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Sample records for artery bypass grafting-a

  1. 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

  2. Postoperative neuralgia in the leg after saphenous vein coronary artery bypass graft: a prospective study.

    OpenAIRE

    Nair, U R; Griffiths, G.; Lawson, R. A.

    1988-01-01

    The degree of cutaneous sensory deficit in the leg was assessed after removal of the long saphenous vein in 50 consecutive patients undergoing coronary artery bypass vein grafts randomly assigned subcutaneous sutures or a single layer of sutures. Removal of the vein and repair of the leg incision were done by the same team of surgeons. In group 1 (25 patients) the leg incision was repaired with "00" Dexon subcutaneous and "00" prolene subcuticular sutures while in group 2 (25 patients) closur...

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

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    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.

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

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    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.

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

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    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

  6. Efficacy of cardiac resynchronization with defibrillator insertion in patients undergone coronary artery bypass graft: A cohort study of cardiac function

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    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.

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

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    Heidari

    2015-12-01

    Full Text Available Background The instability of cardiovascular indices and anxiety disorders are common among patients undergoing coronary artery bypass graft (CABG and could interfere with their recovery. Therefore, improving the cardiovascular indices and anxiety is essential. Objectives This study aimed to investigate the effect of music therapy on anxiety and cardiovascular indices in patients undergoing CABG. Patients and Methods In this randomized controlled trial, 60 patients hospitalized in the cardiovascular surgical intensive care unit of Shahid Beheshti Hospital in Qom city, Iran, in 2013 were selected using a consecutive sampling method and randomly allocated into the experimental and control groups. In the experimental group, patients received 30 minutes of light music, whereas in the control group, patients had 30 minutes of rest in bed. The cardiovascular indices and anxiety were measured immediately before, immediately after and half an hour after the study. Data were analyzed using the chi-square test and repeated measures analysis of variance. Results Compared to the immediately before intervention, the mean anxiety scores immediately after and 30 minutes after the intervention were significantly lower in the experimental group (P 0.05. Conclusions Music therapy is effective in decreasing anxiety among patients undergoing CABG. However, the intervention was not effective on cardiovascular indices. Music can effectively be used as a non-pharmacological method to manage anxiety after CABG.

  8. Predictive Factors for Delayed Extubation in the Intensive Care Unit after Coronary Artery Bypass Grafting; A Southern Iranian Experience

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    Shahrbanoo Shahbazi

    2012-12-01

    Full Text Available Background: Early extubation is implemented in cardiothoracic units worldwide for its advantages such as decreased mortality, morbidity, and hospitalization costs. We conducted a retrospective study to evaluate potential factors which may affect extubation time. Methods: The records of 334 eligible patients who underwent elective coronary artery bypass grafting (CABG in 2008 in Kowsar Hospital in Shiraz, southern Iran were evaluated to find the factors that can affect the extubation time. The patients were divided to early (equal or less than 6 hours and late extubation groups. The patients’ demographic data and operative variables were extracted from the records. We excluded patients with difficult intubation, severe acid base disturbance, neurological problems, and cardiovascular instability; and those who used intra-aortic balloon pump, had underwent emergency operation, or had another concomitant surgery. Results: Multiple logistic regressions comparing age, sex, number of grafts, ejection fraction, pump time, hematocrit, number of risk factors, and number of inotropic drugs, identified only age as a predictor of delayed extubation (odds ratio=1.07, CI 95%=1.04-1.10, P<0.001. Also, in both studied groups the men to women ratio was higher (P<0.05.Conclusion: Although in our study age was the only predictive factor for delayed extubation, a comprehensive study including preoperative, perioperative, and postoperative factors is recommended in our area.

  9. 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

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    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...

  10. 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...

  11. Effects of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting: a propensity score analysis

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    Ayşegül Kunt

    2015-08-01

    Full Text Available Aim To evaluate the effect of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting. Methods A total of 1890 patients who underwent isolated coronary artery bypass were analyzed retrospectively, of which 425 patients (22.4% older than 70 were included in the study. The demographic properties, preoperative, operative and postoperative data and other medications of these patients were recorded. Continuous preoperative and postoperative atorvastatin therapy were received by 124 (29.17% patients; 301 (70.82% patients were matched to a control group (no-statin group. The two groups were matched by propensity score analysis in terms of atrial fibrillation development and cardiac mortality. Results Medical history, medical treatment, cardiovascular history, and operative characteristics demonstrated significant heterogeneity in both groups. Postoperative atrial fibrillation was similar in both groups. Before propensity score matching, the percentages of patients in postoperative atrial fibrillation with respect to Atorvastain-group and No-statin-group were 13.71 and 10.3 respectively; however, those were 13.71 and 14.51 after matching. In a multivariate regression analysis, five-vessel bypass (odds ratio OR, 2.354; 95% confidence interval CI, 0.99 to 5.57 was an independent predictor of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. In-hospital mortality was higher in the Atorvastatin-group compared with the No-statingroup: 124 (8.9% versus 301 (3.7%, respectively; p=0.027. Conclusion Perioperative atorvastatin treatment is not found to be associated with reduced postoperative atrial fibrillation and cardiac mortality in patients undergoing isolated coronary artery bypass grafting above the age of seventy years.

  12. 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...

  13. 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

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    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

  14. Coronary Artery Bypass

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    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.

  15. 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

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    Solange Guizilini

    2014-12-01

    Full Text Available 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 space; SI group (n=29 - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5 was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1. Results: In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second until POD5 (P<0.05. However, when compared, SI group presented less decrease in these parameters (P<0.05. Pulmonary shunt fraction was significantly lower in SI group (P<0.05. Respiratory events, pain score, orotracheal intubation time and postoperative length of hospital stay were lower in the SI group (P<0.05. Conclusion: Subxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting.

  16. Myocardial transfection of hypoxia inducible factor-1α via an adenoviral vector during coronary artery bypass grafting. A multicenter phase I and safety study

    International Nuclear Information System (INIS)

    Increasing numbers of patients with advanced coronary artery disease have limited options for percutaneous and/or surgical revascularization. A prospective, randomized, phase I clinical multicenter trial was performed to assess the feasibility and safety of delivering a pro-angiogenic transcription factor termed 'hypoxia inducible factor-1α', delivered to ischemic cardiac muscle via a type 2 adenoviral (Ad2HIF) vector. The 13 patients were included under the following criteria: 1 hypoperfused area of viable ventricular muscle without options for revascularization and left ventricular ejection fraction ≥30%. After coronary artery bypass grafting was completed, 10 injections of the study drug (n=10), in 3 escalating doses up to 1 x 1011 viral particles or saline (n=3) as a placebo control, were injected intramyocardially. After completion of the 1-year follow-up, all patients had uncomplicated postoperative courses, are alive and feeling well; 1 patient had a self-limited run of tachycardia postoperatively and at 6 months, 1 patient developed recurrent angina. Positron emission tomography perfusion analysis revealed improvement in the Ad2HIF injected areas in selected patients. These data support the feasibility and preliminary safety of adenoviral transfection with Ad2HIF in regions of viable myocardium. Additional studies will be required to determine the efficacy and safety of Ad2HIF. (author)

  17. The role of neutrophil gelatinase-associated lipocalin in predicting acute kidney injury in patients undergoing off-pump coronary artery bypass graft: A pilot study

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    Vishal Jain

    2016-01-01

    Full Text Available Objective: Acute kidney injury (AKI is a commonly encountered postoperative complication after cardiac surgery especially in high risk patients. AKI though seen more commonly after conventional on pump coronary artery bypass surgery (CCABG, is not uncommon after off pump coronary bypass surgery (OPCAB. Various biomarkers have shown promise over last one decade as an early marker for predicting AKI postoperatively. NGAL is one such biomarker whose concentration is increased in urine after any nephrotoxic and ischemic insult. The objective of this study was to assess the role of urine NGAL in predicting AKI after OPCAB in patients with increased risk of developing AKI. Design: A prospective cohort study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty patients. Materials and Methods: study was approved by the hospital research ethics committee. 80 patients posted for OPCAB with an increased risk of developing AKI defined as having a Cleveland Clinic Foundation Acute renal failure scoring System score of ≥6 were included in the study. Patients with coronary angiography (CAG within 48 hrs prior to surgery, pre-existing AKI, preoperative renal replacement therapy (RRT and CKD stage 5 were excluded. Urine NGAL level before the start of surgery baseline and at 4 hrs post surgery were done. Renal function tests were assessed on the day of surgery (4 hrs post surgery and on the next three days. Result: Seven patients developed AKI as defined by acute kidney infection network (AKIN and risk injury failure loss end stage (RIFLE criteria for AKI. NGAL value at 4 hrs in patients who developed AKI was significantly higher than in those patients who did not develop AKI (P < 0.05. Conclusion: urine NGAL is an early biomarker of acute kidney injury in patients undergoing OPCAB surgeries. However, large multicentre studies may be needed to confirm it.

  18. The role of neutrophil gelatinase-associated lipocalin in predicting acute kidney injury in patients undergoing off-pump coronary artery bypass graft: A pilot study

    Science.gov (United States)

    Jain, Vishal; Mehta, Yatin; Gupta, Abhinav; Sharma, Reetesh; Raizada, Arun; Trehan, Naresh

    2016-01-01

    Objective: Acute kidney injury (AKI) is a commonly encountered postoperative complication after cardiac surgery especially in high risk patients. AKI though seen more commonly after conventional on pump coronary artery bypass surgery (CCABG), is not uncommon after off pump coronary bypass surgery (OPCAB). Various biomarkers have shown promise over last one decade as an early marker for predicting AKI postoperatively. NGAL is one such biomarker whose concentration is increased in urine after any nephrotoxic and ischemic insult. The objective of this study was to assess the role of urine NGAL in predicting AKI after OPCAB in patients with increased risk of developing AKI. Design: A prospective cohort study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty patients. Materials and Methods: study was approved by the hospital research ethics committee. 80 patients posted for OPCAB with an increased risk of developing AKI defined as having a Cleveland Clinic Foundation Acute renal failure scoring System score of ≥6 were included in the study. Patients with coronary angiography (CAG) within 48 hrs prior to surgery, pre-existing AKI, preoperative renal replacement therapy (RRT) and CKD stage 5 were excluded. Urine NGAL level before the start of surgery baseline and at 4 hrs post surgery were done. Renal function tests were assessed on the day of surgery (4 hrs post surgery) and on the next three days. Result: Seven patients developed AKI as defined by acute kidney infection network (AKIN) and risk injury failure loss end stage (RIFLE) criteria for AKI. NGAL value at 4 hrs in patients who developed AKI was significantly higher than in those patients who did not develop AKI (P < 0.05). Conclusion: urine NGAL is an early biomarker of acute kidney injury in patients undergoing OPCAB surgeries. However, large multicentre studies may be needed to confirm it. PMID:27052061

  19. Doppler derived quantitative flow estimate in coronary artery bypass graft: a computational multiscale model for the evaluation of the current clinical procedure.

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    Ponzini, Raffaele; Lemma, Massimo; Morbiducci, Umberto; Montevecchi, Franco M; Redaelli, Alberto

    2008-09-01

    In order to investigate the reliability of the so called mean velocity/vessel area formula adopted in clinical practice for the estimation of the flow rate using an intravascular Doppler guide wire instrumentation, a multiscale computational model was used to give detailed predictions on flow profiles within Y-shaped coronary artery bypass graft (CABG) models. At this purpose three CABG models were built from clinical patient's data and used to evaluate and compare, in each model, the computed flow rate and the flow rate estimated according to the assumption of parabolic velocity profile. A consistent difference between the exact and the estimated value of the flow rate was found in every branch of all the graft models. In this study we showed that this discrepancy in the flow rate estimation is coherent to the theory of Womersley regarding spatial velocity profiles in unsteady flow conditions. In particular this work put in evidence that the error in flow rate estimation can be reduced by using the estimation formula recently proposed by Ponzini et al. [Ponzini R, Vergara C, Redaelli A, Veneziani A. Reliable CFD-based estimation of flow rate in haemodynamics measures. Ultrasound Med Biol 2006;32(10):1545-55], accounting for the unsteady nature of blood, applicable in the clinical practice without resorting to further measurements. PMID:17980641

  20. COMPARISON OF EPIDURAL ANESTHESIA AND POSTOPERATIVE ANALGESIA WITH ROPIVACAINE AND FENTANYL IN OFF - PUMP CORONARY ARTERY BYPASS GRAFTING: A RANDOMIZED, CONTROLLED STUDY

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    Kaushal

    2014-01-01

    Full Text Available BACKGROUND: Our aim was to assess the efficacy of thoracic epidural anesthesia followed by postoperative epidural infusion with ropivacaine and Fentanyl in off - pump coronary bypass grafting. INTRODUCTION : In cardiosurgical patients, high thoracic epidural anesthesia (EA with local anesthetics and opioids can provide effective analgesia and reduce the number of perioperative complications. However, the use of EA in coronary surgery is controversial, and it is still unclear whether EA influences lung fluid balance , cardiopulmonary function and clinical outcome in OPCAB. Thus, the method requires further evaluation and its potential benefits in coronary patients should be weighed against its risks. MATERIALS AND METHODS : A prospective study was performed in 4 0 patients undergoing coronary artery bypass surgery who received high thoracic epidural analgesia. Group 1 received thoracic epidural 0.2% ropivacaine (bolus 10 ml, 10 min before starting surgery while group 2 pts. received Fentanyl 2 mcg/ml (bolus 10 ml , 10 min before starting surgery, then rate of epidural infusion adjusted between 3 - 8 ml/ hr. of the same concentration according to response. The Regimens aimed at a visual analog scale (VAS score < or = 4/10 . Hemodynamic parameters and blood gases were measured from extubation till 24 h after OPCAB. RESULTS : O utcome measures included the incidence of Visual Analogue Score (VAS < or =4/10, infusion rate adjustments and side - effects. Patients receiving ropivacaine were less likely to experience pain < or =4/10 (P' = 0.002; the infusion rate was lower (P' = 0.024; required less rate adjustments (P' = 0.001; a less need for noradrenaline (P' = 0.001 and antiemetic drugs (P' = 0.001. There were no significant differences between the groups for sedation s cores or the incidence of respiratory depression. CONCLUSION : This study suggests that ropivacaine 0.2% may be superior to fentanyl 2 microg/ml. We found a reduced number of

  1. Prognostic value of strain and strain rate in the prediction of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting: a systematic literature review

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    Leila Bigdelu

    2016-03-01

    Full Text Available Introduction: Atrial fibrillation (AF is a common dysrhythmia postoperatively after coronary artery bypass grafting (CABG. Myocardial strain and strain-rate imaging is used for the assessment of postoperative atrial fibrillation (POAF as a new echocardiographic method. Methods: PubMed and Scopus were searched thoroughly using the following search terms: (strain and strain rate AND (atrial fibrillation OR AF on March 2015 to find English articles in which the strain and strain-rate echocardiographic imaging had been used for the evaluation of AF in patients undergone CABG. Full text of the relevant papers was fully reviewed for data extraction.Result: Of overall 6 articles found in PubMed, 10 records found in Scopus and 4 articles found through reference list search, only 6 papers fully met the inclusion criteria for further assessment and data extraction. The results of strain and strain-rate assessment showed that in total of 542 patients undergoing CABG, POAF occurred in 106 patients. Studies showed that the reduction of left atrial (LA strain rate is correlated with AF. Consistently, the results of present review showed that LA strain and strain-rate in patients who developed AF postoperatively after CABG are significantly reduced, suggesting that strain and strain-rate could be a predictor of POAF.Conclusion: Based on the obtained results, strain and strain-rate is a suitable and accurate echocardiographic technique in the assessment of left atrial function , and it might be helpful to detect the patients who are at high risk of POAF.

  2. Dexamethasone : Benefit and prejudice for patients undergoing on-pump coronary artery bypass grafting - A study on myocardial, pulmonary, renal, intestinal, and hepatic injury

    NARCIS (Netherlands)

    Morariu, AM; Loef, BG; Aarts, LPHJ; Rietman, GW; Rakhorst, G; van Oeveren, W; Epema, AH

    2005-01-01

    Study objectives: Cardiac surgery with cardiopulmonary bypass (CPB) results in perioperative organ damage caused by the systemic inflammatory response syndrome (SIRS) and ischemia/ reperfusion injury. Administration of corticosteroids before CPB has been demonstrated to inhibit the activation of the

  3. Coronary Artery Bypass

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    ... 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 ...

  4. 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...

  5. Multimodality imaging of coronary artery bypass grafts

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    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 coronary artery bypass grafting (CABG).

  6. 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

    Directory of Open Access Journals (Sweden)

    Baikoussis Nikolaos G

    2010-03-01

    Full Text Available 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 cardiopulmonary bypass, in an effort to prevent this syndrome. In addition, we studied the influence of infused vasopressin on the hemodynamics of the patients, as well as on the postoperative urine-output and blood-loss. In our study 50 patients undergoing coronary artery bypass grafting were included in a blind-randomized basis. Two main criteria were used for the eligibility of patients for coronary artery bypass grafting: ejection fraction between 30-40%, and patients receiving ACE inhibitors, at least for four weeks preoperatively. The patients were randomly divided in two groups, the group A who were infused with 0.03 IU/min vasopressin and the group B who were infused with normal saline intraoperativelly and for the 4 postoperative hours. Measurements of mean artery pressure (MAP, central venous pressure (CVP, systemic vascular resistance (SVR, ejection fracture (EF, heart rate (HR, mean pulmonary artery pressure (MPAP, cardiac index (CI and pulmonary vascular resistance (PVR were performed before, during, and after the operation. The requirements of catecholamine support, the urine-output, the blood-loss, and the requirements in blood, plasma and platelets for the first 24 hours were included in the data collected. The incidence of vasodilatory shock was significantly lower (8% vs 20% in group A and B respectively (p = 0,042. Generally, the mortality was 12%, exclusively deriving from group B. Postoperatively, significant higher values of MAP, CVP, SVR and EF

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

    Directory of Open Access Journals (Sweden)

    Ravulapalli Harish

    2010-01-01

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

  8. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... And the bypass vessel is the so-called “internal mammary artery.” That’s an artery, as opposed to ... you very much. -- while I’m preparing the internal mammary artery for bypass. Good. All right. We ...

  9. 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...

  10. 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...

  11. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... as doctors use for this operation is “TECAB,” meaning “Totally Endoscopic Coronary Artery Bypass.” This procedure will ... make sure his vessels are able for bypass, meaning doing the CT angiograph for the peripheral arteries. ...

  12. 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

  13. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... going to thread that up to the patient’s bypass graft using X-ray, and there you are. So what we’re going to do is manipulate this catheter into actually the artery that leads to the arm, the subclavian, which is where the bypass comes off. Let me just saw it for ...

  14. TECAB - Totally Endoscopic Coronary Artery Bypass

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    Full Text Available ... Artery Bypass June 10, 2009 Welcome to the University of Maryland Medical Center in Baltimore, where you ... to Maryland. Welcome to Baltimore. Welcome to the University of Maryland Medical Center here in OR-26. ...

  15. Types of Coronary Artery Bypass Grafting

    Science.gov (United States)

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

  16. Comparison of hemodynamic responses to laryngoscopy and intubation with Truview PCD TM , McGrath ® and Macintosh laryngoscope in patients undergoing coronary artery bypass grafting: A randomized prospective study

    Directory of Open Access Journals (Sweden)

    Deepak K Tempe

    2016-01-01

    Full Text Available Context: We hypothesized that reduced oropharyngolaryngeal stimulation with video laryngoscopes would attenuate hemodynamic response to laryngoscopy and intubation. Aim: Comparison of hemodynamic response to laryngoscopy and intubation with video laryngoscopes and Macintosh (MC laryngoscope. Setting and Design: Superspecialty tertiary care public hospital; prospective, randomized control study. Methods: Sixty adult patients undergoing elective coronary artery bypass grafting (CABG were randomly allocated to three groups of 20 each: MC, McGrath (MG, and Truview (TV. Hemodynamic parameters were serially recorded before and after intubation. Laryngoscopic grade, laryngoscopy, and tracheal intubation time, ST segment changes, and intra-/post-operative complications were also recorded and compared between groups. Statistical Analysis: SPSS version 17 was used, and appropriate tests applied. P < 0.05 was considered significant. Results: Heart rate and diastolic arterial pressure increased at 0 and 1 min of intubation in all the three groups (P < 0.05 while mean arterial pressure increased at 0 min in the MG and TV groups and at 1 min in all three groups (P < 0.05. A significant increase in systolic arterial pressure was only observed in TV group at 1 min (P < 0.05. These hemodynamic parameters returned to baseline by 3 min of intubation in all the groups. The intergroup comparisons of all hemodynamic parameters were not significant at any time of observation. Highest intubation difficulty score was observed with MC (2.16 ± 1.86 as compared with MG (0.55 ± 0.88 and TV (0.42 ± 0.83 groups (P = 0.003 and P = 0.001, respectively. However, duration of laryngoscopy and intubation was significantly less in MC (36.68 ± 16.15 s as compared with MG (75.25 ± 30.94 s and TV (60.47 ± 27.45 s groups (P = 0.000 and 0.003, respectively. Conclusions: Video laryngoscopes did not demonstrate any advantage in terms of hemodynamic response in patients with normal

  17. 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 ...

  18. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... coronary artery bypass grafting procedure using robotics. We call this operation a “TECAB,” “Totally Endoscopic Coronary Artery ... see 2 the heart beating behind what we call the “pericardium,” the sack where the heart is ...

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

    Science.gov (United States)

    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. ...

  20. 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. ...

  1. Conduits for Coronary Bypass: Internal Thoracic Artery

    OpenAIRE

    Barner, Hendrick B.

    2012-01-01

    This second report in the series on coronary artery bypass presents the authors experience and personal views on the internal thoracic artery (ITA) which date to 1966. There has been a very gradual evolution in the acceptance of this conduit which was initially compared with the saphenous vein and viewed as an improbable alternative to it. As is common with concepts and techniques which are 'outside the box' there was skepticism and criticism of this new conduit which was more difficult and t...

  2. 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 ...

  3. 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

  4. 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.

  5. Robotic coronary artery bypass for aberrant right coronary artery stenosis.

    Science.gov (United States)

    Chen, Kuan-chin Jean; Teefy, Patrick; Kiaii, Bob; Vezina, William C; Chu, Michael Wa

    2010-10-01

    Anomalous coronary arteries that course between the aorta and pulmonary artery are subject to compressive forces and can manifest angina, myocardial infarction and sudden death. The current report presents a young, female patient who presented with a short duration of severe, rapidly progressive angina despite optimal medical therapy. Combined computed tomography and myocardial perfusion scanning identified an anomalous dominant right coronary artery that appeared kinked at its origin between the aorta and main pulmonary artery. A robot-assisted right internal thoracic artery to right coronary artery bypass was performed, which was confirmed to be widely patent (FitzGibbon grade A) on routine intraoperative angiography. The procedure completely resolved the patient's angina symptoms. PMID:20931103

  6. 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

  7. 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

  8. Coronary artery bypass grafting in an achondroplastic dwarf.

    OpenAIRE

    Balaguer, J M; Perry, D; Crowley, J; Moran, J. M.

    1995-01-01

    To our knowledge, coronary bypass for complications of coronary artery disease in achondroplasia has not previously been described. Achondroplasia, in and of itself, is not a contraindication to coronary bypass. Although the anatomic reserve of saphenous vein is less in achondroplastic dwarfs than in people of normal stature, that vessel and the internal mammary artery can be harvested in routine fashion. A 60-year-old woman with several risk factors for coronary artery disease underwent succ...

  9. 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

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

    DEFF Research Database (Denmark)

    Kremke, Michael; Jensen, Mariann Tang; Bak, Mikkel; Kristensen, Katrine Lawaetz; Hindsholm, Karsten; Andreasen, Jan Jesper; Hjortdal, Vibeke; Jakobsen, Carl-Johan

    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...

  11. 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: ...

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

    Science.gov (United States)

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

    2015-01-01

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

  13. 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.

  14. 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

  15. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... perfect bypass. We are often asked how you learn this. Important question. Hours and hours of suturing ... OR-Live” makes it easy for you to learn more. Just click on the “Request information” button ...

  16. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... on for coronary surgery. A very durable bypass running here and supplying the chest wall with blood. ... case the branch, the typical branch that is running between the two heart chambers is located more ...

  17. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... is pulsating behind the fascia. Here is some muscle. Here we have the apex or tip of ... tissue. It then turns into the transverse thoracic muscle here. This bypass vessel has an extremely long ...

  18. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... sure that we preserve this bypass vessel very well in order to achieve this. So I go ... French quick-draw Venus cardiac visions cannula as well, which will draw back, go to the heart- ...

  19. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... as this. Come up. We have this 21 French cardio arterial cannula for arterial profusion. On this right side, this is the 25 French quick-draw Venus cardiac visions cannula as well, ...

  20. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

    DEFF Research Database (Denmark)

    Møller, Christian H; Penninga, Luit; Wetterslev, Jørn; Steinbrüchel, Daniel A; Gluud, Christian

    2012-01-01

    Coronary artery bypass grafting (CABG) is performed both without and with cardiopulmonary bypass, referred to as off-pump and on-pump CABG respectively. However, the preferable technique is unclear.......Coronary artery bypass grafting (CABG) is performed both without and with cardiopulmonary bypass, referred to as off-pump and on-pump CABG respectively. However, the preferable technique is unclear....

  1. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... bypass graft to the LAD. We have a real long-term option. 4 So again, this is under T guidance. Anesthesia tells me that I am in the descending thoracic aorta. That means I’m on the right track. Once that is done then we sequentially ...

  2. 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 ...

  3. 21 CFR 870.4260 - Cardiopulmonary bypass arterial line blood filter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass arterial line blood filter... Cardiopulmonary bypass arterial line blood filter. (a) Identification. A cardiopulmonary bypass arterial line blood filter is a device used as part of a gas exchange (oxygenator) system to filter...

  4. Vascularized Nerve Bypass Graft: A Case Report of an Additional Treatment for Poor Sensory Recovery.

    Science.gov (United States)

    Usami, Satoshi; Tanaka, Kentaro; Ohkubo, Alisa; Okazaki, Mutsumi

    2016-04-01

    End-to-side neurorrhaphy has proven effective in basic research and in clinical application. One of the methods of end-to-side neurorrhaphy, nerve bypass technique, has been reported and axon regeneration has been proven. In clinical application, the utility of the nerve bypass technique has been revealed in some cases; however, these bypasses were performed using nonvascularized nerves. We initially used the vascularized nerve bypass graft technique with the sural nerve as a secondary clinical procedure after median nerve injury in a 61-year-old patient and achieved motor and sensory nerve regeneration, as supported by a nerve conduction study and clinical sensory test. This technique has the potential to become one of the choices for salvage procedure of severe nerve injury. PMID:27200248

  5. 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 ...

  6. 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 ...

  7. 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...

  8. 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 ...

  9. 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 ...

  10. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... endothoracic fascia, as we call it. This is tissue covering that artery, and this is all done ... cleaner as open surgery because there is less tissue trauma and less bleeding, and we also like ...

  11. 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 ...

  12. 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 ...

  13. 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’ ...

  14. 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 ...

  15. 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 ...

  16. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... is pictures of the coronary arteries, by injecting dye into them, which we normally do in a ... Okay. Now we’re going to fill with dye and we’re going to take our picture. ...

  17. 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.

  18. 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.

  19. 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 ...

  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. Constitutive modeling of coronary artery bypass graft with incorporated torsion

    Czech Academy of Sciences Publication Activity Database

    Horný, L.; Chlup, Hynek; Žitný, R.; Adámek, T.

    2009-01-01

    Roč. 49, č. 2 (2009), s. 273-277. ISSN 0543-5846 R&D Projects: GA ČR(CZ) GA106/08/0557 Institutional research plan: CEZ:AV0Z20760514 Keywords : coronary artery bypass graft * constitutive model * digital image correlation Subject RIV: BJ - Thermodynamics Impact factor: 0.439, year: 2009 http:// web .tuke.sk/sjf-kamam/mmams2009/contents.pdf

  2. Coronary Artery Bypass Surgery - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Chinese - Simplified (简体中文) Chinese - Traditional (繁體中文) French (français) Hindi (हिन्दी) Japanese (日本語) Korean (한국어) Russian (Русский) ... coronarien - français (French) Bilingual PDF Health Information Translations Hindi (हिन्दी) Coronary Artery Bypass Surgery हिन्दी ( ...

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

    OpenAIRE

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

    1989-01-01

    The peroxidase-immunoperoxidase immunocytochemical method was used on 27 saphenous vein coronary artery bypass grafts, which had been resected because of recurrent angina, to identify in situ cellular and humoral elements possibly associated with graft occlusion. Immunostaining was performed on paraffin wax embedded control saphenous vein and graft sections incubated directly with primary antibodies against von Willebrand antigen (vWFAg), fibronectin, fibrinogen, leucocyte common antigen (LCA...

  4. 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...

  5. 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.

  6. 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.

  7. Incidental invasive thymoma during coronary artery bypass surgery.

    Science.gov (United States)

    Al-Smady, Moaath; Hammdan, Farouq F; Abu-Abeeleh, Mahmood M; Massad, Islam M

    2009-01-01

    We encountered 2 incidental cases of invasive thymomas at Jordan University Hospital, Amman, Jordan; during routine coronary artery bypass graft surgery between 2005 and 2008 with an incidence of 0.6%. Both patients presented with angina pain. None of the 2 patients had pressure symptoms (cough, shortness of breath or superior vena cava syndrome) or Myasthenia Gravis symptoms. Total thymectomy with dissection of perithymic fat was performed on both cases. No radiotherapy was given. No recurrence of the tumor was seen in 2 years follow up. These cases are presented to emphasize the occurrence of this tumor. PMID:19139788

  8. Fatal Pyoderma Gangrenosum with Pathergy after Coronary Artery Bypass Grafting

    OpenAIRE

    Bryan, Charles S.

    2012-01-01

    Surgeons and others who perform invasive procedures should be aware of the possibility of pyoderma gangrenosum and the risk of pathergy in patients who have a history of unexplained skin ulcers or poor wound-healing. We report the case of a 70-year-old man in whom diffuse erythema over the anterior chest wall and marked leukocytosis developed after coronary artery bypass grafting. This prompted débridement and opening of the sternotomy wound. The cause of the erythema was pyoderma gangrenosum...

  9. Diabetes severely affects attentional performance after coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Krannich Jens-Holger

    2012-11-01

    Full Text Available Abstract Background Diabetes is a risk factor for (micro vascular damage of the brain, too. Therefore cognitive performance after coronary artery bypass grafting may be hypothesized worse in diabetics. To avoid observational errors a reliable tool for testing attentional performance was used. We evaluated whether diabetes mellitus disposes to distinct cognitive dysfunction after coronary artery bypass grafting (CABG. Methods Three aspects in attentional performance were prospectively tested with three different tests (alertness: composed of un-cued and cued reaction, divided attention, and selective attention by a computerized tool one day before and seven days after CABG in a highly selected cohort of 30 males, 10 of whom had diabetes. Statistical comparisons were done with analysis of variance for repeated measurements and Fisher's LSD. Results Prior to CABG there was no statistically meaningful difference between diabetics and non-diabetics. Postoperatively, diabetic patients performed significantly worse than non-diabetics in tests for un-cued (p=0.01 and cued alertness (p=0.03. Test performance in divided attention was worse after CABG but independent of diabetes status. Selective attention was neither affected by diabetes status nor by CABG itself. Conclusions Diabetes may have an impact on cognitive performance after CABG. More severe deficits in alertness may point to underlying microvascular disease.

  10. 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.

  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. 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...

  13. Cost Performance and Efficacy of Off-pump Coronary Artery Bypass Grafting

    OpenAIRE

    Nomura, Fumikazu; Mukai, Shogo; Tamura, Kentaro; Shimazutsu, Kazufumi; Okuma, Kazuhide; Ihara, Katsuhiko

    2002-01-01

    Off-pump coronary artery bypass grafting (Off-Pump CABG) may provide an alternative form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in high-risk patients. To clarify the efficacy and cost performance of Off- Pump CABG, we studied the postoperative course of Off-Pump CABG and compared it to On- pump coronary artery bypass grafting (On-Pump CABG). From Aug. 1998 to Feb. 2002, twenty-eight patients who had preoperative complicatio...

  14. 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.

  15. 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.

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

    Science.gov (United States)

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

    2013-03-01

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

  17. 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

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. 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; Wynia, Klaske; Reijneveld, Sijmen A

    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....

  3. 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.

  4. 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...

  5. 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)...

  6. 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.

  7. 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...

  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. 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.

  10. Local complications after harvesting of radial artery conduit for coronary artery bypass grafting: mayo hospital experience

    International Nuclear Information System (INIS)

    Objectives: To evaluate incidence of local complications of radial artery (RA) harvesting for coronary art-ery bypass grafting (CABG). Patients and Methods: From March 2011 to January 2012, a total of 87 consecutive patients fulfilling the inclusion and exclusion criteria, who underwent CA-BG and had left radial artery used as a conduit were included in this study. Prospective surveillance of surgical site (radial artery harvest site) was assessed on a daily basis during the patient's stay in the Department of Cardiac Surgery, Mayo Hospital / KEMU, Lahore and were reassessed after one month and six months interval. Surgical site assessment includes cutaneous paraesthesia, compartment syndrome, hand Ischemia, donor arm weakness, superficial infection, wound dehiscence, hematoma and impact of these complications on the quality of life. Results: During the study period 6 Patients (6.8%) reported cutaneous paraesthesia around the thenar eminence after 6 months; 3 Patients (3.4%) developed donor arm weakness, normalized after 6 months. Superficial wound infection and Hematoma (not requiring re-exploration) was noted in 1.1% and 2.9% respectively. None of the patients developed compartment syndrome, hand Ischemia, wound dehiscence. Conclusions: Findings confirm that the local complications after radial artery harvesting are rare and are clinically insignificant. (author)

  11. 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...

  12. 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

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

    International Nuclear Information System (INIS)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  15. 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....

  16. 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...

  17. 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...

  18. Contrast-enhanced cardiac MRI before coronary artery bypass surgery: impact of myocardial scar extent on bypass flow

    International Nuclear Information System (INIS)

    The aim of the study was to relate the extent of myocardial late gadolinium enhancement (LGE) in cardiac MRI to intraoperative graft flow in patients undergoing coronary artery bypass graft (CABG) surgery. Thirty-three CAD patients underwent LGE MRI before surgery using an inversion-recovery GRE sequence (turboFLASH). Intraoperative graft flow in Doppler ultrasonography was compared with the scar extent in each coronary vessel territory. One hundred and fourteen grafts were established supplying 86 of the 99 vessel territories. A significant negative correlation was found between scar extent and graft flow (r = -0.4, p -1; p < 0.0001). In summary, the extent of myocardial scar as defined by contrast-enhanced MRI predicts coronary bypass graft flow. Beyond the probability of functional recovery, preoperative MRI might add value to surgery planning by predicting midterm bypass graft patency. (orig.)

  19. 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

  20. 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.

  1. Adaptive mechanisms of arterial and venous coronary bypass grafts to an increase in flow demand

    OpenAIRE

    Gurné, Olivier; Chenu, Patrick; Buche, Michel; Louagie, Yves; Eucher, Philippe; Marchandise, Baudouin; Rombaut, E; Blommaert, Dominique; Schroeder, Erwin

    1999-01-01

    OBJECTIVE—To compare the mechanisms by which arterial and venous grafts increase their flow during pacing induced tachycardia, early and later after coronary bypass surgery.
DESIGN—43 grafts (13 epigastric artery, 15 mammary artery, 15 saphenous vein) evaluated early (9 (3) days (mean (SD)) after bypass surgery were compared with 41 other grafts (15 epigastric, 11 mammary, 15 saphenous vein) evaluated later after surgery (mean 23 months, range 6 to 168 months) by quantitative angiography and ...

  2. 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.

  3. 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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2007-09-01

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

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

    Medline Plus

    Full Text Available ... needs to be bypassed. So I feel more confident that I can go ahead and start taking ... more so as people become more familiar and confident with their skills. 00:39:31 JOHN PENNOCK, ...

  7. 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.

  8. 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.

  9. 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...

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

    Medline Plus

    Full Text Available ... I'm freeing up the vein and this white vessel here is actually the artery. 00:24: ... going to the circumflex artery, which is the white straight line underneath. Off. That tells me that ...

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

    Medline Plus

    Full Text Available ... MD: Now, this time you're going to leave the [unintelligible] attached. 00:39:36 CHRIS MCCARTY, ... internal mammary artery distally. We're going to leave it attached proximally to the subclavian artery. We' ...

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

    Medline Plus

    Full Text Available ... The blood flow that goes down that artery rises from the takeoff of the mammary artery from ... able to fluoresce the dye on a low-level laser camera. Okay, good. I think we've ...

  13. 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...

  14. 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...

  15. 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...

  16. Indications, algorithms, and outcomes for coronary artery bypass surgery in patients with acute coronary syndromes.

    Science.gov (United States)

    Yerokun, Babatunde A; Williams, Judson B; Gaca, Jeffrey; Smith, Peter K; Roe, Matthew T

    2016-06-01

    For patients with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), guideline recommendations and treatment pathways focus on revascularization for definitive treatment if the patient is an appropriate candidate. Despite the widespread use of revascularization for NSTE-ACS, most patients undergo a percutaneous coronary intervention, whereas a minority of patients undergo coronary artery bypass grafting. Focusing specifically on the USA, the contemporary utilization, preoperative and perioperative considerations, and outcomes of NSTE-ACS patients undergoing coronary artery bypass grafting have not been comprehensively reviewed. PMID:26945187

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

    OpenAIRE

    Raissi Kamal; Givtaj Nader; Abdi Seifollah; Motevali Marzieh; Noohi Fereidoun; Salari Farzad; Bassri Hosseinali; Haghjoo Majid

    2009-01-01

    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 aft...

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

    OpenAIRE

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

    2013-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘in coronary artery bypass grafting using radial artery grafts, does proximal anastomosis to the aorta or left internal mammary artery achieve better patency’. Altogether >183 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study ty...

  19. Endovascular therapeutic occlusion following bilateral carotid artery bypass for radiation-induced carotid artery blowout. Case report

    International Nuclear Information System (INIS)

    A patients with breast cancer received radiation therapy to the upper chest wall. Twenty-two years later, she presented with repeated severe bleeding through a left lower neck ulcer. She was taken to surgery for hemostasis, which was not successful because the carotid artery was surgically inaccessible. To manage for explosive carotid blowout, we performed common carotid artery ligation and endovascular coil embolization after contralateral-external-carotid to ipsilateral-common-carotid artery bypass with a polytetrafluoroethylene (PTFE) graft. The patients has experienced no ischemic events or bleeding since this treatment. (author)

  20. 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...

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

    OpenAIRE

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

    2003-01-01

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

  2. Does Off-pump Coronary Artery Bypass Reduce the Prevalence of Atrial Fibrillation?

    OpenAIRE

    Khosrow Hashemzadeh; Marjan Dehdilani; Mahnaz Dehdilani

    2013-01-01

    Introduction: To examine whether or not off-pump CABG (Coronary Artery Bypass Reduce) reduces the incidence of AF after cardiac surgery. Methods: The study was carried out in 939 consecutive coronary artery disease patients with sinus rhythm from which 383 patients underwent off-pump CABG, and 556 patients were operated through on-pump CABG. All patients were monitored postoperatively during intensive care unit (ICU) stay. Then, the incidence and predictive risk factors of post operative A...

  3. Does Off-pump Coronary Artery Bypass Reduce the Prevalence ofAtrial Fibrillation?

    OpenAIRE

    Hashemzadeh, Khosrow; Dehdilani, Marjan; Dehdilani, Mahnaz

    2013-01-01

    Introduction: To examine whether or not off-pump CABG (Coronary Artery Bypass Reduce) reduces the incidence of AF after cardiac surgery. Methods: The study was carried out in 939 consecutive coronary artery disease patients with sinus rhythm from which 383 patients underwent off-pump CABG, and 556 patients were operated through on-pump CABG. All patients were monitored postoperatively during intensive care unit (ICU) stay. Then, the incidence and predictive risk factors of post opera...

  4. 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...

  5. 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

  6. 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

  7. 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...

  8. Contrast enhanced magnetic resonance angiography for determining patency of coronary bypass grafts. A comparison with coronary angiography

    International Nuclear Information System (INIS)

    Aim: Assessment of graft patency with current non-invasive MRA techniques is particularly difficult for evaluating internal mammary artery grafts. Our aim is to determine the accuracy of a contrast enhanced MRA technique in assessing graft patency. Methods: We examined 19 patients with a total of 53 grafts (32 venous/21 arterial), using an ultrafast contrast enhanced 3D gradient-echo technique and compared this with the results of selective angiography. Results: Sensitivity of the contrast enhanced method was 95.2% for venous grafts, 94.4% for IMA grafts and 94.8% overall. Specificity was 85.7% overall, 90.9% for venous and 66.7% for IMA grafts. Positive predictive value was 94.4%. Conclusion: Compared with previous studies, visualisation of IMA grafts was improved by using contrast enhanced MRA. In this preliminary study, contrast enhanced MRA proved promising for the assessment of graft patency. (orig.)

  9. Effect of trimetazidine and glucose- insulin-potassium use on myocard during beating heart coronary artery bypass surgery

    OpenAIRE

    Ercan, Abdulkadir; Velioğlu, Yusuf; Ercan, Arzu; Gürbüz, Orçun; Özkan, Hakan; Karal, İlker Hasan; Biçer, Murat; Ener, Serdar

    2011-01-01

    Objectives: This prospective, randomised, controlled, clinical study was planned to determine the effect of trimetazidine and glucose - insulin - potassium (GIK) on myocardial ischemia-rep­erfusion during beating heart coronary artery bypass surgery. Materials and methods: Patients (n=45) with coronary artery disease who required beating heart coronary artery bypass grafting were randomly allocated into three groups. Patients in group 1 (n=15) was recevied trimetazidine (20 mg x 3...

  10. Effect of trimetazidine and glucose- insulin-potassium use on myocard during beating heart coronary artery bypass surgery

    OpenAIRE

    Abdulkadir Ercan; Yusuf Velioğlu; Arzu Ercan; Orçun Gürbüz; Hakan Özkan; İlker Hasan Karal; Murat Biçer; Serdar Ener

    2011-01-01

    Objectives: This prospective, randomised, controlled, clinical study was planned to determine the effect of trimetazidine and glucose - insulin - potassium (GIK) on myocardial ischemia-reperfusion during beating heart coronary artery bypass surgery.Materials and methods: Patients (n=45) with coronary artery disease who required beating heart coronary artery bypass grafting were randomly allocated into three groups. Patients in group 1 (n=15) was recevied trimetazidine (20 mg x 3 per day) 7 da...

  11. 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.

  12. 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

  13. 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.

  14. 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 ...

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

    Medline Plus

    Full Text Available ... went to his family physician, who did a stress test, which was markedly abnormal, especially in what ... across them because I'm also worried about injury to the artery as I do that. So ...

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

    Medline Plus

    Full Text Available ... a profession that allows me with a good computer line and a telephone, I can pretty much ... take a left-sided artery down. It's not super common to take both IMAs down but I' ...

  17. 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 ...

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

    Medline Plus

    Full Text Available ... need to be a proficient off-pump surgeon, meaning a beating heart surgeon. To me, I don' ... sure that we have all of the arteries, meaning the left IMA and the right IMA ready ...

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

    Medline Plus

    Full Text Available ... which was markedly abnormal, especially in what we call the lateral wall, or where the circumflex artery ... front surface of the heart is what we call atretic, or very small for him. He was ...

  20. Coronary artery bypass graft in a patient with Fabry's disease.

    Science.gov (United States)

    Osada, Hiroaki; Kanemitsu, Naoki; Kyogoku, Masahisa

    2016-01-01

    Fabry's disease is a lysosomal storage disease characterized by intracellular accumulation of ceramide trihexoside resulting from alpha-galactosidase A deficiency. While the heart is often involved, coronary artery disease and its management in Fabry's disease patients are extremely rare clinical entities. We report a case of a 72-year-old man with left main disease in Fabry's disease with special consideration of the arterial wall pathology. PMID:27131517

  1. 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. PMID:6968314

  2. Management of a patient with hyperkalemic periodic paralysis requiring coronary artery bypass grafts

    Directory of Open Access Journals (Sweden)

    Sanjay Orathi Patangi

    2012-01-01

    Full Text Available Hyperkalemic periodic paralysis (HPP is an autosomal-dominant inherited muscle disease characterized by episodes of flaccid weakness and intermittent myotonia. There are no previous reports in the literature about anesthesia for cardiac surgery with cardiopulmonary bypass in this disorder. We describe perioperative anesthetic management for on-pump coronary artery bypass grafting in a 75-year-old man with a history of hyperkalemic periodic paralysis. This case report outlines our management strategy and the issues encountered during the perioperative period.

  3. 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...

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

    Medline Plus

    Full Text Available ... years, helping me to do what is my dream, not necessarily their dream, but my dream to do this for patients. So, here we ... across them because I'm also worried about injury to the artery as I do that. So ...

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

    Medline Plus

    Full Text Available ... be cognizant of that as well. 00:20:42 JOHN PENNOCK, MD: For the non-cardiac surgeons ... the artery will come fairly freely. 00:23:42 JOHN PENNOCK, MD: We're mostly looking at ...

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

    Science.gov (United States)

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

    2014-12-01

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

  7. 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.

  8. 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).

  9. [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

  10. 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.

  11. 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 ...

  12. 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.

  13. 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...

  14. 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...

  15. Heart Rate Variability after Off-Pump versus On-Pump Coronary Artery Bypass Graft Surgery

    OpenAIRE

    Dusko Cerovec; Franjo Baborski; Valentina Slivnjak; Nenad Lakusic

    2009-01-01

    Background. It is known that after coronary artery bypass graft surgery (CABG) heart rate variability (HRV) becomes significantly decreased with a gradual recovery in a few months after surgery. However, literature data about the impact of the off-pump CABG on postoperative HRV are not complete. Therefore, the aim of this study was to analyze postoperative value of HRV in CABG patients operated on with off-pump versus on-pump coronary surgery. Methods. This study included 206 consecutive pati...

  16. Hypercoagulability in patients undergoing coronary artery bypass grafting: prevalence, patient characteristics and postoperative outcome

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Johansson, Per Ingemar; Ostrowski, Sisse Rye; Stissing, Trine; Steinbrüchel, Daniel Andreas

    2012-01-01

    OBJECTIVESTo investigate the prevalence of preoperative hypercoagulability assessed by thromboelastography (TEG), to identify patient characteristics associated with hypercoagulability and to explore whether hypercoagulability is associated with a greater risk for myocardial infarction (MI), stroke...... and mortality 30 days after coronary artery bypass grafting (CABG) surgery.METHODSThis is a prospective, observational study of 200 consecutive CABG surgery patients. Hypercoagulability was defined as TEG maximum amplitude >69 mm.RESULTSEighty-seven out of 200 (43.5%) CABG patients were TEG...

  17. 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...

  18. 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...

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

    OpenAIRE

    Amit Vora

    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,...

  20. Treatment of failing vein grafts in patients who underwent lower extremity arterial bypass

    OpenAIRE

    Park, Keun-Myoung; Park, Yang Jin; Yang, Shin-Seok; Kim, Dong-Ik; Kim, Young-Wook

    2012-01-01

    Purpose We attempted to determine risk factors for the development of failing vein graft and optimal treatment in patients with infrainguinal vein grafts. Methods We retrospectively reviewed a database of patients who underwent infrainguinal bypass using autogenous vein grafts due to chronic atherosclerotic arterial occlusive disease of lower extremity (LE) at a single institute between September 2003 and December 2011. After reviewing demographic, clinical, and angiographic features of the p...

  1. Aspects of psychological and social morbidity in patients awaiting coronary artery bypass grafting.

    OpenAIRE

    Underwood, M J; Firmin, R K; Jehu, D

    1993-01-01

    OBJECTIVES--To assess anxiety, depression, and social adjustment in patients awaiting coronary artery bypass surgery. DESIGN--Patient completed questionnaire study. SETTING--Regional cardiothoracic centre. PATIENTS--109 questionnaires were sent to patients on the waiting list of two cardiothoracic surgeons. Sixty eight (62%) were returned and 15 (22%) of the respondents were women. There was no difference in the response rates for men (53/84) 63% and women (15/25) 60%. MAIN OUTCOME MEASURES--...

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

    OpenAIRE

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

    2014-01-01

    Background Atherosclerotic disease in coronary artery bypass grafting (CABG) patients is a potential contributor to complications in the perioperative periods. This study was undertaken to better define how the frequency of aortic atheromatous disease among patients coming for CABG has evolved over the last decade. Methods Data from elective patients coming for CABG who underwent transesophageal echocardiography (TEE) examinations following induction of anesthesia were obtained for the years ...

  3. Risk factors for deterioration of renal function after coronary artery bypass grafting

    OpenAIRE

    van Straten, Albert; Hamad, Mohamed; Van Zundert, Adrien; Martens, Elisabeth; Schönberger, Jacques; de Wolf, Andre

    2010-01-01

    Abstract Objective: Various definitions of impairment of renal function after coronary artery bypass grafting (CABG) are used in the literature. Depending on the definition, several risk factors are identified. We analysed our data to determine the risk factors for postoperative deterioration of the creatinine clearance of 10% or more. Methods: All patients undergoing isolated coronary surgery in a single centre between January 1998 and December 2007 are included. Clinical data, including ...

  4. 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...

  5. 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 (...

  6. 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 ...

  7. 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...

  8. 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 ...

  9. 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...

  10. 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...

  11. 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, ...

  12. Myocardial protection with prophylactic oral metoprolol during coronary artery bypass grafting surgery: evaluation by troponin I

    Directory of Open Access Journals (Sweden)

    João Manoel Rossi Neto

    2013-12-01

    Full Text Available INTRODUCTION: Biochemical markers of myocardial injury are frequently altered after cardiac surgery. So far there is no evidence whether oral beta-blockers may reduce myocardial injury after coronary artery bypass grafting. OBJECTIVE: To determine if oral administration of prophylactic metoprolol reduces the release of cardiac troponin I in isolated coronary artery bypass grafting, not complicated by new Q waves. METHODS: A prospective randomized study, including 68 patients, divided in 2 groups: Group A (n=33, control and B (n=35, beta-blockers. In group B, metoprolol tartrate was administered 200 mg/day. The myocardial injury was assessed by troponin I with 1 hour and 12 hours after coronary artery bypass grafting. RESULTS: No significant difference between groups regarding pre-surgical, surgical, complication in intensive care (15% versus 14%, P=0.92 and the total number of hospital events (21% versus 14%, P=0.45 was observed. The median value of troponin I with 12 hours in the study population was 3.3 ng/ml and was lower in group B than in group A (2.5 ng/ml versus 3.7 ng/ml, P<0,05. In the multivariate analysis, the variables that have shown to be independent predictors of troponin I release after 12 hours were: no beta-blockers administration and number of vessels treated. CONCLUSION: The results of this study in uncomplicated coronary artery bypass grafting, comparing the postoperative release of troponin I at 12 hours between the control group and who used oral prophylactic metoprolol for at least 72 hours, allow to conclude that there was less myocardial injury in the betablocker group, giving some degree of myocardial protection.

  13. Off-pump awake coronary artery bypass grafting under high thoracic epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Bharat Paliwal

    2016-01-01

    Full Text Available Conventionally general anesthesia has been the preferred anesthetic technique for coronary artery bypass grafting (CABG. Ever since the first awake CABG the concept though appearing promising is still being continually evaluated. From the Indian perspective, the practice has been largely limited to certain institutions and seems to be not widely practiced across India. This case reports our experience with this technique from the western part of the country.

  14. 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...

  15. 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; Vach, Werner; Haghfelt, Torben; Høilund-Carlsen, Poul F.; Andersen, Lars Ib

    2007-01-01

    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...

  16. Robotic totally endoscopic coronary artery bypass and catheter based coronary intervention in one operative session.

    Science.gov (United States)

    Bonatti, Johannes; Schachner, Thomas; Bonaros, Nikolaos; Laufer, Günther; Kolbitsch, Christian; Margreiter, Josef; Jonetzko, Patrycja; Pachinger, Otmar; Friedrich, Guy

    2005-06-01

    A 56-year-old male patient underwent robotically assisted totally endoscopic left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafting. After protamine administration complete heart block developed in the patient. On intraoperative angiography the LIMA to LAD graft was perfectly patent but an acute occlusion of the right coronary artery (RCA) was noted. We performed an immediate on table percutaneous coronary angioplasty and stent placement to the RCA. The heart regained sinus rhythm and the wall motion abnormalities on the back wall of the heart resolved. No clinical symptoms indicating ongoing myocardial ischemia were noted postoperatively. This case demonstrates that a hybrid procedure of robotic totally endoscopic coronary artery bypass grafting and catheter based coronary intervention is feasible in one simultaneous session. PMID:15919329

  17. Nurse’s Perception of Stressors Associated with Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Kobra Parvan

    2012-11-01

    Full Text Available Introduction: Cardiac surgery has many physiological, psychological, emotional, growth and spiritual potential consequences due to stress. Identifying and understanding the nature of stress can help nurses in controlling and reducing it. However, few studies have been conducted to identify the stressors. Therefore, the objective of this study was to determine nurses' perceptions of patients' stressors associated with coronary artery bypass surgery. Methods: During a two month investigation, qualified nurses (n = 68 of patients undergoing coronary artery bypass were selected on the third to fifth day after surgery. With the use of Revised Cardiac Surgery Stressors Scale (RCSSS, interpersonal, intrapersonal and extrapersonal stressors were determined. Results: The findings showed that the most interpersonal, intrapersonal and extrapersonal stressors were; “the need to have cardiac surgery”, “death due to illness or surgery”, “needing assistance with various activities”, “doctors and nurses discussing about other patients”, “having chest tube” and “Payment of hospital and medical bills”. Conclusion: Identification of stressors in patients with coronary artery bypass graft helps nurses in taking better care of them. It would make a better ground for the officials and practitioners towards managing the stressors, especially interpersonal and extrapersonal stressors. Thereby patients are helped to cope with stressors.

  18. 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; Thomsen, Carsten; Hassager, Christian; Steinbrüchel, Daniel; Schroeder, Torben; Clemmensen, Peter; Kelbæk, Henning

    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......-operative subclinical cerebral lesions. The associations between CAS/VAS post-operative cerebral lesions were investigated. RESULTS: Forty-six patients were included in the study. 13% had significant CAS and 11% had significant VAS. Thirty-five percent had new cerebral infarction postoperatively. We found a significant...... association between the presence of cerebral vessel stenosis and acute cerebral infarction (67% vs. 27%, p = 0.047). However none of the patients with stenosis had isolated cerebral lesions in the ipsilateral vascular territory. CONCLUSION: Asymptomatic CAS and VAS is common in CABG patients and is associated...

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Comparison of flow capacities of arterial and venous grafts for coronary artery bypass grafting: evaluation with exercise thallium-201 single-photon emission tomography

    International Nuclear Information System (INIS)

    Stress thallium-201 tomography was performed to compare the flow capacities of arterial and saphenous vein grafts in patients with coronary artery bypass grafting (CABG). One hundred and seven consecutive patients (95 male and 12 female; mean age 58±9.1 years) underwent exercise-redistribution 201Tl myocardial single-photon emission tomography 4-5 weeks after CABG. When a reversible perfusion defect was present in the area covered by a patent bypass graft, the flow capacity of the graft was defined as insufficient. Of all 285 grafts, 211 were considered as complete bypass. Reversible perfusion defects were present in 29 (27%) of 108 myocardial areas supplied by patent arterial grafts but in only 5 (5%) of 103 myocardial areas supplied by patent saphenous vein grafts (P<0.0001). In the LAD area reversible defects were observed in 22 of 82 areas covered by arterial grafts, in contrast to only 1 of 29 areas covered by venous grafts (P<0.01); in the RCA area reversible defects were observed in 7 of 17 and 4 of 41 areas respectively (P<0.01). There was no difference between the native coronary artery stenosis bypassed by patent arterial and venous grafts (88%±12% vs 86%±14% respectively, P=0.27). In conclusion, flow capacities during peak myocardial demand were more frequently insufficient in arterial bypass grafts than in saphenous vein grafts. (orig.)

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Intraarterial digital subtraction angiography for evaluation of internal mammary artery graft in coronary bypass surgery

    International Nuclear Information System (INIS)

    Digital subtraction angiography (DSA) was performed to evaluate graft patency in 60 patients who had undergone coronary artery bypass grafting with the internal mammary artery (IMA). Sixty IMA grafts with 62 distal anastomoses, and 84 saphenous vein grafts with 85 distal anastomoses were evaluated by intraarterial DSA with an image frequency of 4 frames/sec. A No.4 Fr. angiography catheter was introduced percutaneously into the left brachial artery and contrast medium was injected both into the subclavian artery for opacification of the IMA grafts and into the ascending aorta for opacification of aortocoronary saphenous vein grafts. Bypass grafts were defined as patent when grafts were opacified through their entire course, including anastomotic sites. Fifty-nine IMA grafts with 61 distal anastomoses (98%) and 76 saphenous vein grafts with 77 distal anastomoses (91%) were patent. The overall patency rate for total grafts was 94%. In 4 patients, DSA showed a 'string sign' in the IMA graft which was patent but narrowed at its distal segment. In 5 patients, large first intercostal branches were opacified. Intraarterial DSA with the retrograde brachial approach is not difficult, and is an excellent low risk method of evaluating the patency of IMA and saphenous vein grafts. DSA provided information about functional patency as well as anatomical patency of the IMA graft. (author)

  3. 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.

  4. 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

    BACKGROUND: Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time...... patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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...

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

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    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.

  11. 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.

  12. 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

  13. Echocardiographic detection of free-floating thrombus in left ventricle during coronary artery bypass grafting

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    Jagadeesh N Vaggar

    2015-01-01

    Full Text Available We report an incident of detection of a free-floating thrombus in the left ventricle (LV using intraoperative two-dimensional (2D and three-dimensional (3D transesophageal echocardiography (TEE during proximal coronary artery bypass graft anastomosis. A 58-year-old man presented to us with a 6-month history of chest pain without any history suggestive of myocardial infarction or transient ischemic attacks. His preoperative echocardiography revealed the systolic dysfunction of LV, mild hypokinesia of basal and mid-anterior wall, and the absence of an aneurysm. He was scheduled for on-pump coronary artery bypass surgery. On intraoperative TEE before establishing cardiopulmonary bypass (CPB, a small immobile mass was found attached to LV apical area. After completion of distal coronary artery grafting, when the aortic cross-clamp was removed, the heart was filled partially and beating spontaneously. TEE examination using 2D mode revealed a free-floating mass in the LV, which was suspected to be a thrombus. Additional navigation using biplane and 3D modes confirmed the presence of the thrombus and distinguished it from papillary muscles and artifact. The surgeon opened the left atrium after re-establishing electromechanical quiescence and removed a thrombus measuring 1.5 cm Χ 1 cm from the LV. The LV mass in the apical region was no longer seen after discontinuation of CPB. Accurate TEE-detection and timely removal of the thrombus averted disastrous embolic complications. Intraoperative 2D and recent biplane and 3D echocardiography modes are useful monitoring tools during the conduct of CPB.

  14. 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...

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

    Science.gov (United States)

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

    2015-11-01

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

  16. 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...

  17. Rehabilitation after coronary artery by-pass grafting and improved quality of life.

    OpenAIRE

    Hoad, N A; Crawford, I C

    1990-01-01

    Long waiting lists for coronary artery by-pass grafting often mean that patients have to endure a prolonged period of pre-operative disability, a known poor prognostic factor for their future quality of life and employment prospects. A survey of 60 patients who attended a post-operative rehabilitation course designed to restore their fitness and self-esteem, and hence their quality of life, has shown encouraging results. When questioned a mean 16 months later, 85 per cent are working and sign...

  18. 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...

  19. 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...

  20. 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.

  1. 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.

  2. 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.

  3. Non-invasive assessment of coronary artery bypass grafts - an update; Koronare Bypassdiagnostik mit CT und MRT - eine Bestandsaufnahme

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, K.F.; Ehrhard, K.; Kunz, R.P.; Oberholzer, K.; Mildenberger, P.; Thelen, M. [Klinik und Poliklinik fuer Radiologie der Johannes Gutenberg-Univ. Mainz (Germany); Abegunewardene, N.; Horstick, G. [2. Medizinische Klinik und Poliklinik der Johannes Gutenberg-Univ. Mainz (Germany); Hake, U. [Klinik und Poliklinik fuer Herz-Thorax- und Gefaesschirurgie der Johannes Gutenberg-Univ. Mainz (Germany)

    2004-08-01

    The limited lifetime and the correlation between graft occlusion and recurring symptoms underline the need for repeated imaging of coronary artery bypass grafts. CT and MRI allow for noninvasive imaging of coronary bypasses with high accuracies concerning the patency of these vessels. Multidetector CT seem to be the CT technique of choice, especially after the introduction of 16 slice CT scanners for morphologic assessment of coronary artery bypass grafts. Compared with MRI, CT is a robust technique for assessment of cardiac anastomoses, native coronary arteries, anf for the detection of graft stenoses. MRI, however, is able to deliver functional information about the grafts and the recipient coronary arteries by determining the coronary flow reserve. Furthermore, it can be integrated in a multiparametric MR examination protocol. The follow-up of asymptomatic patients can primarily be done by these non-invasive techniques as nearly every third patient reveals an asymptomatic bypass occlusion 5 years after operation. Furthermore, patients with atypical complaints after the operation may undergo non-invasive imaging as long as documented patency of the bypass averts coronary angiography. Patients with recurrent angina pectoris and/or myocardial ischemia discovered by other cardiologic tests have to undergo coronary angiography. (orig.)

  4. 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)

  5. 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)

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

    Science.gov (United States)

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

    2015-01-01

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

  7. 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.

  8. Efficacy of preoperative trimetazidine for preventing myocardial injury in patients undergoing off-pump coronary artery bypass grafting

    OpenAIRE

    Tamer Turk; Yusuf Ata; Ufuk Aydin; Hasan Ari; Kagan Ahmet As; Senol Yavuz

    2016-01-01

    Objective. Off-pump coronary artery bypass grafting (CABG) with median sternotomy have been shown to be beneficial and associated with reduced myocardial injury. However, there is still a risk for ischemic myocardial injury that results from the normothermic  and metabolically active myocardium during the occlusion of the target coronary artery. We aimed to evaluate the efficacy of trimetazidine in prevention of myocardial tissue injury in patients undergoing off-pump CABG by measuring serum ...

  9. 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...

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

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    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.

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

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    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.

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

    Directory of Open Access Journals (Sweden)

    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

  13. 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 >...

  14. 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...

  15. 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 ...

  16. Indications for coronary artery bypass grafting in 2009: what is left to surgery.

    Science.gov (United States)

    Caparrelli, D J; Ghazoul, M; Diethrich, E B

    2009-02-01

    Coronary artery bypass grafting (CABG) remains the most common procedure performed by cardiac surgeons, yet it is clear that the landscape of coronary intervention is constantly changing as new technology is introduced and data from countless studies continues to be published. However, no single study will be able to clearly define the indications for surgical versus percutaneous revascularization in every clinical scenario given the complexity of this disease as well as that of the patients it afflicts. Moreover, the significant improvements in percutaneous therapy, medical therapy management, perioperative care and secondary prevention after revascularization have decreased the morbidity and mortality of coronary artery disease making comparison between therapies far more difficult. Based on the available literature to date, surgical revascularization (CABG) provides significant benefit in certain patient populations; particularly those with comorbid conditions (for example diabetes, left ventricular [LV] dysfunction) and with more severe disease (for example left main, three-vessel). The goal of this article is to outline the current for surgical revascularization (CABG) understanding that coronary artery disease will continue be an important cause of morbidity and mortality and further study and re-evaluation of these recommendations will likely be necessary as time goes on. PMID:19179987

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2013-12-01

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

  19. 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

  20. 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

  1. PTFE bypass to below-knee arteries: distal vein collar or not? A prospective randomised multicentre study

    DEFF Research Database (Denmark)

    Lundgren, Fredrik; Bergqvist, David; Norgren, Lars; Schroeder, Torben Veith

    2010-01-01

    Patency and limb salvage after synthetic bypass to the arteries below-knee are inferior to that which can be achieved with autologous vein. Use of a vein collar at the distal anastomosis has been suggested to improve patency and limb salvage, a problem that is analysed in this randomised clinical...

  2. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Frequency of Use of Statins and Aspirin in Patients With Previous Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Curl, Kevin; LeBude, Bryan; Ruggiero, Nicholas; Fischman, David; Rose, Andrew; Patel, Sulay; Ogilby, David; Walinsky, Paul; Jasti, Babu; Savage, Michael

    2016-07-01

    Coronary artery bypass grafting (CABG) is commonly performed to treat ischemic heart disease, but long-term benefits are limited by failed patency of bypass grafts. Both statin medications and aspirin hold class I indications for all post-CABG patients and should be continued indefinitely unless contraindications exist. Unfortunately, there are limited data regarding long-term usage of these essential medications. We assessed the utilization rates of statins and aspirin among post-CABG patients referred for coronary angiography. Analysis of post-CABG patients presenting to Thomas Jefferson University for a cardiac catheterization procedure at least 3 years after surgery was performed. Inpatient and outpatient records were reviewed to assess prescribing patterns of these medications, as well as other pertinent clinical and laboratory data. The study population was 381 consecutive patients presenting at a mean of 11 ± 6 years from CABG. Mean age was 69 ± 11 years and 78% were men. A total 67% of patients were being prescribed a statin, whereas 75% were prescribed aspirin. Only 52% were prescribed both at the time of catheterization. Patients prescribed a statin had a significantly lower mean low-density lipoprotein (87 vs 106 [p grafts in the patients not on statin medications remained patent. In conclusion, long-term statin and aspirin use after CABG remains suboptimal despite clear guideline recommendations and clinical trial evidence of their effectiveness. PMID:27178330

  5. Evaluation of Factors Influencing Liver Function Test in On-Pump Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Shahrbano Shahbazi

    2013-12-01

    Full Text Available Background: Liver dysfunction during on-pump coronary artery bypass graft surgery (CABG is a rare complication but is associated with significant morbidity and mortality. The ability to identify high-risk patients may be helpful in planning appropriate management strategies. We aimed to evaluate the factors influencing liver function tests during on-pump CABG. Methods: In 146 patients scheduled for on-pump CABG, the liver function test was done preoperatively and on the first postoperative day. Some preoperative and intraoperative risk factors were checked and then the postoperative liver function tests were compared with the preoperative ones. Probable relationships between these changes and the preoperative and intraoperative risk factors were studied. Results: A medical history of diabetes had a significant relationship with the changes in direct bilirubin. Preoperative central venous pressure had a significant relationship with the changes in aspartate aminotransferase and alanine aminotransferase. Use of intra-aortic balloon pump and duration of aortic cross-clamp were significantly related to the changes in the liver function tests except for alanine aminotransferase and alkaline phosphatase. Conclusion: It seems that the techniques for the reduction of cardiopulmonary bypass and aortic cross-clamp duration may be useful to protect liver function. We recommend that a larger population of patients be studied to confirm these findings.

  6. 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.

  7. 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.

  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. 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

    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 was...... 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...... of atrial fibrillation compared with 32 in the control group (p < 0.01) whereas there were no differences in the length of stay. The mean total cost per patient was 7,639 euros in the amiodarone group and 7,814 euros in the placebo group (p < 0.01). CONCLUSIONS: Routine use of postoperative...

  10. Randomized trial of the effects of exercise training after coronary artery bypass surgery

    International Nuclear Information System (INIS)

    Fifty-three male volunteers who had undergone coronary artery bypass surgery were randomized to a medically supervised exercise program (N = 28) or to usual community care (N = 25). They were tested initially and at one year with exercise tests for thallium scintigraphy, maximal oxygen uptake, and electrocardiography. Approximately one third of the patients had signs and/or symptoms of ischemia consistent with incomplete or unsuccessful revascularization. Over the year there were five dropouts, but no major complications occurred. The exercisers attended an average of 82% of the sessions (three times a week) and trained at 80% of their maximal heart rate. Both the exercisers with and those without angina had significant increases in estimated and measured oxygen uptake and significant declines in submaximal and resting heart rate. There was a trend toward improved thallium scans in the exercised patients with angina

  11. 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)

  12. Intra-arterial papaverine and leg vascular resistance during in situ bypass surgery with high or low epidural anaesthesia

    DEFF Research Database (Denmark)

    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T V; Lorentzen, J E; Secher, N H

    1993-01-01

    In situ saphenous vein arterial bypass flow was studied in 16 patients with respect to level of epidural anaesthesia. Arterial pressure and electromagnetic flow were used to evaluate arterial tone by intra-arterial (i.a.) papaverine. Eight patients had a low epidural block (< or = Th. 10) and eight...... patients were operated during high epidural anaesthesia (> Th. 10). Flow increased and arterial pressure decreased after i.a. papaverine in all patients. When compared with patients operated during high epidural anaesthesia, flow increase and decrease in vascular resistance took place in patients operated...... during low epidural anaesthesia (P < 0.02). Increase in arterial flow after i.a. papaverine was not significantly different in patients operated in low epidural and general anaesthesia (n = 8). In eight patients with insulin-dependent diabetes mellitus who had low epidural anaesthesia, the increase in...

  13. 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

  14. Induced Remote Ischemic pre-conditioning on Ischemia - reperfusion Injury in patients undergoing coronary artery bypass

    International Nuclear Information System (INIS)

    To determine the role of remote ischemic pre-conditioning (riPC) on myocardium, against ischemia reperfusion injury in patients undergoing coronary artery bypass graft (CABG) surgery by measuring CKMB levels. Study Design: A randomized controlled trial. Place and Duration of Study: The Surgical Department of Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, from January to June 2008. Methodology: One hundred patients with double and triple vessels coronary artery disease were randomized in two groups of 50 each. riPC protocol consisted of 3 x 5 minutes of forearm ischemia, induced by a blood pressure cuff inflated to 200 mmHg, with an intervening 5 minutes of reperfusion, during which the cuff was deflated. Patients in the control group were not subjected to limb ischemia. The protocol of induced ischemia was completed before placing patients on extracorporeal bypass circuit. At the end of surgery serum CKMB levels were measured and compared at 8, 16, 24 and 48 hours from both the groups. Written informed consent was taken from patients. Study was approved by the hospital ethical committee. Results: Remote ischemic pre-conditioning significantly reduced CKMB levels at 8, 16, 24 and 48 hours after surgery with p-values of 0.026, 0.021, 0.052 and 0.003 respectively. There was mean reduction of 3 iu/l in CKMB levels, in patients who underwent riPC protocol prior to CABG surgery, compared to control group. Conclusion: This study showed a significant reduction of enzyme marker CKMB in patients subjected to riPC prior to CABG surgery. This suggests lesser degree of myocardial damage compared to control group in CABG patients. (author)

  15. 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

  16. 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

  17. 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)

  18. 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

  19. 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.

  20. 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

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

    International Nuclear Information System (INIS)

    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. 99mTc-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. 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

  3. 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...

  4. 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.

  5. Effect of trimetazidine and glucose- insulin-potassium use on myocard during beating heart coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Abdulkadir Ercan

    2011-12-01

    Full Text Available Objectives: This prospective, randomised, controlled, clinical study was planned to determine the effect of trimetazidine and glucose - insulin - potassium (GIK on myocardial ischemia-reperfusion during beating heart coronary artery bypass surgery.Materials and methods: Patients (n=45 with coronary artery disease who required beating heart coronary artery bypass grafting were randomly allocated into three groups. Patients in group 1 (n=15 was recevied trimetazidine (20 mg x 3 per day 7 days before surgery. Patients in group 2 (n=15 received GIK infusion after induction of anesthesia through the first 12 hours of intensive care unit convalescence. Patients in group 3 (n=15 were control group. Measurements of blood glucose, circulating creatine kinase MB (CK-MB and Troponin I (TnI concentrations were obtained before surgery, 5 minutes after completion of operation and at 12, 24, and 48 hours postoperatively. Mean pulmonary artery pressure, cardiac index, morbidity and data associated with operation were recorded in all patients preoperatively and postoperatively.Results: Preoperative risk profiles and operative variables were statistically similar when the groups were compared. The concentration of circulating CK-MB and Tn I significantly increased over time after off - pump coronary artery surgery, with no significant intergroup differences. Cardiac index and mean pulmonary artery pressure did not differ significantly between groups.Conclusion: Pretreatment with trimetazidine and GIK infusion protocol were used as an adjunct to ischemic - reperfusion therapy in off - pump coronary artery bypass surgery. These results suggested that pretreatment with trimetazidine and GIK infusion protocol do not significantly reduce ischemic reperfusion damage.

  6. Do preoperative pulmonary function indices predict morbidity after coronary artery bypass surgery?

    Directory of Open Access Journals (Sweden)

    Mahdi Najafi

    2015-01-01

    Full Text Available Context: The reported prevalence of chronic obstructive pulmonary disease (COPD varies among different groups of cardiac surgical patients. Moreover, the prognostic value of preoperative COPD in outcome prediction is controversial. Aims: The present study assessed the morbidity in the different levels of COPD severity and the role of pulmonary function indices in predicting morbidity in patients undergoing coronary artery bypass graft (CABG. Settings and Design: Patients who were candidates for isolated CABG with cardiopulmonary bypass who were recruited for Tehran Heart Center-Coronary Outcome Measurement Study. Methods: Based on spirometry findings, diagnosis of COPD was considered based on Global Initiative for Chronic Obstructive Lung Disease category as forced expiratory volume in 1 s [FEV1]/forced vital capacity 75% predicted, mild (FEV1 60-75% predicted, moderate (FEV1 50-59% predicted, severe (FEV1<50% predicted. The preoperative pulmonary function indices were assessed as predictors, and postoperative morbidity was considered the surgical outcome. Results: This study included 566 consecutive patients. Patients with and without COPD were similar regarding baseline characteristics and clinical data. Hypertension, recent myocardial infarction, and low ejection fraction were higher in patients with different degrees of COPD than the control group while male gender was more frequent in control patients than the others. Restrictive lung disease and current cigarette smoking did not have any significant impact on postoperative complications. We found a borderline P = 0.057 with respect to respiratory failure among different patients of COPD severity so that 14.1% patients in control group, 23.5% in mild, 23.4% in moderate, and 21.9% in severe COPD categories developed respiratory failure after CABG surgery. Conclusion: Among post-CABG complications, patients with different levels of COPD based on STS definition, more frequently developed

  7. 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

  8. 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.

  9. Graft occlusion after coronary artery bypass grafting and stent deformation and in-stent restenosis after succedent stenting in a patient with deep position myocardial bridging

    OpenAIRE

    Zou, Yi-Xi; Huang, Fang-Jiong; Wu, Qiang; Zhu, En-jun

    2012-01-01

    We present a case of deep position myocardial bridging in a patient who had early graft occlusion after coronary artery bypass grafting and had stent deformation and in-stent restonesis after succedent stenting.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. Preventive Effect of Intraoperative Landiolol Administration on Atrial Fibrillation After Off-Pump Coronary Artery Bypass Grafting

    OpenAIRE

    Osumi, Masahiro; Tashiro, Tadashi; Morita, Yuichi; Kamiya, Shinji; Minematsu, Noritoshi; Nishimi, Masaru; Wada, Hideichi

    2014-01-01

    Introduction Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery that is associated with an increased incidence of other complications. This study evaluated the safety and efficacy of landiolol hydrochloride—an ultrashort-acting β1-selective blocker and highly regulated drug, positioned as a class 1 antiarrhythmic in Japan guidelines—for the prevention of AF after off-pump coronary artery bypass grafting (CABG). Methods Between January 2011 and November 2013, 11...

  19. 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...

  20. 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...

  1. Aorto-Bilateral-Femoral-Bilateral-Popliteal Bypass for Leriche Syndrome With Occlusion of Both Superficial Femoral Arteries

    OpenAIRE

    Mitrev, Zan; Veljanovska, Lidija; HRISTOV, Nikola

    2009-01-01

    A 68-year-old man, who is a smoker with hypertension and hyperlipidemia, presented in our hospital with rest pain in both calves. His symptoms started 1 year prior with short distance walking pain in both legs. Preoperative work up discovered Leriche's syndrome with occlusion of both superficial femoral arteries, as shown on the 64-slice computerized tomographic scan (Fig 1). Operative treatment included aorto-bilateral femoral bypass, using 16/8 mm Dacron (Edwards Lifesciences, Irvine, CA) Y...

  2. Is there a surgeon or hospital volume–outcome relationship in off-pump coronary artery bypass surgery?

    OpenAIRE

    Sepehripour, Amir H.; Athanasiou, Thanos

    2012-01-01

    A best evidence topic was written according to a structured protocol. The question addressed was whether there is a surgeon or hospital volume–outcome relationship in patients undergoing off-pump coronary artery bypass surgery. A total of 281 papers were found using the reported searches, of which six represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the...

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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 ...

  8. 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...

  9. 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...

  10. 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

  11. 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

  12. 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

  13. 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...

  14. 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.

  15. [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

  16. 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)

  17. 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

  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. 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...

  20. 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)

  1. 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

  2. Evaluation of the graft flow reserve after coronary artery bypass grafting by stress 201Tl myocardial SPECT. Comparison between arterial grafts and venous grafts

    International Nuclear Information System (INIS)

    We performed stress 201Tl myocardial SPECT to evaluate ischemia and perfusion reserve after coronary artery bypass grafting (CABG). A total of 103 patients was performed stress 201Tl 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 201Tl defect, however, 36 of 117 (30.8%) segments which covered by patent arterial grafts showed reversible 201Tl 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)

  3. 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.

  4. 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.

  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. 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

  7. 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...... E+A 10 of 35 (28.6%), in group A 10 of 36 (27.8%), and in the control group 20 of 48 (41.7%) patients developed AF (odds ratio amiodarone/nonamiodarone 0.47 [0.24-0.90]; P = 0.02). CONCLUSIONS: The perioperative amiodarone regimen used in this study was effective in reducing the incidence of AF...... 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...

  8. 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.

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

    Science.gov (United States)

    Dylewicz, Piotr

    2015-01-01

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

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. Elemental content of erythrocytes from patients undergoing Coronary Artery Bypass Grafting (CABG) surgery using PIXE analysis

    International Nuclear Information System (INIS)

    This on-going study was conducted on erythrocytes to further establish the content of elements of blood fractions from patients undergoing Coronary Artery Bypass Grafting (CABG) surgery. As the quality and quantity of elements in these samples were unknown, proton induced X-ray emission (PIXE) analysis was chosen for its multi-elemental analysis capabilities on small mass samples. Previous work demonstrated the detection of several elements using PIXE analysis and that the elemental concentrations of S, Cl, Ca and Fe were worthy of note. It is indicated that continuing analysis of these cell fractions may be significant in the study of trace element metabolism as it provides insight into understanding mechanisms for preventative, diagnostic and therapeutic purposes and hence a patient's state of health. The analysis of erythrocytes was conducted at pre, during and post-operative timepoints to investigate the changes that occur during and post-surgical intervention. Elements Na, Mg, Si, P, S, Cl, K, Ca, Fe, Cu, Zn, Br and Rb were detected in erythrocytes at all surgery timepoints and from normalized graphs, elements S, K and Fe revealed that the changes in concentration through surgery followed an almost identical pattern. It is anticipated that statistical correlation and interpretation of data may provide, in the long-term, information that could have an impact on the patients' rate of recovery or appropriate aftercare. (author)

  16. 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...

  17. 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

  18. Cabrol-Type Aortocoronary Anastomosis Technique in Coronary Artery Bypass Surgery.

    Science.gov (United States)

    Kim, Tae Sik; Na, Chan-Young; An, Hyonggin

    2016-04-01

    Background In conventional coronary artery bypass grafting (CABG), multiple anastomoses in the ascending aorta are needed for multiple coronary targeting. We have introduced a single-site proximal anastomosis technique for multiple coronary targeting. A single anastomosis between the ascending aorta and graft was performed using a side-to-side maneuver (Cabrol type). Additionally, the graft was connected to another graft by end-to-end anastomosis for the coronary artery on the opposite side. We evaluated the long-term clinical outcome and graft patency of this Cabrol-type aortocoronary anastomosis technique. Methods From 2002 to 2012, a total of 483 patients (mean age, 64.6 years) underwent CABG using our Cabrol-type aortocoronary anastomosis technique. The average number of target coronary arteries per person was 3.4 ± 0.6. The mean follow-up duration was 74.2 ± 31.3 months; 98.7% of hospital survivors completed the follow-up. Postoperative coronary computed tomography angiography was performed in 377 patients (81.8%). Results Operative mortality was 4.6%. The actuarial overall survival rates at 1, 5, and 10 years were 97.8 ± 0.7%, 89.3 ± 1.5%, and 69.0 ± 3.9%, respectively. The actuarial major adverse cardiac and cerebrovascular event-free survival rates at 1, 5, and 10 years were 95.7 ± 0.9%, 80.1 ± 2.0%, and 60.8 ± 3.7%, respectively. One- and 5-year patency rates of the Cabrol-type aortocoronary graft were 81.1 ± 2.2% and 61.3 ± 3.6%, respectively. Conclusion Our Cabrol-type aortocoronary anastomosis technique did not have superior clinical outcomes and graft patency compared with conventional CABG. However, this technique might be an alternative option in select patients with atherosclerotic disease of the ascending aorta, or other embarrassing situations. PMID:26090886

  19. 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

  20. A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery

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    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.

  1. 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.

  2. Renal Dysfunction after Off-Pump Coronary Artery Bypass Surgery- Risk Factors and Preventive Strategies

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    Gaurab Maitra

    2009-01-01

    Full Text Available Postoperative renal dysfunction is a relatively common and one of the serious complications of cardiac surgery. Though off-pump coronary artery bypass surgery technique avoids cardiopulmonary bypass circuit induced adverse effects on renal function, multiple other factors cause postoperative renal dysfunction in these groups of patients. Acute kidney injury is generally defined as an abrupt and sustained decrease in kidney function. There is no consen-sus on the amount of dysfunction that defines acute kidney injury, with more than 30 definitions in use in the literature today. Although serum creatinine is widely used as a marker for changes in glomerular filtration rate, the criteria used to define renal dysfunction and acute renal failure is highly variable. The variety of definitions used in clinical studies may be partly responsible for the large variations in the reported incidence. Indeed, the lack of a uniform definition for acute kidney injury is believed to be a major impediment to research in the field. To establish a uniform definition for acute kidney injury, the Acute Dialysis Quality Initiative formulated the Risk, Injury, Failure, Loss, and End-stage Kidney (RIFLE classification. RIFLE , defines three grades of increasing severity of acute kidney injury -risk (class R, injury (class I and failure (class F - and two outcome classes (loss and end-stage kidney disease. Various perioperative risk factors for postoperative renal dysfunction and failure have been identified. Among the important preoperative factors are advanced age, reduced left ventricular function, emergency surgery, preoperative use of intraaortic balloon pump, elevated preoperative serum glucose and creatinine. Most important intraoperative risk factor is the intraoperative haemodynamic instability and all the causes of postoperative low output syndrome com-prise the postoperative risk factors. The most important preventive strategies are the identification of the

  3. Evaluation of false-positive results on Tc myocardial scintigraphy in patients with coronary artery bypass grafting including left internal thoracic artery-left anterior descending artery grafting

    International Nuclear Information System (INIS)

    Stress myocardial scintigraphy in patients who have undergone coronary artery bypass grafting (CABG) frequently shows false-positive results. To investigate the reason for these false-positive results, two different stress tests-adenosine triphosphate (ATP) stress testing and ergometer exercise testing, and Tc-tetrofosmin myocardial scintigraphy were performed with a 1-day stress/rest protocol. The subjects were 6 patients with a history of myocardial infarction (MI) and 14 patients with a history of angina pectoris (AP) who had undergone CABG that included left internal thoracic artery-left anterior descending artery grafting. Graft patency was confirmed with coronary angiography. Short-axis images were reconstructed with single photon emission tomography. The severity of perfusion defects on short-axis images was evaluated quantitatively with a normal database as severity score, and the difference in severity score between stress and rest was defined as fill-in. Fill-in on the ATP stress test was 3.1±7.0 in the AP group and 16.3±13.2 in the MI group (p<0.01). Fill-in on the exercise stress test was 2.7±8.3 in the AP group and 34.8±20.6 in the MI group (p<0.01). In the MI group, fill-in on the exercise stress test was significantly greater than that on the ATP stress test (p<0.05). The exercise time and the amount of exercise stress in patients with MI were significantly greater than those in patients with AP. In conclusion, coronary flow reserve may play a role in false positive-finding on myocardial perfusion scintigraphy in patients who have undergone CABG. (author)

  4. 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)

  5. 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).

  6. The study of neuropsychological alterations following coronary artery bypass operation as predicted by computed tomography scan of the brain

    International Nuclear Information System (INIS)

    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)

  7. 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

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

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    K Muralidhar

    2010-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  10. 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.

  11. 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.

  12. Outcome of tight versus standard glycemic control in coronary artery bypass patients

    International Nuclear Information System (INIS)

    Objectives: To compare the outcome of tight versus standard glycemic control and its impact on post operative morbidity and short term mortality in patients undergoing Coronary Artery Bypass Grafting (CA-BG). Patients and Methods: A prospective surveillance of 124 patients undergoing isolated CABG surgery (on pump) was included in the study, 62 patients in each group were randomly assigned to tight and standard glucose control group. The main exposure was insulin in respect to level of blood glucose and the primary outcome measures were Sternotomy wound infection, Leg wound infection and new Myocardial Infarction. Surgical Site infection was assessed on a daily basis during the patient's stay in the Department of Cardio-thoracic Surgery, Sheikh Zayed Hospital, Lahore or within 30 days of operation prompting the patient to return to the hospital. Chi-square test or test was used to identify the significance of various short term morbidities and mortality. Results: In this study, 12 patients in the standard group and 4 patients in the tightly controlled group developed Sternal wound infection (p value 0.046). Similarly, 9 versus 2 patients in the standard and tight group respectively developed Leg wound infection (p-value 0.035). Test of proportion was applied and it was found that there was significant difference in the pro-portion of infection in the two groups (p value 0.05). However, there were no significant differences in other morbidities and the short term mortality. Conclusion: Study confirmed that tight glucose con-trol post operatively in CABG patient's results in reduced sternal and leg wound infection rates; however, there was no effect on other morbidities and short term mortality. (author)

  13. Coronary artery bypass graft imaging using ECG-gated multislice computed tomography: Comparison with catheter angiography

    International Nuclear Information System (INIS)

    AIM: To compare the value of multislice computerized tomography (MSCT) in imaging coronary artery bypass grafts (CABGs) by direct quantitative comparison with standard invasive angiography. METHODS: Using MSCT, 50 consecutive patients who had previously undergone CABG surgery and had recently undergone invasive angiography for recurrent angina pectoris, were studied further using MSCT after intravenous injection of non-ionic contrast agent; cardiac imaging was performed during a single breath-hold. Graft anatomy was quantified, using both quantitative coronary angiography (QCA) and MSCT, by different investigators blinded to each other. Reproducibility was quantified using the standard error of the measurement expressed as a percentage in log-transformed values (CV%) and intraclass correlation (ICC). RESULTS: All 150 grafts were imaged using MSCT; only 4 patent grafts were not imaged using selective angiography. Good agreement was achieved between MSCT and QCA on assessment of proximal anastomoses (CV% 25.2, ICC 0.84), mid-vessel luminal diameter (CV% 15.5, ICC 0.91) and aneurysmal dilations (CV% 14.3). Reasonable agreement was reached on assessment of distal anastomoses (CV% 26.7, ICC 0.66) and categorization of distal run-off (ICC 0.73). Good agreement was observed for stenoses of over 50% luminal loss (CV% 8.7, ICC 0.97) but agreement on assessment of less severe lesions was poor (CV% 208.7, ICC 0.51). CONCLUSION: This study demonstrates that CABGs can be quantitatively evaluated using MSCT, and that significant lesions present in all CABG segments can be reliably identified. Agreement between MSCT and QCA for lesions of less than 50% luminal loss was poor

  14. 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.

  15. Frequency and Predictors of Cognitive Decline in Patients Undergoing Coronary Artery Bypass Graft Surgery

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS). Study Design: An observational study. Place and Duration of Study: The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009. Methodology: Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. Results: One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 +- 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. Conclusion: Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time. (author)

  16. 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

  17. An audit of follow-up chest radiography after coronary artery bypass graft

    International Nuclear Information System (INIS)

    AIM: To investigate the clinical value and audit chest radiography, which is currently undertaken as part of routine practice, in the follow-up of coronary artery bypass graft (CABG) patients. MATERIAL AND METHODS: Six hundred and sixty-six first time CABG patients were identified from the Patient Analysis and Tracking System database representing the work of a single surgeon between February 2001 and September 2005. The data regarding the clinical and radiological findings on follow-up were collected from the follow-up clinic letters and case notes. Any need for re-admission/intervention was also noted. RESULTS: Of the 666 patients, 11 died and a further 10 either refused or failed to arrive for follow-up. Chest radiography was undertaken in 645 patients. Only 13 patients (2%) were found to have an abnormality on chest radiography. In all cases this was a pleural effusion that was confirmed on clinical examination in seven patients (53.9%) patients. Only one patient needed re-admission and intervention. In this case the effusion had been noted on clinical examination. Seven patients were discharged and the remaining five were followed up with repeat chest radiography before discharge. Seventy-four patients had a respiratory complication postoperatively, but only three had any evidence of an effusion on follow-up. CONCLUSION: The diagnostic yield of a routine chest radiography in a CABG follow-up clinic is low (2%) and the need for intervention is rare and is determined by clinical examination. The practice of routine radiography in this group of patients has now stopped and follow-up audit will be conducted in 12 months

  18. Gabapentin May Relieve Post-Coronary Artery Bypass Graft Pain: A Double Blind Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. Effect of Cardiac Rehabilitation on Strength and Balance in Patients after Coronary Artery Bypass Graft

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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

  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. PMID:26993975

  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. Combined extracranial-intracranial bypass and balloon occlusion of internal carotid artery for the treatment of intracranial wide-neck giant aneurysms

    International Nuclear Information System (INIS)

    Objective: To present and evaluate the treatment and long-period follow-up of intracranial broad neck giant aneurysms treated by extracranial-intracranial bypass and balloon occlusion of internal carotid artery. Methods: Retrospectively analyze the treatment and long-period follow-up result of 2 wide neck giant aneurysms treated by combined extracranial-intracranial bypass and balloon occlusion of internal carotid artery during recent 4 years. Results: The aneurysm located at C1, C2 segment of L-ICA and M1 segment of L-MCA; the other involved petrosal segment from of R-ICA to M1 of R-MCA and A1 of R-ACA. The occlusion test in all 2 cases were positive. The authors first made bypass between the superficial temporal artery and ipsilateral MCA. The cranial angiography was followed the next day to prove the patency of the bypass. Then the proximal segment of the ipsilateral ICA was occluded by using detachable balloon. After treatment and during 4-year follow-up period, two patients showed no neurological deficits and CT scan showed thrombi within the lumens. The volume of one aneurysm decreased sharply. Cerebral angiography of the bypasses were patent and the no opacification of aneurysm any more. Conclusions: Combined extracranial-intracranial bypass and balloon occlusion of internal carotid artery is an alternative method for treating the aneurysm not to be cured by the interventional method and surgical operation

  6. Self-responsibility predicts the successful outcome of coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    C. J. Eales

    2004-02-01

    Full Text Available Purpose: This study was designed to determine whetherthe acceptance of self-responsibility is an important determinant of the successful outcome of coronary artery bypass graft (CABG surgery. The success of this costly intervention may be limited unless patients understand and adhere to the prescribed medical regimen, including diet and exercise after surgery. Patients suffering from chronic diseases must take charge of their own health and not abrogate that responsibility to the care providers.Method: Questionnaires were designed to determine aspects of improved quality of life and self-responsibility. For the study, 73 patients who had undergone CABG surgery were selected from surgical patients in the private as well as the public sector. In order to assess the acceptance of self-responsibility, the spouses/care-givers of the patients were included in the study. Patients were interviewed during the first few days after the operation when they had returned to the wards and again six months and 12 months later. Successful outcome was measured in terms of improved quality of life using the criteria suggested by the Coronary Artery Surgery Study (Coronary Artery Surgical Study PrincipalInvestigators, 1983. The acceptance of self-responsibility was then investigated as a possible factor influencing the improvement of the quality of life of these patients.Results: The acceptance of self-responsibility was a significant factor predicting the successful outcome of CABG surgery in the group of patients who achieved an improved quality of life following surgery (p<0.01. From the results of this study, a profile of South African patients with improved quality of life was identified. They are: Men, married, annual income > R50 000 (US $8 000, who had a normal sex-life prior to the operation.  They differ significantly from the group without an improved quality of life in the following aspects: they spend more hours participating in sport at school (p=0

  7. Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications

    OpenAIRE

    Bowling, A; Bond, M.; McKee, D.; McClay, M; Banning, A. P.; Dudley, N.; Elder, A; Martin, A.; Blackman, I

    2001-01-01

    OBJECTIVES—To assess whether patients with heart disease in a single UK hospital have equitable access to exercise testing, coronary angiography, and coronary artery bypass graft surgery (CABG).
METHOD—Retrospective analysis of patients' medical case notes (n = 1790), tracking each case back 12 months and forward 12 months from the patient's date of entry to the study.
SETTING—Single UK district hospital in the Thames Region.
PATIENTS—Patients (elective and emergency) with a cardiac ICD inpat...

  8. 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...

  9. Serum S-100β and NSE levels after off-pump versus on-pump coronary artery bypass graft surgery

    OpenAIRE

    Lei ZHENG; Fan, Qing-Ming; Wei, Zhen-Yu

    2015-01-01

    Background We aimed to evaluate serum levels of S-100 beta (S-100β) and neuron specific enolase (NSE) in patients with coronary heart disease (CHD) after off-pump versus on-pump coronary artery bypass graft (CABG) surgery. Methods The PubMed (~2013) and the Chinese Biomedical Database (CBM) (1982 ~ 2013) were searched without language restrictions. After extraction of relevant data from selected studies, meta-analyses were conducted using STATA software (Version 12.0, Stata Corporation, Colle...

  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. Endovascular therapy for abdominal aortic aneurysm and iliac artery aneurysm using SEAL aortic stent-graft: A single center experience

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

  12. Endovascular therapy for abdominal aortic aneurysm and iliac artery aneurysm using SEAL aortic stent-graft: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Park, Su Young; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin Mo; Choi, Sang Tae; Park, Jae Hyung [Gachon University Gil Hospital, Incheon (Korea, Republic of)

    2015-03-15

    The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

  13. 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...

  14. Incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in the treatment of peripheral arterial occlusive disease in a German referral center 1996-2003

    International Nuclear Information System (INIS)

    Purpose: To determine the current incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in a study population of patients with peripheral arterial occlusive disease in a German referral center. Materials and Methods: In a retrospective study, we recruited patients with peripheral arterial occlusive disease who underwent an amputation, bypass procedure, or PTA in the region of the pelvis or lower limbs between 1996 and 2003 at the Augsburg Medical Center. Patients were identified via the hospital database. This was performed with the help of the International Classification of Diseases (ICD 9 and 10), the operation code (OPS), and appropriate invoices. The incidence of PTAs was further estimated with 200 charts. Results: Of 5379 patients, 627 underwent amputation, 1832 a bypass procedure, and 2920 a PTA. The incidence of PTAs increased during the study period from 51.3/100 000/year to 64.4/100 000/year (p<0.01), while the number of amputations and bypass procedures remained stable. The incidence of PTAs was exceeded by that of bypass procedures only in patients older than 85 years. The age of the amputees decreased during the study period from 72.2 to 70.5 years (p<0.01). The age of patients who underwent a bypass procedure increased from 67.2 to 69.4 years, and the age of patients who underwent PTA increased form 66.3 to 69.8 years (p<0.01). Bypass procedures and PTAs were performed in men 6.3 years earlier than in women (p<0.01). Conclusion: The result is a population-corrected need of 8.4/100 000/year major amputations, 23/100 000/year bypass procedures and 64.4/100 000/year PTAs for patients with peripheral arterial occlusive disease within the referral area of our hospital. The performance of major amputations and bypass procedures stagnates, while the incidence of PTAs is increasing. (orig.)

  15. Health related quality of life trajectories and predictors following coronary artery bypass surgery

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    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

  16. 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

  17. Effects of Cardiac Rehabilitation Program on Right Ventricular Function After Coronary Artery Bypass Graft Surgery

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    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.

  18. 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

  19. 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.

  20. 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

  1. 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.

  2. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2016-04-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Neuraxial anesthesia (NA has been used in association with general anesthesia (GA for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS: Mortality, arrhythmias, cerebrovascular accident (CVA, myocardial infarction (MI, length of hospital stay (LHS, length of ICU stay (ICUS, reoperations, blood transfusion (BT, quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD was estimated for continuous variables, and relative risk (RR and risk difference (RD for categorical variables. RESULTS: 17 original articles analyzed. Meta-analysis of mortality (RD = -0.01, 95% CI = -0.03 to 0.01, CVA (RR = 0.79, 95% CI = 0.32-1.95, MI (RR = 0.96, 95% CI = 0.52-1.79 and LHS (MD = -1.94, 95% CI = -3.99 to 0.12 were not statistically significant. Arrhythmia was less frequent with NA (RR = 0.68, 95% CI = 0.50-0.93. ICUS was lower in NA (MD = -2.09, 95% CI = -2.92 to -1.26. CONCLUSION: There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.

  3. 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

  4. 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。

  5. 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.

  6. 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...

  7. 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.

  8. 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 ...

  9. 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.

  10. 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

    2015-09-01

    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.

  11. 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.…

  12. Myocardial Injury in Coronary Artery Bypass Grafting: On-Pump versus Off-Pump Comparison by Measuring Heart-Type Fatty-Acid-Binding Protein Release

    OpenAIRE

    Malik, Vishwas; Kale, Shailaja C.; Chowdhury, Ujjwal K.; Ramakrishnan, Lakshmy; Chauhan, Sandeep; Kiran, Usha

    2006-01-01

    This prospective study uses heart-type fatty-acid–binding protein (hFABP) and creatine kinase-MB (CK-MB) release to compare myocardial injury in on-pump versus off-pump coronary artery bypass grafting (CABG).

  13. 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...

  14. 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.

  15. 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; Pedersen, Preben Ulrich; Steinbrüchel, Daniel A

    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 ...

  16. 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.

  17. [Coronary subclavian steal syndrome: two cases after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Penninga, L.; Damgaard, S.

    2008-01-01

    Reverse flow in the internal mammary artery (IMA) graft due to stenosis or occlusion of the proximal ipsilateral subclavian artery causes coronary subclavian steal syndrome (CSSS). We describe two patients who were diagnosed with CSSS following CABG. Patient A presented with angina pectoris, was...

  18. 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.

  19. 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

  20. 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.

  1. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Tully, Phillip J; Winefield, Helen R; Baker, Robert A;

    2015-01-01

    BACKGROUND: Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical...... conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level. METHODS: Before coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and...... anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring...

  2. 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...... 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...... with clopidogrel, with no-clopidogrel as reference. By propensity score, of 945 patients with or without clopidogrel treatment who were matched, death or recurrent MI occurred in 38 (4.0%) patients with clopidogrel and 57 (6.0%) without clopidogrel (log-rank p = 0.05). Corresponding hazard ratio was 0...

  3. 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...

  4. 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.

  5. The Best Bypass Surgery Trial

    DEFF Research Database (Denmark)

    Møller, Christian H; Jensen, Birte Østergaard; Gluud, Christian; Perko, Mario J; Lund, Jens T; Andersen, Lars Willy; Madsen, Jan Kyst; Hughes, Pia; Steinbrüchel, Daniel A

    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 addit...

  6. 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.

  7. Coronary Artery Bypass Grafting for an Anomalous Left Coronary Artery from the Pulmonary Artery in a 73-Year-Old Female.

    Science.gov (United States)

    Ishida, Narihiro; Shimabukuro, Katsuya; Ogura, Hiroki; Takemura, Hirofumi; Doi, Kiyoshi

    2016-06-01

    Anomalous left coronary artery from the pulmonary artery (ALCAPA) in adults is a rare congenital coronary abnormality. We report a case of ALCAPA in a 73-year-old female managed by total arterial revascularization. doi: 10.1111/jocs.12755 (J Card Surg 2016;31:380-382). PMID:27102973

  8. 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

  9. 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

  10. 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...

  11. Multi-slice spiral CT of aortocoronary grafts and internal mammary artery bypasses: Assessment of bypasses and their anastomoses; Mehrzeilen-Spiral-CT von aortokoronaren Venenbypaessen und Mammaria-interna-Bypaessen: Beurteilung der Bypaesse und ihrer Anastomosen

    Energy Technology Data Exchange (ETDEWEB)

    Froehner, S.; Wagner, M.; Schmitt, R.; Christopoulos, G.; Coblenz, G. [Inst. fuer Diagnostische und Interventionelle Radiologie, Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany); Brunn, J.; Mueller, M.; Kerber, S. [Fachbereich Kardiologie, Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany); Urbanski, P. [Klinik fuer Herzchirurgie, Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany)

    2002-07-01

    Objective: To assess aortocoronary grafts and internal mammary artery bypasses by means of EKG-triggered contrast-enhanced multi-slice spiral CT, and to evaluate the diagnostic accuracy of this new imaging modality. Material and methods: 59 patients with up to 5 aortocoronary grafts and/or internal mammary artery bypasses per patient were examined with regard to bypass morphology, the free passage, and the proximal as well as the distal anastomoses using multi-slice computed tomography. Axial source images were calculated by means of retrospective triggering at different diastolic delay times, and were postprocessed in several planes with the multiplanar volume reconstruction (MPVR) software. Results: On the pre-condition that data sets were acquired at sinus rhythm and at a heart rate lower than 65/min, aortocoronary grafts and internal mammary artery bypasses could be depicted in adequate diagnostic quality in about 80% of all cases with contrast-enhanced multi-slice spiral CT. Both, the free passage of the bypasses as well as the morphology of the proximal anastomoses were sufficiently assessed with multiplanar volume reconstruction (MPVR), whereas the distal anastomoses couldn't be depicted sufficiently in 20% of all cases. Conclusion: As a non-invasive method, contrast-enhanced and ECG-triggered multi-slice spiral computed tomography has gained diagnostic potential for the accurate visualization of aortocoronary grafts and the internal mammary artery bypasses. (orig.) [German] Ziel: Die vorliegende Arbeit stellt die Moeglichkeiten der kontrastmittelverstaerkten, EKG-getriggerten Mehrzeilen-Computertomographie in der Beurteilung von aortokoronaren Venenbypaessen und Mammaria-interna-Bypaessen dar. Material und Methode: Bei 59 Patienten mit 1 bis 5 aortokoronaren Venen-Bypaessen bzw. Mammaria-interna-Bypaessen wurden deren Morphologie, Durchgaengigkeit, die proximalen Anastomosen und die distalen Insertionsstellen mittels Mehrzeilen-Spiral-CT untersucht

  12. 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)

  13. 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

  14. Optimal temporal windows and dose-reducing strategy for coronary artery bypass graft imaging with 256-slice CT

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Kun-Mu [Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. (China); Lee, Yi-Wei [Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan (China); Guan, Yu-Xiang [Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan (China); Chen, Liang-Kuang [Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. (China); School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (China); Law, Wei-Yip, E-mail: m002325@ms.skh.org.tw [Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. (China); Su, Chen-Tau, E-mail: m005531@ms.skh.org.tw [Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. (China); School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (China)

    2013-12-11

    Objective: To determine the optimal image reconstruction windows in the assessment of coronary artery bypass grafts (CABGs) with 256-slice computed tomography (CT), and to assess their associated optimal pulsing windows for electrocardiogram-triggered tube current modulation (ETCM). Methods: We recruited 18 patients (three female; mean age 68.9 years) having mean heart rate (HR) of 66.3 beats per minute (bpm) and a heart rate variability of 1.3 bpm for this study. A total of 36 CABGs with 168 segments were evaluated, including 12 internal mammary artery (33.3%) and 24 saphenous vein grafts (66.7%). We reconstructed 20 data sets in 5%-step through 0–95% of the R–R interval. The image quality of CABGs was assessed by a 5-point scale (1=excellent to 5=non-diagnostic) for each segment (proximal anastomosis, proximal, middle, distal course of graft body, and distal anastomosis). Two reviewers discriminated optimal reconstruction intervals for each CABG segment in each temporal window. Optimal windows for ETCM were also evaluated. Results: The determined optimal systolic and diastolic reconstruction intervals could be divided into 2 groups with threshold HR=68. The determined best reconstruction intervals for low heart rate (HR<68) and high heart rate (HR>68) were 76.0±2.5% and 45.0±0% respectively. Average image quality scores were 1.7±0.6 with good inter-observer agreement (Kappa=0.79). Image quality was significantly better for saphenous vein grafts versus arterial grafts (P<0.001). The recommended windows of ETCM for low HR, high HR and all HR groups were 40–50%, 71–81% and 40–96% of R-R interval, respectively. The corresponding dose savings were about 60.8%, 58.7% and 22.7% in that order. Conclusions: We determined optimal reconstruction intervals and ETCM windows representing a good compromise between radiation and image quality for following bypass surgery using a 256-slice CT.

  15. 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

  16. 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. PMID:26749228

  17. 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....

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

    DEFF Research Database (Denmark)

    Andreasen, Jan J.; Westen, Mikkel; Pallesen, Peter A.; Jensen, Søren; Gorst-Rasmussen, Anders; Johnsen, Søren P.

    2007-01-01

    allogeneic blood products among patients undergoing first-time CABG. Data on patient characteristics, peri- and postoperative factors were retrieved from 600 patient records (150 records per hospital). Substantial differences were seen regarding preoperative intake of antiplatelet drugs, perioperative use of...... antifibrinolytic drugs, use of cardiopulmonary bypass (CPB), cross-clamp time, time on CPB, lowest hemoglobin during CPB, and number of distal anastomoses. The percentage of patients transfused with allogeneic red blood cells ranged from 30.0% to 64.2%. Several patients (12.1-42.7%) transfused with red blood cells...... were discharged with a hemoglobin concentration >7 mmol/l, indicating inappropriate transfusions. The relative risk of receiving an allogeneic blood transfusion was 2.1 (95% CI: 1.6-2.7) in the hospital with the highest transfusion rate, after adjustment for patient-, drug-, and procedure...

  19. 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.

  20. 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

  1. Perfusion Pressure Cerebral Infarct (PPCI) trial - the importance of mean arterial pressure during cardiopulmonary bypass to prevent cerebral complications after cardiac surgery

    DEFF Research Database (Denmark)

    Vedel, Anne G; Holmgaard, Frederik; Rasmussen, Lars Simon;

    2016-01-01

    coronary vessel and/or valve disease and who are undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients are stratified by age and surgical procedure and are randomised 1:1 to either an increased mean arterial pressure (70-80 mmHg) or 'usual practice' (40-50 mmHg) during cardiopulmonary...... caused by emboli, but inadequate blood flow caused by other mechanisms may increase ischaemia in the penumbra or cause watershed infarcts. During cardiopulmonary bypass, blood pressure can be below the lower limit of cerebral autoregulation. Although much debated, the constant blood flow provided by the...... cardiopulmonary bypass system is still considered by many as appropriate to avoid cerebral ischaemia despite the low blood pressure. METHODS/DESIGN: The Perfusion Pressure Cerebral Infarct trial is a single-centre superiority trial with a blinded outcome assessment. The trial is randomising 210 patients with...

  2. 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

  3. Should computed tomography angiography supersede invasive coronary angiography for the evaluation of graft patency following coronary artery bypass graft surgery?

    Science.gov (United States)

    Gabriel, Joseph; Klimach, Stefan; Lang, Peter; Hildick-Smith, David

    2015-08-01

    Invasive coronary angiography (ICA) has long been the established gold standard in assessing graft patency following coronary artery bypass graft (CABG). Over the past decade or so however, improvements in computed tomography angiography (CTA) technology have allowed its emergence as a useful clinical tool in graft assessment. The recent introduction of 64-slice and now 128-slice scanners into widespread distribution, and the development of 320-detector row technology allowing volumetric imaging of the entire heart at single points in time within one cardiac cycle, has increased the potential of CTA to supersede ICA in this capacity. This study sought to examine the evidence surrounding this potential. A best evidence topic was constructed according to a structured protocol. The enquiry: In [patients who have undergone coronary artery bypass graft surgery] is [computed tomography angiography or invasive coronary angiography] superior in terms of [graft patency assessment, stenosis detection, radiation exposure and complication rate]? Four hundred and twenty-four articles were identified from the search strategy. Four additional articles were identified from references of key articles. Seventeen articles selected as best evidence were tabulated. The reliability of CTA as a tool in the detection of graft patency and stenosis has continued to improve with each successive generation of multislice technology. The latest 64- and 128-slice CTA techniques are able to detect graft patency and stenosis with very high sensitivities and specificities comparable with ICA, while remaining non-invasive procedures associated with fewer complications (ICA carries a 0.08% risk of myocardial infarction and 0.7% risk of minor complications in clinically stable patients). Present limitations of the technology include the accurate visualization of distal anastomoses and clip artefacts. In addition, the capacity of diagnostic ICA to be combined simultaneously with percutaneous coronary

  4. 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

  5. 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

  6. 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

  7. 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...

  8. 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...

  9. 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 ...

  10. Transfusion-free arterial switch operation in a 1.7-kg premature neonate using a new miniature cardiopulmonary bypass system.

    Science.gov (United States)

    Huebler, Michael; Redlin, Matthias; Boettcher, Wolfgang; Koster, Andreas; Berger, Felix; Peters, Björn; Hetzer, Roland

    2008-01-01

    In cardiac surgery, the potentially detrimental effects of transfusions on patient outcome are increasingly appreciated. Therefore, at our institution there are continuing efforts to modify our surgical, perfusion, and blood management strategies with the aim of transfusion-free cardiac surgery even in neonates and small children. Stringent improvement of these strategies, particularly the downsizing of the cardiopulmonary bypass system, have now enabled a transfusion-free arterial switch operation in a 1700-gram prematurely born neonate. PMID:18598328

  11. 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,...

  12. 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...

  13. A meta-analysis of randomized trials for repeat revascularization following off-pump versus on-pump coronary artery bypass grafting

    OpenAIRE

    Takagi, Hisato; Mizuno, Yusuke; Niwa, Masao; Goto, Shin-nosuke; Umemoto, Takuya

    2013-01-01

    To determine whether repeat revascularization rates are increased following off-pump coronary artery bypass grafting (CABG), we performed a meta-analysis of randomized controlled trials of off-pump vs on-pump CABG. Databases including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through March 2013 using web-based search engines (PubMed, OVID). Studies considered for inclusion met the following criteria: the design was a prospective randomized controlled...

  14. Effect of continuous positive airway pressure on blood pressure in hypertensive patients with coronary artery bypass grafting and obstructive sleep apnea

    OpenAIRE

    Dong, Yumei; Dai, Yingnan; Wei, Guoqian; Cha, Li; Li, Xueqi

    2014-01-01

    Background: Previous studies have documented that obstructive sleep apnea (OSA) increases the incidence of hypertension, respiratory failure and unexpected post-operative deaths during night in coronary artery bypass grafting (CABG) patients. We hypothesized that continuous positive airway pressure (CPAP) reduces blood pressure in these patients. Methods: We conducted a prospective, controlled study in 51 patients. The subjects received CPAP treatment were defined as CPAP group, whereas those...

  15. 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

  16. 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 ...

  17. Risk Factors for Incident Peripheral Arterial Disease in Type 2 Diabetes: Results From the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D) Trial

    OpenAIRE

    Althouse, Andrew D.; Abbott, J . Dawn; Forker, Alan D.; Bertolet, Marnie; Barinas-Mitchell, Emma; Thurston, Rebecca C.; Mulukutla, Suresh; Aboyans, Victor; Brooks, Maria Mori; ,

    2014-01-01

    OBJECTIVE The aim of this article was to define risk factors for incidence of peripheral arterial disease (PAD) in a large cohort of patients with type 2 diabetes mellitus (T2DM), overall and within the context of differing glycemic control strategies. RESEARCH DESIGN AND METHODS The Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D) randomized controlled trial assigned participants to insulin-sensitizing (IS) therapy versus insulin-providing (IP) therapy. A total...

  18. 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...

  19. 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...

  20. 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...

  1. The effect of education based on the main concepts of logotherapy approach on the quality of life in patients after coronary artery bypass grafting surgery

    OpenAIRE

    Mahdizadeh, Mostafa; Alavi, Mousa; Ghazavi, Zahra

    2016-01-01

    Background: Improving the patients’ quality of life (QOL) after coronary artery bypass grafting (CABG) is one of the main concerns of the treatment team. Educational interventions may affect the aspects of QOL in various ways. The present study aimed to investigate the effect of education based on the main concepts of logotherapy approach on the CABG patients’ quality of life. Materials and Methods: In this quasi-experimental study, a convenient sample of 67 patients who had undergone CABG in...

  2. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial †

    OpenAIRE

    Thimour-Bergström, Linda; Roman-Emanuel, Christine; Scherstén, Henrik; Friberg, Örjan; Gudbjartsson, Tomas; Jeppsson, Anders

    2013-01-01

    OBJECTIVES The incidence of surgical site infection (SSI) after open vein harvesting in coronary artery bypass grafting (CABG) patients ranges in different studies between 2 and 20%. Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis. We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting. METHODS An investigator-initiated prospective randomized double-blind single-centre study wa...

  3. 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...

  4. 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, ...

  5. Algisyl-LVR™ with coronary artery bypass grafting reduces left ventricular wall stress and improves function in the failing human heart

    OpenAIRE

    Lee, LC; Wall, ST; Klepach, D; Ge, L; Zhang, Z.; Lee, RJ; Hinson, A; Gorman, JH; Gorman, RC; Guccione, JM

    2013-01-01

    Background Left ventricular (LV) wall stress reduction is a cornerstone in treating heart failure. Large animal models and computer simulations indicate that adding non-contractile material to the damaged LV wall can potentially reduce myofiber stress. We sought to quantify the effects of a novel implantable hydrogel (Algisyl-LVR™) treatment in combination with coronary artery bypass grafting (i.e. Algisyl-LVR™ + CABG) on both LV function and wall stress in heart failure patients. Methods and...

  6. High-sensitivity C-reactive protein (hs-CRP) and tumor necrotizing factor-alpha (TNF-alpha) after on- and off- pump coronary artery bypass grafting

    OpenAIRE

    Javadzadegan, H; Nezami, N; Ghobadi, K; Sadighi, A; Abolfathi, A A; Nader, N D

    2010-01-01

    Introduction Coronary artery bypass grafting (CABG) is one of the most frequently performed operations around the world. The aim of this study is to evaluate high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-alpha) differences between on-pump and off-pump coronary surgery. Methods In this prospective study, 90 patients with coronary artery disease referred for CABG were enrolled from July 2006-November 2007. Levels of hs-CRP and TNF-alpha were measured by ELISA...

  7. 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.

  8. Long-term results after recanalization of acute and subacute thrombotic occlusions of the infra-aortic arteries and bypass-grafts using a rotational thrombectomy device

    International Nuclear Information System (INIS)

    Background: Evaluation of the acute and long-term results after recanalization of thrombotic occlusions of infra-aortic native arteries, stented arteries and bypass-grafts using a rotational thrombectomy device (8F Straub-RotarexTM). Materials and methods: From July 2000 to February 2002, in 98 patients (64% male, mean age 66±9 (range 47 to 90) years, mean duration of occlusion 31±33 (range 0 to 140) days, mean occlusion length 21±11 [range 2 to 40 ] cm) 100 vessel recanalizations were performed. 42% of the interventions were performed during the first 14 days after the onset of the symptoms (acute occlusions). These patients were classified according to the after the TASC protocol modified SVS/ISCVS-classification: Class I: n=22 (52%); class IIa: n=13 (32%); class IIb: n=6 (14%); class III: n=1 (2%). Subacute and chronic occlusions were classified according to Rutherford (58%): Stage 1: n=5 (9%); stage 2 and 3: n=39 (68%); stage 4: n=6 (10%); stage 5: n=8 (13%). Results: Primary success rate was 96% (ipsilateral interventions 99%; cross-over 40%). The restenosis rate after a mean follow-up of 13±4 months was 33% for native arteries (group 1), 74% for instent-recanalizations (group 2) and 86% for bypass-graft occlusions (group 3). 3% severe complications occurred: two amputations below the knee after unsuccessful recanalizations of a native artery and bypass-graft, respectively. One death because of multiorgan failure in patient who was already in cardiac shock before the successful intervention. Further 16 complications could be solved periinterventionally. The ancle-brachial index was significantly improved during follow-up (from 0.37±0.19 to 0.82±0.22 before discharge, 0.70±0.21 after 12 months, pTM device is useful in the treatment of acute and subacute thrombotic occlusions of infra-aortic arterial and bypass-graft occlusions, with promising long-term results in native vessels but unchanged high restenosis of stented arteries and bypass-grafts. (orig.)

  9. 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

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    Levy Adrian R

    2008-09-01

    Full Text Available Abstract Background Many health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods. Methods We used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time, 6 weeks for patients needing semi-urgent surgery and 12 weeks for those needing non-urgent surgery. Results Among 7316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1.0% (27 deaths among 2675 patients for patients treated within the recommended time and 1.5% (70 among 4641 for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96. There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11. Conclusion We found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis.

  12. Outcomes of Primary Percutaneous Coronary Intervention for Patients with Previous Coronary Artery Bypass Grafting Presenting with STsegment Elevation Myocardial Infarction

    Science.gov (United States)

    Garg, Pankaj; Kamaruddin, Hazlyna; Iqbal, Javaid; Wheeldon, Nigel

    2015-01-01

    Background: There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting acutely as ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). Objectives: To compare outcomes in STEMI patients undergoing PPCI with or without previous CABG surgery. Methods: An all-comer single-centre observational registry from a cardiothoracic centre in UK. All consecutive patients presenting for PPCI between 2007 and 2012 were included. Electronic records were used to extract relevant information. Mortality data were obtained from the Office of National Statistics. Overall median follow-up period was 1.7 years (intraquartile range 0.9-2.5). Results: Complete data were available for 2133 (97%) patients. 47-patients had previous history of CABG. Out of these, the infarct related artery (IRA) was native vessel in 22 and graft in 25 patients. Post re-vascularization TIMI flow was inferior in CABG cohort (

  13. CARDIOVASCULAR RISK FACTORS AND IN-HOSPITAL MORTALITY IN 1258 CASES OF CORONARY ARTERY BYPASS SURGERY IN TEHRAN HEART CENTER

    Directory of Open Access Journals (Sweden)

    M H Mandegar

    2008-11-01

    Full Text Available "nCoronary artery bypass grafting (CABG surgery is being performed increasingly in Iran. So far, no large-scale report has described characteristics and risk factor profile and in-hospital mortality of patients undergoing this procedure in Iran. We conducted this study to address these topics in order to help clarify Iran's current state of CABG and to provide assistance in planning combat against coronary artery disease based on frequency of major risk factors. Patients who underwent isolated, first-time, elective, on-pump (conventional CABG in a cardiac surgery center in Tehran were prospectively studied from September 2004 and March 2005. Demographic data, risk factor profile and discharge status for each patient were recorded. There were 1258 patients, 937 men (74.5% and 321 women (25.5%. The mean age was 58.7 years (range 28 to 81; 133 patients (10.6% were 70 years old or older. Mean body mass index (BMI was 27.01 and 42.2% of the patients were smokers, 39.4% were hypertensive, and 27.6% had diabetes. Family history was positive in 40.3%. Congestive heart failure was found in 26.6%. New York Heart Association functional class III or IV was observed in 52.8% of patients. Single-vessel, two-vessel, and multi-vessel disease was found in 4.2%, 21.1%, and 74.7% of patients, respectively. Left main was involved in 9.8% and 14.4% had ejection fraction < 35%. The in-hospital mortality was 1.5%, mainly due to cardiac causes. This study indicates significant prevalence of major cardiovascular risk factors in Iranian CABG patients. In-hospital mortality of primary isolated CABG in Iran is similar to reported rates.

  14. Effect of preoperative statin therapy on early postoperative memory impairment after off-pump coronary artery bypass surgery

    Science.gov (United States)

    Das, Sambhunath; Nanda, Sunil K.; Bisoi, Akshya K.; Wadhawan, Ashima N.

    2016-01-01

    Context: Frequent incidence of early postoperative memory impairment (POMI) after cardiac surgery remains a concern because of associated morbidity, impaired quality of life, and increased health care cost. Aim: To assess the effect of preoperative statin therapy on POMI in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Setting and Design: Prospective observational study in a tertiary level hospital. Methods: Sixty patients aged 45–65 years undergoing OPCAB surgery were allocated into two groups of 30 each. Group A patients were receiving statin and Group B patients were not receiving statins. All patients underwent memory function assessment preoperatively after admission to hospital and on the 6th postoperative day using postgraduate institute memory scale. Statistical Analysis: Appropriate tests were applied with SPSS 20 to compare both groups. The value P tested compared to preoperative scores. Intergroup comparison detected less POMI in Group A compared to Group B and was statistically significant in 8 memory functions. Multiple regression analysis detected statin as an independent factor in preventing memory impairment. Conclusions: Preoperative statin therapy attenuates the early POMI in patients undergoing OPCAB. Future long-term studies will define the efficacy of statin on POMI. PMID:26750672

  15. 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.

  16. Effect of Cardiac Rehabilitation Program on Heart Rate Recovery after Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting

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    Ali Abbasi

    2008-07-01

    Full Text Available 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. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR.Results: All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors (except for diabetes mellitus was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively (p=0.019. Conclusion: The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality (i.e. PCI or CABG after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients.

  17. Problems associated with routine PIXE analysis in quantifying elemental concentrations of leukocytes from Coronary Artery Bypass Grafting (CABG) surgery patients

    International Nuclear Information System (INIS)

    Whole blood from patients undergoing Coronary Artery Bypass Grafting (CABG) operations was separated into leukocyte subfractions of polymorphonuclearcytes (PMN) and peripheral blood mononuclear cells (PBMC). Blood samples were collected and analyzed at various timepoints to determine the elemental composition to provide a better understanding of recovery mechanisms and to indicate complications that may occur post-operatively. Proton induced X-ray emission (PIXE) analysis and Rutherford backscattering spectrometry (RBS) using the University of Surrey microprobe was employed to determine the concentrations of a range of elements. Accurate two-dimensional PIXE analysis however, requires knowledge of the sample matrix composition. These samples, on the other hand, showed varying thickness, lacked matrix homogeneity and displayed non-uniform trace element distribution. This paper discusses the results and problems associated with routine PIXE analysis and demonstrates the potential ability of ion beam analysis (IBA) depth profiling software, previously unused in PIXE analysis, to model a RBS spectrum of inhomogeneous, multi-layered samples prior to performing PIXE analysis. (author)

  18. 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.

  19. Effect of nicardipine combined with esmolol on systemic and tissue oxygenation during off-pump coronary artery bypass grafting surgery

    Institute of Scientific and Technical Information of China (English)

    WANG Tian-long; JIANG Yan; YANG Ba-xian

    2005-01-01

    Background The hemodynamics and oxygenation severely fluctuated during the off-pump coronary artery bypass grafting (OPCABG). This study aimed at investigating whether or not nicardipine combined with esmolol (1∶ 10) can maintain systemic and tissue oxygenation during OPCABG.Methods Twenty patients scheduled for OPCABG were divided ramdomly into Group nicardipine (N) and Group nitroglycerine (X) respectively combined with esmolol (E) (Dosage ratio: 1 to 10) (Group N+E and Group X+E) with 10 patients in each group. The mixed solution of N+E or X+E were titrated to maintain mean arterial blood pressure between 70 and 80 mmHg following anesthesia induction. The variables of hemodynamics, arterial blood lactate content (Lac) and gastric intramucosal partial pressure of carbon dioxide were measured at the following time points: after induction of anesthesia (T1), pre-revascularization (T2), grafting of left anterior descending (T3), right coronary descending (T4) and left coronary circumflexus branches (T5), post-revascularization (T6), the end of operation (T7). The delivery of oxygen (DO2), consumption of oxygen (VO2) and gastric intramucosal pH (pHi) were calculated.Results The cardiac index (CI) in Group N+E was significantly increased (P<0.05) as compared with T1 during OPCABG, while it was mildly decreased in Group X+E. The stroke volumes at T4, T5 in Group N+E and at T3-T6 in Group X+E were significantly decreased (P<0.05). The systemic vascular resistance indices in Group N+E were significantly decreased as compared with T1 (P<0.05). The heart rates in these two Groups were significantly elevated intraoperatively (P<0.05). The DO2 after the infusion of N+E was significantly increased (P<0.05) or leveled to T1, and the Lac were within the normal range. But the DO2 in Group X+E was decreased throughout the procedure, reaching significant level at T5 (P<0.05), and the Lac was significantly increased beyond normal range (P<0.05). The pHi in Group N+E was

  20. Effectiveness of Oral N-acetyl-cystein in Reduction of Pulmonary Complications in Smokers Undergoing Coronary Artery Bypass Surgery

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    SJ Mir Hoseini

    2009-10-01

    Full Text Available Introduction: Up to 12% of patients undergoing coronary artery bypass graft have pulmonary complications. Smoking can cause a six-time increase in pulmonary complication after major surgery. The most common pulmonary changes after CABG are decrease in FRC, VC and atelectasis. In this study, the effect of oral N-acetyl-cystein in reduction of severity of hypoxemia and atelectasis in current smokers who smoked more than 10 packs/year and had undergone CABG was evaluated. Methods: In the study, 54 current smoker patients were selected randomly and allocated to two drug and placebo groups. In the study group, 300mg N-acetyl-cystein (ACC long containing vitamin C was prescribed two times a day from 4 days before operation up to 3 days after surgery and in control group, effervescent vitamin C tablet was prescribed as placebo. Patients with body mass index more than 35, NYHA class IV, those who needed intra aortic balloon pump and those who needed reoperation due to bleeding were excluded from the study. In all patients, spirometry was done in the preoperative visit and FEV1/FVC was determined. Induction and maintenance of anesthesia was similar in all patients. Arterial blood gas samples were obtained immediately after anesthesia induction and 4 to 6 hours after extubation. Chest X ray was taken before, 6 to 10 hours after extubation and 3rd postoperative day. Severity of atelectasis was also measured. Quantitative & qualitative data was analyzed by ANOVA and Chi-square tests, respectively. Pvalue<0.05 was considered as statistically significant. Results: Both groups were similar with respect to demographic data including ejection fraction, NYHA class, FEV1/FVC, cigarette smoking and Lima harvesting. The ratio of arterial oxygen pressure to fraction of inspiratory oxygen Pao2/FIo2 was not significantly different after induction but this difference was strongly significant (Pvalue<0.005 after extubation. Duration of mechanical ventilation was

  1. [Mitral valve replacement after previous coronary artrey bypass grafting( CABG) with functioning left internal thoracic artery( LITA) grafts in an elderly patient; report of a case].

    Science.gov (United States)

    Furukawa, Hiroshi; Aono, Hitoshi; Samukawa, Masanobu; Ohkado, Akihiko

    2012-09-01

    An 85-year-old woman had a history of coronary artery bypass grafting (CABG) performed 7 years ago, and dyspnea on effort had been worsening recently. Since echocardiography showed severe mitral valve regurgitation( MR), mitral valve repair was suggested. Preoperative enhanced computed tomography (CT) showed the patent functioning left internal thoracic artery (LITA) graft. Mitral valve replacement (MVR) using a 25 mm CEP bioprosthesis was performed successfully via resternotomy without any intraoperative injury of the heart. Myocardial protection without clamping of functioning LITA was done by both antegrade and retrograde continuous coronary perfusion (RCCP) under mild hypothermia. The postoperative clinical course was uneventful without any hemodynamic compromise. She was discharged on postoperative day 21 without any cardiac events following early introduction of cardiac rehabilitation. From these results, mitral valve reoperation by RCCP under mild hypothermia without control of functioning internal thoracic artery( ITA) grafts could be a safe option in some cases. PMID:22940664

  2. EFFECTS OF LOW-DOSE ASPIRIN (50-MG/DAY), LOW-DOSE ASPIRIN PLUS DIPYRIDAMOLE, AND ORAL ANTICOAGULANT AGENTS AFTER INTERNAL MAMMARY ARTERY BYPASS-GRAFTING - PATENCY AND CLINICAL OUTCOME AT 1 YEAR

    NARCIS (Netherlands)

    VANDERMEER, J; DELARIVIERE, AB; VANGILST, WH; HILLEGE, HL; PFISTERER, M; KOOTSTRA, GJ; DUNSELMAN, PHJM; MULDER, BJM; LIE, KI

    1994-01-01

    Objectives. This study was performed to compare the efficacy and safety of aspirin, aspirin plus dipyridamole, and oral anti coagulant agents in the prevention of internal mammary artery graft occlusion. Background. Antithrombotic drugs increase vein graft patency after coronary artery bypass surger

  3. A case-controlled evaluation of the Medtronic Resting Heart System compared with conventional cardiopulmonary bypass in patients undergoing isolated coronary artery bypass surgery†

    OpenAIRE

    Nozohoor, Shahab; Johnsson, Per; Scicluna, Sara; Wallentin, Per; Andell, Elisabeth; Nilsson, Johan

    2012-01-01

    The Medtronic Resting Heart System (RHS) is a heparin-coated, closed perfusion circuit. Clinical results indicate less haemodilution and reduced complement activation, when compared with a traditional circuit leading to fewer postoperative blood transfusions. We evaluated the potential clinical benefits, including reduced transfusion requirements, when using the RHS compared with conventional cardiopulmonary bypass (cCPB). The study group (n = 330) consisted of patients undergoing isolated co...

  4. Non-ischemic perfusion defects due to delayed arrival of contrast material on stress perfusion cardiac magnetic resonance imaging after coronary artery bypass graft surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeo Koon; Park, Eun Ah; Park, Sang Joon; Cheon, Gi Jeong; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of)

    2014-04-15

    Herein we report about the adenosine stress perfusion MR imaging findings of a 50-year-old man who exhibited two different perfusion defects resulting from two different mechanisms after a coronary artery bypass surgery. An invasive coronary angiography confirmed that one perfusion defect at the mid-anterior wall resulted from an ischemia due to graft stenosis. However, no stenosis was detected on the graft responsible for the mid-inferior wall showing the other perfusion defect. It was assumed that the perfusion defect at the mid-inferior wall resulted from delayed perfusion owing to the long pathway of the bypass graft. The semiquantitative analysis of corrected signal-time curves supported our speculation, demonstrating that the rest-to-stress ratio index of the maximal slope of the myocardial territory in question was similar to those of normal myocardium, whereas that of myocardium with the stenotic graft showed a typical ischemic pattern. A delayed perfusion during long graft pathway in a post-bypass graft patient can mimick a true perfusion defect on myocardial stress MR imaging. Radiologists should be aware of this knowledge to avoid misinterpretation of graft and myocardial status in post bypass surgery patients.

  5. Non-ischemic perfusion defects due to delayed arrival of contrast material on stress perfusion cardiac magnetic resonance imaging after coronary artery bypass graft surgery

    International Nuclear Information System (INIS)

    Herein we report about the adenosine stress perfusion MR imaging findings of a 50-year-old man who exhibited two different perfusion defects resulting from two different mechanisms after a coronary artery bypass surgery. An invasive coronary angiography confirmed that one perfusion defect at the mid-anterior wall resulted from an ischemia due to graft stenosis. However, no stenosis was detected on the graft responsible for the mid-inferior wall showing the other perfusion defect. It was assumed that the perfusion defect at the mid-inferior wall resulted from delayed perfusion owing to the long pathway of the bypass graft. The semiquantitative analysis of corrected signal-time curves supported our speculation, demonstrating that the rest-to-stress ratio index of the maximal slope of the myocardial territory in question was similar to those of normal myocardium, whereas that of myocardium with the stenotic graft showed a typical ischemic pattern. A delayed perfusion during long graft pathway in a post-bypass graft patient can mimick a true perfusion defect on myocardial stress MR imaging. Radiologists should be aware of this knowledge to avoid misinterpretation of graft and myocardial status in post bypass surgery patients.

  6. Myocardial scar identified by magnetic resonance imaging can predict left ventricular functional improvement after coronary artery bypass grafting.

    Directory of Open Access Journals (Sweden)

    Tao Yang

    Full Text Available BACKGROUND: Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR on functional recovery in patients undergoing coronary artery bypass grafting (CABG. METHODS: From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA 6 months post-CABG. Predictors for global functional recovery were analyzed. RESULTS: The baseline LVEF was 32.7 ± 9.2%, which improved to 41.6 ± 11.0% 6 months later and 32/52 patients improved LVEF by ≥ 5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172-6.996, p = 0.021. Receiver-Operator-Characteristic (ROC analysis demonstrated that ≤ 4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, p<0.001. Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001. CONCLUSIONS: Our findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization.

  7. Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol

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    Nakanishi Kazuhiro

    2013-01-01

    Full Text Available Abstract Background Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF after cardiac surgery. Methods Of the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3–5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group and those who did not receive any β-blockers during surgery (control group. An unpaired t test and Fisher’s exact test were used to compare between-group differences in mean values and categorical data, respectively. Results Seventeen of the 105 patients (16.2% developed postoperative atrial fibrillation: 5/57 (8.8% in the landiolol group and 12/48 (25% in the control group. There was a significant difference between the two groups (P=0.03. The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant. Conclusions Our retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.

  8. Numerical investigation of haemodynamics in a helical-type artery bypass graft using non-Newtonian multiphase model.

    Science.gov (United States)

    Wen, Jun; Liu, Kai; Khoshmanesh, Khashayar; Jiang, Wentao; Zheng, Tinghui

    2015-01-01

    The classic single-phase Newtonian blood flow model ignores the motion of red blood cells (RBCs) and their interaction with plasma. To address these issues, we adopted a multiphase non-Newtonian model to carry out a comparative study between a helical artery bypass graft (ABG) and a conventional ABG in which the blood flow is composed of plasma and RBCs. The investigation focused on the mechanism of RBC buildup in an ABG but the haemodynamic parameters obtained by single-phase and multiphase models were also compared. The aggregation of RBCs along the inside wall of a conventional ABG and at the heel of its distal anastomosis was predicted while a poor aggregation was observed along the helical ABG. In addition, RBCs were observed to gradually sediment along the gravity direction. However, the computed haemodynamic parameters by multiphase model qualitatively agreed well with those by single-phase model. It was concluded that (1) the single-phase computational fluid dynamics (CFD) is reasonable to do the computation of haemodynamic parameters in ABGs; (2) secondary flow does not definitely produce buildup of RBCs in the inside curvature, its configuration played an important role in the movement of RBCs and the dominating one-way rotating flow in a helical ABG guaranteed no buildup of RBCs on its inside wall and (3) gravity direction is important for the movement of RBCs which may help to explain why doing exercise is good for human health. This study helps to shed light on the migration of RBCs in ABGs, which cannot be explored by single-phase CFD models, and provides more understanding of the underlying flow mechanism for ABG failure. PMID:24156553

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

    Directory of Open Access Journals (Sweden)

    Abbasi Kyomars

    2007-09-01

    Full Text Available Abstract Background Sternal wound infection (SWI is an uncommon but potentially life-threatening complication of cardiac surgery. Predisposing factors for SWI are multiple with varied frequencies in different studies. The purpose of this study was to assess the incidence, risk factors, and mortality of SWI after coronary artery bypass grafting (CABG at Tehran Heart Center. Methods This study prospectively evaluated multiple risk factors for SWI in 9201 patients who underwent CABG at Tehran Heart Center between January 2002 and February 2006. Cases of SWI were confirmed based on the criteria of the Centers for Disease Control and Prevention. Deep SWI (bone and mediastinitis was categorized according to the Oakley classification. Results In the study period, 9201 CABGs were performed with a total SWI rate of 0.47 percent (44 cases and deep SWI of 0.22 percent (21 cases. Perioperative (in-hospital mortality was 9.1% for total SWI and about 14% for deep SWI versus 1.1% for non-SWI CABG patients. Female gender, preoperative hypertension, high functional class, diabetes mellitus, obesity, prolonged intubation time (more than 48 h, and re-exploration for bleeding were significant risk factors for developing SWI (p = 0.05 in univariate analysis. In multivariate analysis, hypertension (OR = 10.7, re-exploration (OR = 13.4, and female gender (OR = 2.7 were identified as significant predictors of SWI (p Conclusion Rarely reported previously, the two risk factors of hypertension and the female gender were significant risk factors in our study. Conversely, some other risk factors such as cigarette smoking and age mentioned as significant in other reports were not significant in our study. Further studies are needed for better documentation.

  10. Coronary artery bypass grafting (CABG) in patients with immune thrombocytopenia (ITP): a community hospital experience and review of the literature.

    Science.gov (United States)

    Jubelirer, Steven J; Mousa, Luay; Reddy, Usha; Mir, Mohsin; Welch, Christine A

    2011-01-01

    We reviewed the records of 51 patients with Immune Thrombocytopenia (ITP) who underwent Coronary Artery Bypass Grafting (CABG) at Charleston Area Medical Center between June 1992 and September 2005. There were 41 males and 10 females with a median age of 68 years (range 49-87). Four patients had a previous splenectomy, one of whom had it performed concomitantly with the CABG. Three patients were on chronic corticosteroids on admission. The median pump time was 114 minutes (range: 42-244 minutes). The median cross-clamp time was 62 minutes (range 22-192 minutes). The median total chest tube drainage postoperatively was 1,346 cc (range: 265-9875cc). The mean preoperative and 24 hour postoperative platelet count was 126,000 (range 58,000-323,000) and 99,000/mm3 (range: 27,000-194,000), respectively. Twenty-one (40%) patients received platelet transfusions. Platelets were given intraoperatively or postoperatively in all but two of those patients. The median number of units of platelets given was 10 (range: 6-52). Twenty-seven (53%) received packed red cells intraoperatively or postoperatively. The median number of red cells given was 2 (range: 1-34). Other hemostatic agents given intraoperatively/ postoperatively included aprotinin (8 patients), aminocaproic acid (10 patients), DDAVP (5 patients), and intravenous gammaglobulin (IgG) in 3 patients. Thirteen patients were given corticosteroids preoperatively with little improvement in platelet count. CABG may be successfully performed in ITP patients with moderate thrombocytopenia (> or = 50,000/mm3) using conventional therapies (e.g., transfusions, IV IgG, hematinics) without the need for preoperative splenectomy or prolongation of hospital stay. However, a prospective study on the ideal management of ITP patients undergoing CABG would be beneficial. PMID:22235705

  11. The Effect of Ondansetron and Meperedin on Preventing Shivering After Off-pump Coronary Artery Bypass Graft

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    Mohammadtaghi Sarebanhassanabadi

    2012-06-01

    Full Text Available One of the most common complications of operation and anesthesia is shivering. The purpose of this study was to compare the effectiveness of Ondanseton and Meperedine in preventing shivering after off-pump coronary artery bypass graft (OPCAB. In this double-blind randomized clinical trial, the sample consisted of 90 patients, who were candidates of CABG under general anesthesia. These patients were assigned to three groups, each containing 30 subjects: meperedine group (A, ondansetron group (B and control group (C. Group (A received 0.4 mg/Kg/IV of meperedine, group (B received 8mg/IV of ondansetron and group (C received Normal Saline. All these drugs were injected 15 minutes before the end of surgery. After the end of surgery, the intubated patients were transferred to the ICU and their body temperature was assessed through eardrum by a specialist who was blind to the research. The incidence of shivering in groups A, B, and C was 46.48%, 31.18%, and 60.83%, respectively (P=<0.01. The incidence of shivering was 64.4% in males and 35.6% in females (P=0.222. Also, the amount of incidence of shivering up to 3 hours after surgery was 75.87 % (P=0.064. Bradycardia was 3.3% in group (A and 0.0 % in group (B. Other variables (myoclonus, seizure and rash showed no statistically significant difference (P=0.353. According to the findings, it was demonstrated that ondansetron is more effective in preventing shivering after Off-pump CABG than meperedine.

  12. Is severely left ventricular dysfunction a predictor of early outcomes in patients with coronary artery bypass graft?

    Science.gov (United States)

    Ahmadi, Seyed Hossein; Karimi, Abbasali; Movahedi, Namvar; Shirzad, Mahmood; Marzban, Mehrab; Tazik, Mokhtar; Aramin, Hermineh; Dowlatshahi, Samaneh; Fathollahi, Mahmood Sheikh

    2010-01-01

    Background Traditionally, the Coronary artery bypass grafting (CABG) surgery outcomes of patients with low ejection fraction (EF) have been worse compared to patients with moderate to good left ventricular function. During the past decade, despite improvements in surgical techniques, the trend in the outcomes of these patients remained unclear. Aim We sought to determine the effect of left ventricular dysfunction on early mortality and morbidity and to specify predictors of early mortality of isolated CABG in a large group of patients EF≤35%. Method We retrospectively analyzed data of 14 819 consecutive patients undergoing isolated CABG from February 2002 to March 2008 at Tehran Heart Center. Patients were divided into two groups based on their LVEF (EF≤35% and EF>35%). Differences in case-mix between patients with EF≤35% and those without were controlled by constructing a propensity score. Results Mean age of our patients was 58.7±9.5 years. EF≤35% was present in 1342 (9.1%) of patients. In-hospital mortality was significantly increased univariate in EF≤35%, while this association diminished after confounders were adjusted for by using the propensity score (p=0.242). Following adjustment it was demonstrated that renal failure, cardiac arrest, heart block, infectious complication, total ventilation time, and total ICU hours were more frequent in patients with EF≤35%. Conclusion We demonstrated EF≤35% was not predictor of in-hospital mortality in patients underwent CABG. Careful preoperative patient selection remains essential in patients with EF≤35% undergoing CABG.

  13. Five-year Outcome after Coronary Artery Bypass Surgery in Survivors of Out-of-Hospital Cardiac Arrest

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    Matti-Aleski eMosorin

    2015-01-01

    Full Text Available Objective: The aim of this study is to evaluate the role of coronary artery bypass grafting (CABG in patients with out-of-hospital cardiac arrest (OHCA.Methods: The immediate and 5-year outcome after CABG of a consecutive series of 48 patients who survived OHCA were compared with those of control patients having had a recent myocardial infarction without ventricular arrhythmias.Results: All OHCA patients were found to have suffered myocardial infarction-related cardiac arrest. The mean delay from OHCA to CABG was 10.3±13.0 days. Despite not statistically significant, the risk of 30-day postoperative mortality was higher among OHCA patients than control patients (6.3% vs. 0%, p=0.24, propensity score adjusted analysis: p=1.00. Cardioverter defibrillator was implanted in two patients who were alive 3.8 and 4.4 years after CABG, respectively. At 5-year the overall survival rate was 80.7% in OHCA patients and 84.5% in control patients (p=0.98, propensity score adjusted analysis: p=0.87, and survival freedom from fatal cardiac event was 86.1% in OHCA patients and 86.5% in control patients (p=0.61; propensity score adjusted analysis: p=0.90. Conclusions: Early and 5-year survival rates after CABG in OHCA patients are excellent even when cardioverter defibrillator is very selectively implanted. Such good early and intermediate results observed after CABG suggest a confident approach toward surgical revascularization also in this critically ill patient population.

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

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    Soheila Ranjbaran

    2015-10-01

    Full Text Available Background: Poor sleep quality (SQ is common among patients after coronary artery bypass graft surgery (CABG. This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG.Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model or to the control group (recipient of exercise and lifestyle training. Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points.Results: The mean age of the patients in the intervention (24% women and control (24% women groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001, knowledge (p value < 0.001, beliefs (p value < 0.001, sleep self-efficacy (p value < 0.001, enabling factors (p value < 0.001, reinforcing factors (p value < 0.001, and social support (p value < 0.001 were significantly different between the intervention and control groups after the intervention.Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients.

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

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    Hofmann James P

    2007-11-01

    Full Text Available 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 nomogram was derived from the local patient population in the attempt to improve patient safety by convincing clinicians to use an evidence-based approach to vancomycin prescription. Methods We analyzed two different treatment strategies that were applied consecutively to an intensive care unit population. CABG patients dosed empirically with vancomycin (group 1, pre-nomogram were compared with CABG patients dosed using a vancomycin dosing nomogram (group 2, post-nomogram derived from the hospital population using an Internet program that facilitated creation of a local nomogram. The two groups were analyzed as to age, sex, body mass index, creatinine clearance, and vancomycin dosage using logistic regression and testing for continuous and categorical variables. Results Nomogram use decreased the number of patients receiving the customary dose of one gram every 12 hours in those group 2 patients with diminished CrCl as compared with those in group 1 with diminished CrCl (group 2, 2/21 vs. group 1, 14/21, p Conclusion Implementation of the nomogram resulted in a more appropriate antibiotic utilization, regardless of creatinine clearance, that decreased costs without increasing infection rates.

  16. The role of surface ECG and transthoracic echocardiography for predicting postoperative atrial fibrillation after coronary artery bypass surgery

    International Nuclear Information System (INIS)

    Objective was to evaluate the roles of surface electrocardiogram (ECG) and transthoracic echocardiography (ECH) for prediction of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). This study was conducted from 2002-2004 at the Cardiovascular Department of Hacettepe University, Ankara, Turkey. Seventy consecutive patients were enrolled in this study that underwent elective CABG. P-wave dispersion (PWD) was defined as the difference between maximum and minimum P-wave duration. Differences in P-wave duration were compared between the pre- and postoperative 12-lead ECG measurements. Postoperative AF developed in 17 (24%) cases of 70 patients. The PWD was found to be significantly higher in patients with AF preoperatively (60+-19 versus 47+-13, p=0.003), postoperative first day (56+-12 versus 44+-11, p<0.002) and fifth day (51+-29 versus 41+-11, p<0.001). Patients with AF were significantly older, the mean age of the AF group was (68+-7 years) and of the sinus rhythm (SR) group was (59+-10 years) (p<0.001). The AF group has left ventricular systolic dysfunction (56+-13% versus 56+-8%, p=0.042, preoperatively; 49+-8% versus 60+-10%, p=0.001, postoperatively) and a larger left atrium (46+-5 versus 39+-5 mm, p<0.001, preoperatively and 44+-7 versus 39+-5 mm, p=0.046, postoperatively) than the SR group. This prospective study demonstrated that PWD on surface ECG and additional echocardiographic parameters are simple and reliable indexes to predict the development of AF after CABG. (author)

  17. Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    Vincenzo; Tarzia; Giacomo; Bortolussi; Edward; Buratto; Carla; Paolini; Carlo; Dal; Lin; Giulio; Rizzoli; Tomaso; Bottio; Gino; Gerosa

    2015-01-01

    AIM:To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting(CABG).METHODS:Two groups of CABG patients were studied:Group A,treated with aspirin alone(n=50),and Group B treated with aspirin and clopidogrel(n=50).Both had similar preoperative,clinical,biologic characteristics and operative management.Classic coagulation parameters and rotational thromboelastometry(ROTEM)profiles were determined preoperatively for both groups and the same heparin treatment was administered.ROTEM profiles(INTEM and EXTEM assays)were analyzed,both for traditional parameters,and thrombin generation potential,expressed by area-under-curve(AUC).RESULTS:There was no significant difference betweenrates of major bleeding between patients treated with aspirin alone,compared with those treated with aspirin and clopidogrel(12%vs 16%,P=0.77).In the 14 cases of major bleeding,pre-operative classic coagulation and traditional ROTEM parameters were comparable.Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders(5030±1115 Ohm*min)than non-bleeders(6568±548Ohm*min)(P<0.0001).CONCLUSION:We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC,regardless of antiplatelet treatment.This suggests that thrombin generation potential,irrespective of the degree of platelet inhibition,correlates with surgical bleeding.

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

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    Orsel Isabelle

    2007-09-01

    Full Text Available 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-1 was found during cardiac surgery, sFlt-1 levels returning to pre-operative values at the 6th post-operative hour. In contrast sKDR levels did not change during surgery. The ECC-derived sFlt-1 was functional as judge by its inhibitory effect on the VEGF mitogenic response in human umbilical vein endothelial cells (HUVECs. Kinetic experiments revealed sFlt-1 release immediately after the beginning of ECC suggesting a proteolysis of its membrane form (mFlt-1 rather than an elevated transcription/translation process. Flow cytometry analysis highlighted no effect of ECC on the shedding of mFlt-1 on platelets and leukocytes suggesting vascular endothelial cell as a putative cell source for the ECC-derived sFlt-1. Conclusion sFlt-1 is released during CABG with ECC. It might be suggested that sFlt-1 production, by neutralizing VEGF and/or by inactivating membrane-bound Flt-1 and KDR receptors, might play a role in the occurrence of post-CABG complication.

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

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    Mohammad Hasan Ghaffari Nejad

    2008-07-01

    Full Text Available Background: Obesity is a common risk factor for morbidity and mortality after cardiac surgery. However, the relationship between obesity and postoperative risk has not been fully defined. Methods: A prospective study of 1015 consecutive patients undergoing isolated coronary artery bypass grafting (CABG was carried out. Body mass index (BMI was used as the measure of obesity and was categorized as normal weight (BMI=20-25 and obese (BMI>25 and<35. The preoperative, operative, and postoperative risk factors as well as the complication and in-hospital death rates were compared between the two groups. Results: Of the 1015 patients, 40% had a normal weight and 49% were obese. Compared with the normal-weight group, the obese group had a significantly higher incidence of diabetes mellitus (P=0.007 and lower arterial partial pressure of oxygen (PaO2 (P=0.03. The normal-weight patients had a higher New York Heart Association (NYHA Functional Class (P=0.03 and were at a higher risk for emergent surgery (P=0.003 or reoperation (P=0.002. Among the postoperative complications, respiratory complications (P=0.027 were more frequent in the obese patients. The duration of mechanical ventilation (P=0.001, the incidence of arrhythmia (P=0.011, low cardiac output syndrome (P=0.001, reintubation (P=0.001, and neurological complications (P=0.003 were significantly higher in the normal-weight patients. Obesity was associated with a lower risk of reoperation for bleeding (P=0.032. There were no significant differences in infective complications, length of intensive care unit (ICU stay, total length of stay in hospital, and operative mortality between the groups. Conclusion: In the patients undergoing isolated CABG procedures, obesity did not increase the risk of operative mortality and morbidity with the exception of respiratory complications. The normal body weight patients were at a higher risk for complications than were the obese patients. Therefore, obese patients

  20. 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

  1. Prognostic value of myocardial perfusion abnormalities for long-term prognosis in patients after coronary artery bypass grafting

    International Nuclear Information System (INIS)

    The objective was to evaluate the prognostic value of exercise myocardial perfusion scintigraphy (MPS) in patients who underwent coronary artery bypass grafting (CABG). A retrospective, one-center study of 361 patients with multivessel coronary artery disease was carried out. All the patients underwent MPS after CABG due to worsened health status. MPS was performed at 4.5 years standard deviation (SD: 0.2), based on symptoms. MPS was carried out using Tc-99m methoxy isobutyl isonitrile and following a 1-day protocol (stress-rest). The end points were analyzed at 6.5 years (SD: 3.3) after MPS, on the average. SPSS software for Windows, version 13.0. The t-test or the χ2-test was used. Survival times were calculated. A multivariate Cox proportional hazards model was developed. During the follow-up, death occurred in 54 patients, and 37 patients experienced major adverse cardiovascular events (MACE). In the multivariate analysis, advanced age hazard ratio (HR: 1.45; 95% confidence interval [CI]: 1.4–2.02; P = 0.027), previous myocardial infarction (HR: 3.17; 95% CI: 1.22–8.2; P = 0.018), left ventricular ejection fraction of <40% (HR: 2.16; 95% CI: 1.2–3.89; P = 0.01), and the summed stress score (SSS) of ≥4 (HR: 1.87; 95% CI: 1.02–3.41; P = 0.04) were independent predictors of all-cause death. The summed difference score (SDS) was the only independent predictor of MACE (HR: 1.26; 95% CI: 1.06–1.48; P = 0.034). The parameters of MPS were found to have prognostic value in the long-term period after CABG. Advanced age, previous myocardial infarction, decreased left ventricular ejection fraction, and the abnormal SSS were associated with an increased risk of all-cause death. The SDS was found to be the only significant risk factor for MACE

  2. Endoscopic Saphenous harvesting with an Open CO2 System (ESOS trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Campanella Antonio

    2011-11-01

    Full Text Available Abstract Background In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein harvesting, includes postoperative leg wound complications, pain and patient satisfaction. However, to date the short and the long-term benefits of the endoscopic technique remain controversial. This study provides an interesting opportunity to address this gap in the literature. Methods/Design Endoscopic Saphenous harvesting with an Open CO2 System trial includes two parallel vein harvesting arms in coronary artery bypass grafting surgery. It is an interventional, single centre, prospective, randomized, safety/efficacy, cost/effectiveness study, in adult patients with elective planned and first isolated coronary artery disease. A simple size of 100 patients for each arm will be required to achieve 80% statistical power, with a significant level of 0.05, for detecting most of the formulated hypotheses. A six-weeks leg wound complications rate was assumed to be 20% in the conventional arm and less of 4% in the endoscopic arm. Previously quoted studies suggest a first-year vein-graft failure rate of about 20% with an annual occlusion rate of 1% to 2% in the first six years, with practically no difference between the endoscopic and conventional approaches. Similarly, the results on event-free survival rates for the two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5% cross-over rate, the goal is to enrol 230 patients from a single Italian cardiac surgery centre. Discussion The goal of this prospective randomized trial is to compare and to test improvement in wound healing, quality of life, safety/efficacy, cost-effectiveness, short

  3. [Off-pump coronary artery bypass for old myocardial infarction associated with jejunotomy for obstructive ileus due to gall bladder stone; report of a case].

    Science.gov (United States)

    Shibata, T; Fujimatsu, T; Suzuki, H; Kitanaka, Y; Osawa, H; Odagiri, N; Tauchi, K; Koike, H; Aruga, M; Sakurai, S; Yorita, K; Kumazaki, S

    2005-09-01

    In non-cardiac operative cases with inflammatory digestive organ disease, bacterial translocation (BT) often results from non-enteral nutrition postoperatively. If coronary artery bypass grafting (CABG) is performed in the case having old myocardial infarction (OMI) and inflammatory digestive organ disease at first before non-cardiac operation, he seems vulnerable to have severe complications such as multiple organ failure due to systemic inflammatory response syndrome (SIRS) and preexisting BT postoperatively. We performed a off-pump CABG (OPCAB) for OMI associated with jejunotomy for obstructive ileus due to gall bladder stone. No complication was found in the postoperative course. We conclude that combined operation, non-cardiac surgery after OPCAB is worth considering in those cases. And we think OPCAB is better than conventional CABG in such cases, because cardiopulmonary bypass is known to ponder comparable damages to immune system, coagulation system and others. PMID:16167822

  4. Nonselective digital subtraction angiography of aortocoronary bypasses

    International Nuclear Information System (INIS)

    Intra-arterial DSA was performed on 225 patients with a total of 552 coronary bypasses (515 aorto-coronary venous bypasses and 37 internal mammary artery bypasses). Four hundred and ninety-five bypasses were examined in the four weeks following surgery; of these, 428 (85.9%) were patent. Demonstration of the distal anastomosis was obtained in 40.4% of bypasses of the right anterior interventricular artery and in 36.1% of the right coronary artery, at least in their proximal parts. Bypasses of smaller branches showed filling in 12.8 to 19.2%. Because of the unsatisfactory demonstration of distal vessels by non-selective intra-arterial DSA, this method is suitable only for showing the patency of a bypass in the postoperative phase, but should not be used for investigating cardiac signs and symptoms following a bypass examination. (orig.)

  5. Assessment of flow quantification in coronary bypass grafts and coronary arteries with velocity-encoded cine MR imaging; Flussquantifizierung in Koronar- und Bypassgefaessen mit der MR-Phasenkontrasttechnik

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    Kreitner, K.F.; Kalden, P.; Thelen, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Voigtlaender, T.; Wittlinger, T.; Meyer, J. [Mainz Univ. (Germany). 2. Medizinische Klinik und Poliklinik; Dahm, M. [Mainz Univ. (Germany). Klinik fuer Herz-, Thorax-, und Gefaesschirurgie

    2000-02-01

    Materials and methods: 12 patients with 22 coronary bypass grafts underwent intraoperative flow quantification using the transit time ultrasound method. These values were compared to postoperative MR phase shift measurements. Flow measurements were performed preoperatively in 28 coronary arteries of 20 patients. For flow measurement, we used a velocity-encoded k-space segmented gradient echo sequence with a temporal resolution of 110 or 125 ms, respectively. 6-8 pase shift images could be acquired during one cardiac cycle. Results: There was a significant correlation between intraoperative and flow measurements using velocity-encoded MR imaging (r=0.76, p<0.0001, t-test). Flow volumes determined by MR imaging were systematically larger than those determined by the transit time ultrasound method. Mean flow in coronary arteries was reduced in severely stenosed vessels (>70%) compared to normal vessels. Intra- and interobserver variability were 10.5 and 15% (coronary bypass grafts), and 12.3 and 15.8% (coronary arteries), respectively. (orig.) [German] Material und Methode: Die MRT-Flussmessungen von 12 Patienten mit 22 Bypassgefaessen wurden mit intraoperativ mittels Ultraschalldurchflussmethode bestimmten Fluessen verglichen. Praeoperativ wurden zusaetzlich Flussmessungen in 28 Koronararterien von 20 Patienten durchgefuehrt. Zur MRT-Flussmessung wurde eine segmentierte 2D-Flash-Sequenz verwendet, die eine zeitliche Aufloesung von 110 bzw. 125 ms aufwies. Dies ermoeglichte die Akquisition von 6-8 Bildpaaren pro Herzzyklus. Ergebnisse: Es bestand eine signifikante Korrelation zwischen den Ergebnissen der intraoperativen und denen der postoperativen MRT-Flussmessung (r=0,76, p<0,0001, t-Test). Das mit der MRT gemessene Flussvolumen lag ueber dem bei der Ultraschallmessung ermittelten. Die Bestimmung des mittleren Flusses in den Koronararterien zeigte deutliche Unterschiede zwischen Gefaessen mit hoehergradiger Stenose (>70%) und Gefaessen ohne Stenose. Die Intra- und

  6. Effects of continuous administration of clopidogrel before off-pump coronary artery bypass grafting in patients with acute coronary syndrome. A propensity score analysis

    International Nuclear Information System (INIS)

    Clopidogrel has become standard treatment after urgent percutaneous coronary revascularization. Due to its enhanced and irreversible platelet inhibition, patients undergoing urgent surgical revascularization have a higher risk of bleeding complications and transfusions. Therefore, the effect of preoperative continuous administration of clopidogrel on the incidence of hemorrhagic complications in patients undergoing off-pump coronary artery bypass surgery with acute coronary syndrome was evaluated. From March 2004 to September 2006, 172 patients with acute coronary syndrome underwent isolated off-pump coronary artery bypass surgery; 70 (40.7%) and 102 (59.3%) of these patients did or did not take clopidogrel before surgery respectively. Seventy patients in each group were matched using propensity scores and associations between preoperative continuous administration of clopidogrel and postoperative bleeding, hemostatic reoperation, blood products received, the need for multiple transfusions and early graft patency by coronary computed tomography were assessed. Univariate analysis showed the continuous clopidogrel group had similar levels of postoperative bleeding for 24 h (601.4±312.6 ml vs 637.2±452.4 ml, p=0.616) and rates of reexploration (1.4% vs 1.4%), perioperative blood transfusion (33.3% vs 34.3%, p>0.05) and platelet transfusion (2.9% vs 7.1%, p=0.44) compared with the non-continuous group. Preoperative continuous administration of clopidogrel did not increase the risk of hemorrhagic complications in patients with acute coronary syndrome undergoing isolated off-pump coronary artery bypass surgery. These findings indicate that surgery after clopidogrel treatment in patients with acute coronary syndrome should not be delayed until platelet function returns to normal because they may have a higher risk of recurrent myocardial ischemic events. (author)

  7. Intraluminal Projection of Descending Thoracic Aorta and Intraaortic Balloon Pump Catheter Examined by Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Surgery

    OpenAIRE

    Orihashi, Kazumasa; Oka, Yasu

    1991-01-01

    The thoracic descending aorta (DTA) was examined in 57 patients undergoing coronary artery bypass grafting (41 men and 16 women: 63.0 ± 10.6 years old) using two-dimensional transesophageal echocardiography. An intraaortic balloon pump (IABP) was instituted in ten patients. A short-axis view of DTA was examined for intraluminal projection from the diaphragm level to the aortic arch level. In a frozen-frame image, the area and the height of the projection at each clockwise direction was measur...

  8. Evaluations of topical application of tranexamic acid on post-operative blood loss in off-pump coronary artery bypass surgery

    OpenAIRE

    Habibollah Hosseini; Ali Akbar Rahimianfar; Mohammad Hassan Abdollahi; Mohammad Hossein Moshtaghiyoon; Mahdi Haddadzadeh; Asefeh Fekri; Kazem Barzegar; Fatemeh Rahimianfar

    2014-01-01

    Objective: One of the major complications of cardiac surgery is the presence of post-operative bleeding. The aim of the present study was to investigate the topical application of tranexamic acid in the pericardial cavity on post-operative bleeding in off-pump coronary artery bypass graft (CABG) surgery. Materials and Methods: This study was on 71 patients who underwent off-pump CABG. The anesthesia and surgery methods were the same for all patients. Patients were assigned to two equal groups...

  9. Elemental composition of erythrocytes from coronary artery bypass grafting (CABG) patients with and without type II diabetes mellitus using PIXE analysis

    International Nuclear Information System (INIS)

    A study was conducted on erythrocytes in order to determine the composition and concentration of elements from patients undergoing coronary artery bypass grafting (CABG) surgery with and without type II diabetes. Samples were taken at various timeperiods and analyzed by means of proton induced X-ray emission (PIXE) analysis. Elements detected reliably were P, S, Cl, K, Ca, Fe, Cu, Zn, Br and Rb. In particular, elements worthy of note are S, Cl and Ca, which have strong implications in surgical procedures and aftercare. (author)

  10. Incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in the treatment of peripheral arterial occlusive disease in a German referral center 1996-2003; Inzidenzen von Major-Amputationen, Bypass-Operationen und perkutanen transluminalen Angioplastien (PTA) zur Behandlung der peripheren arteriellen Verschlusskrankheit in einer deutschen Klinik der Maximalversorgung 1996-2003

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    Wohlgemuth, W.A. [Klinik fuer Diagnostische Radiologie und Neuroradiologie, Zentralklinikum Augsburg (Germany); Inst. fuer Medizinmanagement und Gesundheitswissenschaften, Univ. Bayreuth (Germany); Freitag, M.H. [Inst. fuer Medizinmanagement und Gesundheitswissenschaften, Univ. Bayreuth (Germany); Woelfle, K.D. [Chirurgisches Zentrum, Klinik fuer Gefaesschirurgie, Zentralklinikum Augsburg (Germany); Bohndorf, K.; Kirchhof, K. [Klinik fuer Diagnostische Radiologie und Neuroradiologie, Zentralklinikum Augsburg (Germany)

    2006-09-15

    Purpose: To determine the current incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in a study population of patients with peripheral arterial occlusive disease in a German referral center. Materials and Methods: In a retrospective study, we recruited patients with peripheral arterial occlusive disease who underwent an amputation, bypass procedure, or PTA in the region of the pelvis or lower limbs between 1996 and 2003 at the Augsburg Medical Center. Patients were identified via the hospital database. This was performed with the help of the International Classification of Diseases (ICD 9 and 10), the operation code (OPS), and appropriate invoices. The incidence of PTAs was further estimated with 200 charts. Results: Of 5379 patients, 627 underwent amputation, 1832 a bypass procedure, and 2920 a PTA. The incidence of PTAs increased during the study period from 51.3/100 000/year to 64.4/100 000/year (p<0.01), while the number of amputations and bypass procedures remained stable. The incidence of PTAs was exceeded by that of bypass procedures only in patients older than 85 years. The age of the amputees decreased during the study period from 72.2 to 70.5 years (p<0.01). The age of patients who underwent a bypass procedure increased from 67.2 to 69.4 years, and the age of patients who underwent PTA increased form 66.3 to 69.8 years (p<0.01). Bypass procedures and PTAs were performed in men 6.3 years earlier than in women (p<0.01). Conclusion: The result is a population-corrected need of 8.4/100 000/year major amputations, 23/100 000/year bypass procedures and 64.4/100 000/year PTAs for patients with peripheral arterial occlusive disease within the referral area of our hospital. The performance of major amputations and bypass procedures stagnates, while the incidence of PTAs is increasing. (orig.)

  11. Effect of remote ischemic conditioning on atrial fibrillation and outcome after coronary artery bypass grafting (RICO-trial

    Directory of Open Access Journals (Sweden)

    Wouters Patrick

    2011-05-01

    Full Text Available Abstract Background Pre- and postconditioning describe mechanisms whereby short ischemic periods protect an organ against a longer period of ischemia. Interestingly, short ischemic periods of a limb, in itself harmless, may increase the ischemia tolerance of remote organs, e.g. the heart (remote conditioning, RC. Although several studies have shown reduced biomarker release by RC, a reduction of complications and improvement of patient outcome still has to be demonstrated. Atrial fibrillation (AF is one of the most common complications after coronary artery bypass graft surgery (CABG, affecting 27-46% of patients. It is associated with increased mortality, adverse cardiovascular events, and prolonged in-hospital stay. We hypothesize that remote ischemic pre- and/or post-conditioning reduce the incidence of AF following CABG, and improve patient outcome. Methods/design This study is a randomized, controlled, patient and investigator blinded multicenter trial. Elective CABG patients are randomized to one of the following four groups: 1 control, 2 remote ischemic preconditioning, 3 remote ischemic postconditioning, or 4 remote ischemic pre- and postconditioning. Remote conditioning is applied at the arm by 3 cycles of 5 minutes of ischemia and reperfusion. Primary endpoint is the incidence AF in the first 72 hours after surgery, detected using a Holter-monitor. Secondary endpoints include length-of-stay on the intensive care unit and in-hospital, and the occurrence of major adverse cardiovascular events at 30 days, 3 months and 1 year. Based on an expected incidence in the control group of 27%, 195 patients per group are needed to detect with 80% power a reduction by 45% following either pre- or postconditioning, while allowing for a 10% dropout and at an alpha of 0.05. With the combined intervention expected to be stronger, we need 75 patients in this group to detect a reduction in incidence of AF of 60%. Discussion The RICO-trial (the effect of

  12. Inflammatory response to coronary artery bypass surgery:Does the heme-oxygenase-1 gene microsatellite polymorphism play a role?

    Institute of Scientific and Technical Information of China (English)

    LI Ping; Jules Sanders; Emma Hawe; David Brull; Hugh Montgomery; Steve Humphries

    2005-01-01

    Background Heme-oxygenase 1 (HO-1) is a rate-limiting enzyme in the degradation of heme to bilirubin, ferritin and carbon monoxide (CO) and may have significant anti-inflammatory function.The HO-1 gene promoter region shows microsatellite polymorphism with different (GT)n repeats, reported to differently induce gene expression, with the short allele associated with higher gene expression.We measured the acute inflammatory response using coronary artery bypass surgery (CABG) as a well-characterized and uniform stimulus and examined the correlation between levels of IL-6, C-reactive protein (CRP) and fibrinogen and their relationship to HO-1 genotype.Methods Two hundred and seventy-five consecutive patients undergoing CABG were genotyped for the HO-1 promoter polymorphism using PCR and automated DNA capillary sequencer.IL-6, CRP and fibrinogen were measured at baseline and 6, 24, 48, 72, 96 and 120 hours after CABG.Results Complete IL-6,CRP and fibrinogen measures were available in 220 patients.Before surgery IL-6 levels showed a strong correlation with CRP and fibrinogen (r=0.48, P37(GT)n as L (long); allele frequency 0.35, 0.58 and 0.07 respectively.Baseline CRP differed by genotype: those carrying at least one long allele having higher CRP than those with no long allele (3.76±0.79 vs.2.07±0.17, P=0.013).Conversely, those carrying at least one short allele had higher fibrinogen levels than those with no short allele (3.83±0.79 vs.3.51±0.88, P=0.006).Conclusions There is a strong correlation between the measured acute phase reactants both at baseline and after the inflammatory response to CABG in patients with coronary disease.There was an association between the HO-1 microsatellite polymorphism and CRP and fibrinogen levels at baseline but there was no similar association following CABG.This may indicate that HO-1 is associated with chronic atherosclerotic inflammatory processes rather than acute.

  13. Potential Effect of L-Carnitine on the Prevention of Myocardial Injury after Coronary Artery Bypass Graft Surgery

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    Farzaneh Dastan

    2015-10-01

    Full Text Available Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG surgery.Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery or a control group (n = 67. CK-MB (creatine kinase, muscle- brain subunits and troponin T (TnT levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively.Results: Our study included 134 patients (99 [73.8%] males at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group did not show any significant differences (p value=0.93 and 0.08, respectively. Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group, but the difference was not significant (p value = 0.28. TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34. Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels.

  14. Comparison of transthoracic electrical bioimpedance cardiac output measurement with thermodilution method in post coronary artery bypass graft patients

    Directory of Open Access Journals (Sweden)

    Sharma Vikas

    2011-01-01

    Full Text Available Transthoracic electrical bioimpedance (TEB has been proposed as a non-invasive, continuous, and cost-effective method of cardiac output (CO measurement. In this prospective, non-randomized, clinical study, we measured CO with NICOMON (Larsen and Toubro Ltd., Mysore, India and compared it with thermodilution (TD method in patients after off-pump coronary artery bypass (OPCAB graft surgery. We also evaluated the effect of ventilation (mechanical and spontaneous on the measurement of CO by the two methods. Forty-six post-OPCAB patients were studied at five predefined time points during controlled ventilation and at five time points when breathing spontaneously. A total of 230 data pairs of CO were obtained. During controlled ventilation, TD CO values ranged from 2.29 to 6.74 L/min (mean 4.45 ± 0.85 L/min, while TEB CO values ranged from 1.70 to 6.90 L/min (mean 4.43 ± 0.94 L/min. The average correlation (r was 0.548 (P = 0.0002, accompanied by a bias of 0.015 L/min and precision of 0.859 L/min. In spontaneously breathing patients, TD CO values ranged from 2.66 to 6.92 L/min (mean 4.66 ± 0.76 L/min, while TEB CO values ranged from 3.08 to 6.90 L/min (mean 4.72 ± 0.82 L/min. Their average correlation was relatively poor (r = 0.469, P= 0.002, accompanied by a bias of −0.059 L/min and precision of 0.818 L/min. The overall percent errors between TD CO and TEB CO were 19.3% (during controlled ventilation and 17.4% (during spontaneous breathing, respectively. To conclude, a fair correlation was found between TD CO and TEB CO measurements among post-OPCAB patients during controlled ventilation. However, the correlation was weak in spontaneously breathing patients.

  15. The Effects of Exercise Cardiac Rehabilitation on Anxiety, Depression and Quality of Life in Coronary Artery Bypass Grafting Patients

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    A. Yalfani

    2012-04-01

    Full Text Available 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 study aim to investigate the effects of a 12 week exercise CR on anxiety, depression and quality of life in the Iranian CABG patients.Materials & Methods: In this cross sectional study 72 consecutive CABG patients referred to and enrolled in a 12 week (3 session per week CR program in rehabilitation center of Shahid Beheshti hospital of Hamadan(Iran. 60 patients completed and 12(17% dropped out of the program. Patients underwent exercise testing using modified Bruce protocol before and immediately after CR. Initial exercise intensity was 45-55% of VO2 peak(peak of oxygen consumption which was progressively increased to 0.5 MET (metabolic equivalent unit per week to 70-85%. Patients also completed the quality of life questionnaire and hospital anxiety and depression scale (HADs at each time point.Results: Compared with pre CR exercise capacity, MET and BMI statistically improved after the program (P<0.001. The prevalence rate of anxiety and depression preprogram were 31.6% and 25% which statistically reduced post CR(11.6% and 8.4% . Further analysis indicated a significant improvement in all components of QoL (physical, mental and social similarly in men and women after the program. Additionally men and women did benefit from CR program similarly as there were no significant differences between men and women in terms of improvements in anxiety, depression and quality of life after the program.Conclusion: It is concluded that the completion of a CR program has

  16. Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age

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    Herzog Michael

    2007-09-01

    Full Text Available Abstract Background Scientific literature on depression and anxiety in patients with coronary heart disease (CHD consistently reports data of elevated anxiety and depression scores indicating clinically relevant quantities of these psychopathological conditions. Depression is considered to be a risk factor for the development of CHD and deteriorates the outcome after cardiac rehabilitation efforts. The aim of our study was to evaluate the presence of clinically relevant anxiety and depression in patients before and after coronary artery bypass grafting (CABG. Additionally we evaluated their relationship to age because of the increasing number of elderly patients undergoing CABG surgery. Methods One hundred and forty-two consecutive patients who underwent CABG in our hospital were asked to fill in the "Hospital Anxiety and Depression Scale – German Version (HADS" to measure depression and anxiety scores two days before and ten days after CABG surgery. Differences between these pre- and post-surgical scores were then calculated as means for changes, and the amount of elevated scores were appraised. In order to investigate the relationship between age and anxiety and depression, respectively, Spearman correlations between age and the difference scores were calculated. In addition, ANOVA procedures with the factor "age group" and McNemar tests were calculated. Therefore the sample was divided into four equally sized age groups. Results 25.8% of the patients were clinically depressed before and 17.5% after surgery; 34.0% of the patients were clinically anxious before and 24.7% after surgery. This overall change is not significant. We found a significant negative correlation between age and the difference between the two time points for anxiety (Spearman rho = -.218; p = 0.03, but not for depression (Spearman rho = -.128; p = 0.21. ANOVA and McNemar-Tests revealed that anxiety scores and the number of patients high in anxiety declined statistically

  17. Predicting target vessel location on robot-assisted coronary artery bypass graft using CT to ultrasound registration

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Daniel S.; Linte, Cristian; Chen, Elvis C. S.; Bainbridge, Daniel; Wedlake, Chris; Moore, John; Barron, John; Patel, Rajni; Peters, Terry [Imaging Research Laboratories, Robarts Research Institute and Biomedical Engineering Graduate Program, University of Western Ontario, Ontario N6A 5K8 (Canada); Imaging Research Laboratories, Robarts Research Institute and Biomedical Imaging Resource, Mayo Clinic, Rochester, Minnesota 55905 (United States); Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, Ontario N6A 5K8 (Canada); Canadian Surgical Technologies and Advanced Robotics, London, Ontario N6A 5A5 (Canada); Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, Ontario N6A 5K8 (Canada); Department of Computer Science, University of Western Ontario, Ontario N6A 5B7 (Canada); Canadian Surgical Technologies and Advanced Robotics, London, Ontario N6A 5A5 (Canada); Imaging Research Laboratories, Robarts Research Institute, Biomedical Engineering Graduate Program, University of Western Ontario N6A 5K8 (Canada); and Canadian Surgical Technologies and Advanced Robotics, London, Ontario N6A 5A5 (Canada)

    2012-03-15

    Purpose: Although robot-assisted coronary artery bypass grafting (RA-CABG) has gained more acceptance worldwide, its success still depends on the surgeon's experience and expertise, and the conversion rate to full sternotomy is in the order of 15%-25%. One of the reasons for conversion is poor pre-operative planning, which is based solely on pre-operative computed tomography (CT) images. In this paper, the authors propose a technique to estimate the global peri-operative displacement of the heart and to predict the intra-operative target vessel location, validated via both an in vitro and a clinical study. Methods: As the peri-operative heart migration during RA-CABG has never been reported in the literatures, a simple in vitro validation study was conducted using a heart phantom. To mimic the clinical workflow, a pre-operative CT as well as peri-operative ultrasound images at three different stages in the procedure (Stage{sub 0}--following intubation; Stage{sub 1}--following lung deflation; and Stage{sub 2}--following thoracic insufflation) were acquired during the experiment. Following image acquisition, a rigid-body registration using iterative closest point algorithm with the robust estimator was employed to map the pre-operative stage to each of the peri-operative ones, to estimate the heart migration and predict the peri-operative target vessel location. Moreover, a clinical validation of this technique was conducted using offline patient data, where a Monte Carlo simulation was used to overcome the limitations arising due to the invisibility of the target vessel in the peri-operative ultrasound images. Results: For the in vitro study, the computed target registration error (TRE) at Stage{sub 0}, Stage{sub 1}, and Stage{sub 2} was 2.1, 3.3, and 2.6 mm, respectively. According to the offline clinical validation study, the maximum TRE at the left anterior descending (LAD) coronary artery was 4.1 mm at Stage{sub 0}, 5.1 mm at Stage{sub 1}, and 3.4 mm at

  18. 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 ... include lifestyle changes, medicines, and a procedure called percutaneous coronary intervention (PCI), also known as coronary angioplasty. PCI is ...

  19. Peripheral artery bypass - leg

    Science.gov (United States)

    ... unable to feel pain. Or, you may have epidural or spinal anesthesia instead. The doctor will inject your spine with ... to feel pain. You may instead have an epidural or spinal anesthesia. The doctor will inject your spine with medicine ...

  20. Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Marano, Riccardo; Storto, Maria Luigia; Maddestra, Nicola; Bonomo, Lorenzo [Department of Clinical Sciences and Bioimaging, Section of Radiology, University ' ' G. d' Annunzio' ' , Ospedale ' ' SS. Annunziata' ' , Via dei Vestini, 66100, Chieti (Italy)

    2004-08-01

    The purpose of this study was to assess the accuracy of four-row multi-detector CT (MDCT) in the evaluation of coronary artery bypass graft (CABG) in patients with at least a left internal mammary artery (LIMA) grafted to the left anterior descending artery (LAD), because of the conduit of choice in bypass surgery and the greater difficulty of evaluation with non-invasive diagnostic tools. Included in the study were 57 patients with a total of 122 grafts (95 arterial and 27 venous) who underwent MDCT (4 x 2.5-mm detector-collimation, 3-mm slice width, 1.5-mm reconstruction increment) with retrospective ECG gating. Twelve patients (21%) with high heart rates were given beta-blockers in order to obtain a heart rate {<=}70 bpm in all patients. The ECG-synchronized axial images, reconstructed in the mid-diastole, MPR, MIP and 3D-VR images were independently and blindly assessed by two radiologists for graft patency and presence of high grade stenosis. Conventional angiography was the standard of reference. MDCT correctly classified 92/94 patent grafts and 26/28 occluded grafts (sensitivity/specificity 93%/97.8%); sensitivity and specificity of MDCT for assessment of arterial grafts were 100 and 98.7% (77/78 patent grafts and 17/17 occluded grafts). Image quality was considered adequate for assessment of significant stenoses in 62/92 (67%) patent grafts, with a significant differences between LIMA and non-LIMA conduits (44/57 vs. 18/65; P=0.002), according to the coronary vessel area supplied (anterior>lateral>posterior-inferior wall; P=0.002). In the remaining 30 patent grafts (33%), the assessment of stenoses was hampered by surgical clips, calcifications and motion artifacts. Sensitivity and specificity of MDCT for detection of significant graft stenoses were 80 and 96%, respectively. Inter-observer agreement was good (K=0.73). MDCT seems to be a valuable diagnostic tool for non-invasive assessment of patency of both venous and arterial grafts. An accurate evaluation

  1. Validating intramyocardial bone marrow stem cell therapy in combination with coronary artery bypass grafting, the PERFECT Phase III randomized multicenter trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Donndorf Peter

    2012-07-01

    Full Text Available Abstract Background For the last decade continuous efforts have been made to translate regenerative cell therapy protocols in the cardiovascular field from ‘bench to bedside’. Successful clinical introduction, supporting safety, and feasibility of this new therapeutic approach, led to the initiation of the German, Phase III, multicenter trial - termed the PERFECT trial (ClinicalTrials.gov Identifier: NCT00950274, in order to evaluate the efficacy of surgical cardiac cell therapy on left ventricular function. Methods/Design The PERFECT trial has been designed as a prospective, randomized, double-blind, placebo controlled, multicenter trial, analyzing the effect of intramyocardial CD 133+ bone marrow stem cell injection in combination with coronary artery bypass grafting on postoperative left ventricular function. The trial includes patients aged between 18 and 79 years presenting with a coronary disease with indication for surgical revascularization and reduced global left ventricular ejection fraction as assessed by cardiac magnet resonance imaging. The included patients are treated in the chronic phase of ischemic cardiomyopathy after previous myocardial infarction. Discussion Patients undergoing coronary artery bypass grafting in combination with intramyocardial CD133+ cell injection will have a higher LV ejection fraction than patient who undergo CABG alone, measured 6 months after the operation. Trial registration ClinicalTrials.gov Identifier: NCT00950274

  2. The monitoring of antiaggregation effect of acetylsalicylic acid therapy by measuring serum thromboxane B2 in patients with coronary artery bypass grafting.

    Science.gov (United States)

    Klasic, Anita; Lakusic, Nenad; Gaspar, Ludovit; Kruzliak, Peter

    2016-06-01

    Cardiovascular patients take acetylsalicylic acid (ASA) for preventing myocardial infarction and other thromboembolic complications. It is already known that in some patients this therapy is not effective. The aim of this study was to assess the percentage of ASA resistance on the sample of patients with coronary artery bypass grafting. Our study included 105 patients with coronary artery bypass grafting treated with ASA 150 mg/day or lesser. Platelet aggregation was measured by serum thromboxane B2 level as well as impedance aggregometry from whole blood to determine ASA antiaggregation effect. The percentage of ASA resistance was 41.9% with impedance aggregometry, and after determining the serum thromboxane B2 level this percentage was only 8.6%. The correlation between these two methods was weak (r = 0.443; P < 0.0001). Thromboembolic complications still occur in ASA-treated patients because some patients are resistant to ASA therapy. It would be useful to monitor the effectiveness of ASA therapy and give another antiaggregation drug to these patients to reduce adverse events. The problem is which test is ideal because different tests show different percentages of ASA resistance. PMID:26575493

  3. The elusive link between high sensitivity C-reactive protein and carotid subclinical atherosclerosis in coronary artery bypass grafting candidates: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Nezami Nariman

    2008-05-01

    Full Text Available Abstract Background Previous studies demonstrated a modest association between C-Reactive Protein (CRP, stenosis of carotid artery, and carotid Intima-Media Thickness (IMT in general population. During present study, we aimed to evaluate the relationship between High Sensitivity C-Reactive Protein (hsCRP and Common Carotid Intima-Media Thickness (CCIMT in patients who candidate for Coronary Artery Bypass Grafting (CABG. Methods The study subjects were enrolled from patients with coronary arteries disease referred from Shahid Madani Hospital (Tabriz, Iran, who have been candidate for elective CABG from January 2005 to August 2007. The common carotid arteries were evaluated with high-resolution B-mode ultrasonography using a 7.5- MHz linear-array transducer to determine the IMT and grade of stenosis. Serum hsCRP level was measured using commercially available enzyme linked immunosorbent assay kit. Results Finally, information of 176 CABG candidates was analysed. The mean age of participants was 62.71 ± 9.45 years with 1.63 male to female ratio. The mean of CCIMT was 0.69 ± 0.54 mm. Although there was no significant correlation between serum hsCRP level and CCIMT in patients without carotid stenosis (p=0.113, r=0.186, participants with common carotid artery stenosis had higher levels of serum hsCRP than participants without stenosis (2.42+/-1.30 vs. 1.20+/-0.97 mg/dl; p=0.009. Conclusion Study results showed that there was no correlation between serum hsCRP level and CCIMT in patients without carotid stenosis, but patients with common carotid artery stenosis had higher levels of serum hsCRP than patients without stenosis.

  4. Efficacy of chronic statin therapy on major cardiac events after coronary artery bypass grafting: low-dose versus high-dose

    Directory of Open Access Journals (Sweden)

    Ayşegül Kunt

    2015-08-01

    Full Text Available Aim To investigate whether chronic statin treatment after coronary artery bypass grafting (CABG protects patients from major cardiac events and provides percutaneous coronary intervention (PCI free survival. Methods A total of 232 patients with previous CABG and chronic statin therapy were selected retrospectively and were divided into two groups according to a dosage of atorvastatin per day, e. g., 20 mg or 40 mg. Groups were compared for the major cardiac events and freedom from PCI by Kaplan Meier analysis as the primary end point. Patency of grafts including left internal thoracic artery (LITA and saphenous vein (SVG and progression of non-grafted native vessel disease were also evaluated as secondary end points. Results Cardiac mortality, periprocedural myocardial infarction (MI, target vessel revascularization and percutaneous coronary intervention free survival were as follows: 2.9% versus 2.1% (p=1.000; 16.1% versus 21.1% (p=0.331; 56.93% versus 52.63% (p>0.005; 58.4% versus 63.2% (log-rank test; p= 0.347 in atorvastatin 20 mg and atorvastatin 40 mg groups, respectively. However, these results were not statistically significant between two groups (p>0.005. Patency of openness of grafts including LITA and SVG and progression of non-grafted native vessel disease were similar between groups (p=0.112, p=0.779, p=0.379 and p=0.663, respectively. Conclusion Low-dose long-term statin treatment had similar outcomes on major cardiac events and identical rate of freedom from percutaneous coronary intervention after coronary artery bypass grafting compared with high-dose long-term statin treatment. It is better to start from low dose statin treatment after surgical interventions.

  5. Serum Lactate Is not Correlated with Mixed or Central Venous Oxygen Saturation for Detecting Tissue Hypo Perfusion During Coronary Artery Bypass Graft Surgery: A Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Shahrbano Shahbazi

    2013-12-01

    Full Text Available Objectives:: Effective assessment of tissue perfusion is highly important during Coronary Artery Bypass Graft (CABG. Mixed venous O2 saturation (Svo2 is one of the best and routinely used markers of tissue perfusion. However, this method is costly and leads to considerable complications. Thus, the present study aimed to determine whether the Svo2 can be substituted with central venous saturation (Scvo2 and if there is any correlation between lactate level and Svo2. Methods:: This prospective observational study was conducted on 62 patients scheduled for CABG. After induction and maintenance of anesthesia, blood samples drawn from central venous, pulmonary artery, and radial artery were used to measure Scvo2, Svo2 and serum lactate level respectively before and after Cardio Pulmonary Bypass (CPB. Pearson’s correlation test was used to determine the correlation between Svo2 and Scvo2 as well as between Svo2 and serum lactate level. Besides, P < 0.05 was considered as statistically significant. Results:: Overall, 62 Patients, 33 males (53.2% and 29 females (46.8% were enrolled into the present study. The most common coexisting illness was hypertension detected in 33 patients (53.2% followed by hypercholesterolemia in 28 ones (44.4%. In this study, Svo2 was positively correlated with Scvo2 (r = 0.63, P < 0.001. However, no correlation was found between Svo2 and lactate (r = 0.124, P = 0.348. Conclusions:: In summary, Scvo2 is considered as the best substitute of Svo2 for detecting tissue hypo perfusion during CPB. Although the lactate level had been considered as an appropriate marker of tissue perfusion and ischemia, it was not correlated to Svo2 during CABG.

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

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    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

  7. Coronary artery bypass graft (CABG) surgery patients in a clinical pathway gained less in health-related quality of life as compared with patients who undergo CABG in a conventional-care plan

    NARCIS (Netherlands)

    El Baz, Noha; Middel, Berrie; van Dijk, Jitse P.; Boonstra, Piet W.; Reijneveld, Sijmen A.

    2009-01-01

    The aim of this study is to determine the difference between clinical pathway (CP) and conventional care in terms of health-related quality of life (HRQoL) domains, depression and anxiety, as well as to determine the relative contribution of CP towards an improved HRQoL after coronary artery bypass

  8. Impact of previous coronary artery bypass surgery on clinical outcome after percutaneous interventions with second generation drug-eluting stents in TWENTE trial and Non-Enrolled TWENTE registry

    NARCIS (Netherlands)

    Sen, Hanim; Lam, Ming Kai; Tandjung, K.; Löwik, Marije M.; Houwelingen, van K. Gert; Stoel, Martin G.; Louwerenburg, Hans W.; Man, de Frits H.A.F.; Linssen, Gerard C.M.; Grandjean, Jan G.; Doggen, Carine J.M.; Birgelen, von Clemens

    2014-01-01

    Background Patients with previous coronary artery bypass grafting (CABG) who underwent percutaneous coronary intervention (PCI) have an increased repeat revascularization rate, but data on contemporary second-generation drug-eluting stents (DES) are scarce. Methods We evaluated 1-year clinical outc

  9. 3-Fluoro-Deoxyglucose for the assessment of cerebral perfusion and glucose transport - Indications for extracranial-intracranial arterial bypass and followup studies

    International Nuclear Information System (INIS)

    3-Fluor-Deoxyglucose (3FDG) is a glucose-analogue which is transported across the blood-brain-barrier by the same carrier as glucose but is only phoshorylated to a minor part. By a newly developed model, it became possible to estimate both cerebral perfusion and glucose transport in a single examination, determining the Michaelis-Menten-constant K/sub M/ and the maximal velocity v/sub m/. Normal values were determined as follows: gray matter perfusion 88+-8 ml/ 100g min; v/sub m/ was 2.46 μmol/g min; K/sub M/ was 6.42 μmol/g. This method was applied successfully in a series of 15 patients with cerebral ischemia to select suitable candidates for extacranial-intracranial (EC-IC) arterial bypass surgery and to follow them up to 15 months postop. In patients with minor strokes and transient ischemic attacks (TIA), areas which appeared normal in conventional CT presented with reduced perfusion values (down to 67 ml/ 100 g min) and either normal or reduced v/sub m/ (down to 0.8 μmol/g min). These patients were thought optimal candidates for EC-IC bypass in order to improve the misery perfusion rate

  10. Myocardial protection during off pump coronary artery bypass surgery: A comparison of inhalational anesthesia with sevoflurane or desflurane and total intravenous anesthesia

    Directory of Open Access Journals (Sweden)

    Sharadaprasad Suryaprakash

    2013-01-01

    Full Text Available Aims and Objectives: The objective of the study was to evaluate the myocardial protective effect of volatile agents-sevoflurane and desflurane versus total intravenous anesthesia (TIVA with propofol in offpump coronary artery bypass surgery (OPCAB by measuring cardiac troponin-T (cTnT as a marker of myocardial cell death. Materials and Methods: The study was conducted on 139 patients scheduled to undergo elective OPCAB surgery. The patients were randomly allocated to receive anesthesia with sevoflurane, desflurane or TIVA with propofol. The cTnT levels were measured preoperatively, at arrival in postoperative intensive care unit, at 8, 24, 48 and 96 hours thereafter. Results: The changes in cTnT levels at all time intervals were comparable in the three groups. Conclusion: The study did not reveal any difference in myocardial protection after OPCAB with either sevoflurane or desflurane or TIVA using propofol as assessed by measuring serial cTnT values.

  11. Use of an Intravascular Warming Catheter during Off-Pump Coronary Artery Bypass Surgery in a Patient with Severe Cold Hemagglutinin Disease.

    Science.gov (United States)

    Tholpady, Ashok; Bracey, Arthur W; Baker, Kelty R; Reul, Ross M; Chen, Alice J

    2016-08-01

    Cold hemagglutinin disease with broad thermal amplitude and high titers presents challenges in treating cardiac-surgery patients. Careful planning is needed to prevent the activation of cold agglutinins and the agglutination of red blood cells as the patient's temperature drops during surgery. We describe our approach to mitigating cold agglutinin formation in a 77-year-old man with severe cold hemagglutinin disease who underwent off-pump coronary artery bypass surgery without the use of preoperative plasmapheresis. This experience shows that the use of an intravascular warming catheter can maintain normothermia and prevent the activation and subsequent formation of cold agglutinins. To our knowledge, this is the first reported use of this technique in a patient with cold hemagglutinin disease. The chief feature in this approach is the use of optimal thermal maintenance-rather than the more usual decrease in cold-agglutinin content by means of therapeutic plasma exchange. PMID:27547154

  12. Postoperative rescue closure of patent foramen ovale in the clinical setting of acute hypoxemic respiratory failure and stroke following coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    José L Díaz-Gómez

    2015-01-01

    Full Text Available We describe a case of intraoperative diagnosis and successful deferred percutaneous closure of a patent foramen ovale (PFO in the clinical setting of acute refractory hypoxemic respiratory failure and new-onset ischemic stroke in an elderly patient after coronary artery bypass graft. Perioperative morbidity (i.e. severe hypoxemia, worsening right ventricular dysfunction, and embolic stroke that is potentially related to intraoperatively diagnosed PFO during cardiac surgery can complicate management in the Intensive Care Unit and perhaps affect the patient′s outcome. Although the PFO closure can be challenging in the clinical setting of hypoxemic respiratory failure and stroke following cardiac surgery, it can be a reasonable perioperative option.

  13. Health-related personal control predicts depression symptoms and quality of life but not health behaviour following coronary artery bypass graft surgery.

    Science.gov (United States)

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

    2016-02-01

    To determine the prospective association between health-related control beliefs, quality of life (QOL), depression symptoms, and health behaviours in coronary artery bypass graft (CABG) patients 6-8 weeks following surgery. 149 patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring health related personal control, treatment control, depression symptoms, QOL, and health behaviours prior to and 6-8 weeks after surgery. Higher levels of health-related personal control predicted better QOL, and lower levels of depression symptoms, but not adherence to medication, cardiac rehabilitation attendance, or physical activity. These results were independent of demographic, behavioural, and clinical covariates. Treatment control was not associated with any outcome. These results suggest that perceived health-related personal control is associated with key aspects of short-term recovery from CABG surgery. Targeted interventions aimed at improving perceptions of health-related personal control may improve health outcomes in this cardiac population. PMID:26341356

  14. Perioperative indocyanine green clearance is predictive for prolonged intensive care unit stay after coronary artery bypass grafting - an observational study

    OpenAIRE

    Sander, Michael; Spies, Claudia D.; Berger, Katharina; Schröder, Torsten; Grubitzsch, Herko; Wernecke, Klaus D; von Heymann, Christian

    2009-01-01

    Introduction During cardiac surgery with cardiopulmonary bypass (CPB) haemodilution occurs. Hepatic dysfunction after CPB is a rare, but serious, complication. Clinical data have validated the plasma-disappearance rate of indocyanine green (PDR ICG) as a marker of hepatic function and perfusion. Primary objective of this analysis was to investigate the impact of haemodilutional anaemia on hepatic function and perfusion by the time course of PDR ICG and liver enzymes in elective CABG surgery. ...

  15. The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial

    Directory of Open Access Journals (Sweden)

    Novikov Ilia

    2011-10-01

    Full Text Available Abstract Background Cardiac rehabilitation has a beneficial effect on the prognosis and quality of life of cardiac patients, and has been found to be cost-effective. This report describes a comprehensive and low cost educational intervention designed to increase the attendance at cardiac rehabilitation programs of patients who have undergone coronary artery bypass graft surgery. Methods/Design A controlled prospective intervention trial. The control arm comprised 520 patients who underwent coronary artery bypass graft surgery between January 2004 and May 2005 in five medical centers across Israel. This group received no additional treatment beyond usual care. The intervention arm comprised 504 patients recruited from the same cardiothoracic departments between June 2005 and November 2006. This group received oral and written explanations about the advantages of participating in cardiac rehabilitation programs and a telephone call two weeks after hospital discharge intended to further encourage their enrollment. The medical staff attended a one-hour seminar on cardiac rehabilitation. In addition, it was recommended that referral to cardiac rehabilitation be added to the letter of discharge from the hospital. Both study groups were interviewed before surgery and one-year post surgery. A one-year post-operative interview assessed factors affecting patient attendance at cardiac rehabilitation programs, as well as the structure and content of the cardiac rehabilitation programs attended. Anthropometric parameters were measured at pre- and post-operative interviews;- and medical information was obtained from patient medical records. The effect of cardiac rehabilitation on one- and three-year mortality was assessed. Discussion We report a low cost yet comprehensive intervention designed to increase cardiac rehabilitation participation by raising both patient and medical staff awareness to the potential benefits of cardiac rehabilitation. Trial

  16. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    ... MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery ... To perform this surgery: The heart surgeon will make a 3- to 5-inch-long surgical cut in the left part of your chest between your ribs ...

  17. Risk factors for cervical carotid and intracranial cerebrovascular lesions in patients undergoing coronary artery bypass grafting. Preoperative evaluation using magnetic resonance imaging and angiography

    Energy Technology Data Exchange (ETDEWEB)

    Makino, Masahiro [Kyoto Prefectural Univ. of Medicine (Japan). Research Inst. for Neurological Diseases and Geriatrics

    2001-12-01

    Recently neurologic complications after coronary artery bypass grafting (CABG) have received increasing attention. There is no detailed report about the risk factors for these complications, although stenosis in the cervical and intracranial arteries, especially in Japanese patients, latent ischemic brain lesions and preoperative neurological conditions are related to these events. In this prospective study, we evaluated occlusive lesions in the cervical carotid and intracranial arteries, silent brain infarction and cerebral deep white matter lesion with MRA and MRI in patients scheduled to undergo CABG to determine the prevalence of occlusive diseases in cervical carotid and intracranial arteries, latent ischemic change in the brain in this population and to identify preoperative risk factors for these patients. The subjects were 144 consecutive patients (103 men and 41 women, mean age 65.9{+-}9.2 years old) who were scheduled for CABG under elective conditions and who were examined by the same MRI apparatus using the same protocol between November 1998 and March 2001. After routine neurological examination and Mini-Mental State Examination (MMSE) were completed, MRI and MRA were obtained, then the prevalence of abnormalities on MRI and MRA studies and risk factors were evaluated. Cervical carotid artery stenosis with {>=}50% luminal narrowing was detected in 29.2% of the subjects, and that with {>=}75% luminal narrowing was detected in 16.0% of the subjects. Intracranial arterial stenosis showing {>=}50% luminal narrowing was detected in 38.2% of subjects, and that showing {>=}75% luminal narrowing was detected in 19.4% of subjects. Brain infarction was observed in 74.3% of subjects, cerebral deep white matter lesion showing grade 2 or higher on Fazekas classification was observed in 17.4% of the subjects. The characteristics, including possible risk factors of subjects with and without these abnormal findings, were compared. Patients with cervical carotid

  18. Risk factors for cervical carotid and intracranial cerebrovascular lesions in patients undergoing coronary artery bypass grafting. Preoperative evaluation using magnetic resonance imaging and angiography

    International Nuclear Information System (INIS)

    Recently neurologic complications after coronary artery bypass grafting (CABG) have received increasing attention. There is no detailed report about the risk factors for these complications, although stenosis in the cervical and intracranial arteries, especially in Japanese patients, latent ischemic brain lesions and preoperative neurological conditions are related to these events. In this prospective study, we evaluated occlusive lesions in the cervical carotid and intracranial arteries, silent brain infarction and cerebral deep white matter lesion with MRA and MRI in patients scheduled to undergo CABG to determine the prevalence of occlusive diseases in cervical carotid and intracranial arteries, latent ischemic change in the brain in this population and to identify preoperative risk factors for these patients. The subjects were 144 consecutive patients (103 men and 41 women, mean age 65.9±9.2 years old) who were scheduled for CABG under elective conditions and who were examined by the same MRI apparatus using the same protocol between November 1998 and March 2001. After routine neurological examination and Mini-Mental State Examination (MMSE) were completed, MRI and MRA were obtained, then the prevalence of abnormalities on MRI and MRA studies and risk factors were evaluated. Cervical carotid artery stenosis with ≥50% luminal narrowing was detected in 29.2% of the subjects, and that with ≥75% luminal narrowing was detected in 16.0% of the subjects. Intracranial arterial stenosis showing ≥50% luminal narrowing was detected in 38.2% of subjects, and that showing ≥75% luminal narrowing was detected in 19.4% of subjects. Brain infarction was observed in 74.3% of subjects, cerebral deep white matter lesion showing grade 2 or higher on Fazekas classification was observed in 17.4% of the subjects. The characteristics, including possible risk factors of subjects with and without these abnormal findings, were compared. Patients with cervical carotid lesions were

  19. Obesity influences propranolol pharmacokinetics in patients undergoing coronary artery bypass grafting employing cardiopulmonary bypass Influência da obesidade na farmacocinética do propranolol em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea

    OpenAIRE

    Valéria Adriana Pereira; Maria José Carvalho Carmona; Célia Etsuco Kobayashi Omosako; José Otávio Costa Auler Júnior; Silvia Regina Cavani Jorge Santos

    2003-01-01

    Propranolol plasma levels and kinetic disposition may be altered by hypothermic cardiopulmonary bypass (CPB-H). We investigated the potential influence of obesity on propranolol pharmacokinetics in patients undergoing coronary artery bypass grafting employing CPB-H. Fifteen patients, receiving propranolol perorally pre- (10-40 mg, 2-3 times a day) and post-operatively (10 mg, once a day) were distributed in two groups, based on body mass index (BMI), in obese (n = 9, BMI: mean 29.4 kg/m²) and...

  20. Comparison of TIVA and Desflurane Added to a Subanaesthetic Dose of Propofol in Patients Undergoing Coronary Artery Bypass Surgery: Evaluation of Haemodynamic and Stress Hormone Changes

    Science.gov (United States)

    Akarsu Ayazoğlu, Tülin; Onk, Oruç Alper; Aksüt, Mehmet; Günay, Murat; Turkmen, Kultigin; Özensoy, Aynur; Yazıcı Ersoy, Çiğdem; Çoban, Abdulkadir

    2016-01-01

    Introduction. Increased levels of stress hormones are associated with mortality in patients undergoing coronary artery bypass grafting (CABG). Aim. To compare total intravenous anaesthesia (TIVA) and desflurane added to a subanaesthetic dose of propofol. Material and Methods. Fifty patients were enrolled in this study. Fentanyl (3–5 mcg/kg/h) was started in both groups. Patients were divided into two groups. The PD group (n = 25) received 1 minimum alveolar concentration (MAC) desflurane anaesthesia in addition to propofol infusion (2-3 mg/kg/h), while P group (n = 25) received propofol infusion (5-6 mg/kg/h) only. Biochemical data, cortisol, and insulin levels were measured preoperatively (T0), after initiation of CPB but before cross-clamping the aorta (T1), after removal of the cross-clamp (T2), and at the 24th postoperative hour (T3). Results. Systolic, diastolic, and mean arterial pressure levels were significantly higher in PD group than those in P group in T1 and T2 measurements (p ≤ 0.05). CK-MB showed a significant decrease in group P (p ≤ 0.05). When we compared both groups, cortisol levels were significantly higher in PD group than P group (p ≤ 0.05). Conclusion. Stress and haemodynamic responses were better controlled using TIVA than desflurane inhalation added to a subanaesthetic dose of propofol in patients undergoing CABG.