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Sample records for artery bypass patients

  1. 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.

  2. 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.

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

    Science.gov (United States)

    Yuan, Xin; Sun, Hansong; Wang, Xianqiang

    2015-08-01

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

  4. 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.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

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    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.

  7. 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...

  8. 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.

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

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    Catherine A Waight

    2015-02-01

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

  10. Coronary Artery Bypass Surgery

    Science.gov (United States)

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

  11. 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...

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

    NARCIS (Netherlands)

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

    1998-01-01

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

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

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    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

  14. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2003-01-01

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

  16. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  19. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

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

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    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.

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

    Institute of Scientific and Technical Information of China (English)

    朱亚彬; 许建屏; 刘志勇; 杨丹宁; 李旭东; 李鸿雁

    2004-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    朱亚彬; 许建屏; 刘志勇; 杨丹宁; 李旭东; 李鸿雁

    2004-01-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Hafiz Abdul Moiz Fakih

    2016-02-01

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

  6. 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...

  7. 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 ...

  8. 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...

  9. 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...

  10. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut

    2011-01-01

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

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

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    Bougioukas Ioannis

    2010-08-01

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

  12. Multimodality imaging of coronary artery bypass grafts

    NARCIS (Netherlands)

    Salm, Liesbeth Pauline

    2006-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  14. 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 ...

  15. 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.

  16. 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.

  17. 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...

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

    Science.gov (United States)

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

    2010-06-01

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

  19. 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.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  1. 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.

  2. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

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

    Science.gov (United States)

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

    2014-11-01

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

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

    OpenAIRE

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

    2016-01-01

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

  6. 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.

  7. 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...

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

    Institute of Scientific and Technical Information of China (English)

    孙立新

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

  11. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting 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 ...

  12. 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...

  13. 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)

  14. Coronary Artery Bypass

    Science.gov (United States)

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

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

    Directory of Open Access Journals (Sweden)

    Chong Alice

    2007-07-01

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

  16. 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...

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

    Institute of Scientific and Technical Information of China (English)

    陈鑫; 蒋英硕; 徐明; 陈振强; 郭子黄

    2002-01-01

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

  18. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  20. On-Pump Beating Coronary Artery Bypass in High Risk Coronary Patients

    Directory of Open Access Journals (Sweden)

    Abbas Afrasiabirad

    2015-01-01

    Full Text Available Background: There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG in coronary high-risk patients in comparison with the conventional methods. Methods: In a prospective research study, 3000 off-pump CABG patients were considered during June 2003 to December 2011. Among these, 157 patients with one or more of the following risk factors were included for OPBCABG; severe left main stenosis, early post-acute myocardial infarction with ongoing chest pain, unstable angina, intractable ventricular arrhythmia, post complicated coronary intervention and severe left ventricular dysfunction. These patients were compared with 157 similar patients undergone CCABG with aortic cross clamp before 2003. Results: Preoperative patient characteristics revealed no significant differences between the two groups. The patients’ mean age and number of grafts were 57 years and 3 per patient respectively. Hospital mortality was 3.2% and 9% in OPBCABG and CCABG groups, respectively (P<0.001. Preoperative myocardial infarction, requirement of inotropic agents and intraaortic balloon pump, renal dysfunction and prolonged ventilation time were significantly higher in CCABG group. Conclusion: Our results suggest that OPBCABG is effective in coronary high-risk patients and significantly reduces mortality and the incidence of perioperative MI and other major complications.

  1. 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...

  2. 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.

  3. The effect of weight loss on the outcome after coronary artery bypass grafting in obese patients

    Directory of Open Access Journals (Sweden)

    Remez Kocz

    2012-01-01

    Full Text Available The role of body mass index (BMI in the setting of coronary artery bypass graft (CABG surgery has been a focus of past studies. However, the effects of postoperative weight loss in patients after CABG is yet to be known. We performed a retrospective study of 899 patients who underwent CABG at our institution. Perioperative patient information was collected from an onsite electronic record system. Patients were grouped into four BMI categories: normal controls, overweight, obese and morbidly obese. Based on the postoperative BMI changes, patients were then grouped into three categories: gainers, no change and losers. Statistical analyses were performed using analysis of variance and linear regression to establish an association among the data. Hazard ratios (HR and cumulative survival were obtained by the Cox-Mantel and Kaplan-Meier analyses, respectively. The normal controls exhibited a markedly higher mortality postoperatively, at 27.9%, especially when compared with the obese individuals (16.1%. Patients who lost weight faced a significantly increased risk of mortality than those who experienced no changes or gained weight after surgery. This trend was especially salient among the obese patients, who more than tripled their mortality risk (HR = 3.24 versus individuals who gained weight, and more than doubled their risk (HR = 2.87 versus those who had no changes. We conclude that obesity confers a survival advantage in the setting of the CABG surgery. Weight loss among all BMI categories of patients studied results in an adverse effect on postoperative survival.

  4. 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

  5. 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

  6. 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.

  7. 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...

  8. 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...

  9. 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

  10. 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

  11. 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.

  12. Local anaesthetic toxicity after bilateral thoracic paravertebral block in patients undergoing coronary artery bypass surgery.

    Science.gov (United States)

    Ho, A M-H; Karmakar, M K; Ng, S K; Wan, S; Ng, C S H; Wong, R H L; Chan, S K C; Joynt, G M

    2016-09-01

    We conducted a small pilot observational study of the effects of bilateral thoracic paravertebral block (BTPB) as an adjunct to perioperative analgesia in coronary artery bypass surgery patients. The initial ropivacaine dose prior to induction of general anaesthesia was 3 mg/kg, which was followed at the end of the surgery by infusion of ropivacaine 0.25% 0.1 ml/kg/hour on each side (e.g. total 35 mg/hour for a 70 kg person). The BTPB did not eliminate the need for supplemental opioids after CABG in the eight patients studied. Moreover, in spite of boluses that were within the manufacturer's recommendation for epidural and major nerve blocks, and an infusion rate that was only slightly higher than what appeared to be safe for epidural infusion, potentially toxic total plasma ropivacaine concentrations were common. We also could not exclude the possibility that the high ropivacaine concentrations were contributing to postoperative mental state changes in the postoperative period. Also, one patient developed local anaesthetic toxicity after the bilateral paravertebral dose. As a result, the study was terminated early after four days. The question of whether paravertebral block confers benefits in cardiac surgery remains unanswered. However, we believe that the bolus dosage and the injection rate we used for BTPB were both too high, and caution other clinicians against the use of these doses. Future studies on the use of BTPB in cardiac surgery patients should include reduced ropivacaine doses injected over longer periods.

  13. The Effects of Regular Physical Activity at Home on Patients' Quality of Life after Coronary Artery Bypass Surgery

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    Zeinab Amirian

    2013-04-01

    Full Text Available Introduction: Chronic diseases such as heart diseases have adverse effects on the physical, psychological, social performance, and overall quality of life of patients. This study aimed to determine the effect of regular physical activity at home on the quality of life in patients undergoing coronary artery bypass surgery. Methods: This Quasi-experimental study was carried out on patients who had undergone coronary artery bypass surgeries. 58 patients from Urmia Syedolshoheda hospital were selected randomly and then allocated into two intervention and control groups randomly. Data collected with using MacNew quality of life questionnaire. Patients in intervention group were trained with combined exercises at least three times a week and performed this exercises for 12 week at home. Data were analyzed using Chi-sqaure, Mann-Whitney and Wilcoxon testes. Results: Findings of the study showed promotion in quality of life domains in physical, emotional and social after performance of regular physical activity at home in intervention group (P=0.001. A significant difference was observed between patients quality of life after regular physical activity in intervention and the control groups (P=0.001. Conclusion: Regular physical activity at home has important effects on patients' promotion of quality of life after coronary artery bypass surgeries. Therefore, it is suggested that after CABG patients be trained with regular physical activity at home.

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

    Science.gov (United States)

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

    2016-01-01

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

  15. Coronary artery bypass grafting for Kawasaki disease

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

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

  16. 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 ...

  17. 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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    OpenAIRE

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

    2016-01-01

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

  20. Audiometric changes after coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Khorsandi M T

    2007-09-01

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

  1. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. 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.

  5. Decreased pre-surgical CD34+/CD144+ cell number in patients undergoing coronary artery bypass grafting compared to coronary artery disease-free valvular patients

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    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.

  6. 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

  7. Off-Pump Triple Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Case Presentation and a Brief Review of the Brazilian and the International Experiences

    Science.gov (United States)

    Karigyo, Carlos Junior Toshiyuki; Batalini, Felipe; Murakami, Alexandre Noboru; Teruya, Rogério Toshio; Gregori Júnior, Francisco

    2016-01-01

    A 76-year-old man with situs inversus totalis underwent a successful off-pump three-vessel coronary artery bypass surgery. The postoperative course was uneventful, and the patient was discharged 8 days later. At 9-month follow-up a coronary computed tomography angiography confirmed the viability of all of the grafts, and one year after the operation the patient remained asymptomatic. It comprises the fifth Brazilian case of a coronary surgery in a patient with situs inversus totalis and the first one of the country of a coronary artery bypass surgery without the use of the cardiopulmonary bypass in this condition. PMID:27556323

  8. 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...

  9. Factors Affecting the Quality and Quantity of Sleep in Coronary Artery Bypass Graft Patients

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    Hashmi, Salila; Anis, Mariam; Darr, Umer

    2012-01-01

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

  11. 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.

  12. Correlation of atherosclerotic changes in peripheral arteries with pathological involvement of aortic arch in coronary bypass patients

    Directory of Open Access Journals (Sweden)

    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.

  13. 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

  14. 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...

  15. 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.

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

    Science.gov (United States)

    Ishikawa, Norihiko; Watanabe, Go

    2016-07-01

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

  17. 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

  18. Perioperative pentoxifylline therapy attenuates early postoperative neuro-cognitive decline in patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Sambhunath Das

    2015-01-01

    Full Text Available Background: Postoperative cognitive decline (POCD after coronary artery bypass grafting (CABG is a common problem. Studies show that pentoxifylline administration reduces inflammation induced by cardiopulmonary bypass and brain injury after ischaemia. Hence the perioperative use of pentoxifylline in attenuating POCD was evaluated in the study. Materials and Methods: Eighty patients were divided randomly into two groups from 106 patients scheduled for CABG surgery. The study group was administered pentoxifylline 400 mg twice daily orally from day of admission to 7th day after surgery, whereas the control group patients received placebo. Neurocognitive assessment was assessed by an independent clinical psychologist one day after admission to hospital and again on 7th postoperative day. The data was analyzed and a P < 0.05 was considered significant results. Results: Pentoxifylline-treated group showed no statistically significant difference in animal naming test scores (10.3 ± 2.2 versus 9.4 ± 2.5, P = 0.07, digit symbol substitution test (26.1 ± 7.47 vs 22.2 ± 6.07, P = 0.09 and 8 subtests of Post Graduate Institute-memory scale. The control group had significant POCD as detected by animal naming test (10.5 ± 3.7 versus 8.6 ± 3.9, P = 0.008, digit symbol substitution test (20.2 ± 8.2 versus 14.7 ± 8.9, P = 0.008 and five subtests of memory scale (P = 0.01, 0.04, 0.003, 0.005 and 0.02. The incidence of POCD was 50% in placebo-treated group compared to 22.5% in pentoxifylline group. Conclusions: The perioperative use of pentoxifylline attenuates the early postoperative neurocognitive decline after CABG using cardiopulmonary bypass.

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  20. 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: ...

  1. 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.

  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......-treated MI patients is largely unknown. METHODS: All patients admitted with first-time MI between 2002 and 2006, treated with CABG within 180 days after admission, were identified by nationwide administrative registers. Clopidogrel treatment was determined by claimed prescriptions after discharge from...... surgery. Risk of death or recurrent MI, and of a combined end point of the 2, were assessed by cumulative incidence and Cox proportional hazards model. A propensity score-matched subgroup analysis was done. RESULTS: We included 3,545 patients, and of these, 957 (27.0%) were treated with clopidogrel after...

  3. 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.

  4. A comparison of urinary neutrophil gelatinase-associated lipocalin in patients undergoing on- versus off-pump coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Wagener, Gebhard; Gubitosa, Gina; Wang, Shuang;

    2009-01-01

    OBJECTIVE: The purpose of this study was to compare urinary neutrophil gelatinase-associated lipocalin (NGAL) levels in off-pump and on-pump coronary artery bypass graft (CABG) surgery. DESIGN: A matched cohort study. SETTING: A tertiary university hospital. PARTICIPANTS: Thirty adult patients...... undergoing CABG surgery without cardiopulmonary bypass (off-pump) matched to 30 patients with on-pump CABG surgery by age, preoperative serum creatinine, Parsonnet score, ejection fraction, body mass index, and number of coronary artery grafts. INTERVENTIONS: None, observational. MEASUREMENTS AND MAIN...

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

    Science.gov (United States)

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

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

  6. 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.…

  7. PILOT STUDY RESULTS OF THE INFLUENCE OF CITICOLINE AND PIRIBEDIL ON COGNITIVE FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS SURGERY

    Directory of Open Access Journals (Sweden)

    M. M. Petrova

    2015-01-01

    Full Text Available Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30 were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32 had piribedil in addition to standard therapy. Patients of the control group (n=32 had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008, categorical association (p=0.002, clock drawing test (Wilcoxon test; p=0,005, while other indices were reduced in comparison with the initial ones.Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.

  8. Endothelial nitric oxide synthase gene polymorphisms -786T >C and 894G >T in coronary artery bypass graft surgery patients

    Directory of Open Access Journals (Sweden)

    Ragia Georgia

    2010-08-01

    Full Text Available Abstract Polymorphisms in the endothelial nitric oxide synthase (eNOS gene (-786T >C and 894G >T enhance endo-thelial dysfunction and have been studied in relation to coronary artery disease (CAD. In the present study, we examined the association of the above polymorphisms with CAD, as well as with myocardial infarction (MI, hypertension, diabetes and smoking in CAD patients. Study subjects consisted of 154 consecutive coronary artery bypass graft (CABG patients and 155 non-CAD controls. eNOS -786T >C and 894G >T polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism. The estimated frequencies of the -786C and 894T alleles did not differ between the two groups (p = 0.46 and p = 0.84, respectively. The prevalence of eNOS polymorphisms was not associated with MI, hypertension or diabetes in CABG patients; however, we found that the 894TT genotype and 894T allele were significantly more frequent in current/past smoker CABG patients (16.7 per cent and 39.6 per cent, respectively compared with never smoker CABG patients (6.1 per cent and 24.4 per cent, respectively (p = 0.01 and p eNOS -786C and 894T variant alleles with CAD; however, within CABG patients, a gene-environment interaction was found between the eNOS 894T allele and smoking.

  9. 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

  10. 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

  11. 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...

  12. Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Temucin Noyan Ogus

    2010-01-01

    Full Text Available Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.

  13. 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

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

    Institute of Scientific and Technical Information of China (English)

    陈长志; 陆佩中

    2003-01-01

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

  15. 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.

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

    Science.gov (United States)

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

    2016-07-01

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

  17. Risk factors for mortality after coronary artery bypass grafting in patients with low left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    WANG Jin; XIAO Feng; REN Jian; LI Yan; ZHANG Ming-li

    2007-01-01

    Background We managed to assess and confirm the risk factors for mortality after coronary artery bypass grafting (CABG) operations so as to map out the proper guidance of surgical strategy especially in patients with low left ventricular ejection fraction (LVEF) in domestic polyclinic like ours.Methods Five hundred and forty-eight consecutive patients underwent CABG from December 1999 through August 2005 were analyzed retrospectively. Eighty-nine cases had an LVEF of 40% or less. All together twenty-two candidate factors were evaluated for their association with perioperative death using univariate and multivariate stepwise Logistic analysis.Results When data from all the patients who had undergone CABG were taken into account, LVEF, left ventricular end diastolic diameter (LVEDD), mitral regurgitation, aneurysm of the heart wall, mitral repair/replacement, resection of aneurysm, concomitant aortic valve replacement, and perioperative intra-aortic balloon counter-pulsation (IABP), left ventricular assist device (LVAD) and cardiopulmonary bypass (CPB) all showed an association with perioperative death in univariate analysis, while an LVEF of >40%, on the other hand, appeared to be a protective factor. In multivariate analysis, moderate to severe mitral regurgitation, aneurysm of the heart wall, repair of septal perforation and aortic regurgitation were proved to be risk factors. When the analysis was restricted to patients with an LVEF of 40% or less,such variables as age, LVEDD, mitral regurgitation, mitral repair/replacement, IABP, and CPB were qualified as risk factors in a univariate analysis. Age, moderate mitral regurgitation, aneurysm of the heart wall, CPB, left main coronary artery disease and female were associated with perioperative death in a multivariate logistic regression analysis.Conclusions Concerning the prognosis, patients who undergo CABG would have different risk factors when data from all the enrolled patients or data from patients with LVEF

  18. 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

  19. Health-related quality of life following off-pump versus on-pump coronary artery bypass grafting in elderly moderate to high-risk patients

    DEFF Research Database (Denmark)

    Jensen, Birte Østergaard; Hughes, Pia; Rasmussen, Lars S;

    2006-01-01

    Previous trials comparing coronary artery bypass grafting (CABG) with or without extracorporeal circulation have mainly enrolled selected patients at younger age and low risk. Patient-reported health-related quality of life has not been significantly different. We compared health-related quality ...... of life in elderly moderate to high-risk patients randomized to either off-pump or on-pump surgery....

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Reza Karbasi Afshar

    2015-01-01

    Full Text Available Introduction: Cardiac resynchronization therapy (CRT is a proven therapeutic method in selected patients with heart failure and systolic dysfunction which increases left ventricular function and patient survival. We designed a study that included patients undergoing coronary artery bypass graft (CABG, with and without CRT-defibrillator (CRT-D inserting and then measured its effects on these two groups. Patients and Methods: Between 2010 and 2013, we conducted a prospective cohort study on 100 coronary artery disease patients where candidate for CABG. Then based on the receiving CRT-D, the patients were categorized in two groups; Group 1 ( n = 48, with CRT-D insertion before CABG and Group 2 ( n = 52 without receiving CRT-D. Thereafter both of these groups were followed-up at 1-3 months after CABG for mortality, hospitalization, atrial fibrillation (AF, echocardiographic assessment, and New York Heart Association (NYHA class level. Results: The mean age of participants in Group 1 (48 male and in Group 2 (52 male was 58 ± 13 and 57 ± 12 respectively. Difference between Groups 1 and 2 in cases of mean left ventricular ejection fraction (LVEF changes and NYHA class level was significant ( P > 0.05. Hospitalization ( P = 0.008, mortality rate ( P = 0.007, and AF were significantly different between these two groups. Conclusions: The results showed that the increase in LVEF and patient′s improvement according to NYHA-class was significant in the first group, and readmission, mortality rate and AF was increased significantly in the second group.

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

    Science.gov (United States)

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

    2016-01-01

    Background: The cardioprotective effect of ischemic preconditioning has been known for many years. Since the temporary ischemia in the heart may cause lethal cardiac effects, the idea of creating ischemia in organs far from the heart such as limbs was raised as remote ischemic preconditioning (RIPC). We hypothesized that the extension of RIPC has more cardioprotective effect in patients undergoing coronary artery bypass graft (CABG) surgeries. Methods: In this triple-blind randomized clinical trial study, 96 patients were randomly divided into 3 groups and two blood pressure cuffs were placed on both upper and lower extremities. In group A, only upper extremity cuff and in group B upper limb and lower limb cuff was inflated intermittently and group C was the control group. RIPC was induced with three 5-min cycles of cuff inflation about 100 mmHg over the initial systolic blood pressure before starting cardiopulmonary bypass. The primary endpoints were troponin I and creatine phosphokinase-myoglobin isoenzyme (CK-MB). Results: Six hours after the termination of CPB, there was a peak release of the troponin I level in all groups (group A=4.90 ng/ml, group B=4.40 ng/ml, and group C=4.50 ng/ml). There was a rise in plasma CK-MB in all groups postoperatively and there were not any significant differences in troponin I and CK-MB release between the three groups. Conclusion: RIPC induced by upper and lower limb ischemia does not reduce postoperative myocardial enzyme elevation in adult patients undergoing CABG. Trial Registration Number: IRCT2012071710311N1 PMID:27365547

  3. 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

  4. 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

  5. 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.

  6. Evaluation of Left Ventricular Dyssynchrony after Coronary Artery Bypass Grafting in Patients with Ischemic Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    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.

  7. Usefulness of colchicine to reduce perioperative myocardial damage in patients who underwent on-pump coronary artery bypass grafting.

    Science.gov (United States)

    Giannopoulos, Georgios; Angelidis, Christos; Kouritas, Vasileios K; Dedeilias, Panagiotis; Filippatos, Gerasimos; Cleman, Michael W; Panagopoulou, Vasiliki; Siasos, Gerasimos; Tousoulis, Dimitrios; Lekakis, John; Deftereos, Spyridon

    2015-05-15

    The objective of the present study was to test whether a perioperative course of colchicine, in patients who underwent standard coronary artery bypass grafting, would result in reduced postoperative increase of myocardial injury biomarker levels. Patients were prospectively randomized to colchicine or placebo starting 48 hours before scheduled coronary artery bypass grafting and for 8 days thereafter (0.5 mg twice daily). The primary outcome parameter was maximal high-sensitivity troponin T (hsTnT) concentration within 48 hours after surgery. Secondary outcome measures were maximal creatine kinase-myocardial brain fraction (CK-MB) levels and area under the curve (AUC) of hsTnT and CK-MB concentrations; 59 patients were included. Maximal hsTnT was 616 pg/ml (396 to 986) in the colchicine group versus 1,613 pg/ml (732 to 2,587) in controls (p = 0.002). Maximal CK-MB was 44.6 ng/ml (36.6 to 68.8) and 93.0 ng/ml (48.0 to 182.3), respectively (p = 0.002). The median AUC for hsTnT was 40,755 pg h/ml (20,868 to 79,176) in controls versus 20,363 pg h/ml (13,891 to 31,661) in the colchicine group (p = 0.002). AUCs for CK-MB were 2,552 ng h/ml (1,564 to 4,791) in controls and 1,586 ng h/ml (1,159 to 2,073) in the colchicine group (p = 0.003). The main complaints associated with colchicine were, as expected, gastrointestinal, with 5 patients (16.7%) in the colchicine group reporting diarrhea versus 1 control (3.4%) (p = 0.195). In conclusion, a short perioperative course of colchicine was effective in attenuating postoperative increases of hsTnT and CK-MB compared with placebo. This finding, which needs confirmation in a larger clinical trial powered to assess clinical endpoints, suggests a potential role for this agent in reducing cardiac surgery-related myocardial damage.

  8. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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,...

  11. 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 ...

  12. 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

  13. 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...

  14. 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

  15. 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

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

    Directory of Open Access Journals (Sweden)

    Deepak Prakash Borde

    2016-01-01

    Full Text Available Context: One of the main limitations of off-pump coronary artery bypass grafting (OPCAB is the occasional need for intraoperative conversion (IOC to on-pump coronary artery bypass grafting. IOC is associated with a significantly increased risk of mortality and postoperative morbidity. The impact of IOC on outcome cannot be assessed by a randomized control design. Aims: The objective of this study was to analyze the incidence, risk factors, and impact of IOC on the outcome in patients undergoing OPCAB. Settings and Design: Three tertiary care level hospitals; retrospective observational study. Subjects and Methods: This retrospective observational study included 1971 consecutive patients undergoing  OPCAB from January 2012 to October 2015 at three tertiary care level hospitals by four surgeons. The incidence, patient characteristics, cause of IOC, and its impact on outcome were studied. Statistical Analysis Used: The cohort was divided into two groups according to IOC. Univariate logistic regression was performed to describe the predictors of IOC. Variables that were found to be significant in univariate analysis were introduced into multivariate model, and adjusted odds ratio (OR was calculated. To further assess the independent effect of IOC on mortality, propensity score matching with a 5:1 ratio of non-IOC to IOC was performed. Results: The overall all-cause in-hospital mortality was 2.6%. IOC was needed in 128 (6.49% patients. The mortality in the IOC group was significantly higher than non-IOC group (21 of 128 [16.4%] vs. 31 of 1843 [1.7%], P = 0.0001. The most common cause for IOC was hemodynamic disturbances during grafting to the obtuse marginal artery (51/128; 40%. On multivariate logistic regression analysis, left main disease, pulmonary hypertension, and mitral regurgitation independently predicted IOC. We obtained a propensity-matched sample of 692 patients (No IOC 570; IOC 122, and IOC had OR of 16.26 (confidence interval 6

  17. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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...

  20. 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. ...

  1. 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. ...

  2. 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...

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  4. 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 ...

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

    Directory of Open Access Journals (Sweden)

    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

  6. 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...

  7. 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...

  8. 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.

  9. Comparison of two models of hospital rehabilitation in patients after coronary artery bypass grafting

    OpenAIRE

    Karaszewski, Daniel

    2014-01-01

    Introduction Taking into consideration the rise in ischemic heart disease and the increasing number of performed cardiac surgery procedures, attempts have been made to prepare an optimal rehabilitation program enabling the effective improvement of patient condition in the shortest possible time-frame that would be of most benefit for the patients [1, 2]. Aim of the study Aim of the study was to compare the therapeutic efficacy of two rehabilitation models (I – a modified model, and II – the s...

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

    OpenAIRE

    Nahid Nazari; Ali Akbar Hashemi-Javaheri; Amir Rashid-Lamir; Emad Alaviniya

    2014-01-01

    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. t...

  11. "Demografic characteristics of opioid addiction in patients undergoing Coronary Artery Bypass Graft "

    Directory of Open Access Journals (Sweden)

    Abdollahi M.H

    2007-04-01

    Full Text Available Background: According to some previous reports prevalence of addiction estimated to be 3٪ in Iran. One of the most important key points about addiction is the identification of predisposing factors for starting substance use. False general believes can play important roles in this regard. This study evaluated the demographic characteristics of opioids addiction and the visions of them about the effect of opioids on their cardiac diseases. Methods: This cross-sectional analytical study intended to evaluate situation of opiate dependency among 1329 CABG patients in Yazd Afshar hospital based on criteria of the diagnostic and statistical manual of mental disorders, Fourth edition (DSM-IV.Data were collected from each subject by a self report questionnaire and structured interview and was analyzed using chi-square and ANOVA and MC nemar test. P<0.05 was determined significant. Results: The data were gathered from 1329 CABG patients (945 men and 384 women. In addition 131 patients (9.9% containing 127 men (98.9% and 4 women (1.1% were opium dependent based on DSM-IV criteria. Mean age of opium dependent group was significantly higher than non-dependent patients (58.5 ± 10.08 VS 50.7 ± 10.15 (P= 0.000. Opium was the most common used substance (96.9% and inhalation was the preferred pattern of use (52.7%. Majority of addicted patients were simple workers (44%. Based on educational levels, 57.2% of opium dependents have had primary education (under high school. Eighty two (62.5% of addicted groups believed that after starting opium, their cardiovascular function and chest pain had been improved. Although before starting opium use 58 (44.6% of them have had this belief Conclusion: The prevalence of opium addiction in CABG patients is relatively high, and the majority of addicted patients are on this belief that opiates have positive effects on improvement of their chest pain and cardiovascular function. Because the effects of opioids on chest pain are

  12. 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...

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  15. A novel blood-sparing agent in cardiac surgery? First in-patient experience with the synthetic serine protease inhibitor MDCO-2010: a phase II, randomized, double-blind, placebo-controlled study in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

    OpenAIRE

    Englberger, Lars; Dietrich, Wulf; Eberle, Balthasar; Erdös, Gabor; Keller, Dorothee; Carrel, Thierry

    2014-01-01

    BACKGROUND Antifibrinolytics have been used for 2 decades to reduce bleeding in cardiac surgery. MDCO-2010 is a novel, synthetic, serine protease inhibitor. We describe the first experience with this drug in patients. METHODS In this phase II, double-blind, placebo-controlled study, 32 patients undergoing isolated primary coronary artery bypass grafting with cardiopulmonary bypass were randomly assigned to 1 of 5 increasing dosage groups of MDCO-2010. The primary aim was to evalua...

  16. Sleep Quality and Emotional Correlates in Taiwanese Coronary Artery Bypass Graft Patients 1 Week and 1 Month after Hospital Discharge: A Repeated Descriptive Correlational Study.

    Directory of Open Access Journals (Sweden)

    Pei-Lin Yang

    Full Text Available Poor sleep quality is a common health problem for coronary artery bypass graft patients, however few studies have evaluated sleep quality during the period immediately following hospital discharge.The aim of this study was to investigate changes in sleep quality and emotional correlates in coronary artery bypass graft patients in Taiwan at 1 week and 1 month after hospital discharge.We used a descriptive correlational design for this study. One week after discharge, 87 patients who had undergone coronary artery bypass surgery completed two structured questionnaires: the Pittsburgh Sleep Quality Index and the Hospital Anxiety and Depression Scale. Three weeks later (1 month after discharge the patients completed the surveys again. Pearson correlations, t-tests, ANOVA and linear multiple regression analysis were used to analyze the data.A majority of the participants had poor sleep quality at 1 week (82.8% and 1 month (66.7% post-hospitalization, based on the global score of the Pittsburgh Sleep Quality Index. Despite poor sleep quality at both time-points the sleep quality at 1 month was significantly better than at 1-week post hospitalization. Poorer sleep quality correlated with older age, poorer heart function, anxiety and depression. The majority of participants had normal levels of anxiety at 1 week (69.0% and 1 month (88.5% as measured by the Hospital Anxiety and Depression Scale. However, some level of depression was seen at 1 week (78.1% and 1 month (59.7%. Depression was a significant predictor of sleep quality at 1 week; at 1 month after hospital discharge both anxiety and depression were significant predictors of sleep quality.Sleep quality, anxiety and depression all significantly improved 1 month after hospital discharge. However, more than half of the participants continued to have poor sleep quality and some level of depression. Health care personnel should be encouraged to assess sleep and emotional status in patients after

  17. 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.

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

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    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.

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

    OpenAIRE

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

    2015-01-01

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

  20. 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.

  1. 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

  2. Cephalic veins in coronary artery bypass surgery

    DEFF Research Database (Denmark)

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

    1996-01-01

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

  3. 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

  4. 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

  5. [VIABILITY OF MYOCAROIUM AS RISK FACTOR FOR MORTALITY IN EARLY AND LATE PERIOD AFTER BYPASS SURGERY OF CORONARY ARTERIES IN PATIENTS WITH CORONARY HEART DISEASE AND SEVERE LEFT VENTRICULAR DYSFUNCTION].

    Science.gov (United States)

    Todurov, B M; Zelenchuk, V; Kuzmich, I M; Ivanyuk, N B; Nikolaichuk, M V

    2015-06-01

    In coronary heart disease and low ejection fraction of the left ventricle (LV) in patients after coronary artery bypass surgery tend mortality and complication rate higher than preserved LV systolic function. Significant preoperative predictors of early mortality and remote in these patients, and the incidence of complications in the early postoperative period were reveald.

  6. Current status of coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin

    2009-01-01

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

  7. Effect of thoracic epidural anesthesia on oxygen delivery and utilization in cardiac surgical patients scheduled to undergo off-pump coronary artery bypass surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Suryaprakash Sharadaprasad

    2011-01-01

    Full Text Available To evaluate the effect of thoracic epidural anesthesia (TEA on tissue oxygen delivery and utilization in patients undergoing cardiac surgery. This prospective observational study was conducted in a tertiary referral heart hospital. A total of 25 patients undergoing elective off-pump coronary artery bypass surgery were enrolled in this study. All patients received thoracic epidural catheter in the most prominent inter-vertebral space between C7 and T3 on the day before operation. On the day of surgery, an arterial catheter and Swan Ganz catheter (capable of measuring cardiac index was inserted. After administering full dose of local anesthetic in the epidural space, serial hemodynamic and oxygen transport parameters were measured for 30 minute prior to administration of general anesthesia, with which the study was culminated. A significant decrease in oxygen delivery index with insignificant changes in oxygen extraction and consumption indices was observed. We conclude that TEA does not affect tissue oxygenation despite a decrease in arterial pressures and cardiac output.

  8. 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.

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

    Science.gov (United States)

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

    2016-10-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  12. 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...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  14. 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.

  15. 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

  16. Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery.

    Science.gov (United States)

    Vorstrup, S; Brun, B; Lassen, N A

    1986-01-01

    Cerebral blood flow (CBF) was measured by xenon-133 inhalation tomography in 18 patients with cerebrovascular disease before and 4 months after extracranial-intracranial bypass surgery. Only patients who showed a reduced CBF in areas that were intact on the CT scan and relevant to the clinical and angiographical findings were operated. The majority of the patients had suffered a minor stroke with or without subsequent transient ischemic attacks. They were studied at least 6 weeks following the stroke. All patients had an occlusion of the relevant internal carotid artery. To identify preoperatively the patients with a compromised collateral circulation and hence reduced CBF due to reduced perfusion pressure, a cerebral vasodilatory stress test was performed using acetazolamide (Diamox). In normal subjects, Diamox has been shown to increase tomographic CBF without change of the flow distribution. In the present series 9 patients showed a significant redistribution of flow in favor of the non-occluded side ("positive" Diamox test). Two of these 9 patients showed even a paradoxical decrease in focal CBF preoperatively, i.e., a "steal" effect. These 2 patients were the only patients who improved in focal CBF after shunting. The remaining 9 patients all showed uniform flow responses ("negative" Diamox test), and none of these increased in focal CBF postoperatively. The finding of an unchanged flow map postoperatively confirmed that the low flow areas were not due to restricted flow via collateral pathways. However, an increase in the regional vasodilatory capacity was observed postoperatively in the majority of patients. PMID:3492787

  17. Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery

    International Nuclear Information System (INIS)

    Cerebral blood flow (CBF) was measured by xenon-133 inhalation tomography in 18 patients with cerebrovascular disease before and 4 months after extracranial-intracranial bypass surgery. Only patients who showed a reduced CBF in areas that were intact on the CT scan and relevant to the clinical and angiographical findings were operated. The majority of the patients had suffered a minor stroke with or without subsequent transient ischemic attacks. They were studied at least 6 weeks following the stroke. All patients had an occlusion of the relevant internal carotid artery. To identify preoperatively the patients with a compromised collateral circulation and hence reduced CBF due to reduced perfusion pressure, a cerebral vasodilatory stress test was performed using acetazolamide (Diamox). In normal subjects, Diamox has been shown to increase tomographic CBF without change of the flow distribution. In the present series 9 patients showed a significant redistribution of flow in favor of the non-occluded side (positive Diamox test). Two of these 9 patients showed even a paradoxical decrease in focal CBF preoperatively, i.e., a steal effect. These 2 patients were the only patients who improved in focal CBF after shunting. The remaining 9 patients all showed uniform flow responses (negative Diamox test), and none of these increased in focal CBF postoperatively. The finding of an unchanged flow map postoperatively confirmed that the low flow areas were not due to restricted flow via collateral pathways. However, an increase in the regional vasodilatory capacity was observed postoperatively in the majority of patients

  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

    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

  19. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2002-01-01

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

  1. 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

    Directory of Open Access Journals (Sweden)

    Didem Onk

    2016-01-01

    Full Text Available 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.

  2. 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.

  3. 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...

  4. The long term prognosis of patients with peripheral arterial disease after infrainguinal bypass surgery : the follow-up of the Dutch Bypass and Oral anticoagulants or Aspirin Study

    NARCIS (Netherlands)

    van Hattum, E.S.

    2010-01-01

    Peripheral arterial disease (PAD) is a major public health burden with a prevalence of approximately 27 million people in Europe and North America. PAD is characterised by a progressive narrowing or occlusion of the major arteries in the lower limbs as a result of atherosclerosis. Because atheroscle

  5. In-Hospital and Long-Term Prognosis after Myocardial Infarction in Patients with Prior Coronary Artery Bypass Surgery; 19-Year Experience

    Directory of Open Access Journals (Sweden)

    Predrag M. Mitrovic

    2009-01-01

    Full Text Available To present a 19-year experience of the prognosis of patients with acute myocardial infarction (AMI and prior coronary artery bypass surgery (CABS, 748 patients with AMI after prior CABS (postbypass group and a control group of 1080 patients with AMI, but without prior CABS, were analyzed. All indexes of infarct size were lower in the postbypass group. There was more ventricular fibrillation in the postbypass group. In-hospital mortality was similar (p = 0.3675. In the follow-up period, postbypass patients had more heart failure, recurrent CABS, reinfarction, and unstable angina than did control patients. Cumulative survival was better in the control group than in the postbypass group (p = 0.0403. Multiple logistic regression model showed that previous angina (p = 0.0005, diabetes (p = 0.0058, and age (p = 0.0102 were independent predictor factors for survival. Use of digitalis and diuretics, together with previous angina, also influenced survival (p = 0.0092, as well as male gender, older patients, and diabetes together (p = 0.0420. Patients with AMI after prior CABS had smaller infarct, but more reinfarction, reoperation, heart failure, and angina. Previous angina, diabetes, and age, independently, as well as use of digitalis and diuretics together with angina, and male gender, older patients, and diabetes together, influenced a worse survival rate in these patients.

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

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

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

  7. Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease

    Institute of Scientific and Technical Information of China (English)

    LIU Wei; ZHU Xiao-Ling; MA Chang-sheng; KANG Jun-ping; DU Xin; CHEN Fang; ZHOU Yu-jie; L(U) Shu-zheng; HUANG Fang-jiong; GU Cheng-xiong

    2011-01-01

    Background In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG)in the patients with CTO and multivessel disease.Methods From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n=679) or DES (n=267) treatment. Their propensity risk score was used for adjusting baseline differences.Results At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95% Cl 1.219-3.179, P=0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95% CI 5.739-45.391, P <0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.Conclusions Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

  8. 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)...

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

    OpenAIRE

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

    2015-01-01

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

  10. Morphological, histochemical, and interstitial pressure changes in the tibialis anterior muscle before and after aortofemoral bypass in patients with peripheral arterial occlusive disease

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    Grigoriadis Nikolaos

    2002-02-01

    Full Text Available Abstract Background Morphological and electrophysiological studies of ischemic muscles in peripheral arterial disease disclosed evidence of denervation and fibre atrophy. The purpose of the present study is to describe morphological changes in ischemic muscles before and after reperfusion surgery in patients with peripheral occlusive arterial disease, and to provide an insight into the effect of reperfusion on the histochemistry of the reperfused muscle. Methods Muscle biopsies were obtained from the tibialis anterior of 9 patients with chronic peripheral arterial occlusive disease of the lower extremities, before and after aortofemoral bypass, in order to evaluate the extent and type of muscle fibre changes during ischemia and after revascularization. Fibre type content and muscle fibre areas were quantified using standard histological and histochemical methods and morphometric analysis. Each patient underwent concentric needle electromyography, nerve conduction velocity studies, and interstitial pressure measurements. Results Preoperatively all patients showed muscle fibre atrophy of both types, type II fibre area being more affected. The mean fibre cross sectional area of type I was 3,745 μm2 and of type II 4,654 μm2 . Fibre-type grouping, great variation in fibre size and angular fibres were indicative of chronic dennervation-reinnervation, in the absence of any clinical evidence of a neuropathic process. Seven days after the reperfusion the areas of both fibre types were even more reduced, being 3,086 μm2 for type I and 4,009 μm2 for type II, the proportion of type I fibres, and the interstitial pressure of tibialis anterior were increased. Conclusions The findings suggest that chronic ischemia of the leg muscles causes compensatory histochemical changes in muscle fibres resulting from muscle hypoxia, and chronic dennervation-reinnervation changes, resulting possibly from ischemic neuropathy. Reperfusion seems to bring the oxidative

  11. Intra-aortic balloon pump use does not affect the renal function in patients undergoing off pump coronary artery bypass surgery

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    Muniraju Geetha

    2011-01-01

    Full Text Available Renal dysfunction is known to occur during cardiac surgery. A few factors such as perioperative hypotension, use of potential nephrotoxic therapeutic agents, radio opaque contrast media in the recent past, intra-aortic balloon pump (IABP and cardiopulmonary bypass have been blamed as the contributing factors to the causation of postoperative renal dysfunction in cardiac surgical patients. At times, in patients with renal failure and low cardiac output status, one may face the dilemma if the use of IABP is safe. We undertook this prospective observational study to determine the degree of possible renal injury when IABP is used by measuring serial values of serum creatinine and Cystatin C. Elective patients scheduled for off-pump coronary artery bypass surgery requiring preoperative use of IABP were included in this study. Cystatin C and serum creatinine levels were checked at fixed intervals after institution of IABP. Twenty-two patients were eligible for enrolment to the study. There was no significant change in the values of serum creatinine; from the basal value of 1.10 ± 0.233 to 0.98 ± 0.363 mg /dL (P value >0.05. Cystatin C levels significantly decreased from the basal level of 0.98 ± 0.29 to 0.89 ± 0.23 (P value <0.05. Contrary to the belief, Cystatin C, the early indicator of renal dysfunction decreases suggesting absence of renal injury after the use of IABP. Absence of elevation of cystatin C levels in our study suggests the lack of potential of the IABP to cause renal dysfunction in patients who received elective IABP therapy preoperatively.

  12. Assessment of the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft surgery in a group of Iranian patients

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    Hamidreza Jamaati

    2015-01-01

    Full Text Available Background and Aims: Previous studies around the world indicated validity and accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE risk scoring system we evaluated the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft (CABG surgery in a group of Iranian patients. Materials and Methods: In this cohort 2220 patients more than 18 years, who were performed CABG surgery in Massih Daneshvari Hospital, from January 2004 to March 2010 were recruited. Predicted mortality risk scores were calculated using logistic EuroSCORE and Acute Physiology and Chronic Health Evaluation II (APACHE II and compared with observed mortality. Calibration was measured by the Hosmer-Lemeshow (HL test and discrimination by using the receiver operating characteristic (ROC curve area. Results: Of the 2220 patients, in hospital deaths occurred in 270 patients (mortality rate of 12.2%. The accuracy of mortality prediction in the logistic EuroSCORE and APACHE II model was 89.1%; in the local EuroSCORE (logistic was 91.89%; and in the local EuroSCORE support vector machines (SVM was 98.6%. The area under curve for ROC curve, was 0.724 (95% confidence interval [CI]: 0.57-0.88 for logistic EuroSCORE; 0.836 (95% CI: 0.731-0.942 for local EuroSCORE (logistic; 0.978 (95% CI: 0.937-1 for Local EuroSCORE (SVM; and 0.832 (95% CI: 0.723-0.941 for APACHE II model. The HL test showed good calibration for the local EuroSCORE (SVM, APACHE II model and local EuroSCORE (logistic (P = 0.823, P = 0.748 and P = 0.06 respectively; but there was a significant difference between expected and observed mortality according to EuroSCORE model (P = 0.033. Conclusion: We detected logistic EuroSCORE risk model is not applicable on Iranian patients undergoing CABG surgery.

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

    Science.gov (United States)

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

    2006-09-01

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

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

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

    2016-01-15

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

  15. Early and midterm results of patients above or below 65-year-old undergoing coronary artery bypass grafting combined with valve replacement

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    Yang WU

    2013-03-01

    Full Text Available 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 0.05, neither in the mechanical ventilation time, the intensive care time, application of intra-aortic balloon counter pulsation (IABCP, the postoperative hospitalization time, CPB time and cross-clamping time. The patients of ≥65 years were followed up from 2 months to 11 years after surgery, of whom 3 patients were lost to follow-up. One patient died of severe drug eruption in 2 months, another one died of lung cancer 2 years later, 2 patients suffered from cerebral infarction, and the life quality in other patients improved obviously with cardiac function evaluated in class I or Ⅱ. The patients in <65 years group were followed up by 3 months to 12 years. Of whom 8 patients lost the follow-up, two patients who received mechanic valve replacement got complications related to anticoagulation treatment in 3 and 6 years after surgery. One of the two died of severe low cardiac output. Conclusion  The early and mid-term outcomes of CABG combined with valve replacement in elderly patients may be safe and satisfying as in younger patients, so long as the right surgery strategy and the precise perioperative treatment are reasonably applied.

  16. Influence of preoperative coronary collateral circulation on in-hospital mortality in patients undergoing coronary artery bypass graft surgery with intra-aortic balloon pump support

    Institute of Scientific and Technical Information of China (English)

    Hasan Gungor; Cemil Zencir; Abraham Samuel Babu; Cagdas Akgullu; Ufuk Eryilmaz; Ali Zorlu; Mithat Selvi

    2014-01-01

    Background Outcomes in patients requiring coronary artery bypass graft (CABG) surgery have been improved with devices such as the intra-aortic balloon pump (IABP).Good coronary collateral circulation (CCC) has been shown to reduce mortality in patients with coronary artery disease (CAD).We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.In-hospital mortality rate in poor CCC group was significantly higher than good CCC group (14 (50%) vs.4 (13%),P=0.013).Preoperative hemoglobin level (OR:0.752; 95% CI,0.571-0.991,P=0.043),chronic obstructive pulmonary disease (OR:6.731; 95% CI,1.159-39.085,P=0.034) and poor CCC grade (OR:5.750; 95% CI,1.575-20.986,P=0.008) were associated with post-CABG in-hospital mortality.Poor CCC grade (OR:4.853; 95% CI,1.124-20.952,P=0.034) and preoperative hemoglobin level (OR:0.624; 95% CI,0.476-0.954,P=0.026) were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.

  17. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m 2 for off pump coronary artery bypass surgery

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    Sharma Munish

    2010-01-01

    Full Text Available Perioperative Thoracic epidural analgesia (TEA is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB. We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index> 30 kg/m 2 for elective OPCAB were randomized into two groups (n=30 each. Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO 2 /FiO 2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB.

  18. Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study

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    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

  19. Effects of Phase III Cardiac Rehabilitation Programs on Anxiety and Quality of Life in Anxious Patients after Coronary Artery Bypass Surgery

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    Gholamreza Babaei Ruchi

    2007-09-01

    Full Text Available 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 cardiac rehabilitation program that consisted of formal supervised exercise training and educational sessions. The state/trait anxiety inventory and SF-36 questionnaire were two instruments for collecting data in the present study. Of the total of 83, 66 participants saw out the eight-week period. Results: With the exception of the mental health aspect, significant improvements were noted in the following components of the quality of life measures after the cardiac rehabilitation program: physical functioning (P<0.001, role-physical (P<0.001, bodily pain (P<0.001, social functioning, (P=0.003, general health (P=0.020, vitality (P=0.006, and role-emotional (P=0.003. Additionally, significant reductions were observed in state anxiety (P=0.010 and trait anxiety (P=0.010(.Conclusion: These findings suggest that phase III cardiac rehabilitation may be an effective therapy for improving psychological outcomes of patients with psychological problems after CABG

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

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

    2012-01-01

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

  1. Association of Atrial Fibrillation and Amino-terminal Pro-brain Natriuretic Peptide Concentrations in Patients After Off-Pump Coronary Artery Bypass Grafting

    Institute of Scientific and Technical Information of China (English)

    Junquan Li; Qinghua Zhang; Weichen Tian; Hongyu Liu

    2008-01-01

    Objectives To investigate the possible role of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in the occurrence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG).Methods This study group included 70 consecutive patients scheduled for elective off-pump CABG.The patients with ejection fraction (EF) less than 0.30,history of AF,use of class Ⅰor Ⅲ antiarrhythmic drug,implanted pacemaker,postoperative myocardial infarction or chest reopening for pericardial tamponade were excluded.Preoperative and postoperative serum NT-proBNP levels were measured by radioimmunoassay technique.Results Postoperative AF occurred in 15 patients (21.4%);these patients had significantly higher median NT-proBNP levels when compared with those without AF after the operation (P<0.01).Using multivariate logistic regression analyses,an increase in NT-proBNP level after CABG was found to be independently associated with AF (OR=3.78,95% IC=1.81~4.89,P<0.01 ).Increased age,diabetes mellitus,preoperative use of β-blocker,proximal right coronary artery involvement,and longer operation time were also associated with AF.Conclusions These results indicated that AF was associated with higher NT-proBNP concentrations after off pump CABG;the increase in NT-proBNP after CABG may play an important role in the occurrence of AF after the operation.The further studies are needed to define the reason that lead to higher NT-proBNP concentrations among the patients who present AF after off pump CABG.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  3. The effects of preemptive pregabalin on attenuation of stress response to endotracheal intubation and opioid- sparing effect in patients undergoing off-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Ayya Syama Sundar

    2012-01-01

    Full Text Available The clinical study was designed to evaluate and compare single preoperative dose of pregabalin to a placebo regarding hemodynamic responses to laryngoscopy and endotracheal intubation, to assess perioperative fentanyl requirement and any side-effects. It was a randomized, double-blind, placebo-controlled, parallel assignment, efficacy study. The study was done at a tertiary university hospital. This study was a comparison between two groups of 30 adult patients scheduled for elective off pump coronary artery bypass surgery. In the control group, the patients were given placebo capsules, and in the pregabalin group, the patients were given pregabalin 150 mg capsule orally 1 h before surgery. The patients were compared for hemodynamic changes before the start of the surgery, after induction, 1, 3, and 5 min after intubation. Additionally, fentanyl requirement during surgery and the first postoperative day was also compared. The present study shows that a single oral dose of 150 mg pregabalin given 1 h before surgery attenuated the pressor response to tracheal intubation in adults, but the drug did not show any effect on perioperative opioid consumption and was devoid of side-effects in the given dose.

  4. 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.

  5. Depression following coronary artery bypass grafting surgery revisited.

    Science.gov (United States)

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

    2016-09-01

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

  6. On Pump versus Off Pump Coronary Artery Bypass Surgery in Patients Over Seventy Years Old with Triple Vessels Disease and Severe Left Ventricle Dysfunction: Focus on Early Clinical Outcomes

    OpenAIRE

    Seyed Jalil Mirhosseini; Seyed Khalil Forouzannia; Sadegh Ali-Hassan-Sayegh; Mehdi Hadad-Zadeh; Mohammad Hassan Abdollahi; Hossein Moshtaghiom; Habiballah Hosseini

    2013-01-01

    Cardiovascular disease is the leading reason of morbidity in older people. Coronary artery bypass graft (CABG) surgery is the most common type of operations in world. This study was designed to characterize comparison of early clinical outcome following on pump vs. off pump in patients over 70 years old with triple vessels disease and severe left ventricle dysfunction. 80 patients were divided into two groups: In group A (n=40) on pump CABG was performed with hypothermic cardiopulmonary bypas...

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  8. Comparison of the Complications between Left Side and Right Side Subclavian Vein Catheter Placement in Patients Undergoing Coronary Artery Bypass Graft Surgery

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    Masoud Tarbiat

    2014-10-01

    Full Text Available Introduction: Percutaneous subclavian vein catheterization is one of the most common invasive procedures performed in cardiac surgery. The aim of this study was to compare left and right subclavian vein catheter placement via the infraclavicular approach in patients who undergo coronary artery bypass graft (CABG surgery.Methods: This prospective, randomized clinical trial was performed in193 patients. The technique applied for cannulation was infraclavicular approach for both the right and the left sides. Subclavian vein of other side was attempted only when catheterization at initial side was unsuccessful at two attempts. The success and complication rates were compared for the two sides.Results: On193 patients, catheterization attempts were performed. 177 catheterizations (91.7% were successful during the first attempt, 105 (92.1% on the right side and 72 (91.1% on the left side. There was no significant difference between success rate and side of catheterization. Malposition of the catheter tip on the right side (9.6% was significantly more than the left side (0% (P= 0.003. The differences in other complications on two sides were statistically insignificant.Conclusion: Compared with the right side, insertion of the cannula on the left side resulted in fewer catheter tip misplacements. Incidence of cannulation failure and other complications were similar on both sides.

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

    Science.gov (United States)

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

    2016-06-01

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

  10. Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: “A clinical outcome and biomarker-based study”

    Science.gov (United States)

    Kapoor, Poonam Malhotra; Magoon, Rohan; Rawat, Rajinder; Mehta, Yatin

    2016-01-01

    Goal-directed therapy (GDT) encompasses guidance of intravenous (IV) fluid and vasopressor/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high-risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation ≥3 undergoing coronary artery bypass grafting on cardiopulmonary bypass. The patients were randomly divided into the control and GDT group. All the participants received standardized care; arterial pressure monitored through radial artery, central venous pressure (CVP) through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour, and frequent arterial blood gas (ABG) analysis. In addition, cardiac index (CI) monitoring using FloTrac™ and continuous central venous oxygen saturation (ScVO2) using PreSep™ were used in patients in the GDT group. Our aim was to maintain the CI at 2.5–4.2 L/min/m2, stroke volume index 30–65 ml/beat/m2, systemic vascular resistance index 1500–2500 dynes/s/cm5/m2, oxygen delivery index 450–600 ml/min/m2, continuous ScVO2 >70%, and stroke volume variation 30%, and urine output >1 ml/kg/h. The aims were achieved by altering the administration of IV fluids and doses of inotropes or vasodilators. The data of sixty patients in each group were analyzed in view of ten exclusions. The average duration of ventilation (19.89 ± 3.96 vs. 18.05 ± 4.53 h, P = 0.025), hospital stay (7.94 ± 1.64 vs. 7.17 ± 1.93 days, P = 0.025), and Intensive Care Unit (ICU) stay (3.74 ± 0.59 vs. 3.41 ± 0.75 days, P = 0.012) was significantly less in the GDT group, compared to the control group. The extra volume added and the number of inotropic dose adjustments were

  11. 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.

  12. Sevoflurane Versus Propofol for Myocardial Protection in Patients Undergoing Coronary Artery Bypass Grafting Surgery:a Meta-analysis of Randomized Controlled Trials

    Institute of Scientific and Technical Information of China (English)

    Yun-tai Yao; Li-huan Li

    2009-01-01

    Objective To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting(CABG)surgery.Methods Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardiurn in adult patients undergoing CABG surgery.Two authors independently extracted patients' perioperative data,including patients' baseline characteristics,surgical variables,and outcome data.For continuous variables,treatment effects were calculated as weighted mean difference(WMD)and 95% confidential interval(C0.For dichotomous data,treatment effects were calculated as odds ratio(OR)and 95% CI.Each outcome was tested for heterogeneity,and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity(Q test P<0.05).Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects.Publication bias was explored through visual inspection of funnel plots of the outcomes.Statistical significance was defined as P<0.05.Results Our search yielded 13 studies including 696 patients,and 402 patients were allocated into sevoflurane group and 294 into propofol group.There was no significant difference in postoperative mechanical ventilation time,inotropic support,mortality,myocardial infarction,and atrial fibrillation between the two groups(all P>0.05).Patients randomized into sevoflurane group had higher post-bypass cardiac index(WMD=0.39,95% CI:0.18 to 0.60,P=0.0003),lower troponin I level(WMD=-0.82,95% CI:-0.87 to-0.85,P=0.0002),lower incidence of myocardial ischemia(OR=0.37,95% CI:0.16 to 0.83,P=0.02),shorter ICU and hospital stay length(WMD=-10.99,95% CI:-12.97 to-9.01,P<0.00001;WMD=-0.78,95% CI:-1.00 to-0.56,P<0.00001,respectively).Conclusion This meta-analysis has found some evidence showing that sevoflurane has better myocardial

  13. 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....

  14. The effect of continuous low dose methylprednisolone infusion on inflammatory parameters in patients undergoing coronary artery bypass graft surgery: a randomized-controlled clinical trial.

    Directory of Open Access Journals (Sweden)

    Abbas Ghiasi

    2015-02-01

    Full Text Available This trial was performed to determine if a continuous low-dose infusion of methylprednisolone is as effective as its bolus of high-dose in reducing inflammatory response. The study was single-center, double-blinded randomized clinical trial and performed in a surgical intensive care unit of an academic hospital. In this study, 72 consecutive patients undergoing elective coronary artery bypass grafting (CABG were assigned to receive either a methylprednisolone loading dose (1mg/kg followed by continuous infusion (2mg/Kg/24 hours for 1 day (low-dose regime or a single dose of methylprednisolone (15 mg/kg before cardiopulmonary bypass (high dose regime. Serum concentrations of IL-6 and C- reactive protein (CRP were measured preoperatively and 6, 24 and 48 hours after surgery, and serum creatinine was measured before the operation and 24, 48 and 72 hours postoperatively. The measurements were then compared between the groups to evaluate the efficacy of each regimen. The basic characteristics and measurements were not different between the study groups. There was no significant difference in IL-6 and CRP elevation (P=0.52 and P=0.46, respectively. Early outcomes such as the length of stay in the intensive care unit, intubation time, changes in serum creatinine and blood glucose levels, inotropic support, insulin requirements, and rate of infection were also similar in both groups. A continuous low dose infusion of methylprednisolone was as effective as a single high dose methylprednisolone in reducing the inflammatory response after CABG with extracorporeal circulation with no significant difference in the postoperative measurements and outcomes.

  15. 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...

  16. Comparison of effectiveness of carvedilol versus bisoprolol for prevention of postdischarge atrial fibrillation after coronary artery bypass grafting in patients with heart failure.

    Science.gov (United States)

    Marazzi, Giuseppe; Iellamo, Ferdinando; Volterrani, Maurizio; Caminiti, Giuseppe; Madonna, Mariapina; Arisi, Giovanna; Massaro, Rosalba; Righi, Daniela; Rosano, Giuseppe M C

    2011-01-15

    Atrial fibrillation (AF) occurs frequently soon after coronary artery bypass grafting (CABG) and often results in increased mortality and morbidity, particularly in patients with heart failure. New-onset AF is also a common event in the early period after discharge from a cardiac surgery clinic. Current guidelines recommend β blockers as first-line medication for the prevention of AF after CABG. In this prospective study, we investigated the effectiveness of the highly selective β1 receptor antagonist bisoprolol compared to the less selective β blocker carvedilol in preventing postdischarge AF after CABG in patients with decreased left ventricular function. Three hundred twenty patients (231 men, 89 women, mean age 66 ± 10 years) with ejection fraction CABG and were then referred to an in-hospital cardiac rehabilitation program were randomized to receive bisoprolol (n = 160) or carvedilol (n = 160) starting 4 to 5 days after surgery. Bisoprolol was started at 1.25 mg 1 time/day and carvedilol was started 3.125 mg 2 times/day. All patients underwent continuous telemetric electrocardiographic monitoring for 5 days after entry in the study and thereafter 2 times/day routinely up to hospital discharge. During follow-up, 23 patients (14.6%) in the bisoprolol group and 37 patients (23%) in the carvedilol group developed AF (relative risk 0.6, confidence interval 0.4 to 0.9, p = 0.032). Twenty-six percent of all AF episodes were asymptomatic. At the 4-week outpatient visit, those in the bisoprolol group showed a significantly greater decrease in heart rate, being in sinus rhythm or AF (-15.6 ± 3 vs -9.4 ± 3 beats/min, p = 0.021), whereas changes in systolic and diastolic blood pressures did not differ significantly. In conclusion, bisoprolol is more effective than carvedilol in decreasing the incidence of postdischarge AF after CABG in patients with decreased left ventricular function. PMID:21129714

  17. The prevalence of Chlamydia pneumoniae in the aortic wall and in peripheral blood of patients scheduled for coronary artery bypass grafting.

    Science.gov (United States)

    Kuczaj, A; Stryjewski, P J; Fudal, M; Domal-Kwiatkowska, D; Ryfiński, B; Sliupkas-Dyrda, E; Smolik, S; Węglarz, L; Mazurek, U; Nowalany-Kozielska, E

    2016-01-01

    Some reports confirm a potential role of Chlamydia pneumoniae (ChP) in atherogenesis. In order to explore possible association between ChP and atherosclerosis, investigations were carried out in which the frequency of ChP in the arterial wall and peripheral blood was assessed in a group of patients with chronic coronary artery disease (CAD). Fifty-seven patients were enrolled in the study, 13 women and 44 men aged 61.8±6.5 (47-74), with previously diagnosed CAD, scheduled for planned coronary artery bypass grafting due to clinical indications. Vessel specimens retrieved from the ascending aorta (as a part of routine proximal venous graft development procedure) and peripheral blood mononuclear cells (PBMCs) from venous blood were evaluated for the presence of ChP DNA. Genomic DNA was extracted from PBMCs and vessel specimens. Quantitative real-time polymerase chain reaction (qPCR) was performed to detect ChP DNA. A statistically more frequent occurrence of ChP was observed in aortic tissues compared to blood samples (70.2% vs 56.1%, respectively). Similarly, the number of ChP DNA genomic copies [n/1μg genomic DNA] was significantly higher in tissue specimens compared to blood samples (89±91 vs 41±77, respectively; p=0.0046). In patients without ChP in blood specimens, we observed significantly higher amounts of ChP in tissue specimens compared to patients with ChP in blood specimens (156±71 vs 107±88, respectively; p=0.0453). No correlation was found between the number of ChP DNA copies [n/1μg genomic DNA] in blood and in aortic specimens. The infection of ChP in the aortic wall was connected with hypercholesterolemia (p=0.029) and diabetes (p=0.03). We conclude that Chlamydia pneumoniae is a pathogen frequently occurring in the aortic wall of patients with CAD. The occurrence of ChP DNA in the aortic tissue is related to classic CAD risk factors such as diabetes and dyslipidemia. PMID:27358129

  18. 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

  19. 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...

  20. 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

    Directory of Open Access Journals (Sweden)

    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.

  1. Simultaneous coronary artery bypass grafting, replacement of the innominate artery and subtotal thyroidectomy in a 61 year-old patient: a case-report

    Institute of Scientific and Technical Information of China (English)

    Jens Litmathe; Muhammed Kurt; Klaus Grabitz; Wolfram T. Knoefel; Emmeran Gams

    2005-01-01

    @@ The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally, the surgical procedures have been staged with the cardiac surgery performed first followed by the visceral operation at a later date. However, especially in cases of malignant disease (e. g. pulmonary or abdominal) the curative treatment is delayed and the additional costs of two settings have to be considered.1 Although encouraging results have been reported concerning simultaneous pulmonary tumor resection, carotid endarterectomy or abdominal aneurysm repair,2-5 detailed knowledge concerning further coexisting non-cardiac diseases requiring surgical therapy is still lacking. In some extremely rare cases patients suffer from more than just one coexisting disease of different origins: the current report focuses on a 61-year-old female patient suffering from ischemic heart disease, occlusion of the innominate artery and a retrosternal goiter as an incidental finding. She was treated in a simultaneous procedure with three operations in only one setting. The perioperative features of this special case are reflected in the following course.

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

    Institute of Scientific and Technical Information of China (English)

    Xiang HU; Qiang ZHAO

    2011-01-01

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

  3. 冠状动脉搭桥术患者并发精神障碍的影响因素分析%Analysis on Affecting Factors of Complicated Mental Disorder among the Patients after Coronary Artery Bypass Grafting

    Institute of Scientific and Technical Information of China (English)

    刘萍

    2014-01-01

    目的:探讨冠状动脉搭桥术后患者并发精神障碍的影响因素。方法收集自2012年1月至2013年1月于本科室行冠状动脉搭桥术的患者资料,按术后有无发生精神障碍分为两组,结果用SPSS 19.0软件进行t检验,χ2检验。结果冠状动脉搭桥术后精神障碍发生率为16.67%,主要表现为抑郁、意识障碍、认知障碍。结论冠状动脉搭桥术后发生精神障碍是多种因素共同作用的结果,医护人员应采取综合护理措施,以改善疾病预后。%Objective To explore the affecting factors of complicated mental disorder among the patients after coronary artery bypass grafting .Methods Collecting the data of patients undergoing coronary artery bypass grafting from Jan .2012 to Jan .2013 in Xinhua hospital .The patients were divided into two groups according to the presence or absence of mental disorder .And the data was analyzed by SPSS 19 .0 .Results After coronary artery bypass grafting , the mental disorder occurrence rate is 16 .67%.Mainly appearance is depression , disturbance of consciousness , cognitive impairment .Conclusion After coronary artery bypass grafting mental disorder is the re-sult of interaction of multiple factors , Medical workers should take comprehensive nursing measures , in order to im-prove the prognosis of the disease .

  4. No evidence for activated autophagy in left ventricular myocardium at early reperfusion with protection by remote ischemic preconditioning in patients undergoing coronary artery bypass grafting.

    Directory of Open Access Journals (Sweden)

    Nilgün Gedik

    Full Text Available Remote ischemic preconditioning (RIPC by repeated brief limb ischemia/reperfusion reduces myocardial injury in patients undergoing coronary artery bypass grafting (CABG. Activation of signal transducer and activator of transcription 5 (STAT5 in left ventricular (LV myocardium at early reperfusion is associated with such protection. Autophagy, i.e., removal of dysfunctional cellular components through lysosomes, has been proposed as one mechanism of cardioprotection. Therefore, we analyzed whether or not the protection by RIPC is associated with activated autophagy.CABG patients were randomized to undergo RIPC (3×5 min blood pressure cuff inflation/5 min deflation or placebo (cuff deflated before skin incision (n = 10/10. Transmural myocardial biopsies were taken from the LV before cardioplegia (baseline and at early (5-10 min reperfusion. RIPC-induced protection was reflected by decreased serum troponin I concentration area under the curve (194±17 versus 709±129 ng/ml × 72 h, p = 0.002. Western blotting for beclin-1-phosphorylation and protein expression of autophagy-related gene 5-12 (ATG5-12 complex, light chain 3 (LC3, parkin, and p62 was performed. STAT3-, STAT5- and extracellular signal-regulated protein kinase 1/2 (ERK1/2-phosphorylation was used as positive control to confirm signal activation by ischemia/reperfusion.Signals of all analyzed autophagy proteins did not differ between baseline and early reperfusion and not between RIPC and placebo. STAT5-phosphorylation was greater at early reperfusion only with RIPC (2.2-fold, p = 0.02. STAT3- and ERK1/2-phosphorylation were greater at early reperfusion with placebo and RIPC (≥2.7-fold versus baseline, p≤0.05.Protection through RIPC in patients undergoing CABG surgery does not appear to be associated with enhanced autophagy in LV myocardium at early reperfusion.

  5. 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.

  6. 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.

  7. [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

  8. Epicardial and Subcutaneous Adipose Tissue Fatty Acids Profiles in Diabetic and Non-Diabetic Patients Candidate for Coronary Artery Bypass Graft

    Directory of Open Access Journals (Sweden)

    Masoud Pezeshkian

    2013-01-01

    Full Text Available Introduction: We have recently shown that in high cholesterol-fed rabbits, the sensitivity of epicardial adipose tissue to changes in dietary fat is higher than that of subcutaneous adipose tissue. Although the effects of diabetes on epicardial adipose tissue thickness have been studied, the influence of diabetes on profile of epicardial free fatty acids (FFAs has not been studied. The aim of this study is to investigate the effect of diabetes on the FFAs composition in serum and in the subcutaneous and epicardial adipose tissues in patients undergoing coronary artery bypass graft (CABG. Methods: Forty non-diabetic and twenty eight diabetic patients candidate for CABG with > 75% stenosis participated in this study.Fasting blood sugar (FBS and lipid profiles were assayed by auto analyzer. Phospholipids and non-estrified FFA of serum and the fatty acids profile of epicardial and subcutaneous adipose tissues were determined using gas chromatography method. Results: In the phospholipid fraction of diabetic patients’ serum, the percentage of 16:0, 18:3n-9, 18:2n-6 and monounsaturated fatty acids (MUFAs was lower than the corresponding values of the non-diabetics; whereas, 18:0 value was higher. A 100% increase in the amount of 18:0 and 35% decrease in the level of 18:1n-11 was observed in the diabetic patients’ subcutaneous adipose tissue. In epicardial adipose tissue, the increase of 18:0 and conjugated linolenic acid (CLA and decrease of 18:1n-11, ω3 (20:5n-3 and 22:6n-3 were significant; but, the contents of arachidonic acid and its precursor linoleic acid were not affected by diabetes. Conclusion: The fatty acids’ profile of epicardial and subcutaneous adipose tissues is not equally affected by diabetes. The significant decrease of 16:0 and ω3 fatty acids and increase of trans and conjugated fatty acids in epicardial adipose tissue in the diabetic patients may worsen the formation of atheroma in the related arteries.

  9. MYCTOIC ANEURYSM OF POPLITEAL ARTERY AND AORTOFEMORAL BYPASS GRAFT

    Directory of Open Access Journals (Sweden)

    A. Sohrabi

    1979-11-01

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

  10. 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).

  11. Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies

    Directory of Open Access Journals (Sweden)

    Babak Amra

    2014-01-01

    Conclusions: Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.

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

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    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.

  13. 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

  14. Effect of minimized perfusion circuit on brain injury markers carnosinase and brain-type fatty binding protein in coronary artery bypass grafting patients.

    Science.gov (United States)

    Pahari, Dipak R; Gu, Y John; van Oeveren, Willem; El-Essawi, Aschraf; Harringer, Wolfgang; Brouwer, René M H

    2013-02-01

    A minimized perfusion circuit (MPC) has proven to be superior to the conventional circulatory perfusion bypass (CCPB) as it reduces the blood-material interaction and hemodilution. Until now not much is known about impact these different perfusion systems have on the brain. The objective of this study is to determine carnosinase and brain-type fatty binding protein (BFABP) activity as novel specific biomarkers for ischemic brain tissue damage and how their activity differs during and after MPC and CCPB as well as to compare the inflammatory response of both perfusion systems. In a prospective pilot study, 28 patients undergoing coronary artery bypass grafting were randomly divided into an MPC group (n = 14) and a CCPB group (n = 14). Blood samples were taken before, during, and after operation until the fifth postoperative day. The brain biomarker carnosinase was determined by measuring the rate of histidine production from the substrate homocarnosine, whereas BFABP and interleukin-6 were determined by enzyme-linked immunosorbent assay (ELISA). C-reactive protein (CRP) and endothelin-1 were determined by enzyme immunoassay. The mean serum carnosinase activity was significantly higher in MPC (0.57 ± 0.34 nM histidine/mL/min) as compared with the CCPB group (0.36 ± 0.13 nM histidine/mL/min) at the end of operation (P = 0.02). The BFABP did not show any difference between the two groups in the immediate postoperative period until the second postoperative day. From that time point onward, it showed a steep increase in the CCPB group (581.3 ± 157.11 pg/mL) as compared with the concentrations in the MPC group (384.6 ± 39 pg/mL) (P = 0.04). The inflammation markers interleukin-6 and CRP showed a similar pattern in both groups without significant difference. In contrast, the leukocyte count on operation day and endothelin-1 on the first postoperative day were significantly higher in the CCPB group (P = 0.01, P = 0

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  16. 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

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

    Institute of Scientific and Technical Information of China (English)

    刘昌伟; 管珩; 李拥军; 郑曰宏; 刘卫

    2001-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    刘昌伟; 管珩; 李拥军; 郑曰宏; 刘卫

    2001-01-01

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

  19. Assessment of feasibility and efficacy of Class IV laser therapy for postoperative pain relief in off-pump coronary artery bypass surgery patients: A pilot study

    Directory of Open Access Journals (Sweden)

    Anil Karlekar

    2015-01-01

    Full Text Available Background: Laser therapy, for its established analgesic properties with minimal side effects, has been used for the treatment of chronic pain. However, it has not been used for the treatment of acute postoperative pain. This pilot study was designed to assess the feasibility and efficacy of Class IV laser on postoperative pain relief following off-pump coronary artery bypass graft (OPCABG surgery, as a component of multimodal analgesia (MMA technique. Methods: This open observational prospective study comprised of 100 adult patients (84 male, 16 female who underwent OPCABG through sternotomy. For postoperative analgesia, they were subjected to laser therapy subjected to laser therapy in addition to the standard institutional pain management protocol comprising of IV infusion/bolus of tramadol and paracetamol and fentanyl bolus as rescue analgesic. Pain intensity was measured by Verbal Rating Scale (VRS. The laser therapy was scheduled as once a day regime for three consecutive postoperative days (PODs starting on POD 1, 30 min following tracheal extubation. The subsequent laser applications were also scheduled at the same time of the day as on day 1 if VRS was ≥5. 10 W Class IV laser was applied over 150 cm 2 sternal wound area for 150 s. VRS was used to assess pain severity and was recorded for statistical analysis using Friedman Test. Results: The mean (standard deviation [SD] VRS of all the 100 patients just before application of the first dose of laser was 7.31 (0.94 while on MMT; the same fell to 4.0 (1.279 and 3.40 (2.697 at 1 h and 24 h respectively following first dose of laser. The change of VRS over first 24 h among all the 100 patients was statistically significant (P = 0.000. Laser was re-applied in 40 patients whose VRS was ≥5 (mean [SD] - 6.38 [0.868] at 24 th h. After receiving the 2 nd dose of laser the VRS scores fell significantly (P = 0.000 and became 0 at 54 th h. No patients required 3 rd dose of the laser. No patient

  20. Perioperative prostate specific antigen levels among coronary artery bypass grafting patients: Does extracorporeal circulation and body temperature induce prostate specific antigen levels alterations?

    Science.gov (United States)

    Patris, Emmanuel; Giakoumidakis, Konstantinos; Patris, Vasileios; Kuduvalli, Manoj; Argiriou, Mihalis; Charitos, Christos; Kalaitzis, Christos; Touloupidis, Stavros

    2015-01-01

    Purpose: The purpose of this study is to compare the perioperative total prostate specific antigen (tPSA) levels among coronary artery bypass grafting (CABG) patients with and without extracorporeal circulation (ECC), to investigate the changes overtime of tPSA in each group separately and to determine the effect of body core temperature on tPSA levels. Materials and Methods: A prospective study was conducted. Our sample was allocated to: (a) Seven patients who underwent off pump CABG (Group I) and (b) 16 CABG patients with ECC (Group II). The levels of tPSA were measured preoperatively (baseline), intra-operatively and at the 4th postoperative day. We compared the two groups on their tPSA levels and we investigated the changes of tPSA overtime in each group separately. Results: Intra-operative serum samples were obtained in significantly lower body temperature in patients of Group II than in those of Group I (31°C vs. 36.9°C, P < 0.001). In each group separately, postoperative tPSA levels were increased significantly compared to the baseline values (2.55 ng/ml vs. 0.39 ng/ml for Group I, P = 0.005 and 4.36 ng/ml vs. 0.77 for Group II, P < 0.001). CABG patients with ECC had significantly lower intra-operative tPSA levels than the baseline values (0.67 ng/ml vs. 0.77 ng/ml, P = 0.008). We did not observe significant differences of tPSA levels between the two groups. Conclusions: CABG surgery affects similarly the perioperative tPSA independently the involvement of ECC. Although all patients had significantly higher early postoperative tPSA levels, only those who underwent CABG with ECC had exceeded normal values and significantly decreased intra-operative tPSA. Hypothermia seems to be the causal factor of tPSA reduction. PMID:25657546

  1. 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...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-09-01

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

  3. Comparison of Percutaneous Coronary Intervention with Drug Eluting Stents Versus Coronary Artery Bypass Grafting in Patients With Multivessel Coronary Artery Disease: Meta-Analysis of Six Randomized Controlled Trials

    Science.gov (United States)

    Fanari, Zaher; Weiss, Sandra A.; Zhang, Wei; Sonnad, Seema S.; Weintraub, William S.

    2015-01-01

    Objective Comparing outcomes of percutaneous coronary intervention (PCI) with drug eluting stent (DES) and Coronary Artery Bypass Grafting (CABG) in patients with multivessel Coronary Artery Disease (CAD) using data from randomized controlled trials (RCT). Background PCI and CABG are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple RCT have compared outcomes of the two modalities in patients with multivessel CAD. Methods We did a meta-analysis from six RCT in the contemporary era comparing the effectiveness of PCI with DES to at 1 year, 2 years and 5 years respectively. Results Compared to CABG, at one year PCI was associated with a significantly higher incidence of TVR (RR= 2.31; 95% CI: [1.80–2.96]; P=<0.0001), lower incidence of stroke (RR= 0.35; 95% CI: [0.19–0.62]; P=0.0003), and no difference in death (RR= 1.02; 95% CI: [0.77–1.36]; P= 0.88) or MI (RR= 1.16; 95% CI: [0.72–1.88]; P= 0.53). At 5 years, PCI was associated with a higher incidence of death (RR= 1.3; 95% CI: [1.10 – 1.54]; P= 0.0026) and MI (RR= 2.21; 95% CI: [1.75–2.79]; P=<0.00 01).While the higher incidence of MI with PCI was noticed in both diabetic and non-diabetics, death was increased mainly in diabetic patients. Conclusion In patients with multi-vessel CAD, PCI with DES is associated with no significant difference in death or MI at 1 or 2 years. However at 5 years, PCI is associated with higher incidence of death and MI. PMID:25662779

  4. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study.

    Directory of Open Access Journals (Sweden)

    Trevor W R Lee

    Full Text Available Cardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery.This prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2, anti-inflammatory (IL-10, TNF-RII, IL-1Ra, acute phase protein (CRP, PTX3 and cardiovascular risk (sST2 biomarkers.The kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005.This hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia.ClinicalTrials.gov NCT00348920.

  5. Patients undergoing elective coronary artery bypass grafting exhibit poor pre-operative intakes of fruit, vegetables, dietary fibre, fish and vitamin D.

    Science.gov (United States)

    Ruiz-Núñez, B; van den Hurk, G H A M; de Vries, J H M; Mariani, M A; de Jongste, M J L; Dijck-Brouwer, D A J; Muskiet, F A J

    2015-05-14

    CHD may ensue from chronic systemic low-grade inflammation. Diet is a modifiable risk factor for both, and its optimisation may reduce post-operative mortality, atrial fibrillation and cognitive decline. In the present study, we investigated the usual dietary intakes of patients undergoing elective coronary artery bypass grafting (CABG), emphasising on food groups and nutrients with putative roles in the inflammatory/anti-inflammatory balance. From November 2012 to April 2013, we approached ninety-three consecutive patients (80% men) undergoing elective CABG. Of these, fifty-five were finally included (84% men, median age 69 years; range 46-84 years). The median BMI was 27 (range 18-36) kg/m(2). The dietary intake items were fruits (median 181 g/d; range 0-433 g/d), vegetables (median 115 g/d; range 0-303 g/d), dietary fibre (median 22 g/d; range 9-45 g/d), EPA+DHA (median 0.14 g/d; range 0.01-1.06 g/d), vitamin D (median 4.9 μg/d; range 1.9-11.2 μg/d), saturated fat (median 13.1% of energy (E%); range 9-23 E%) and linoleic acid (LA; median 6.3 E%; range 1.9-11.3 E%). The percentages of patients with dietary intakes below recommendations were 62% (fruits; recommendation 200 g/d), 87 % (vegetables; recommendation 150-200 g/d), 73% (dietary fibre; recommendation 30-45 g/d), 91% (EPA+DHA; recommendation 0.45 g/d), 98% (vitamin D; recommendation 10-20 μg/d) and 13% (LA; recommendation 5-10 E%). The percentages of patients with dietary intakes above recommendations were 95% (saturated fat; recommendation < 10 E%) and 7% (LA). The dietary intakes of patients proved comparable with the average nutritional intake of the age- and sex-matched healthy Dutch population. These unbalanced pre-operative diets may put them at risk of unfavourable surgical outcomes, since they promote a pro-inflammatory state. We conclude that there is an urgent need for intervention trials aiming at rapid improvement of their diets to reduce peri-operative risks. PMID:25827177

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

    Directory of Open Access Journals (Sweden)

    Giurgea Corina

    2014-03-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  8. Functional recovery of patients with ischemic cardiomyopathy treated with coronary artery bypass surgery and concomitant intramyocardial bone marrow mononuclear cell implantation: A long term follow-up study

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    Trifunović Zoran

    2015-01-01

    Full Text Available Background/Aim. Intramyocardial bone marrow mononuclear cells (BMMNC implantation concomitant to coronary artery bypass grafting (CABG surgery as an option for regenerative therapy in chronic ischemic heart failure was tested in a very few number of studies, with not consistent conclusions regarding improvement in left ventricular function, and with a follow-up period between 6 months and 1 year. This study was focused on testing of the hypothesis that intramyocardial BMMNC implantation, concomitant to CABG surgery in ischemic cardiomyopathy patients, leads to better postoperative long-term results regarding the primary endpoint of conditional status-functional capacity and the secondary endpoint of mortality than CABG surgery alone in a median follow-up period of 5 years. Methods. A total of 30 patients with ischemic cardiomyopathy and the median left ventricular ejection fraction (LVEF of 35.9 ± 4.7% were prospectively and randomly enrolled in a single center interventional, open labeled clinical trial as two groups: group I of 15 patients designated as the study group to receive CABG surgery and intramyocardial implantation of BMMNC and group II of 15 patients as the control group to receive only the CABG procedure. All the patients in both groups received the average of 3.4 ± 0.7 implanted coronary grafts, and all of them received the left internal mammary artery (LIMA to the left anterior descending (LAD and autovenous to other coronaries. Results. The group with BMMNC and CABG had the average of 17.5 ± 3.8 injections of BMMNC suspension with the average number of injected bone marrow mononuclear cells of 70.7 ± 32.4 × 106 in the total average volume of 5.7 ± 1.5 mL. In this volume the average count of CD34+ and CD133+ cells was 3.96 ± 2.77 × 106 and 2.65 ± 1.71 × 106, respectively. All the patients were followed up in 2.5 to 7.5 years (median, 5 years. At the end of the follow-up period, significantly more patients from the group

  9. 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 ...

  10. Preoperative evaluation of basal free triiodothyronine in patients undergoing coronary artery bypass grafting surgery. Does it help?

    Directory of Open Access Journals (Sweden)

    Kaushal Kishore Tiwari

    2015-11-01

    Full Text Available noBackground & Objectives: The postoperative Low T3 syndrome has been considered as a possible source of reduced myocardial contractility, resulting in increased mortality after CABG. Effect of preoperative Low T3 has not been well studied in patients undergoing CABG surgery. Aim of our study is to evaluate effect of preoperative Low T3 syndrome in patients undergoing CABG surgery.Materials & Methods: Six hundred and six patients undergoing CABG were included in this prospective study. The impact of the base-line FT3 concentration and of preoperative low T3 syndrome on the risk of postoperative low cardiac output and hospital death was analyzed.Results: Fifteen patients (2.3% postoperatively and 159 (26.2% developed major complications. At univariate analysis a reduced EF, the presence of peripheral vascular disease, the NYHA class, the surgical urgency, the aortic cross-clamp time, the CPB time and the FT3 concentration at admission were significantly associated with low CO and higher mortality. At multivariate analysis, the CPB time, an emergency procedure, a reduced LVEF, and the fT3 concentration were independently related to the development of low CO. However, in multivariate analysis low EF, and the fT3 concentration were the only predictors of hospital death.Conclusion: We conclude that preoperative low EF and low T3 syndrome independently causes low cardiac output and higher mortality in patients undergoing CABG. Therefore, all patients undergoing CABG should be evaluated for low T3 syndrome and patients with low T3 syndrome should be considered at increased risk. Appropriate preoperative T3 replacement therapy could decrease the postoperative complications in patients undergoing CABG.JCMS Nepal. 2015; 11(2:1-7

  11. A randomized prospective analysis of alteration of hemostatic function in patients receiving tranexamic acid and hydroxyethyl starch (130/0.4 undergoing off pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Murali Chakravarthy

    2012-01-01

    Full Text Available Postoperative hemorrhagic complications is still one of the major problems in cardiac surgeries. It may be caused by surgical issues, coagulopathy caused by the side effects of the intravenous fluids administered to produce plasma volume expansion such as hydroxyl ethyl starch (HES. In order to thwart this hemorrhagic issue, few agents are available. Fibrinolytic inhibitors like tranexamic acid (TA may be effective modes to promote blood conservation; but the possible complications of thrombosis of coronary artery graft, precludes their generous use in coronary artery bypass graft surgery. The issue is a balance between agents that promote coagulation and those which oppose it. Therefore, in this study we have assessed the effects of concomitant use of HES and TA. Thromboelastogram (TEG was used to assess the effect of the combination of HES and TA. With ethical committee approval and patient′s consent, 100 consecutive patients were recruited for the study. Surgical and anesthetic techniques were standardized. Patients fulfilling our inclusion criteria were randomly allocated into 4 groups of 25 each. The patients in group A received 20 ml/kg of HES (130/0.4, 10 mg/kg of T.A over 30 minutes followed by infusion of 1 mg/kg/hr over the next 12 hrs. The patients in group B received Ringer′s lactate + TA at same dose. The patients in the Group C received 20 ml/kg of HES. Group D patients received RL. Fluid therapy was goal directed. Total blood loss was assessed. Reaction time (r, α angle, maximum amplitude (MA values of TEG were assessed at baseline, 12, 36 hrs. The possible perioperative myocardial infraction (MI was assessed by electrocardiogram (ECG and troponin T values at the baseline, postoperative day 1. Duration on ventilator, length of stay (LOS in the intensive care unit (ICU were also assessed. The demographical profile was similar among the groups. Use of HES increased blood loss significantly (P < 0.05. Concomitant use of TA

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2002-01-01

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

  15. 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...

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

    Science.gov (United States)

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

    1996-01-01

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

  17. 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...

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Fotios Mitropoulos

    2016-01-01

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

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

    Science.gov (United States)

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

    1982-09-01

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

  1. Fabric heart retractor for coronary artery bypass operations.

    Science.gov (United States)

    Kazama, S; Ishihara, A

    1993-06-01

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

  2. 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 ...

  3. Predictors and clinical outcomes of postoperative delirium after administration of dexamethasone in patients undergoing coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Davoud Mardani

    2012-01-01

    Full Text Available Background: Postoperative delirium (POD is one of the important complications of cardiac surgery and it is assumed to provoke inflammatory responses. Theoretically, anti-inflammatory effects of dexamethasone can have an influence on the incidence and outcomes of POD. The aim of our study was to assess POD predictors and outcomes of dexamethasone administration after cardiac surgery. Methods: Patients′ mental status was examined by mini-mental status examination and psychiatric interviewing to diagnose delirium. Subsequently, authors analyzed the patient variables for identification of predictors and outcomes of POD. Results: Between 196 patients who met the inclusion criteria, 34 (17.34% patients were delirious. History of chronic renal failure, obstructive pulmonary disease, smoking, and addiction strongly predicted development of POD. Other predictors were intra-aortic balloon pump insertion, transfusion of packed cells, and atrial fibrillation rhythm. In our study, the administration of dexamethasone significantly reduced the risk for POD. Furthermore, delirium was associated with longer intensive care unit (ICU stay. Conclusion: Our study reports the predictors of POD, which patients commonly facing them in cardiac surgery ICU. Appropriate management and prevention of these predictors, especially modifiable ones, can decrease the incident of POD and improves cognitive outcomes of cardiac surgeries.

  4. The association between Chlamydia pneumoniae DNA in atherosclerotic plaque and major risk factors in patients undergoing coronary artery bypass grafting

    NARCIS (Netherlands)

    Hedayat, Daryoosh Kamal; Jebeli, Mohammad; Mandegar, Mohammad Hossein; Bagheri, Jamshid; Nabavi, Seyed Abbas; Eghtesadi-Araghi, Payam; Mohammadzadeh, Robabeh; Darehzereshki, Ali; Chitsaz, Sam; Abbasi, Ali

    2009-01-01

    Background and aim: This study was conducted to investigate the prevalence of Chlamydia pneumoniae pathogen inside the atherosclerotic plaque of patients undergoing CABG by using PCR assay and to determine whether there is any association between the presence of bacteria in atherosclerotic lesions a

  5. 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 ...

  6. 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.

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

    Science.gov (United States)

    Lemma, Massimo; Atanasiou, Thanos; Contino, Monica

    2013-01-01

    Coronary artery bypass graft (CABG) is among the most common operations performed in the world. Different surgical strategies can be used with different invasiveness. This paper describes a recent development of the technique that merges the advantages resulting from both the adoption of an 'off-pump no-touch aorta operation' and a 'complete arterial revascularization through a left minithoracotomy' in a single procedure. This operation is currently known with the acronym MICS (minimally invasive cardiac surgery)-CABG (minimally invasive cardiac surgery). It is an off-pump operation performed through a minithoracotomy in the fourth or fifth left intercostal space across the midclavicular line. The left internal thoracic artery (LITA) is harvested under direct vision using a special rib-retractor with multiple interchangeable thoracotomy blades, including blades to use with lift systems for proximal artery harvesting, while the right radial artery (RA) is harvested endoscopically. A Y-connection is made between the two arteries. The LITA is used to bypass the left anterior descending coronary artery, while the right RA is used on the obtuse marginal branches and/or the posterior descending coronary artery. A special coronary stabilizer and a heart positioner with a shaft for remote thoracic insertion are needed.

  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. Quality of Life After Bypass Surgery in Patients with Chest Pain and Heart Failure

    Science.gov (United States)

    Annals of Internal Medicine Summaries for Patients Quality of Life After Bypass Surgery in Patients With Chest Pain and Heart Failure The full report is titled “Quality-of-Life Outcomes With Coronary Artery ...

  10. Predictors of post coronary artery bypass grafting atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

  11. Mental Health and Depression after Coronary Artery Bypass Graft

    Directory of Open Access Journals (Sweden)

    Hassan Farrashbandi

    2014-08-01

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

  12. Low-dose amiodarone for the prevention of atrial fibrillation after coronary artery bypass grafting in patients older than 70 years

    Institute of Scientific and Technical Information of China (English)

    GU Song; SU Pi-xiong; LIU Yan; YAN Jun; ZHANG Xi-tao; WANG Tian-you

    2009-01-01

    Background Atrial fibrillation (AF) is one of the most common arrhythmia after coronary artery bypass grafting (CABG), which not only increases the suffering of the patients, but also prolongs hospital stay and enhances cost of care, especially for patients older than 70 years. This study was designed to evaluate the efficacy and safety of low-dose amiodarone in the prevention of AF after CABG, especially for the elderly.Methods Two hundred and ten senile patients undergoing off-pump CABG were included in this prospective, randomized, double-blind and placebo controlled study. Patients were given 10 mg/kg of amiodarone (low-dose amiodarone group, n=100) or placebo (control group, n=110) daily for 7 days before surgery and followed by 200 mg of amiodarone or placebo daily for 10 days postoperatively.Results Postoperative AF occurred in 16 patients (16%) receiving amiodarone and in 36 (37.7%) patients receiving placebo (P=0.006). AF occurred at (58.13±16.63) hours after CABG in the low-dose amiodarone group and at (45.03±17.40) hours in the control group (P=0.018). The maximum ventricular rate during AF was significantly slower in the low-dose amiodarone group ((121.42±28.91) beats/min) than in the control group ((134.11 ±30.57) beats/min, P=0.036). The duration of AF was (10.92±9.56) hours for the low-dose amiodarone group compared with (14.81 ±10.37) hours for the control group (P=0.002). The postoperative left ventricular ejection fraction (LVEF) was significantly improved in the low-dose amiodarone group (from (59.9 ±10.3)% to (63.4±11.4)%, P=0.001), and significantly higher compared with the control group ((58.5±10.7)%, P=0.002). Both groups had a similar incidence of complication other than rhythm disturbances (12.0% vs 16.4%, P=0.368). The low-dose amiodarone group patients had shorter hospital stays ((11.8±3.2) days vs (13.8±4.7) days, P=0.001) and lower cost of care (RMB (79 115±16 673) Yuan vs RMB (84 997±21 587) Yuan, P=0.031) than that of

  13. 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 ...

  14. 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 ...

  15. 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 ...

  16. 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 ...

  17. 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’ ...

  18. 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 ...

  19. 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 ...

  20. 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

  1. Direct reperfusion of the right common carotid artery prior to cardiopulmonary bypass in patients with brain malperfusion complicated with acute aortic dissection.

    Science.gov (United States)

    Okita, Yutaka; Matsumori, Masamichi; Kano, Hiroya

    2016-04-01

    The cases of 3 patients with brain malperfusion secondary to acute aortic dissection who underwent preoperative perfusion of the right common carotid artery are presented. The patients were 64, 65 and 72 years old and 2 were female. All were in a comatose or semi-comatose state with left hemiplegia. The right common carotid artery was exposed and directly cannulated, using a 12-Fr paediatric arterial cannula. The right common femoral artery was chosen for arterial drainage, using a 14-Fr double-lumen cannula. The circuit contained a small roller pump and heat exchanger coil. Target flow was set at 90 ml/min and blood temperature at 30 °C. Durations of right carotid perfusion were 120, 100 and 45 min, respectively. All underwent partial arch replacement and survived. Postoperative neurological sequelae were minimal in all cases. PMID:26003959

  2. 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...

  3. 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, ...

  4. 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...

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

    Science.gov (United States)

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

    2011-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Sh. Shirani

    2007-05-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  9. 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 ...

  10. 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.

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

    NARCIS (Netherlands)

    Drenth, Derk Jan

    2005-01-01

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

  12. Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery

    DEFF Research Database (Denmark)

    Vorstrup, S; Brun, B; Lassen, N A

    1986-01-01

    and angiographical findings were operated. The majority of the patients had suffered a minor stroke with or without subsequent transient ischemic attacks. They were studied at least 6 weeks following the stroke. All patients had an occlusion of the relevant internal carotid artery. To identify preoperatively...

  13. 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

  14. 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...

  15. 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...

  16. 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...

  17. 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 (...

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

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

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

  20. Dual antiplatelet therapy in patients with aspirin resistance following coronary artery bypass grafting: study protocol for a randomized controlled trial [NCT01159639

    Directory of Open Access Journals (Sweden)

    Gasparovic Hrvoje

    2012-08-01

    Full Text Available Abstract Background Coronary artery disease remains the dominant cause of mortality in developed countries. While platelets have been recognized to play a pivotal role in atherothrombosis, the ideal antiplatelet regime after coronary artery surgery remains elusive. The evolution of CABG has presently moved beyond technical improvements to involve modulation of pharmacologic management designed to improve patient outcomes. The aim of this trial will be to test the hypothesis that the addition of clopidogrel to patients with documented postoperative aspirin resistance will reduce the incidence of major cardiovascular events. Methods Patients scheduled for isolated coronary artery surgery will be eligible for the study. Patients in whom postoperative multiple electrode aggregometry documents aspirin resistance will be randomized into two groups. The control group will receive 300 mg of aspirin. The dual antiplatelet group will receive 75 mg of clopidogrel in addition to 300 mg of aspirin. Patients will be followed for 6 months. Major adverse cardiac and cerebrovascular events (death from any cause, myocardial infarction, stroke, hospitalization due to cardiovascular pathology as well as bleeding events will be recorded. Discussion This will be the first trial that will specifically address the issue of dual antiplatelet therapy in patients undergoing coronary artery surgery who have been found to be aspirin resistant. In the event that the addition of clopidogrel proves to be beneficial in this subset of surgical patients, this study could significantly impact their future antiplatelet management. This randomized controlled trial has been registered at the ClinicalTrials.gov website (Identifier NCT01159639.

  1. 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.

  2. 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

  3. Evaluation of retrospectively ECG-gated 4-row multidetector CT in patients planned for minimal invasive coronary artery bypass grafting; Die EKG-getriggerte 4-Zeilen-Spiral-CT des Herzens in der praeoperativen Bildgebung vor minimalinvasiver koronarer Bypass-Operation

    Energy Technology Data Exchange (ETDEWEB)

    Begemann, P.G.C.; Ittrich, H.; Koops, A.; Adam, G.; Weber, C. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Radiologisches Zentrum, Universitaetsklinikum, Hamburg (Germany); Arnold, M.; Detter, C.; Boehm, D.H.; Reichenspurner, H. [Universitaetsklinikum Hamburg-Eppendorf, Herzzentrum, Herz und Gefaesschirurgie, Hamburg (Germany)

    2005-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Mirkhani S. H

    2002-07-01

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

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

    Science.gov (United States)

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

    1983-03-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja

    2004-01-01

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

  7. Heart bypass surgery

    Science.gov (United States)

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

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

  9. Treinamento muscular respiratório na revascularização do miocárdio Respiratory muscle training in patients submitted to coronary arterial bypass graft

    Directory of Open Access Journals (Sweden)

    Graziella Ferreira Barros

    2010-12-01

    Full Text Available OBJETIVOS: 1 Evidenciar a perda de capacidade ventilatória no período de pós-operatório, em pacientes submetidos à revascularização do miocárdio. 2 Testar a hipótese de que o treinamento muscular respiratório (TMR, realizado após a cirurgia, pode melhorar a capacidade ventilatória nessa população. MÉTODOS: Estudo randomizado, onde 38 pacientes (idade: 65 ± 7 anos, 29 masculinos, submetidos à revascularização miocárdica com circulação extracorpórea, foram divididos em dois grupos: 23 pacientes no grupo TMR e 15 no grupo controle (CO. O grupo TMR realizou fisioterapia convencional + TMR, o grupo CO realizou apenas fisioterapia convencional. Avaliaram-se, em três momentos (pré-operatório, primeiro dia de pós-operatório e alta hospitalar, as variáveis: pressões inspiratória e expiratória máximas (Pimáx e Pemáx, dor, dispneia (Borg, pico de fluxo expiratório (PFE, volume corrente e dias de internação. RESULTADOS: A Pimáx do grupo TMR foi maior no momento da alta (90 ± 26 vs. 55 ± 38 cmH2O, P=0,01, assim como a Pemáx (99 ± 30 vs. 53 ± 26 cmH2O, P=0,02. O PFE do grupo TMR foi maior após a internação (237 ± 93 vs. 157 ± 102 lpm, P=0,02. O volume corrente dos grupos foi também diferente no momento da alta (TMR: 0,71 ± 0,21 vs. CO: 0,44 ± 0,12 litros, P=0,00. Não houve diferenças entre os grupos com relação aos dias de internação, dispneia ou dor. CONCLUSÕES: Ocorre perda de força muscular respiratória em pacientes submetidos à revascularização miocárdica. O TMR, realizado no período pós-operatório, foi eficaz em restaurar os seguintes parâmetros: Pimáx, Pemáx, PFE e volume corrente, nessa população.OBJECTIVES: 1 To demonstrate the impaired ventilatory capacity during the post operatory period, in patients submitted to coronary arterial bypass graft surgery (CABG. 2 To test the hypothesis that the respiratory muscle training (RMT, performed after the surgery, may increase the

  10. 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...

  11. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... crack the chest. The surgery requires just three micro-sized scars, and the patient typically makes a ... all. And this looks good. Okay. All right. Micro forceps in both sites. Okay. First micro forceps ...

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

    DEFF Research Database (Denmark)

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

    2004-01-01

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

  13. 3703例非体外循环冠状动脉旁路移植术%Case series of off-pump coronary artery bypass grafting involving 3703 patients

    Institute of Scientific and Technical Information of China (English)

    于洋; 顾承雄; 闫晓蕾; 李琴; 韦华; 刘晓

    2010-01-01

    Objective To summarize our experience with off-pump coronary artery bypass grafting (OPCAB) during previous 13 years. Methods Data from 3703 patients who underwent OPCAB between October 1996 and December 2008 were collected and analyzed in this study. Following perioperative variables were reviewed and evaluated: changes in the number of patients, demographic characteristics of patients, coexisting conditions such as hypertension, and diabetes, grafting options,numbers of grafts per patient, and postoperative complications and clinical outcomes. Patients were divided into four age subgroups: those who were less than 45 years were assigned to group 1, those who were 45 to 60 years were assigned to group 2,those who were 60 to 75 years were assigned to group 3, and those older than 75 years of age were assigned to group 4. Perioperative data, including the use of internal mammary artery and the constituent of the grafts, were collected retrospectively and analyzed. Results Three thousand and twenty-five patients were male (81.7%) and 678 were female ( 18.3% ), mean age was (61.35 ±9.38) years old. The number of patients who underwent OPCAB increased steadily over time. The mean grafts per patient were 3.3 ± 0.8. The use of left internal mammary artery and "hybrid" bypass grafts composed of vein and artery played a predominant role in this cohort (P75岁4组,记录并分析各组乳内动脉应用情况、旁路血管的支数及构成.结果 病人平均每例移植旁路血管(3.3±0.8)支.OPCAB手术的病人数量与比例逐年上升,而左乳内动脉的使用和动静脉混合方式旁路移植占据绝对优势(P<0.05).术后死亡26例(0.7%),病死率逐渐下降.结论 采用切实、可行的外科处理策略、完善的围术期管理结合多项适应病情变化改进与创新的OPCAB术式,使得OPCAB的适应证不断扩大、治愈率逐年提高.

  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. 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 ...

  16. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... on the heart-lung machine, meaning the heart-lung machine is artificially doing the work of the heart for the patient. The heart ... cardioplegia, as we call it, with the heart-lung machine. No tremor, completely tremor-free work. High precision of every stitch here. You can ...

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

    Science.gov (United States)

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

    2011-01-01

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

  18. 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.

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

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

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

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

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    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.

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

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    Reijane Oliveira Lima

    2015-08-01

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

  3. 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

  4. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

  6. Effectiveness of human atrial natriuretic peptide in patients with chronic kidney disease without dialysis undergoing coronary artery bypass grafting%人心房钠尿肽在患慢性肾病未经透析的患者冠状动脉移植术中的有效性

    Institute of Scientific and Technical Information of China (English)

    Isamu Yoshitake

    2010-01-01

    @@ Chronic kidney disease(CKD)is most important risk factors for cardiac surgery.In this study,the subjects were patients undergoing coronary artery bypass grafting(CABG)with CKD.Not only the early postoperative results but also the renal function including long-term prognosis were examined.

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

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    Elayne Kelen de Oliveira

    2013-09-01

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

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

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    Sh. Shirani

    2007-07-01

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

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

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    Daniel Lago Borges

    2013-09-01

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

  10. 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.

  11. 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

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

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    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.

  13. 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

  14. 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

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

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    Mahmoodreza Sarzaeem

    2014-03-01

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

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

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    More Ranjit

    2011-05-01

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

  17. 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...

  18. 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.

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

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    A. Arjmand Shabestari

    2007-05-01

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

  20. 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...

  1. 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)

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

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    A. Mehr-Aein

    2006-09-01

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

  3. 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.

  4. Avaliação carotídea em doentes submetidos a revascularização miocárdica Carotid evaluation of patients undergoing coronary artery bypass graft

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    Luiz Roberto Felizzola

    2001-10-01

    Full Text Available OBJETIVO: Como a doença carotídea é a principal causa isolada de acidente vascular cerebral de origem tromboembólica, acredita-se ser imprescindível o seu diagnóstico precoce. O presente estudo tem por objetivo realizá-lo, mantendo os conceitos de praticidade e viabilidade econômica, adequando-se às condições socioeconômicas desfavoráveis locais. MÉTODO: No período de 18 meses foram avaliados 50 doentes, sendo 35 homens e 15 mulheres, com média de idade de 67,2 anos. Todos apresentavam indicação de revascularização miocárdica, considerados coronariopatas graves. Avaliou-se a incidência e o grau de estenose carotídea com base no mapeamento dúplex. Da mesma forma, foi avaliada a relação com possíveis fatores de risco: diabetes melito, hipertensão arterial sistêmica, tabagismo, sintomatologia neurológica focal prévia, doença arterial troncular dos membros inferiores e presença de sopro carotídeo. RESULTADOS: A incidência de estenose carotídea hemodinamicamente significativa (>50% foi de 48%, e crítica (>70% de 32%. Mostraram-se fatores de risco estatisticamente significativos, antecedentes de diabetes melito, sintomatologia neurológica focal prévia, presença de sopro carotídeo e presença de alterações arteriais tronculares dos membros inferiores. CONCLUSÃO: Concluiu-se que no grupo estudado houve aumento significativo de risco para estenose carotídea hemodinamicamente significativa e crítica, em relação à população geral. Desta forma, justifica-se o rastreamento ultra-sonográfico para doença carotídea em doentes coronariopatas, principalmente quando os fatores de risco significativos se fizerem presentes.PURPOSE: Carotid disease is known as the main individual cause of stroke. It is necessary to develop means to achive an early diagnosis using economically viable methods. METHOD: During 18 months, 50 patients with coronary disease and were indication for coronary artery bypass evaluated (35

  5. Causes and indications for reoperation in valve replacement and coronary artery bypass graft (CABG in 915 patients in cardiac surgery department in Imam Khomeini Hospital, 1374-77

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    Radmehr H

    2001-08-01

    Full Text Available Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female. The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A Valvular complications (female/male=3/1, B Non valvular complications (female/male=1/3. The most common nonvalvular complication was bleeding (66.6 percent. The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915 the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

  6. Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease: A meta-analysis with 5-year patient-level data from the ARTS, ERACI-II, MASS-II, and SoS trials

    NARCIS (Netherlands)

    J. Daemen (Joost); H. Boersma (Eric); M. Flather (Marcus); J. Booth (Jean); R.H. Stables (Rodney); A. Rodriguez (Alfredo Chapin); G.A. Rodriguez-Granillo (Gaston); W.A. Hueb (Whady Armindo); P.A. Lemos Neto (Pedro); P.W.J.C. Serruys (Patrick)

    2008-01-01

    textabstractBackground - Randomized trials that studied clinical outcomes after percutaneous coronary intervention (PCI) with bare metal stenting versus coronary artery bypass grafting (CABG) are underpowered to properly assess safety end points like death, stroke, and myocardial infarction. Pooling

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

    Science.gov (United States)

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

    2005-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Raissi Kamal

    2009-12-01

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

  9. 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

  10. Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study

    Directory of Open Access Journals (Sweden)

    Karin Kogstad Else

    2000-11-01

    Full Text Available Abstract Objectives 1. To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases (myocardial infarction, acute coronary syndrome, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. 2. To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group, in comparison with similar changes in the conventional care group. Design Randomized, controlled, parallel-group design (intervention/conventional care. Setting Akershus County, southeast of Oslo City, Norway. Participants 500 patients, men and women, aged 40-85 years, who have sustained at least one of the above-mentioned cardiovascular diseases. Interventions 8 weeks of supervised, structured physical training of three periods of 20 min per week, targeting a heart rate of 60-70% of the individual's maximum; home-based physical exercise training with the same basic schedule as in the supervised period; quantification of patients' compliance with the exercise programme by the use of wristwatches, information stored in the watch memory being retrieved once a month during the 3-year follow-up period; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control.

  11. 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...

  12. 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...

  13. 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...

  14. 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)

  15. 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

  16. The Best Bypass Surgery Trial

    DEFF Research Database (Denmark)

    Møller, Christian H; Jensen, Birte Østergaard; Gluud, Christian;

    2007-01-01

    Recent trials suggest that off-pump coronary artery bypass grafting (OPCAB) reduces the risk of mortality and morbidity compared with conventional coronary artery bypass grafting (CCAB) using cardiopulmonary bypass. Patients with a moderate- to high-risk of complications after CCAB may have...

  17. 高龄冠状动脉旁路移植术患者的中期疗效分析%Analysis of median-term therapeutic effect of coronary artery bypass grafting in the elderly patients

    Institute of Scientific and Technical Information of China (English)

    徐根兴; 郑家豪; 朱洪生; 薛松; 申达甫; 黄日太; 刘沙; 胡振雷; 连锋; 谢波; 叶清

    2009-01-01

    Objective To summarize the clinical experiences and early-to median effect of coronary artery bypass grafting(CABG)in patients aged 70 years or above.Methods From Dec.2006 to Dec.2007,86 patients aged 70 or above underwent CABG,of whom 71 cases underwent off-pump coronary artery bypass grafting(OPCAB),15 cases had CABG with cardiopulmonary bypass(CPB).5 cases underwent mitral valve replacement,3 underwent aortic valve replacement besides CABG,and one case underwent removal of ventricular aneurysm.Their clinical data were retrospectively analyzed.Results There was one case who died of enterobrosis after operation.The average ICU stay time was(77.4±49.6)h,the average postoperative stay time was 15 d,and the average drainage was 530 ml.22 postoperative complications were found.76 cases were followed up for 10-22 months.Follow up effect was better showing cardiac classification I-II and no angina pectoris,myocardial infarction and late death.Conclusion Patients with coronary heart disease in good condition will have not remarkable improvement in mortality as compared with ordinary patients but attention should be paid to their preoperative pulmonary function and angina pectoffs.OPCABG would have encouraging result in reducing the rate of postoperative complications and hospital death,which should be recommended as the first choice for the elderly patients.%目的 总结70岁以上高龄冠心病患者行冠状动脉搭桥术的早、中期结果和经验教训,以期提高手术治疗效果.方法 回顾性分析我院2006年12月至2007年12月86例70岁以上冠心病患者进行冠状动脉旁路移植术(CABG)的临床资料,其中行不停搏CABG 71例,体外循环下CABG 15例,同时行二尖瓣置换5例、主动脉瓣置换3例和室壁瘤切除1例.结果 1例术后死亡,死亡原因为术后肠穿孔.平均术后气管插管时间8 h,ICU停留时间(77.4±49.6)h,术后住院时间15 d,术后引流量平均530 ml.共有22例次术后

  18. 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

  19. 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

  20. 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)

  1. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-12-15

    Multi-detector row CT (MDCT) scanners with high spatial and temporal resolutions are now available and are increasingly used for non-invasive assessment of vascular disease, including coronary arteries and coronary artery bypass grafts (CABG). Follow-up of patients who have previously undergone surgical revascularization for coronary artery disease is nowadays one of the main applications of MDCT. Thanks to the continuous technical evolution of the CT scanners, it is now possible to scan the heart and the full anatomic extent of grafts with sub-millimeter slice-thickness within a single breath-hold. In the evaluation of these patients, it is important for the radiologist to be familiar with the different types of grafts and surgical techniques to know the main characteristics of each graft type and what to look for in the assessment of a patient who has undergone coronary artery surgical revascularization. This review summarizes some surgical aspects, the biological characteristics of conduits, and the main technical MDCT features, and describes the CABG anatomy together with some typical CT findings. (orig.)

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

    Science.gov (United States)

    Marano, Riccardo; Liguori, Carlo; Rinaldi, Pierluigi; Storto, Maria Luigia; Politi, Marco Angelo; Savino, Giancarlo; Bonomo, Lorenzo

    2007-12-01

    Multi-detector row CT (MDCT) scanners with high spatial and temporal resolutions are now available and are increasingly used for non-invasive assessment of vascular disease, including coronary arteries and coronary artery bypass grafts (CABG). Follow-up of patients who have previously undergone surgical revascularization for coronary artery disease is nowadays one of the main applications of MDCT. Thanks to the continuous technical evolution of the CT scanners, it is now possible to scan the heart and the full anatomic extent of grafts with sub-millimeter slice-thickness within a single breath-hold. In the evaluation of these patients, it is important for the radiologist to be familiar with the different types of grafts and surgical techniques to know the main characteristics of each graft type and what to look for in the assessment of a patient who has undergone coronary artery surgical revascularization. This review summarizes some surgical aspects, the biological characteristics of conduits, and the main technical MDCT features, and describes the CABG anatomy together with some typical CT findings. PMID:17874112

  4. 老年糖尿病患者行冠状动脉搭桥术围术期护理研究%Perioperative Nursing of Elderly Patients with Diabetes Mellitus Undergoing Coronary Artery Bypass Grafting

    Institute of Scientific and Technical Information of China (English)

    景丽丽

    2015-01-01

    Objective To study the perioperative nursing care of elderly patients with diabetes mellitus, and to study the ef-fect of perioperative nursing. Methods from June 2012 to March 2015, the clinical data of elderly patients with diabetes mellitus were studied, and the patients were treated with careful perioperative nursing. Results in this study, 110 cases of elderly patients with diabetes, 2 cases of hypoglycemia symptoms, 3 cases of elderly patients with diabetes after surgery, the symptoms of superficial infection, and the rest of the elderly patients with diabetes were not complications, after active treatment and care, all the elderly patients with diabetes were discharged. Conclusion elderly patients with diabetes melli-tus underwent coronary artery bypass grafting surgery has a greater risk, provide a careful perioperative care, and close monitoring of patients with blood glucose changes is a smooth operation of coronary artery bypass surgery, elderly patients with diabetes safely through perioperative period of important guarantee.%目的:研究老年糖尿病患者行冠状动脉搭桥术围术期护理方法,以及围术期的护理效果。方法选取2012年6月—2015年3月该院收治的实施行冠状动脉搭桥术的老年糖尿病患者临床资料为研究对象,并对这些患者进行精心围术期护理,并且严密监控患者血糖变化。结果在此次研究的110例老年糖尿病患者中有2例出现低血糖症状,3例老年糖尿病患者术后切口出现表浅感染症状,其余老年糖尿病患者均未出现并发症,经过该院积极治疗和护理,所有老年糖尿病患者均康复出院。结论老年糖尿病患者行冠状动脉搭桥术有着较大的风险,提供精心围术期护理,以及密切监控患者血糖变化是行冠状动脉搭桥手术顺利进行、老年糖尿病患者安全渡过围术期的重要保证。

  5. 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...

  6. 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...

  7. Does transfusion of residual cardiopulmonary bypass circuit blood increase postoperative bleeding? A prospective randomized study in patients undergoing on pump cardiopulmonary bypass

    OpenAIRE

    Duara Rajnish; Misra Manoranjan; Bhuyan Ritwick; Sarma P; Jayakumar Karunakaran

    2008-01-01

    Objective: Homologous blood transfusion after open heart surgery puts a tremendous load on the blood banks. This prospective randomized study evaluates the efficacy of infusing back residual cardiopulmonary bypass (CPB) circuit i.e., pump blood as a means to reduce homologous transfusion after coronary artery bypass surgery (CABG) and whether its use increases postoperative drainage. Materials and Methods: Sixty-seven consecutive patients who underwent elective CABGs under CPB were randomi...

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  10. 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...

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

    Directory of Open Access Journals (Sweden)

    Sergiu C. BATÂR

    2010-06-01

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

  12. Thrombelastographic haemostatic status and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial: assessing and monitoring the antithrombotic effect of clopidogrel and aspirin versus aspirin alone in hypercoagulable patients: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rafiq Sulman

    2012-04-01

    Full Text Available Abstract Background Hypercoagulability, assessed by the thrombelastography (TEG assay, has in several observational studies been associated with an increased risk of post-procedural thromboembolic complications. We hypothesize that intensified antiplatelet therapy with clopidogrel and aspirin, as compared to aspirin alone, will improve saphenous vein graft patency in preoperatively TEG-Hypercoagulable coronary artery bypass surgery (CABG patients and reduce their risk for thromboembolic complications and death postoperatively. Methods/Design This is a prospective randomized clinical trial, with an open-label design with blinded evaluation of graft patency. TEG-Hypercoagulability is defined as a TEG maximum amplitude above 69 mm. Two hundred and fifty TEG-Hypercoagulable patients will be randomized to either an interventional group receiving clopidogrel 75 mg daily for three months (after initial oral bolus of 300 mg together with aspirin 75 mg or a control group receiving aspirin 75 mg daily alone. Monitoring of antiplatelet efficacy and on-treatment platelet reactivity to clopidogrel and aspirin will be conducted with Multiplate aggregometry. Graft patency will be assessed with Multislice computed tomography (MSCT at three months after surgery. Conclusions The present trial is the first randomized clinical trial to evaluate whether TEG-Hypercoagulable CABG patients will benefit from intensified antiplatelet therapy after surgery. Monitoring of platelet inhibition from instituted antithrombotic therapy will elucidate platelet resistance patterns after CABG surgery. The results could be helpful in redefining how clinicians can evaluate patients preoperatively for their postoperative thromboembolic risk and tailor individualized postoperative antiplatelet therapy. Trial registration Clinicaltrials.gov Identifier NCT01046942

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1982-06-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  15. 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...

  16. 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)

  17. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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).

  19. 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.

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

    Science.gov (United States)

    Ghista, Dhanjoo N; Kabinejadian, Foad

    2013-01-01

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

  1. Comparison of the centrifugal and roller pump in elective coronary artery bypass surgery--a prospective, randomized study with special emphasis upon platelet activation.

    Science.gov (United States)

    Andersen, Knut S; Nygreen, Else L; Grong, Ketil; Leirvaag, Beryl; Holmsen, Holm

    2003-12-01

    Objective--Evaluation of the centrifugal pump vs roller pump concerning effects upon platelet function, hemolysis and clinical outcome in elective coronary artery bypass surgery. Design--Thirty-four patients were randomized to centrifugal or roller pump. Platelet activation was studied by flow cytometry before, during and up to 3 days after bypass. Results--Duration of bypass, ischemic period, peripheral anastomoses, hospital stay and mortality did not differ. In roller pump patients, platelet aggregates increased by 250% between end of bypass and 3 h postoperatively (p centrifugal pump group, these changes were not significant. Hemolysis increased (20%) at end of bypass and 3 h postoperatively (p centrifugal pump patients, indicating higher susceptibility to postoperative thrombotic complications with the roller pump. Otherwise, there was no clinical evidence for superiority of the centrifugal pump.

  2. 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.

  3. 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.

  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. 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 ...

  6. 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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Wasmuth Hermann E

    2011-06-01

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

  9. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  10. 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.

  11. 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

  12. Application of sufentanil anesthesia in patients undergoing off-pump coronary artery bypass graft surgery%舒芬太尼在非体外循环冠脉搭桥术应用中的临床研究

    Institute of Scientific and Technical Information of China (English)

    牛强; 马传根; 赵冬梅; 施巩宁

    2008-01-01

    目的 观察舒芬太尼在非体外循环冠状动脉搭桥手术应用中的安全性和有效性.方法 择期行OPCABG病人54例,被随机分成两组,舒芬太尼组和芬太尼组,每组27例,麻醉诱导应用丙泊酚1 mg/ks~2 ms/ks,同时分别静注舒芬太尼0.5 μg/ks~1μg/kg,或芬太尼4 μg/ks-8 μg/ks,同时吸入安氟醚维持麻醉,持续输注舒芬太尼0.08 μg·ks-1min-1,或芬太尼0.6 μg·ks-1·min-1.记录各组气管插管、切片、麻醉维持和拨除气管导管各时间的收缩压和舒张压.结果 在气管插管过程中,浅麻醉反应的病人数舒芬太尼组明显低于芬太尼组,在气管插管切皮,麻醉维持和拔管期间,芬太尼组收缩压、舒张压明显高于舒芬太尼组,术后清醒和拔管时间两组病人无统计学差异.结论 舒芬太尼的麻醉效果优于芬太尼,舒芬太尼能提供术中更稳定的血液动力学.%Objective To compare the efficacy and safety of sufentanil and fentanyl anesthesia in patients undergoing off-ptanp coronary artery bypass graft surgery. Methods Forty patients were evenly randomized into sufentanil group and fentanyl group. Anesthesia was induced with propofol ( 1 mg/kg-2 mg/kg) and either sufentanil ( 1 μg/kg-2 μp/kg) or fentanyl (5μg/kg-10 μg/kg), and was maintained Results Light anesthesia responses during intubation and the maintenance of anesthesia was significantly less observed in sufentanil group than that in fentanyl group. Both systolic and diastolic blood pressures were significantly lower during intubafion, skin incision, maintenance of anesthesia and extubation in sufentanil group than those in fentanyl group. The time to opening eyes on command and the time for extuhation after surgery were comparable between the two groups. Conclusion The anesthetic effects of sufentanil are more potent than those of fentanyl. Sufentanil can offer superior intraoperative hemodynamic stability in comparison to fentanyl.[ Key words] sufentanil

  13. 糖尿病足下肢动脉闭塞性病变的外科血管搭桥治疗%Surgical Vascular By-pass Operation of Lower Limb Artery Occlusion in Patients with Diabetic Foot

    Institute of Scientific and Technical Information of China (English)

    黄斌; 赵纪春; 马玉奎; 冉兴无; 袁丁; 杨轶; 吴洲鹏; 卢武胜

    2012-01-01

    Objective To document the effectiveness and patient experience of surgical treatment for diabetic lower limb arterial occlusion. Methods Out of 290 diabetic patients with lower limb arterial occlusion, 69 received by-pass operation because of severe stenosis below the abdominal aorta and severe ulcers in feet from April 2004 to April 2011. We reviewed the experience and outcome of the 69 diabetic patients who underwent surgical operations on lower limb arterial occlusion. Results 100% initial surgical success was achieved. The morbidity (excluding death) was 12. 3% + 4. 1% and 15. 7% ±5. 1% at 1 year and 3 years after operations, respectively. Five (7. 2%) death cases were recorded, which resulted in a survival rate of 94. 2%±2. 8% and 92. 0%±3. 5% at 1 year and 3 years after operations, respectively. About 90. 6%+ 3. 6% and 87. 2%±4. 9% of patients had graft patency 1 year and 3 years after operations, respectively; and 6. 5% + 3. 1% had amputations. Four (5. 8%) patients developed graft thrombosis, in which 2 (2. 9%) had amputations because of recurrence of thrombosis after thrombectomy. Two (2. 9%) patients had amputations because of graft infection accompanied with graft resection operations. One (1.4%) patient received repeated arterialized operation on great saphenous vein because of popliteal artery occlusion, and obtained a good outcome within two years. One (1. 4%) patient developed stomas false aneurysm, but the excision of the false aneurysm resulted in a good outcome in four years. Conclusion Detailed pre-operation assessment, optimal selection of surgical procedure and perioperative management can help improve the outcome of diabetes and decrease amputation rate in patients with diabetic lower limb arterial occlusion.%目的 总结糖尿病足下肢动脉闭塞病变的外科血管搭桥(BPG)治疗经验及体会.方法 回顾性分析2004年4月至2011年4月收治糖尿病足临界性肢体缺血(CLI)的290例患者中69例选择外科BPG方式

  14. 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

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

    Directory of Open Access Journals (Sweden)

    Margarete Diprat Trevisan

    2015-12-01

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

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

    Science.gov (United States)

    Likosky, Donald S.; Al-Attar, Paul M.; Malenka, David J.; Furnary, Anthony P.; Lehr, Eric J.; Paone, Gaetano; Kommareddi, Mallika; Helm, Robert; Jin, Ruyun; Maynard, Chuck; Hanson, Eric C.; Olmstead, Elaine M.; Mackenzie, Todd A.; Ross, Cathy S.; Zhang, Min

    2016-01-01

    We assessed regional differences in potentially discretionary [coronary artery bypass (CABG) surgery. Regional variation in overall RBC rates remained after risk adjustment, perhaps due to differences in regional practice environments. Objective A number of established regional quality improvement collaboratives have partnered to assess and improve care across their regions under the umbrella of the “Cardiac Surgery Quality IMPROVEment (IMPROVE) Network”. The first effort of the IMPROVE Network has been to assess regional differences in potentially discretionary [coronary artery bypass (CABG) surgery across 56 medical centers in four IMPROVE Network regions between January 2008 and June 2012. Each center submitted the most recent 200 patients who received 0, 1, or 2 units of RBC transfusion during the index admission. Patient and disease characteristics, intra-operative practices, and percentage of cases receiving RBC transfusions were collected. Region-specific transfusion rates were calculated, after adjusting for pre- and intra-operative factors among region-specific centers. Results There were small, but significant, differences in patient case mix across regions. RBC transfusions of 1 or 2 units occurred among 25.2% (2,826/11,200) of CABG procedures. Significant variation in use and number of RBCs existed across regions [None: 74.8% (min:max 70.0%, 84.1%), 1 unit: 9.7% (5.1%, 11.8%), 2 units: 15.5% (9.1%, 18.2%)], p<0.001. Variation in overall transfusion rates remained after adjustment (9.1% – 31.7%, p<0.001). Conclusions Delivery of small volumes of RBC transfusions was common, yet varied across geographic regions. These data suggest that differences in regional practice environments, including transfusion triggers and anemia management, may contribute to variability in RBC transfusion rates. PMID:25227699

  17. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ram Prasad Kaushal

    2015-01-01

    Full Text Available Introduction: The concerns for induction of anaesthesia in patients undergoing cardiac surgery include hemodynamic stability, attenuation of stress response and maintenance of balance between myocardial oxygen demand and supply. Various Intravenous anaesthetic agents like Thiopentone, Etomidate, Propofol, Midazolam, and Ketamine have been used for anesthetizing patients for cardiac surgeries. However, many authors have expressed concerns regarding induction with thiopentone, midazolam and ketamine. Hence, Propofol and Etomidate are preferred for induction in these patients. However, these two drugs have different characteristics. Etomidate is preferred for patients with poor left ventricular (LV function as it provides stable cardiovascular profile. But there are concerns about reduction in adrenal suppression and serum cortisol levels. Propofol, on the other hand may cause a reduction in systemic vascular resistance and subsequent hypotension. Thus, this study was conducted to compare induction with these two agents in cardiac surgeries. Methods: Baseline categorical and continuous variables were compared using Fisher′s exact test and student′s t test respectively. Hemodynamic variables were compared using student′s t test for independent samples. The primary outcome (serum cortisol and blood sugar of the study was compared using Wilcoxon Rank Sum test. The P value less than 0.05 was considered significant. Results: Etomidate provides more stable hemodynamic parameters as compared to Propofol. Propofol causes vasodilation and may result in drop of systematic BP. Etomidate can therefore be safely used for induction in patients with good LV function for CABG/MVR/AVR on CPB without serious cortisol suppression lasting more than twenty-four hours.

  18. Effect of exercise training program in post-CRET post-CABG patients with normal and subnormal ejection fraction (EF > 50% or after coronary artery bypass grafting surgery.

    Science.gov (United States)

    Ansari, Basit; Qureshi, Masood A; Zohra, Raheela Rahmat

    2014-11-01

    The aim of the present study is to compare the effect of exercise training program in post-Cardiac Rehabilitation Exercise Training (CRET), post-CABG patients with normal & subnormal ejection fraction (EF >50% or CABG) surgery. The study was conducted on 100 cardiac patients of both sexes (age: 57-65 years) who after CABG surgery, were referred to the department of Physiotherapy and Rehabilitation between 2008 and 2010 at Liaquat National Hospital & Medical College, Karachi. The patients undertook exercise training program (using treadmill, Recumbent Bike), keeping in view the Borg's scale of perceived exertion, for 6 weeks. Heart Rate (HR) and Blood Pressure (BP) were measured & compared in post CABG Patients with EF (>50% or cardiac functional indicators. Exercise significantly restores the values of HR and BP (systolic) in post CABGT Patients with EF (>50% or cardiac function four to six weeks of treadmill exercise training program. After CABG all patients showed similar improvement in cardiac function with exercise training program. The exercise training program is beneficial for improving exercise capacity linked with recovery cardiac function in Pakistani CABG patients. PMID:26045379

  19. Predicting Blood Transfusion Factors in Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    L. Kasraian

    2007-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Stephen M McHugh

    2016-01-01

    Full Text Available Background and Aims: Tranexamic acid (TA is used for prophylactic antifibrinolysis in coronary artery bypass surgeries to reduce bleeding. We evaluated the efficacy of two different doses of TA for prophylactic antifibrinolysis in patients undergoing primary coronary artery bypass grafting (CABG surgery in this retrospective cohort study at a tertiary care referral centre. Methods: One-hundred eighty-four patients who underwent primary CABG with cardiopulmonary bypass (CPB via sternotomy between January 2009 and June 2011 were evaluated. Pre-operative patient characteristics, intraoperative data, post-operative bleeding, transfusions, organ dysfunction and 30-day mortality were compared between high-dose TA (30 mg/kg loading dose followed by infusion of 15 mg/kg/h until the end of surgery along with 2 mg/kg priming dose in the bypass circuit and low-dose TA (15 mg/kg loading dose followed by infusion of 6 mg/kg/h until the end of surgery along with 1 mg/kg priming dose in the bypass circuit groups. Univariate comparative analysis of all categorical and continuous variables was performed between the two groups by appropriate statistical tests. Linear and logistic regression analyses were performed to control for the effect of confounding on the outcome variables. Results: Chest tube output, perioperative transfusion of blood products and incidence of re-exploration for bleeding did not differ significantly (P> 0.05 between groups. Post-operative complications and 30-day mortality were comparable between the groups. The presence of cardiogenic shock and increased pre-operative creatinine were found to be associated with increased chest tube output on the post-operative day 2 by multivariable linear regression model. Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB.

  1. 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...

  2. 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

  3. 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.

  4. Nonlinear Heart Rate Dynamics in Off-pump Coronary Artery Bypass Grafting Patients and The Relevance with Atrial Fibrillation and Ventricular Tachycardia

    Institute of Scientific and Technical Information of China (English)

    Wu Zhongkai; Yao Jianping; Huang Xiaodan; Jari Laurikka; Saila Vikman; Matti R. Tarkka

    2007-01-01

    Objectives To elucidate the clinical relevance of nonlinear HRV with postoperative arrhythmias in patients undergoing off-pump CABG. Methods Twenty-seven elective off-pump CABG patients were recruited in the present study. Atrial fibrillation (AF),ventricular tachycardia (VT), linear and nonlinear HRV were analysed using 24-hour electrocardiogram before and after surgery. Results All time domain (SDNN,pNN50 and rMSSD ), frequency domain (LF and HF)of linear measures of HRV variables and nonlinear measures of HRV variable, the short-term fractal-like correlation α1 decreased significantly after surgery. The postoperative nonlinear HRV variable α1 tended to be lower in patients with postoperative AF ( P = 0.056). Significant depressed α1 was found in patients with postoperative VT(P = 0.022 ). Elder patient's age and longer inotropic treatment time negatively correlated with postoperative α1. Conclusions Off-pump CABG procedures resulted in significant depressed of linear and nonlinear HRV variables. The depressed nonlinear HRV variables α1 related to age, inotropic supports and postoperative AF and VT.

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

    Science.gov (United States)

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

    2016-01-01

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

  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. 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...

  8. Hypothyroid patient undergoing Coronary bypass surgery- a nightmare, perioperative management challenge.

    OpenAIRE

    Vittal Rao, Anand Rampure; G, Anand Kumar P; Gudimani, Santosh C

    2014-01-01

    The management of hypothyroid patients for coronary artery bypass grafting (CABG) surgery has remained challenging. The patient will have depressed cardiac function with unpredictable response to the routine inotropes, depressed adrenergic response and baroreceptor reflexes, as well as increased systemic vascular resistance (SVR).Though there have been reports about the successful management of such patients, the risk is definitely higher. We hereby describe how we managed a grossly hypothyro...

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

    OpenAIRE

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

    2008-01-01

    Dialysis patients have a high risk of cardiovascular disease. In the general population, cardiac rehabilitation is recommended as a standard component of care and is covered by Medicare for patients who have undergone coronary artery bypass grafting (CABG). Previous investigation demonstrated survival benefit of cardiac rehabilitation in dialysis patients. This study investigated its impact on Medicare expenditure and its cost effectiveness. A cohort of 4,324 end-stage renal disease (ESRD) pa...

  10. Patients undergoing elective coronary artery bypass grafting exhibit poor pre-operative intakes of fruit, vegetables, dietary fibre, fish and vitamin D

    NARCIS (Netherlands)

    Ruiz-Nunez, B.; van den Hurk, G. H. A. M.; de Vries, J. H. M.; Mariani, M. A.; de Jongste, M. J. L.; Dijck-Brouwer, D. A. J.; Muskiet, F. A. J.

    2015-01-01

    CHD may ensue from chronic systemic low-grade inflammation. Diet is a modifiable risk factor for both, and its optimisation may reduce post-operative mortality, atrial fibrillation and cognitive decline. In the present study, we investigated the usual dietary intakes of patients undergoing elective

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

    Science.gov (United States)

    Rai, Mridula; Rustagi, Tarun

    2013-10-01

    Coronary artery bypass grafting (CABG) was one of major surgical advances of the 20th century and it has proven to be one of the most effective and long-lasting therapies in the treatment of ischemic heart disease. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. We seek to review the emerging role and patency rates of newer arterial grafts in comparison with the traditional saphenous vein grafts.

  12. The Role of Nasopharyngeal Temperature Monitoring in Detection of a Malpositioned Superior Vena Cava Cannula in an Emergency Coronary Artery Bypass in a Patient With Ventricular Septal Defect

    OpenAIRE

    Dabbagh, A; M Shahzamani; M Foroughi; K Ghods; M Ghomeisi; Rahimian, H.

    2010-01-01

    A 55 year-old woman was admitted to the CCU ward of our university hospital due to typical chest pain. The patient received supportive care and was transferred to the operating room for an emergency repair of the ventricular septal defect (VSD) and myocardial revascularization. The surgical team was notified regarding the tolerance to cooling detected by the temperature monitoring and also, the congestion of eye and blanching of forehead. After a few maneuvers, the cannula was repositioned. I...

  13. 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.

  14. 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.

  15. Dynamic Cerebral Autoregulation after Cardiopulmonary Bypass

    DEFF Research Database (Denmark)

    Christiansen, Claus Behrend; Berg, Ronan M G; Plovsing, Ronni;

    2016-01-01

    Background Cerebral hemodynamic disturbances in the peri- or postoperative period may contribute to postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). We therefore examined dynamic cerebral autoregulation (d...

  16. The Role of Nasopharyngeal Temperature Monitoring in Detection of a Malpositioned Superior Vena Cava Cannula in an Emergency Coronary Artery Bypass in a Patient With Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    A Dabbagh

    2010-03-01

    Full Text Available A 55 year-old woman was admitted to the CCU ward of our university hospital due to typical chest pain. The patient received supportive care and was transferred to the operating room for an emergency repair of the ventricular septal defect (VSD and myocardial revascularization. The surgical team was notified regarding the tolerance to cooling detected by the temperature monitoring and also, the congestion of eye and blanching of forehead. After a few maneuvers, the cannula was repositioned. In a few seconds, the forehead was cooled, while the airlocking episodes were lifted completely and the blanching and chemosis in the face and eyes all resolved. The septal defect was approached through the left ventricle; a 15 in 20 mm foramen, due to the ischemic rupture of the superior portion of the anteroseptal wall, was repaired with a patch of hemoshield. The incision over the LV was then repaired with 2 parallel bands of felt. The patient was operated on and transferred to the intensive care unit.

  17. Complicated type B aortic dissection causing ischemia in the celiac and inferior mesenteric artery distribution despite patent superior mesenteric artery bypass.

    Science.gov (United States)

    Afifi, Rana O; Zhu, Youwei; Leake, Samuel S; Kott, Amy; Azizzadeh, Ali; Estrera, Anthony L; Safi, Hazim J; Charlton-Ouw, Kristofer M

    2015-08-01

    Mortality rates associated with acute type B aortic dissection (ABAD) complicated by malperfusion remains significant. Optimal management of patients with ABAD is still debatable. We present a case report of a 50-year-old man who was admitted due to ABAD. He was treated medically with his pain resolved and he was discharged on oral antihypertensive medications. One month after initial diagnosis, he was readmitted with abdominal pain, nausea, vomiting, and diarrhea. On imaging, an extension of the aortic dissection into the visceral arteries with occlusion of the celiac and superior mesenteric arteries (SMA) was noted. He underwent thoracic endovascular aortic repair (TEVAR) and bypass grafting to the SMA. Despite the intervention, the patient developed large bowel, liver, and gastric ischemia and underwent bowel resection. He died from multi-organ failure. In selected cases of uncomplicated ABAD, TEVAR should be considered and when TEVAR fails and visceral malperfusion develops, an aggressive revascularization of multiple visceral arteries should be attempted.

  18. 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

  19. Sobrevida em longo prazo de octogenários submetidos à cirurgia de revascularização miocárdica isolada Long-term survival of octogenarian patients submitted to isolated coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Fernando Pivatto Júnior

    2011-03-01

    Full Text Available INTRODUÇÃO: Um crescente número de pacientes octogenários tem sido submetido à cirurgia de revascularização miocárdica (CRM. Os resultados em curto prazo desse procedimento têm sido amplamente estudados, mas há poucos relatos nacionais até o presente momento sobre os seus desfechos em longo prazo. OBJETIVOS: Descrever a mortalidade hospitalar e a sobrevida em longo prazo de pacientes com idade 80 anos submetidos à CRM isolada. MÉTODOS: Estudo de coorte retrospectivo com 142 pacientes consecutivos de idade 80 anos submetidos à CRM isolada no período de janeiro/1996 a dezembro/2007. A idade média (±dp foi de 82,3±2,1 anos e 56,3% eram masculinos. A prevalência de hipertensão arterial sistêmica foi de 73,2%, infarto agudo do miocárdio prévio 30,3%, diabetes melito 26,8% e disfunção renal (creatinina ³ 2,0mg/ml 4,9%. A mediana do seguimento foi de 4,0 anos, havendo perda de 11,6% dos pacientes. A análise da sobrevida foi feita pela curva de Kaplan-Meier. RESULTADOS: A mortalidade hospitalar geral foi de 14,8% (IC95%: 8,8-20,8, observando-se uma redução desse percentual ao longo do período estudado (1996-1999: 25,9%, 2000-2003: 15,8% e 2004-2007: 8,6%. A média de sobrevida foi de 6,5 anos (IC95%: 5,5-7,5, sendo a taxa de sobrevida em 1, 3 e 5 anos de 83,3, 79,5 e 77,3%, respectivamente. CONCLUSÕES: A média de sobrevida foi de 6,5 anos, sendo a taxa em 5 anos de 77,3%, dados condizentes com a literatura internacional.INTRODUCTION: An increasing number of octogenarian patients is undergoing coronary artery bypass graft surgery (CABG. The short-term results of this procedure have been broadly studied, but there are few national reports on long-term outcomes. OBJECTIVES: To describe hospital mortality and long-term survival of patients aged > 80 years undergoing isolated CABG. METHODS: Retrospective cohort study with 142 consecutive patients aged > 80 years undergoing isolated CABG in the period between January/1996

  20. Biological artificial vessel graft in distal arterial bypass for treating diabetic lower limb ischemia: a case report

    Institute of Scientific and Technical Information of China (English)

    GU Yong-quan; WU Ying-feng; QI Li-xing; GUO Lian-ri; LI Xue-feng; CUI Shi-jun; TONG Zhu; GUO Jian-ming; ZHANG Jian

    2011-01-01

    A 68-year-old female patient was treated for unhealed ulcer in the fourth toe of the left foot. Clinical examinations identified severe stenosis of the proximal segment and occlusion of the distal segment of the left anterior tibial artery, and occlusion of the left posterior tibial artery and the peroneal artery. The proximal stenotic segment of the left anterior tibial artery was dilated, but the distal occlusive part failed to be re-canalized. Left anterior tibial artery to dorsal pedal artery bypass was performed on the patient with an epoxide-crosslinked, special radicals antigen-sealed, porcine-derived biological graft; debridement of the left 4th digiti pedis was also performed. Postoperation course was uneventful. The pulse of the left dorsal pedal artery was strong. The ankle brachial index (ABI) increased from 0.60 to 1.09. Warfarin and two antiplatelet drugs were given after the operation. Six months after operation, computed tomographic angiogram (CTA)identified the patent graft.

  1. 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

  2. Meta-analysis of randomized trials comparing the effectiveness of on-pump and off-pump coronary artery bypass

    Institute of Scientific and Technical Information of China (English)

    CHEN Yong-bing; SHU Jian; YANG Wen-tao; SHI Li; GUO Xu-feng; WANG Fei-ge; QIAN Yong-yue

    2012-01-01

    Background The growing enthusiasm for coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is emerging,but the role of off-pump coronary artery bypass (OPCAB) in clinical practice remains controversial.The purpose of this study was to assess differences in the incidences of stroke,atrial fibrillation (AF),and myocardial infarction (MI) between OPCAB and conventional coronary artery bypass grafting (CCABG) by meta-analyses of randomized clinical trials.Methods A literature search for the period before March 2010 supplemented with manual bibliographic review was performed for all Chinese or English publications in Medline,the Science Citation Index Expanded,the Cochrane Central Register of Controlled Trials (CENTRAL) and CBMdisc.A systematic overview (meta-analyses) of randomized clinical trials was conducted to evaluate the differences between OPCAB and CCABG in the incidences of stroke,AF,and MI.The meta-analysis was performed using RevMan 5 software.Results Forty-three randomized clinical trials were selected for meta-analysis after screening a total of 356 references,with 8104 patients in the OPCAB group and 8724 cases in the CCABG group.The meta-analyses of these trials showed no significant difference between OPCAB and CCABG in the incidences of stroke (odds ratio (OR)=0.80,95% confidence interval (CI)=0.52-1.22,P=0.30) and MI (OR=0.73,95%CI=0.52-1.02,P=0.06).However,we found a significantly reduced risk of AF (OR=0.65,95%CI =0.52-0.82,P=0.0002)in off-pump patients.Conclusions Our meta-analyses suggest that OPCAB reduces the risk of postoperative AF compared with CCABG,but there is no significant difference in the incidences of stroke and MI between OPCAB and CCABG.

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

    Science.gov (United States)

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

    2011-06-01

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

  4. 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)

  5. 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.

  6. beta-blocker Therapy is Not Associated with Reductions in Angina or Cardiovascular Events After Coronary Artery Bypass Graft Surgery : Insights from the IMAGINE Trial

    NARCIS (Netherlands)

    Booij, Harmen G.; Damman, Kevin; Warnica, J. Wayne; Rouleau, Jean L.; van Gilst, Wiek H.; Westenbrink, B. Daan

    2015-01-01

    To evaluate whether beta-blockers were associated with a reduction in cardiovascular events or angina after Coronary Artery Bypass Graft (CABG) surgery, in otherwise stable low-risk patients during a mid-term follow-up. We performed a post-hoc analysis of the IMAGINE (Ischemia Management with Accupr

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

    DEFF Research Database (Denmark)

    Lundgren, F; Schroeder, Torben Veith

    2012-01-01

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

  8. 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...

  9. 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 ...

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  11. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2004-01-01

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

  13. 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...

  14. 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)

  15. 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

  16. Osteopontin in relation to Prognosis following Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Eftihia Sbarouni

    2016-01-01

    Full Text Available Cardiovascular events may occur even after complete revascularization in patients with coronary artery disease. We measured preoperative osteopontin (OPN levels in 131 consecutive patients (66.5±10 years old, 117 men and 14 women with left ventricular ejection fraction of 50.7±9.2% and low logistic EuroScore (3.5±3.2% undergoing elective Coronary Artery Bypass Grafting (CABG surgery. Patients were prospectively followed up for a median of 12 months (range 11–24. The primary study endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, need for repeat revascularization, and hospitalization for cardiovascular events. Pre-op OPN plasma levels were 77.9 (49.5, 150.9. Patients with prior acute myocardial infarction (AMI had significantly higher OPN levels compared to those without [131.5 (52.2, 219 versus 73.3 (45.1, 125, p=0.007]. OPN levels were positively related to EuroScore (r=0.2, p=0.031. Pre-op OPN levels did not differ between patients who had a major adverse event during follow-up compared to those with no event (p=0.209 and had no effect on the hazard of future adverse cardiac events [HR (95% CI: 1.48 (0.43–4.99, p=0.527]. The history of AMI was associated with increased risk of subsequent cardiovascular events at follow-up (p=0.02. OPN is associated with preoperative risk assessment prior to low-risk CABG but did not independently predict outcome.

  17. Early outcome after off-pump coronary artery bypass grafting: effect on mortality and stroke Resultado inicial após revascularização miocárdica: efeito na mortalidade e no acidente cerebrovascular

    OpenAIRE

    Delawer Reber; Marcus Fritz; Alfred Germing; Peter Marks; Axel Laczkovics

    2008-01-01

    OBJECTIVE: One of the major and devastating complications of the coronary artery bypass grafting (CABG) is the stroke. Avoiding cardiopulmonary bypass (CPB) may reduce this neurological complication. In the past years there was an increased interest in the off-pump coronary artery grafting (OPCAB). The benefit of this method of revascularization in term of stroke and mortality is controversially discussed. METHODS: A retrospective analysis of collected data from 252 patients were operated wit...

  18. 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 ...

  19. 64层螺旋CT脑灌注成像联合CT血管造影评价颅内外血管搭桥术后疗效%Assessment of cerebral internal and external vascular bypass graft in patients with single middle cerebral artery stenosis or occlusion by combining 64-row CT cerebral perfusion with angiography

    Institute of Scientific and Technical Information of China (English)

    陈天金; 朱栓庄; 温有信; 王耀彬; 韩向东; 白莹; 于旋

    2012-01-01

    Objective To assess the curative effect of cerebral internal and external vascular bypass graft in patients with sin -gle middle cerebral artery (MCA) stenosis or occlusion by combining 64 -row CT cerebral perfusion (CTP) with angiography ( CTA ). Methods Patients with middle cerebral artery stenosis or occlusion were recruited and underwent superficial temporal artery and mid -die cerebral artery(STA -MCA) bypass graft between March 2009 and Mar 2011. CTP and CTA examinations were performed in all patients before and after operation. The cerebral perfusion parameters were analyzed quantitatively and qualitatively . The origin, travel and anastomotic stoma of bypass grafts were evaluated by reconstructed CTA images . Results 46 patients were found with severe MCA stenosis or occlusion. The time to peak (TTP) and relative mean transit time (rMTT) images before therapy displayed the existence of perfusion delay. The relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCRV) images did not change significantly. The decrease of TTP and rMTT after therapy was of statistical significance ( P 0.05). In reconstructed CTA images , 82 bridge vessels were well displayed, including double bridges in 39 patients. The accuracy of CTA examination was 96.5%. All the bypass grafts were well shown and the anastomotic stomas were unobstructed. Conclusions It is feasible to evaluate the curative effects of cerebral internal and ex — ternal vascular bypass graft by combining CTP images of cerebral perfusion after therapy with CTA images of cerebral internal and exter -nal bypass grafts.%目的 探讨64层螺旋CT脑灌注成像(CT perfusion,CTP)联合CT血管造影(CT angiography,CTA)评价单侧大脑中动脉(middle cerebral artery,MCA)重度狭窄(闭塞)颅内外血管搭桥术后疗效的可行性.方法 46例拟行颅内外血管搭桥术患者,术前、后均行CTP及CTA检查.计算脑灌注参数图,对治疗前后脑灌注参数进行定量和定性对

  20. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Mehta Yatin

    2008-01-01

    Full Text Available Minimally invasive surgery with robotic assistance should elicit minimal pain. Regional analgesic techniques have shown excellent analgesia after thoracotomy. Thus the aim of this study was to compare thoracic epidural analgesia (TEA technique with paravertebral block (PVB technique in these patients with regard to quality of analgesia, complications, and haemodynamic and respiratory parameters. This was a prospective randomised study involving 36 patients undergoing elective robotic-assisted coronary artery bypass grafting (CABG. TEA or PVB were administered in these patients. The results revealed no significant differences with regard to demographics, haemodynamics, and arterial blood gases. Pulmonary functions were better maintained in PVB group postoperatively; however, this was statistically insignificant. The quality of analgesia was also comparable in both the groups. We conclude that PVB is a safe and effective technique for postoperative analgesia after robotic-assisted CABG and is comparable to TEA with regard to quality of analgesia.

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  2. Predictors of atrial fibrillation after coronary artery bypass graft: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Liang Yin; Zhi-Nong Wang; Yi-Feng Wang; Wen-Tao Wang; Guang-Yu Ji; Xin-Wei Yang; Zhi-Yun Xu

    2009-01-01

    Objectives Postoperative atrial fibrillation (AF) has been associated with less favorable outcomes in patients undergoing coronary artery bypass graft surgery (CABG) and may result in increased post-operative morbidity and mortality. A systematic review and meta-analysis of published studies was conducted to examine the risk factors of occurrence AF after CABG. Methods Using the Medline database, the Cochrane clinical trials database and online clinical trial databases, we reviewed all randomized controlled trials (RCTs) and observational studies examining the risk factors of occurrence of AF after CABG. We searched for literature published April 2009 or earlier. Results Our review identified 8 studies (observational studies), involving 14548 patients, that examined the risk factors of occurrence of AF after CABG. Although studies provide conflicting results, the overall outcomes suggests that advanced age, previous hypertension, numbers of bridge vessels may increase the occurrence of AF after CABG, while no significant difference of diabetes, preoperative myocardial infarction, and preoperative medication of 13 -Blocker have been observed between the AF patients and no-AF patiens. Conclusions Patients with advanced age, previous hypertension and more numbers of bridge vessels had higher risk for the occurrence of AF after CABG, and perioperative medication and care must be intensified to decrease the postoperative occurrence of AF.

  3. 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.

  4. 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 ...

  5. 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 ...

  6. 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.

  7. 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...

  8. Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm.

    Science.gov (United States)

    Bowers, Christian A; Taussky, Philip; Park, Min S; Neil, Jayson A; Couldwell, William T

    2015-12-01

    We report the microsurgical rescue and removal of a Pipeline stent embolization of a giant internal carotid artery terminus aneurysm. After the initial placement of a Pipeline Embolization Device (PED), it migrated proximally to the cavernous carotid with the distal end free in the middle of the aneurysm, resulting in only partial aneurysm neck coverage. The patient underwent microsurgical rescue with trapping, bypass, and opening of the aneurysm with PED removal. The vessel remained patent in the proximal segment previously covered by the Pipeline stent. Microsurgical rescue for definitive aneurysm treatment with PED removal can be safe and effective for aneurysms unsuccessfully treated with PED.

  9. 冠状动脉旁路移植术后ICU监护时间延长的危险因素%Predictive risk factors for prolonged stay in intensive care unit in patients undergoing coronary artery bypass grafting surgery

    Institute of Scientific and Technical Information of China (English)

    袁忠祥; 刘健

    2011-01-01

    Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses for preoperative risk factors were performed. Prolonged length of ICU stay was defined as initial admission to ICU exceeding 72 h. Results The mean age of patients ( 322women and 996 men) was (67.4±9.4) years. Of 1318 patients undergoing isolated CABG from 1997 to 2009, 205 experienced prolonged length of ICU stay. The length of ICU stay was (40.1 ± 22.5 ) hours and ( 122.6 ± 48.7 ) hours separately.Overall in-hospital mortality was higher among these 205 patients ( 13.7% vs. 1.2%, P <0.05 ). The overall mortality was 3.1%. In univariate analyses, there were statistically significant differences with respect to the percentage of CPB, total bypass time, cross-clamp time, number of distal anastomoses, use of pressor agent, use of intro-aortic balloon pump,time of ventilation and hospital mortality. The significant risk factors were age, NYHA class Ⅲ/Ⅳ, left ventricular ejection fraction(LVEF) <0.40, renal failure, cerebrovascular and/or peripheral vascular disease, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, left main stenosi, three-vessels disease. The variables entered into the multivariate logistic regression were age, NYHA class Ⅲ/Ⅳ, LVEF <0.40, renal failure, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, three-vessels disease. According to the outcome of multivariate logistic regression, we can conclude the model of probability forecast and create a new variable named Pre. The area under ROC curve of the new variable Pre was larger than other variables. Conclusion The main risk factors of prolonged ICU

  10. 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...

  11. 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...

  12. 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

  13. Carotid Artery Sonography Findings in 291 Patients Undergoing Cabg

    Directory of Open Access Journals (Sweden)

    HR Dehghan

    2006-07-01

    Full Text Available Introduction: Doppler ultrasonography (DUS is the most preferable method for screening of carotid artery disease in patients undergoing CABG. The purpose of this study was to investigate the frequency of carotid artery disease and determine the relation between known risk factors of atherosclerosis and rate of carotid artery narrowing in order to identify high-risk groups among patients scheduled for isolated elective coronary artery bypass grafting (CABG procedures. Methods: Two-hundred ninety-one patients (222 males and 69 females undergoing isolated coronary artery bypass grafting were preoperatively evaluated by carotid artery Doppler ultrasomography and the morphology of carotid artery was determined. Age, sex, cervical bruit, diabetes mellitus (DM, hypertension, hyperlipidemia, smoking, history of cerebrovascular event (CVE and coronary angiographic findings were investigated to define the high-risk group for carotid artery disease. Data were analyzed by SPSS software and P60 years (P=0.84, female sex (P=0.730, and left main coronary disease (P=0.390 were not identified as high-risk factors for carotid artery stenosis greater than 50%. But positive MI history (P=0.025, and cervical bruit (P=0.002, were significantly related to 50% carotid artery stenosis. Conclusion: Based on the results of this study, we can not suggest DUS as a routine screening method in all patients undergoing CABG, except for patients with history of MI and cervical bruit. Another important finding was that 56.4% of patients posted for CABG had different degrees of carotid artery stenosis which requires a long term CVA prophylaxis program.

  14. Angiography-based prediction of outcome after coronary artery bypass surgery versus changes in myocardial perfusion scintigraphy

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Haghfelt, Torben;

    2011-01-01

    The present study compared the clinical prediction of the effect of coronary artery bypass grafting (CABG) on coronary blood flow and left ventricular ejection fraction (LVEF) with changes in gated myocardial perfusion scintigraphy. A prospective group of 92 patients underwent myocardial perfusion...... predicted and observed regional changes in coronary blood flow and perfusion defects were poor. LVEF increased (by over five ejection fraction units) in almost half of the patients, but with no correlation between the predicted and the observed changes. Based on clinical and angiographic findings...... scintigraphy before and 6 months after CABG, the results being kept secret from the surgeon. Based on clinical and angiographic findings, the surgeons filled in a questionnaire indicating the predicted changes in coronary blood flow in each of the three coronary artery territories and in the LVEF. Symptomatic...

  15. Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients

    Energy Technology Data Exchange (ETDEWEB)

    Alkan, Ozlem [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey)], E-mail: yalinozlem@hotmail.com; Kizilkilic, Osman; Yildirim, Tulin [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey); Atalay, Hakan [Department of Cardiovascular Surgery, Baskent University, Faculty of Medicine, Ankara (Turkey)

    2009-09-15

    Purpose: Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors. Methods: We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS {>=} 50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or {<=}25%, 25-49%, and {>=}50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded. Results: ECAS < 70% in 42 patients and ECAS {>=} 70% in 141 patients. ICAS was found in 51 patients and ICAS {>=} 50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS. Conclusions: We found ICAS in 27.8% of the patients with ECAS > 50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.

  16. Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention

    Science.gov (United States)

    Liu, Jiexin (Jason); Bellamy, Gail R.; McCormick, Melissa

    2007-01-01

    Purpose: To assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally. Methods: Six hundred and forty-seven subjects, aged 18 years and older, who had been admitted to…

  17. 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

  18. 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

  19. [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

  20. 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.

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

    NARCIS (Netherlands)

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

    2002-01-01

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

  2. One-year results of coronary revascularization in diabetic patients with multivessel coronary artery disease.Sirolimus stent vs. coronary artery bypass surgery and bare metal stent: insights from ARTS-II and ARTS-I.

    OpenAIRE

    Macaya, Carlos; Garcia-Garcia, Hector M; Colombo, Antonio; Morice, Marie-Claude; LEGRAND, Victor; Kuck, Karl-Heinz; Sheiban, Imad; Suttorp, Maarten Jan; Carrie, Didier; Vrolix, Mathias; Wittebols, Kristel; Stoll, Hans-Peter; Donohoe, Dennis; Bressers, Marco; Serruys, Patrick W.

    2006-01-01

    Background: ARTS-II was designed to evaluate the sirolimus-eluting stent (SES) versus ARTS-I. The objective of this analysis is to assess the safety and efficacy of the SES in diabetic patients with multivessel disease (MVD) versus both arms of ARTS-I.Methods and results: The ARTS studies included 367 diabetic patients (ARTS-II: 159; ARTS-I-CABG: 96; ARTS-I-PCI: 112). Baseline characteristics showed a more diseased patient population in the ARTS-II study: 50.3% with 3VD vs. 35.4% (ARTS-I-CABG...

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

    Science.gov (United States)

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

    2008-01-01

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

  4. [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

  5. 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...

  6. 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...

  7. Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitus Coronary artery bypass grafting using both internal mammary arteries in patients with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Stevan Krieger Martins

    2007-09-01

    Full Text Available OBJETIVO: Descrever a utilização de ambas artérias mamárias internas (MIs em pacientes submetidos à operação de revascularização do miocárdio (RM, que sejam portadores de diabetes mellitus (DM. MÉTODO: No período compreendido entre janeiro de 1995 e agosto de 2005, 4.569 pacientes foram submetidos a RM em nossa instituição, sendo que 1.298 eram portadores de DM. A média de idade era de 62 anos, e a mortalidade global foi de 2,18% (100 pacientes. Ambas MIs foram empregadas em 700 pacientes, que foram divididos em dois grupos, portadores de DM (grupo I, com 148 pacientes e não portadores de DM (grupo II, 552 pacientes. A seleção de pacientes para utilizar estes enxertos foi baseada nas características angiográficas das artérias coronárias e qualidade do esterno quando de sua transsecção. Quando ambos fatores eram considerados favoráveis, foram dissecadas ambas MIs, independente de o paciente ser portador ou não de DM. Durante a dissecção dos enxertos arteriais, tomava-se o cuidado de procurar manter as cavidades pleurais fechadas. RESULTADOS: Houve pouca variação entre os grupos de pacientes no tocante a morbidade e mortalidade. CONCLUSÃO: Nossos dados sugerem que pacientes portadores de DM podem se beneficiar do uso de ambas artérias MIs, com pouco acréscimo de risco quando sua aplicação for adequadamente indicada.OBJECTIVE: We sought to describe the use of both internal mammary arteries (IMA in patients with diabetes mellitus (DM submitted to coronary artery bypass grafting (CABG. METHOD: Between January of 1995 to August of 2005, 4.569 patients received isolated CABG in our institution, of these, 1.298 had DM. Mean sample age was 62 years, and total mortality was 2.18% (100 patients. We have used both IMA's in 700 patients, that here are split in two groups, with DM (group I, 148 patients, and without DM (group II, 552 patients. Patient selection for double IMA grafting was based on coronary artery anatomy and

  8. 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, ...

  9. 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

  10. 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.

  11. Study of perioperative extravascular lung water and intrathoracic blood volume in patients undergoing CABG surgery with or without cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Samia Ragab El Azab

    2014-10-01

    Discussion and Conclusion: The clinical advantage of off-pump CABG surgery over standard extracorporeal circulation in regard to lung water content was not found in our study. In conclusion, the presumed superiority of off pump surgery for coronary artery bypass grafting could not be confirmed in our group of patients.

  12. 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.

  13. 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.

  14. Can preoperative myocardial perfusion scintigraphy predict changes in left ventricular perfusion and function after coronary artery bypass graft surgery?

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Johansen, Allan;

    2012-01-01

    OBJECTIVESWe wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG).METHODSNinety-two patients with stable angina......%. Before CABG, one patient had normal perfusion; in the rest of them the defects were classified as follows: reversible (60%), partly reversible (27%) and irreversible (12%). Following CABG, 33% had normal perfusion; in the rest the defects were reversible in 29%, partly reversible in 12% and irreversible...... in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects...

  15. 非体外循环法冠状动脉搭桥术15例报道%Octopus Off- Pump Coronary Artery Bypass Grafting Experience in 15 Patients

    Institute of Scientific and Technical Information of China (English)

    李小波; 单根法; 张辅贤; 杜奇容; 李国庆; 戚晓敏

    2002-01-01

    目的报告15例用"Octopus方法"行冠状动脉搭桥术(Off-Pump coronary artery bypass,OPCAB).方法正中切口非体外循环下"Octopus方法"的冠状动脉搭桥术.1例搭桥1根,1例搭桥2根,搭桥3根以上13例.移植血管:左乳内动脉12根,大隐静脉33根.移植部位:前降支15根,对角支6根,回旋支9根,右冠脉11根,后降支4根. 结果无手术死亡,无术中中转体外循环,术后心绞痛消失,MRI提示桥血管通畅. 结论OPCAB"Octopus方法"适用于多支血管病变,几乎包括所有靶血管,手术效果好,并发症少.

  16. 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

  17. Endothelial Injury Associated with Cold or Warm Blood Cardioplegia during Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    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.

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. 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)

  1. 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.

  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. In situ saphenous vein bypass surgery in diabetic patients

    DEFF Research Database (Denmark)

    Jensen, L P; Schroeder, T V; Lorentzen, J E

    1992-01-01

    From 1986 through to 1990 a total of 483 consecutive in situ infra-inguinal vein bypass procedures were performed in 444 patients, of whom 112 (25%) were diabetics (57 insulin dependent diabetes mellitus and 55 non-insulin-dependent diabetes mellitus). Based on a prospective vascular data registry.......005). Indication for surgery was gangrene or ulceration in 57% of diabetics, as opposed to 36% in non-diabetic patients (p = 0.0002). A femoro-popliteal bypass was performed in 18% of patients, whereas 82% received an infrapopliteal procedure, of which 42% were to the distal third of the calf or foot. Diabetic...

  4. Nursing Experience of Postoperative Pain of Coronary Artery Bypass Grafting%心内直视下冠状动脉搭桥术后疼痛护理

    Institute of Scientific and Technical Information of China (English)

    杨梦

    2015-01-01

    In January 2010, 88 patients were treated by heart surgery in December 2013, including 77 patients with coronary artery bypass grafting, 11 cases with coronary artery bypass grafting and valve replacement. The postoperative pain of the patients with coronary artery bypass surgery is a major obstacle to the rehabilitation of patients. Good pain nursing can improve the recovery rate, shorten the time of postoperative care. Have a definite object in view of postoperative care, to al eviate the suf ering of patients, improve the quality of people's lives.%2010年1月~2013年12月心脏术后患者88例,其中冠状动脉搭桥术77例,冠状动脉搭桥+瓣膜置换术11例。冠状动脉搭桥术的后疼痛更是患者康复道路上的一大障碍。良好的疼痛护理能提高恢复的速度,术后监护平均时间的缩短。有的放矢地进行术后护理,减轻患者的痛苦,提高人们的生活质量。

  5. Investigation of clustering events of surgical site infections in patients undergoing coronary artery bypass grafting%冠状动脉搭桥术患者手术部位感染聚集性调查研究

    Institute of Scientific and Technical Information of China (English)

    程丽峰; 阿依古丽; 朱敏; 卢辉; 魏育涛

    2015-01-01

    OBJECTIVE To investigate the high risk factors for clustering events of surgical site infections in wards of cardiothoracic surgery department so as to provide guidance for prevention and control of nosocomial infections . METHODS The epidemiological survey was conducted for the patients with suspected surgical site infections who were treated in the cardiothoracic surgery department from Jul to Aug ,2012 ,the high risk factors were analyzed , and the comprehensive interventions were taken to avoid the spread of nosocomial infections .RESULTS The surgical site infections occurred in 4 of 8 patients who underwent the coronary artery bypass grafting in the cardiothoracic surgery department ,with the infection rate of 50 .00% .All the 4 cases were complicated with se‐vere underlying diseases ,and 3 cases were complicated with diabetic mellitus ;the surgical procedures were com‐plex ,the operation duration was long ,and the symptoms of surgical incision infections were the same ,all the ca‐ses had the redness ,swelling ,heat ,and bloody discharge ,accompanied by incision dehiscence ,and the culture of wound secretions showed that there was no growth of bacteria .The hand hygiene of the health care workers and the cleaning of object surfaces were unqualified ,the environmental hygiene surveillance indicated that the Staphy‐lococcus aureus have been isolated , the outbreak of the surgical site infections could not completely excluded , which was defined as the clustering events of surgical site infections ,and the 4 patients were cured and discharged successively after the active treatment .CONCLUSION It is an effective way to intensify the consciousness of control of the nosocomial infections and take targeted prevention measures so as to control the clustering events of nosoco‐mial infections .%目的:调查医院心胸外科病房手术部位感染聚集性事件发生的高危因素,为预防与控制医院感染提供参考依据。方法对2012年7

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

    Medline Plus

    Full Text Available ... say about it. 00:27:56 PATIENT ON VIDEO: The discussion I had on how the operation – ... recovery was remarkable. 00:29:17 PATIENT ON VIDEO: So, my recovery time was – I'm still ...

  7. Comparison of the standard roller pump and a pulsatile centrifugal pump for extracorporeal circulation during routine coronary artery bypass grafting.

    Science.gov (United States)

    Driessen, J J; Fransen, G; Rondelez, L; Schelstraete, E; Gevaert, L

    1991-01-01

    The present prospective study compared the standard nonpulsatile twin roller pump with the Sarns centrifugal pump, in the pulsatile mode, as arterial pumps for extracorporeal circulation during coronary artery bypass grafting (CABG). The study was conducted in two consecutive groups of 25 patients receiving a standard anaesthetic and surgical protocol. The investigated parameters included haemodynamic profiles, oxygen exchange, blood gas and acid-base homeostasis, haematology, coagulation and complement consumption. With comparable settings for pump flow, gas flow and delivered oxygen concentrations, there was no difference between the groups in the main haemodynamic parameters during cardiopulmonary bypass (CPB). However, a tenfold lower dose of sodium nitroprusside was required to keep systemic vascular resistance within physiologic limits during CPB in the centrifugal group (C group) compared with the roller group (R group). During rewarming oxygen extraction was higher in the C group than in the R group. During the first eight hours after CPB no differences in haemodynamics, oxygenation parameters and pulmonary shunt between the groups were observed. During, as well as after, CPB there was no significant difference in blood gas and acid-base homeostasis between either group. Average postoperative blood loss via chest tubes, total transfusions of blood products, haemoglobin and coagulation did not differ between the two groups. However, the white blood cell count, corrected for changes in haematocrit, decreased during the early phase of CPB in the R group, but not in the C group.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Heart bypass surgery - minimally invasive

    Science.gov (United States)

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

  9. Recovery After Coronary Artery Bypass Graft Surgery (Beyond the Basics)

    Science.gov (United States)

    ... shoulder movement (eg, as in tennis, baseball, and golf) for six to eight weeks after surgery to ... stress. ● Group skill-building exercises help patients to learn about living with stress and heart disease, including ...

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

    Medline Plus

    Full Text Available ... with one other small incision up by the shoulder. So, what they're going to start doing ... Post-operatively, this patient will have very little pain. He'll be able to breathe better than ...

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  12. 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...

  13. 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