study was to investigate the impact of previous repeated PCI on the subsequent coronary artery bypass grafting (CABG. (Methods Between January 1990 and January 2008, a total of 894 patients underwent first-time isolated elective CABG. Among the 894 patients, 515 patients had had no PCI (group A, 179 patients had had single PCI (Group B, and 200 patients had had multiple PCI (2-15 times, mean 3.6 ± 2.3 times (group C before CABG. These groups were compared in terms of early and late clinical results. (Results Preoperative left ventricular ejection fraction was significantly higher in group A (group A;58 ± 13%, group B;54 ± 12%, and group C;54 ± 12%. Number of bypass grafts was significantly smaller in group C (A:3.3 ± 1.0, B 3.4 ± 0.9, C 3.1 ± 1.0. Although there was no statistically significant difference among the groups, in-hospital mortality in group C was higher than that in group A and B (A:1.6%, B:1.1%, C:3.5%, p = 0.16. Survival analysis by Kaplan-Meier method (mean follow-up: 58 ± 43 methods revealed that freedom from all-cause death and cardiac death was significantly lower in group C in comparison with group A. Freedom from cardiac event was significantly higher in group C than that in group A. Multivariate analysis identified a number of previous PCI as an independent risk factor for cardiac death. (Conclusions Repeated PCI increased risk for long-term prognosis of subsequent CABG.

  7. Comparison of transient changes in renal function between off-pump and on-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    ZHANG Wen-feng; GU Tian-xiang; DIAO Cheng; ZHANG Yu-hai; WANG Chun; FANG Qin; WANG Hai-long

    2008-01-01

    Background Acute renal failure following coronary artery bypass grafting(CABG)surgery is associated with high morbidity and mortality.Approximately half of all patients who develop acute kidney injury(AKI)subsequently develop acute renal failure(ARF).The purpose of the study was to compare early transient changes in renal function within the first post-operative week following CABG in patients that were either off-pump or on-pump.Methods Eight hundred and forty-nine consecutive patients with isolated CABG in a single institution between January 1990 and August 2006 were retrospectively analyzed.including 51 8 off-pump and 331 on-pump patients.A multivariate Logistic regression model was constructed to identify risk factors for the development of AKI.Results sixty-one off-pump patients and 63 on-pump patients developed AKI.Risk factors for the development of post-operative AKI included an ejection fraction≥50%or≤30%,a pulse pressure>60 mmHg,peripheral vascular disease,diabetes,emergent procedure,triple-vessel disease,body mass index,peri-operative and post-operative.intra.aortic balloon pumping,NYHA class III and IV,and cardiopulmonary bypass.An ejection fraction Z50%and peri-operative and post-operative intra-aortic balloon pumping were protective(OR<1).Peak serum creatinine for post-operative Akl was noted 12 hours and 24 hours in the off-pump and on-pump patients,respectively.Serum creatinine kinetics revealed rapid recovery in the 24th to 48th hour(off-pump)and the 48th to 72nd hour(on-pump).Conclusion Renal protection strategies are indicated from general anesthesia induction until 48 and 72 houm post-operatively in off-pump and on-pump patients,respectively.

  8. Cardioprotective Effect of Extended Remote Ischemic Preconditioning in Patients Undergoing Coronary Artery Bypass Grafting : A Randomized Clinical Trial

    Science.gov (United States)

    Karami, Ali; Khosravi, Mohamad Bagher; Shafa, Masih; Azemati, Simin; Khademi, Saeed; Akhlagh, Seyed Hedayatalla; Maghsodi, Behzad

    2016-01-01

    Background: The cardioprotective effect of ischemic preconditioning has been known for many years. Since the temporary ischemia in the heart may cause lethal cardiac effects, the idea of creating ischemia in organs far from the heart such as limbs was raised as remote ischemic preconditioning (RIPC). We hypothesized that the extension of RIPC has more cardioprotective effect in patients undergoing coronary artery bypass graft (CABG) surgeries. Methods: In this triple-blind randomized clinical trial study, 96 patients were randomly divided into 3 groups and two blood pressure cuffs were placed on both upper and lower extremities. In group A, only upper extremity cuff and in group B upper limb and lower limb cuff was inflated intermittently and group C was the control group. RIPC was induced with three 5-min cycles of cuff inflation about 100 mmHg over the initial systolic blood pressure before starting cardiopulmonary bypass. The primary endpoints were troponin I and creatine phosphokinase-myoglobin isoenzyme (CK-MB). Results: Six hours after the termination of CPB, there was a peak release of the troponin I level in all groups (group A=4.90 ng/ml, group B=4.40 ng/ml, and group C=4.50 ng/ml). There was a rise in plasma CK-MB in all groups postoperatively and there were not any significant differences in troponin I and CK-MB release between the three groups. Conclusion: RIPC induced by upper and lower limb ischemia does not reduce postoperative myocardial enzyme elevation in adult patients undergoing CABG. Trial Registration Number: IRCT2012071710311N1 PMID:27365547

  9. Comparing the Effects of Morphine Sulfate and Diclofenac Suppositories on Postoperative Pain in Coronary Artery Bypass Graft Patients

    Science.gov (United States)

    Imantalab, Vali; Mirmansouri, Ali; Sedighinejad, Abbas; Naderi Nabi, Bahram; Farzi, Farnoush; Atamanesh, Hadi; Nassiri, Nassir

    2014-01-01

    Background: Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care. Objectives: This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management. Patients and Methods: In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 μg/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 μg/kg/min, fentanyl 1-2 μg/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients. Results: No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ≥ 0.05). Total dosage of used morphine was 22 ± 8.3 mg in each patient and total dosage of used diclofenac was 94 ± 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ≤ 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023). Conclusions: Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery. PMID:25346897

  10. Comparison of amiodarone vs magnesium sulphate in the prevention of atrial fibrillation after coronary artery bypass grafting surgery

    International Nuclear Information System (INIS)

    Background: Atrial fibrillation (AF) is common in patients after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality, increased length of hospital stay, and increased cost. In this study we compared the efficacy of amiodarone versus magnesium sulphate in the prophylaxis of post-CABG atrial fibrillation. Objective: This study was carried out to assess the efficacy of amiodarone in comparison to magnesium sulphate in the prevention of atrial fibrillation after coronary artery bypass grafting. Study Design: Randomized controlled trials. Place and duration of study: The study was carried out at Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from July 2010 to December 2011 Patients and Methods: Total 240 patients were included in the study and randomly divided in two groups of 120 each using random number table. Patients in Group A (Amiodarone group) were given a loading dose of amiodarone 5 mg/Kg after induction of anesthesia which was then continued as infusion at 5 micro gm/Kg/minute on first postoperative day. This was followed by an oral dose of 600 mg/day postoperatively for 5 days. Those in Group B (Magnesium Sulphate group) received 2 g of magnesium sulphate in 100 ml of isotonic 0.9% solution intravenously over 1 hour at following times: preoperatively, immediately following the operation, and on postoperative days 1, 2, and 3. Results: Thirteen patients (10.8%) developed AF in Amiodarone group, compared to 31 patients (25.8%) in magnesium sulphate group. The results proved amiodarone to be more effective than magnesium sulphate in preventing post-CABG AF (p<0.001). Thirty one patients who developed AF postoperatively in the magnesium group were treated with amiodarone, and all patients recovered normal sinus rhythm. In the amiodarone prophylaxis group, 9 patients regained sinus rhythm in 6 - 8 hours, while for 4 remaining patients cardioversion was attempted out of which 2

  11. Effects of allopurinol and vitamin E on renal function in patients with cardiac coronary artery bypass grafts

    Directory of Open Access Journals (Sweden)

    Nader Nouri-Majalan

    2009-05-01

    Full Text Available Nader Nouri-Majalan1, Ehsan Fotouhi Ardakani2, Khalil Forouzannia3, Hosein Moshtaghian41Department of Nephrology, 3Department of Cardiovascular Surgery, 4Department of Anesthesiology, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 2Ali bin Abu Taleb Medical College, Yazd Azad University, Yazd, IranBackground: Acute renal failure is a common complication of cardiac surgery, with oxidants found to play an important role in renal injury. We therefore assessed whether the supplemental antioxidant vitamin E and the inhibitor of xanthine oxidase allopurinol could prevent renal dysfunction after coronary artery bypass graft (CABG surgery.Methods: Of 60 patients with glomerular filtration rate (GFR < 60 mL/min scheduled to undergo CABG surgery, 30 were randomized to treatment with vitamin E and allopurinol for 3–5 days before surgery and 30 to no treatment. Serum creatinine levels and potassium and creatinine clearances were measured preoperatively and daily until day 5 after surgery. Results: The patients consisted of 31 males and 29 females, with a mean age of 63 ± 9 years. After surgery, there were no significant differences in mean serum creatinine (1.2 ± 0.33 vs 1.2 ± 0.4 mg/dL; p = 0.43 concentrations, or creatinine clearance (52 ± 12.8 vs 52 ± 12.8 mL/min; p = 0.9. The frequency of acute renal failure did not differ in treatment group compared with control (16% vs 13%; p = 0.5. Length of stay in the intensive care unit (ICU was significantly longer in the control than in the treated group (3.9 ± 1.5 vs 2.6 ± 0.7 days; p < 0.001.Conclusion: Prophylactic treatment with vitamin E and allopurinol had no renoprotective effects in patients with pre-existing renal failure undergoing CABG surgery. Treatment with these agents, however, reduces the duration of ICU stay.Keywords: antioxidants, coronary artery bypass, prevention and control, renal function

  12. Usefulness of colchicine to reduce perioperative myocardial damage in patients who underwent on-pump coronary artery bypass grafting.

    Science.gov (United States)

    Giannopoulos, Georgios; Angelidis, Christos; Kouritas, Vasileios K; Dedeilias, Panagiotis; Filippatos, Gerasimos; Cleman, Michael W; Panagopoulou, Vasiliki; Siasos, Gerasimos; Tousoulis, Dimitrios; Lekakis, John; Deftereos, Spyridon

    2015-05-15

    The objective of the present study was to test whether a perioperative course of colchicine, in patients who underwent standard coronary artery bypass grafting, would result in reduced postoperative increase of myocardial injury biomarker levels. Patients were prospectively randomized to colchicine or placebo starting 48 hours before scheduled coronary artery bypass grafting and for 8 days thereafter (0.5 mg twice daily). The primary outcome parameter was maximal high-sensitivity troponin T (hsTnT) concentration within 48 hours after surgery. Secondary outcome measures were maximal creatine kinase-myocardial brain fraction (CK-MB) levels and area under the curve (AUC) of hsTnT and CK-MB concentrations; 59 patients were included. Maximal hsTnT was 616 pg/ml (396 to 986) in the colchicine group versus 1,613 pg/ml (732 to 2,587) in controls (p = 0.002). Maximal CK-MB was 44.6 ng/ml (36.6 to 68.8) and 93.0 ng/ml (48.0 to 182.3), respectively (p = 0.002). The median AUC for hsTnT was 40,755 pg h/ml (20,868 to 79,176) in controls versus 20,363 pg h/ml (13,891 to 31,661) in the colchicine group (p = 0.002). AUCs for CK-MB were 2,552 ng h/ml (1,564 to 4,791) in controls and 1,586 ng h/ml (1,159 to 2,073) in the colchicine group (p = 0.003). The main complaints associated with colchicine were, as expected, gastrointestinal, with 5 patients (16.7%) in the colchicine group reporting diarrhea versus 1 control (3.4%) (p = 0.195). In conclusion, a short perioperative course of colchicine was effective in attenuating postoperative increases of hsTnT and CK-MB compared with placebo. This finding, which needs confirmation in a larger clinical trial powered to assess clinical endpoints, suggests a potential role for this agent in reducing cardiac surgery-related myocardial damage.

  13. Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients

    Directory of Open Access Journals (Sweden)

    Bhanu Prakash Zawar

    2015-01-01

    Full Text Available Objective: Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump coronary artery bypass (OPCAB surgery triggers a systemic stress response as seen in coronary artery bypass grafting (CABG. Thoracic epidural anesthesia (TEA, combined with general anesthesia (GA attenuates the stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor necrosis factor-Alpha( TNF ά, interleukin-6 and leucocyte count. Design: A prospective randomised non blind study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty six patients. Material and Methods/intervention: The study was approved by hospital research ethics committee and written informed consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study group or GA only (control group. Inclusion Criteria (for participants were -Age ≥ 70 years, Patient posted for OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction. Serum concentration of Interlukin: - 6, TNF ά, cortisol, Troponin - I, CK-MB, and HsCRP (highly sensitive C reactive protein, was compared for both the group and venous blood samples were collected and compared just after induction, at day 2, and day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were noted and compared. Independent t test was used for statistical analysis. Primary Outcomes: Postoperative complications, total intensive care unit stay and hospital stay. Secondary Outcome: Stress response. Result: Study group

  14. Risk factors for mortality after coronary artery bypass grafting in patients with low left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    WANG Jin; XIAO Feng; REN Jian; LI Yan; ZHANG Ming-li

    2007-01-01

    Background We managed to assess and confirm the risk factors for mortality after coronary artery bypass grafting (CABG) operations so as to map out the proper guidance of surgical strategy especially in patients with low left ventricular ejection fraction (LVEF) in domestic polyclinic like ours.Methods Five hundred and forty-eight consecutive patients underwent CABG from December 1999 through August 2005 were analyzed retrospectively. Eighty-nine cases had an LVEF of 40% or less. All together twenty-two candidate factors were evaluated for their association with perioperative death using univariate and multivariate stepwise Logistic analysis.Results When data from all the patients who had undergone CABG were taken into account, LVEF, left ventricular end diastolic diameter (LVEDD), mitral regurgitation, aneurysm of the heart wall, mitral repair/replacement, resection of aneurysm, concomitant aortic valve replacement, and perioperative intra-aortic balloon counter-pulsation (IABP), left ventricular assist device (LVAD) and cardiopulmonary bypass (CPB) all showed an association with perioperative death in univariate analysis, while an LVEF of >40%, on the other hand, appeared to be a protective factor. In multivariate analysis, moderate to severe mitral regurgitation, aneurysm of the heart wall, repair of septal perforation and aortic regurgitation were proved to be risk factors. When the analysis was restricted to patients with an LVEF of 40% or less,such variables as age, LVEDD, mitral regurgitation, mitral repair/replacement, IABP, and CPB were qualified as risk factors in a univariate analysis. Age, moderate mitral regurgitation, aneurysm of the heart wall, CPB, left main coronary artery disease and female were associated with perioperative death in a multivariate logistic regression analysis.Conclusions Concerning the prognosis, patients who undergo CABG would have different risk factors when data from all the enrolled patients or data from patients with LVEF

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

    OpenAIRE

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

    2014-01-01

    Familial hypercholesterolemia (FH) is a dominantly inherited disorder caused by mutation at the locus for the low-density lipoprotein (LDL) receptor and is frequently associated with premature coronary artery disease and aortic valve involvement. The surgical treatment of these complications is accompanied by a high degree of risk, even in skillful hands. An intensive cholesterol-lowering therapy and LDL aphaeresis in association with surgery may be useful. The case of a 12-year-old girl, wit...

  16. Effects of Skeletonized versus Pedicled Internal Thoracic Artery Grafts on Free Flow Capacity during Bypass

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The free flow of skeletonized ITA grafts was compared with that of pedicled ITA grafts. One hundred patients with coronary artery diseases underwent elective CABG. In the group I (n=50), the left ITA was dissected using the skeletonization technique. In the group Ⅱ (n= 50), the ITA was harvested as a pedicled graft. Free flow of the ITA was recorded before and 15 min after intraluminal application of diluted papaverine. Mean arterial pressure was maintained at 9.31 kPa (70 mmHg). The results showed that before the application of papaverine, free flow of skeletonized and pedicled ITA grafts was identical between the two groups. After treatment with papaverine, the maximum free flow was significantly higher in the skeletonized ITA's in the group I (199.3± 69. 6 ml /min) than in the group Ⅱ (145.7±70. 3 ml/min, P<0. 05). There was on significant difference between the free flow after dilatation of the left and right ITA in the group I (left 199.3±69.6 ml/min, right 198. 9±61.8 rl/min, respectively). It was concluded that preparation of the ITA with the skeletonization technique resulted in significantly higher free flow capacity than in pedicled grafts and would improve the results of arterial revascularization. The complication rate seems to be lower than with the conventional method.

  17. Early outcome after off-pump coronary artery bypass grafting: effect on mortality and stroke Resultado inicial após revascularização miocárdica: efeito na mortalidade e no acidente cerebrovascular

    OpenAIRE

    Delawer Reber; Marcus Fritz; Alfred Germing; Peter Marks; Axel Laczkovics

    2008-01-01

    OBJECTIVE: One of the major and devastating complications of the coronary artery bypass grafting (CABG) is the stroke. Avoiding cardiopulmonary bypass (CPB) may reduce this neurological complication. In the past years there was an increased interest in the off-pump coronary artery grafting (OPCAB). The benefit of this method of revascularization in term of stroke and mortality is controversially discussed. METHODS: A retrospective analysis of collected data from 252 patients were operated wit...

  18. Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study

    OpenAIRE

    Baikoussis Nikolaos G; Koletsis Efstratios; Siminelakis Stavros; Sintou Eleni; Papadopoulos Georgios; Apostolakis Efstratios

    2010-01-01

    Abstract Preoperative medication by inhibitors of angiotensin-converting enzyme (ACE) in coronary artery patients predisposes to vasoplegic shock early after coronary artery bypass grafting. Although in the majority of the cases this shock is mild, in some of them it appears as a situation, "intractable" to high-catecholamine dose medication. In this study we examined the possible role of prophylactic infusion of low-dose vasopressin, during and for the four hours post-bypass after cardiopulm...

  19. Systemic and myocardial inflammatory response in coronary artery bypass graft surgery with miniaturized extracorporeal circulation: differences with a standard circuit and off-pump technique in a randomized clinical trial

    OpenAIRE

    Formica, F; Mariani, S.; F Broccolo; CARUSO R; Corti, F; D'Alessandro, S.; Amigoni, P; Sangalli, F; Paolini, G

    2013-01-01

    Inflammatory response and hemodilution are the main drawbacks of extracorporeal circulation. We hypothesize that the use of miniaturized extracorporeal circulation (MECC) might lower the systemic and myocardial inflammatory patterns compared with a standard system (SECC) and off-pump coronary artery bypass grafting (OPCABG). Sixty-one patients undergoing isolated coronary artery bypass graft were prospectively randomized to MECC (n = 19), SECC (n = 20), or OPCABG (n = 22). Blood samples were ...

  20. Postoperative acute kidney injury defined by RIFLE criteria predicts early health outcome and long-term survival in patients undergoing redo coronary artery bypass graft surgery

    OpenAIRE

    Zakkar, Mustafa; Bruno, Vito D; Guida, Guida A; Angelini, Gianni D; Chivasso, Pierpaolo; Suleiman, M Sadeeh; Bryan, Alan J.; Ascione, Raimondo

    2016-01-01

    OBJECTIVE: To investigate the impact of postoperative acute kidney injury (AKI) on early health outcome and on long-term survival in patients undergoing redo coronary artery bypass grafting (CABG).METHODS: We performed a Cox analysis with 398 consecutive patients undergoing redo CABG over a median follow-up of 7 years (interquartile range, 4-12.2 years). Renal function was assessed using baseline and peak postoperative levels of serum creatinine. AKI was defined according to the risk, injury,...

  1. Early and midterm results of patients above or below 65-year-old undergoing coronary artery bypass grafting combined with valve replacement

    OpenAIRE

    Wu, Yang; Gao, Chang-Qing; Li, Bo-Jun; Sheng-li JIANG; Cang-song XIAO; Wang, Rong

    2013-01-01

    Objective  To retrospectively analyze the early and midterm outcomes and summarize experiences of coronary artery bypass grafting (CABG) combined with valve replacement (VR) in patients below or above 65-year-old. Methods  The clinical data of 110 patients, who received valve replacement combined with CABG in the General Hospital of PLA from Apr. 1998 to May 2012, were analyzed retrospectively. The patients were divided into two groups according to their age of ≥65 years (39 cases) or

  2. Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study

    OpenAIRE

    Pértega-Díaz Sonia; Martínez-González Ursicino; Juffé-Stein Alberto; Pita-Fernández Salvador; Yánez-Brage Isabel; Mauleón-García Ángeles

    2009-01-01

    Abstract Background Heart surgery is associated with an occurrence of pulmonary complications. The aim of this study was to determine whether pre-surgery respiratory physiotherapy reduces the incidence of post-surgery pulmonary complications. Methods Observational study of 263 patients submitted to off-pump coronary artery bypass grafting (CABG) surgery at the A Coruña University Hospital (Spain). 159 (60.5%) patients received preoperative physiotherapy. The fact that patients received preope...

  3. Anesthetic management of a patient with polycythemia vera undergoing emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting: a case report

    OpenAIRE

    Im, Hyeongwoo; Min, Jeong Jin; Yang, Jaeyoung; Lee, Sangmin Maria; Lee, Jong Hwan

    2015-01-01

    Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopa...

  4. Health-related personal control predicts depression symptoms and quality of life but not health behaviour following coronary artery bypass graft surgery

    OpenAIRE

    Kidd, T.; Poole, L; Leigh, E.; Ronaldson, A.; Jahangiri, M; Steptoe, A

    2015-01-01

    To determine the prospective association between health-related control beliefs, quality of life (QOL), depression symptoms, and health behaviours in coronary artery bypass graft (CABG) patients 6–8 weeks following surgery. 149 patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring health related personal control, treatment control, depression symptoms, QOL, and health behaviours prior to and 6–8 weeks after surgery. Higher levels of heal...

  5. Effects of Phase III Cardiac Rehabilitation Programs on Anxiety and Quality of Life in Anxious Patients after Coronary Artery Bypass Surgery

    OpenAIRE

    Gholamreza Babaei Ruchi; Fazlollah Ghofranipour; Saeed Sadeghian; Ali Ramezankhani; Alireza Heidarnia; Tahereh Dehdari; Soraya Etemadi

    2007-01-01

    Background: Patients with psychological problems after coronary artery bypass graft surgery (CABG) show poorer outcomes; nevertheless, there is a paucity of research into the effects of cardiac rehabilitation programs on such patients. The purpose of this study was to determine the effect of phase III cardiac rehabilitation programs on the anxiety and quality of life of anxious patients who had undergone CABG in Iran.Methods: Six weeks after CABG, 83 anxious patients participated in an 8-week...

  6. Otpornost na acetilsalicilnu kiselinu u kasnom poslijeoperacijskom razdoblju nakon kirurške revaskularizacije miokarda [Aspirin resistance in late postoperative period after coronary artery bypass grafting

    OpenAIRE

    Fučkar, Krunoslav

    2016-01-01

    Study goals: In patients after coronary artery bypass grafting during the early postoperative stage there is a higher prevalence of aspirin resistance. Data concerning the issue of aspirin resistance in the late postoperative period are rare. Clinical impact of aspirin resistance has not yet been thoroughly investigated. The primary objective of this dissertation was to assess the prevalence of laboratorically defined aspirin resistance during the late postoperative period afte...

  7. Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft

    OpenAIRE

    Esra Mercanooglu Efe; Basak Atabey Bilgin; Zekeriyya Alanoglu; Murat Akbaba; Cigdem Denker

    2014-01-01

    BACKGROUND AND OBJECTIVE: The aim of this randomized, prospective and double blinded study is to investigate effects of different esmolol use on hemodynamic response of laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft surgery. METHODS: After approval of local ethics committee and patients' written informed consent, 45 patients were randomized into three groups equally. In Infusion Group; from 10 min before intubation up to 5th minute after sternotomy, ...

  8. Health-related quality of life following off-pump versus on-pump coronary artery bypass grafting in elderly moderate to high-risk patients

    DEFF Research Database (Denmark)

    Jensen, Birte Østergaard; Hughes, Pia; Rasmussen, Lars S;

    2006-01-01

    Previous trials comparing coronary artery bypass grafting (CABG) with or without extracorporeal circulation have mainly enrolled selected patients at younger age and low risk. Patient-reported health-related quality of life has not been significantly different. We compared health-related quality ...... of life in elderly moderate to high-risk patients randomized to either off-pump or on-pump surgery....

  9. Comparison of the Complications between Left Side and Right Side Subclavian Vein Catheter Placement in Patients Undergoing Coronary Artery Bypass Graft Surgery

    OpenAIRE

    Masoud Tarbiat; Babak Manafi; Maryam Davoudi; Ziae Totonchi

    2014-01-01

    Introduction: Percutaneous subclavian vein catheterization is one of the most common invasive procedures performed in cardiac surgery. The aim of this study was to compare left and right subclavian vein catheter placement via the infraclavicular approach in patients who undergo coronary artery bypass graft (CABG) surgery. Methods: This prospective, randomized clinical trial was performed in193 patients. The technique applied for cannulation was infraclavicular approach for both the right and ...

  10. Effects of different levels of positive airway pressure on breathing pattern and heart rate variability after coronary artery bypass grafting surgery

    OpenAIRE

    C.B.F. Pantoni; L. Di Thommazo; R.G. Mendes; A.M. Catai; Luzzi, S.; O. Amaral Neto; A. Borghi-Silva

    2011-01-01

    The application of continuous positive airway pressure (CPAP) produces important hemodynamic alterations, which can influence breathing pattern (BP) and heart rate variability (HRV). The aim of this study was to evaluate the effects of different levels of CPAP on postoperative BP and HRV after coronary artery bypass grafting (CABG) surgery and the impact of CABG surgery on these variables. Eighteen patients undergoing CABG were evaluated postoperatively during spontaneous breathing (SB) and a...

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

    OpenAIRE

    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...

  12. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Sajith Sulaiman

    2012-01-01

    Full Text Available This study was designed to study the efficacy of intravenous dexmedetomidine for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation in patients with coronary artery disease. Sixty adult patients scheduled for elective off-pump coronary artery bypass surgery were randomly allocated to receive dexmedetomidine (0.5 mcg/kg or normal saline 15 min before intubation. Patients were compared for hemodynamic changes (heart rate, arterial blood pressure and pulmonary artery pressure at baseline, 5 min after drug infusion, before intubation and 1, 3 and 5 min after intubation. The dexmedetomidine group had a better control of hemodynamics during laryngoscopy and endotracheal intubation. Dexmedetomidine at a dose of 0.5 mcg/kg as 10-min infusion was administered prior to induction of general anesthesia attenuates the sympathetic response to laryngoscopy and intubation in patients undergoing myocardial revascularization. The authors suggest its administration even in patients receiving beta blockers.

  13. Comparative study of on-pump and off-pump coronary bypass surgery in patients with triple-vessel coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    陈鑫; 徐明; 史宏伟; 穆心伟; 陈振强; 邱志兵

    2004-01-01

    Background Studies on selected patients undergoing off-pump versus on-pump coronary artery bypass surgery have produced inconsistent results, especially in patients with multiple coronary artery disease. This study compared the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease.Methods A total of 300 consecutive isolated, multiple coronary artery bypass grafting (CABG) patients were assigned to the off-pump coronary artery bypass (OPCAB, n=150) or CABG with cardiopulmonary bypass (CCABG, n=150) groups. There were no significant differences regarding degree of angina, history of myocardial infarction or diabetes, and presence of left main coronary artery disease between the two groups. Ejection fraction in the OPCAB group before surgery was lower than in the CCABG group (P<0.01). In addition, more patients had a history of stroke and abnormal renal function preoperatively in the OPCAB group(P< 0.01). In OPCAB patients, single deep pericardial stay suture with a sling snared down was used to expose the target vessels, along with a stabilizer and a coronary shunt. A Medi-Stim Butterfly Flowmeter was used to measure blood flow through grafts in both groups.Results No OPCAB patient was converted to the CCABG group. The average numbers of distal anastomoses and the indexes of completeness of revascularization (ICR) were similar in both groups. Postoperative respiratory support time and the volumes of chest tube drainage and of blood transfusions were less in the OPCAB group than in the CCABG group (both P<0.01). The postoperative incidences of pulmonary dysfunction and renal insufficiency were lower in the OPCAB group than in the CCABG group (both P<0.05). There were no significant differences between the two groups in mortality and other causes of morbidity (periopetative myocardial infarction, stroke, atrial fibrillation). Conclusions OPCAB can be applied to patients with triple-vessel coronary artery disease and can

  14. Nursing Experience of Postoperative Pain of Coronary Artery Bypass Grafting%心内直视下冠状动脉搭桥术后疼痛护理

    Institute of Scientific and Technical Information of China (English)

    杨梦

    2015-01-01

    In January 2010, 88 patients were treated by heart surgery in December 2013, including 77 patients with coronary artery bypass grafting, 11 cases with coronary artery bypass grafting and valve replacement. The postoperative pain of the patients with coronary artery bypass surgery is a major obstacle to the rehabilitation of patients. Good pain nursing can improve the recovery rate, shorten the time of postoperative care. Have a definite object in view of postoperative care, to al eviate the suf ering of patients, improve the quality of people's lives.%2010年1月~2013年12月心脏术后患者88例,其中冠状动脉搭桥术77例,冠状动脉搭桥+瓣膜置换术11例。冠状动脉搭桥术的后疼痛更是患者康复道路上的一大障碍。良好的疼痛护理能提高恢复的速度,术后监护平均时间的缩短。有的放矢地进行术后护理,减轻患者的痛苦,提高人们的生活质量。

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

    Science.gov (United States)

    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.

  16. Efficacy of cardiac resynchronization with defibrillator insertion in patients undergone coronary artery bypass graft: A cohort study of cardiac function

    Directory of Open Access Journals (Sweden)

    Reza Karbasi Afshar

    2015-01-01

    Full Text Available Introduction: Cardiac resynchronization therapy (CRT is a proven therapeutic method in selected patients with heart failure and systolic dysfunction which increases left ventricular function and patient survival. We designed a study that included patients undergoing coronary artery bypass graft (CABG, with and without CRT-defibrillator (CRT-D inserting and then measured its effects on these two groups. Patients and Methods: Between 2010 and 2013, we conducted a prospective cohort study on 100 coronary artery disease patients where candidate for CABG. Then based on the receiving CRT-D, the patients were categorized in two groups; Group 1 ( n = 48, with CRT-D insertion before CABG and Group 2 ( n = 52 without receiving CRT-D. Thereafter both of these groups were followed-up at 1-3 months after CABG for mortality, hospitalization, atrial fibrillation (AF, echocardiographic assessment, and New York Heart Association (NYHA class level. Results: The mean age of participants in Group 1 (48 male and in Group 2 (52 male was 58 ± 13 and 57 ± 12 respectively. Difference between Groups 1 and 2 in cases of mean left ventricular ejection fraction (LVEF changes and NYHA class level was significant ( P > 0.05. Hospitalization ( P = 0.008, mortality rate ( P = 0.007, and AF were significantly different between these two groups. Conclusions: The results showed that the increase in LVEF and patient′s improvement according to NYHA-class was significant in the first group, and readmission, mortality rate and AF was increased significantly in the second group.

  17. Sonographic Screening for Abdominal Aortic Aneurysm (AAA in Persian Candidates of Coronary Artery Bypass Graft (CABG

    Directory of Open Access Journals (Sweden)

    Sh. Shirani

    2005-08-01

    Full Text Available Introduction & Background: Five percent of the Northern European elder men suffer from AAA. Selective re-pair of unruptured AAA has 5-8% mortality, but mortality rate rises to 50-80% in emergency repair after its rupture. Regarding the fact that coronary artery disease and AAA have similar risk factors such as smoking, atherosclerosis, and hypertension, western references suggest AAA screening in the male candidates of CABG. Other studies have shown that incidence of AAA is lower in Mediterranean ethnic groups than the Northern European origin. The objective of this prospective study is to determine the prevalence of AAA in Persian eth-nic group. Patients & Methods: A total of 717 consecutive candidates of CABG were evaluated by gray scale sonography in Tehran Heart Center from February 2005.untill September 2005. The diameter of aorta was measured in three levels: above superior mesenteric artery, between SMA and renal arteries, and in infrarenal aorta. In each segment the maximum diameter was recorded. Results: Our study population included 192 women (mean age 61.2 years and 525 men (mean age 59.6 years.The prevalence of AAA was 0.52% and 1.9% in women and men respectively. The prevalence of AAA was 5.76% in active or ex-smoker men that is similar to Oxford university study of elderly patients (5%, but lower than Manchester university screening program of CABG male candidates (15%. Conclusion: The incidence of AAA is lower in the Persian ethnic group than the Northern European group. Screening for AAA is not justified in Persian male candidates of CABG except for the smoker subgroup.

  18. Epicardial radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmias during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; GAO Ming-xin; LI Hai-tao; ZHANG Fan; GU Cheng-xiong

    2012-01-01

    Background Left ventricular aneurysm (LVA) is one of the serious complications after acute myocardial infarction.We attempted to evaluate the preliminary efficacy of LVA repair combined with epicardial radiofrequency ablation for ventricular arrhythmia during off-pump coronary artery bypass grafting (OPCAB).Methods From June 2009 to April 2011,31 patients with LVA had angina symptoms and ventricular arrhythmia.In all patients,circular and cross-shaped radiofrequency epicardial ablations were performed using unipolar ablation pen along the border between the aneurysm wall and normal cardiac tissue and in the central zone of the aneurysms,followed by a linear placation of ventricular aneurysms on beating heart.Results All the patients showed complete recovery.The average number of grafted vessels was 2.7±1.3.Intraoperative examinations revealed that the ventricular arrhythmia was effectively controlled by radiofrequency ablation.All cases had been followed up for one year.Holter monitoring revealed a significant reduction in ventricular arrhythmias (P <0.05).Echocardiography showed significant increase in left ventricular ejection fraction (P <0.05) and decrease in left ventricular end-diastolic diameter (P <0.05).Conclusions For patients with ventricular aneurysm and preoperative malignant arrhythmia,aneurysm repair plus epicardial radiofrequency ablation in OPCAB was found to be an effective and feasible therapeutic technique.However,medium-to long-term therapeutic efficacy of this method remains to be determined by future studies and observations.

  19. Evaluation of Left Ventricular Dyssynchrony after Coronary Artery Bypass Grafting in Patients with Ischemic Left Ventricular Dysfunction

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    MA Babaee Beigi

    2009-12-01

    Full Text Available Background: Ischemic left ventricular (LV dysfunction is one of the major causes of LV dyssynchrony. This is indicative of poor prognosis in patients with LV dysfunction and correction of ischemia by Coronary Artery Bypass Grafting (CABG may resynchronize LV contraction. The aim of this study was to evaluate the effect of CABG on LV dyssynchrony, systolic and diastolic function.Patients: The present study comprised 31 patients with ischemic LV dysfunction with Ejection Fraction (EF:25- 50%. Echocardiography with Tissue Doppler Imaging (TDI was performed to assess LV dyssynchrony (calculated by basal LV segment,to evaluate diastolic function by measurement of peak early diastolic mitral annular velocity (Em ,systolic function by measurement of peak early systolic mitral annular velocity (Sm and Ejection Fraction (EF by Simpson method.Results: Mean LV dyssychrony before CABG was 30±16 ms that decreased to 22±14 ms after operation (P=0.04.There was also improved diastolic and systolic function after CABG ( Em 0.04m/s versus 0.05 m/s , P=0.01 and Sm 0.06 m/s versus 0.08 m/s P=0.01.The mean ejection fraction rose from 40±8.6% to 42±8.2% (P=0.01.Conclusion: CABG is associated with improvement of LV dyssynchrony, systolic and diastolic function in patients with ischemic LV dysfunction.

  20. The Effect of Diabetes Mellitus on Short Term Mortality and Morbidity after Isolated Coronary Artery Bypass Grafting Surgery

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    Vahideh Koochemeshki

    2013-06-01

    Full Text Available Background: This study was conducted to determine whether Diabetes Mellitus (DM is a predictor of short term mortality ; morbidity, or early readmission to hospital after Coronary Artery Bypass Graft (CABG. Methods: We analyzed a large cohort of 952 patients who had undergone isolated CABG. The preoperative, intera operative and postoperative risk factors as well as the complications and 30-day mortality rates were compared between the diabetics and non-diabetics. Among the 952 patients; 734 ones ( (77.1% were in non-diabetic group and 218 (22.9% were diabetics. Results: Having DM did not increase the risk of 30-day mortality. In addition, DM did not affect the major complications; arrhythmia, Myocardial Infarction(MI, infective complications, neurological complications, Pulmonary Embolism (PE except renal complications that was higher in the diabetics (5.5% vs 1.4%; P<0.001, OR=4.2 However reoperation for bleeding was higher in non-diabetic patients (7.9% vs 4.6%; P=0.009, OR=1.7. Nevertheless ,no significant difference was observed between the two groups regarding mechanical ventilation time (hour, reintubation, length of ICU stay (day, length of hospital stay (day, and readmitting as postoperative variables. Conclusions: Except for renal complications, DM was not associated with adverse outcomes in the patients undergoing isolated CABG.