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Sample records for bypass graft patency

  1. Association of sex with patency of femorodistal bypass grafts

    DEFF Research Database (Denmark)

    Watson, H R; Schroeder, T V; Simms, M H

    2000-01-01

    There is evidence for superior patency in infra-inguinal bypass procedures in men compared to women. A large, prospectively planned series was investigated in order to confirm this finding and to determine the origin of this difference in outcome.......There is evidence for superior patency in infra-inguinal bypass procedures in men compared to women. A large, prospectively planned series was investigated in order to confirm this finding and to determine the origin of this difference in outcome....

  2. Influence of Diabetes on Long-Term Coronary Artery Bypass Graft Patency.

    Science.gov (United States)

    Raza, Sajjad; Blackstone, Eugene H; Houghtaling, Penny L; Rajeswaran, Jeevanantham; Riaz, Haris; Bakaeen, Faisal G; Lincoff, A Michael; Sabik, Joseph F

    2017-08-01

    Nearly 50% of patients undergoing coronary artery bypass grafting have diabetes. However, little is known about the influence of diabetes on long-term patency of bypass grafts. Because patients with diabetes have more severe coronary artery stenosis, we hypothesized that graft patency is worse in patients with than without diabetes. This study sought to examine the influence of diabetes on long-term patency of bypass grafts. From 1972 to 2011, 57,961 patients underwent primary isolated coronary artery bypass grafting. Of these, 1,372 pharmacologically treated patients with diabetes and 10,147 patients without diabetes had 15,887 postoperative angiograms; stenosis was quantified for 7,903 internal thoracic artery (ITA) grafts and 20,066 saphenous vein grafts. Status of graft patency across time was analyzed by longitudinal nonlinear mixed-effects modeling. ITA graft patency was stable over time and similar in patients with and without diabetes: at 1, 5, 10, and 20 years, 97%, 97%, 96%, and 96% in patients with diabetes, and 96%, 96%, 95%, and 93% in patients without diabetes, respectively (early p = 0.20; late p = 0.30). In contrast, saphenous vein graft patency declined over time and similarly in patients with and without diabetes: at 1, 5, 10, and 20 years, 78%, 70%, 57%, and 42% in patients with diabetes, and 82%, 72%, 58%, and 41% in patients without diabetes, respectively (early p bypass grafts. Use of ITA grafts should be maximized in patients undergoing coronary artery bypass grafting because they have excellent patency in patients with and without diabetes even after 20 years. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. Hypercoagulability in relation to coronary artery bypass graft patency and clinical outcome

    DEFF Research Database (Denmark)

    Zacho, Mette; Rafiq, Sulman; Kelbæk, Henning

    2013-01-01

    Hypercoagulability evaluated with thrombelastography (TEG) has been reported to be associated to thrombembolic events in patients undergoing coronary artery bypass graft surgery (CABG). The objective of this study was to test the hypothesis that graft patency and post-CABG thrombembolic events...... are related to the pre-surgical TEG status....

  4. 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.

  5. Comparison of Mid-Term Graft Patency between On-Pump and Off-Pump Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Seki, Tatsuya; Yoshida, Toshihito

    2017-06-20

    Multiple studies have compared on-pump coronary artery bypass (ONCAB) grafting with off-pump coronary artery bypass (OPCAB) grafting, but the optimal surgical strategy has yet to be established. Furthermore, there is limited evidence regarding mid-term graft patency rates. Between April 2001 and March 2014, 365 consecutive patients underwent isolated coronary artery bypass grafting (CABG; male: 75%; mean age: 69 ± 10 years). After propensity-score-matched analysis, we assessed the results of 67 patients in each group (ONCAB: group A, OPCAB: group B). The mean follow-up period of graft patency and survival rate was 35 ± 37 months and 54 ± 47 months, respectively. There were no significant differences in baseline characteristics between the two groups. There was a trend for an increased number of distal anastomoses in group B as compared to group A (group A vs. group B: 3.8 ± 1.1 vs. 4.1 ± 1.6, P = 0.17). The total graft patency rate was tend to be lower in group A, but not statistically significant (group A: 156 months, 45.2%; group B: 96 months, 72.6%; P = 0.21). There was no difference for survival and major-adverse-cardiac-and-cerebrovascular-events (MACCE) free rate (P = 0.42 and 0.76, respectively). Propensity-score-matched analysis revealed no difference in mid-term survival rate, MACCE free rate, graft patency rates, and number of distal anastomoses between ONCAB and OPCAB groups.

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

    Science.gov (United States)

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

    2016-05-01

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

  7. Patency of Saphenous Vein Grafts Using the PAS-Port System During Coronary Artery Bypass Surgery.

    Science.gov (United States)

    Kubota, Hiroshi; Endo, Hidehito; Ishii, Hikaru; Tsuchiya, Hiroshi; Takahashi, Yu; Inaba, Yusuke; Noma, Mio; Yoshimoto, Akihiro; Higuchi, Satoshi; Kohshoh, Hideyasu; Taniai, Seiichi; Ishiguro, Haruhisa; Yoshino, Hideaki; Sudo, Kenichi

    2017-08-01

    Several proximal anastomosis devices have been developed to shorten the time required for a proximal anastomosis and to avoid aortic cross-/side-clamping during coronary artery bypass grafting. This study retrospectively examined the patency of saphenous vein grafts (SVGs) using the PAS-Port System (Cardia Inc, Redwood City, CA). From 2004 to 2014, 451 patients underwent coronary artery bypass graft operations requiring at least 1 proximal anastomosis using a PAS-Port device. A total of 802 PAS-Port devices were used, and 95.0% (762 of 802) were implanted successfully. Among the successfully implanted anastomoses, 76.8% (585 of 762) were evaluated using coronary angiography or multidimensional computed tomography, or both. The evaluations were performed between postoperative days 4 and 3,182 (mean, 319 ± 624 days). The early (1 to 365 days) and the midterm to long-term (more than 366 days) occlusion rates were examined. A complete postoperative clinical course was recorded for 70.7% of the patients. Overall, 93.8% (549 of 585) of the device-dependent SVGs were patent. The patency rates of device-dependent SVGs that were 1, 2, 3, 4, 5, 6, 7, and 8 years old were 90.1% ± 1.8%, 87.1% ± 2.3%, 86.1% ± 2.5%, 82.9% ± 3.3%, 80.6% ± 3.9%, 77.2% ± 5.0%, 77.2% ± 5.0%, and 70.2% ± 8.1%, respectively. The longest follow-up period was 3,182 days (8.7 years). The occlusion rate for device-dependent SVGs tended to decrease as the number of patients accumulated. The PAS-Port system provided acceptable SVG patency and clinical outcome for the early and midterm to long-term. There may be a learning curve for the use of PAS-Port device that affects the device-dependent SVG patency. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. 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...

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

    DEFF Research Database (Denmark)

    Houlind, Kim Christian; Fenger-Grøn, Morten; Juel Holme, Susanne

    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...

  10. One-week postoperative patency of lower extremity in situ bypass graft comparing epidural and general anesthesia

    DEFF Research Database (Denmark)

    Wiis, Julie Therese; Jensen-Gadegaard, Peter; Altintas, Ümit

    2014-01-01

    BACKGROUND: The purpose of this study was to determine whether anesthesia affects graft patency after lower extremity arterial in situ bypass surgery. METHODS: This investigation was a retrospective study using a national database on vascular surgical patients at a single medical institution. We...... under epidural (n = 386) or general (n = 499) anesthesia. Thirty-day mortality (3.4% for epidural anesthesia versus 4.4% general anesthesia; P = 0.414) and comorbidity were comparable in the 2 groups. Graft occlusion within 7 days after surgery was reported in 93 patients, with a similar incidence...... in the epidural (10.1%) and general (10.8%) anesthesia groups (P = 0.730). When examining a subgroup of patients (n = 242) exposed to surgery on smaller vessels (femorodistal in situ bypass procedures, n = 253), the incidence of graft occlusion was also similar in the 2 groups at 14.0% and 9.4%, respectively (P...

  11. Worse clinical outcome but similar graft patency in women versus men one year after coronary artery bypass graft surgery owing to an excess of exposed risk factors in women

    NARCIS (Netherlands)

    Tan, ES; van der Meer, J; de Kam, PJ; Dunselman, PHJM; Mulder, BJM; Ascoop, CAPL; Pfisterer, M; Lie, KI

    1999-01-01

    OBJECTIVES This retrospective study sought to assess differences in graft patency and clinical outcome between women and men after coronary artery bypass graft surgery (CABG). BACKGROUND A less favorable clinical outcome has been reported in women as compared with men. Its relation to graft patency

  12. Off-pump Versus On-pump Coronary Artery Bypass Surgery: Graft Patency Assessment With Coronary Computed Tomographic Angiography: A Prospective Multicenter Randomized Controlled Pilot Study.

    Science.gov (United States)

    Noiseux, Nicolas; Stevens, Louis-Mathieu; Chartrand-Lefebvre, Carl; Soulez, Gilles; Prieto, Ignacio; Basile, Fadi; Mansour, Samer; Dyub, Adel M; Kieser, Teresa M; Lamy, André

    2017-11-01

    A large multicenter randomized trial (RCT) is needed to assess off-pump coronary artery bypass graft (CABG) patency when performed by skilled surgeons. This prospective multicenter randomized pilot study compares graft patency after on-pump and off-pump techniques and addresses the feasibility of such an RCT. Consecutive patients were prospectively recruited for ≥64-slice computed tomography angiography graft patency assessment 1 year after randomization to off-pump or on-pump CABG. Blinded assessment of graft patency was performed, and the results were categorized as normal, ≥50% stenosis, or occlusion. A multilevel model with random effects on the patient was used to account for correlation of results in patients with multiple grafts. A total of 157 patients (3 centers, 84 off-pump and 73 on-pump patients, 512 grafts, assessability rate 98.4%) were included. Patency index (% nonoccluded grafts) was 89% for the off-pump technique and 95% for the on-pump technique (P=0.09). Patency was similar for arterial and vein grafts (both 92%; P=0.88), as well as between target territories (89% to 94%; P=0.53). In this pilot study, 1-year graft patency results after off-pump and on-pump surgery were similar. This feasibility trial demonstrates that a large multicenter RCT to compare CABG patency after on-pump with that after off-pump techniques is feasible and can be reliably undertaken using computed tomography angiography.

  13. 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

  14. Coronary artery bypass grafts: assessment of graft patency and native coronary artery lesions using 16-slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Stauder, Norbert I.; Drosch, Tanja; Claussen, Claus D.; Kopp, Andreas F. [Eberhard-Karls-University, Department of Diagnostic Radiology, Tuebingen (Germany); Kuettner, Axel [Friedrich-Alexander-University, Department of Diagnostic Radiology, Erlangen (Germany); Schroeder, Stephen; Beck, Torsten [Eberhard-Karls-University, Department of Internal Medicine, Division Cardiology, Tuebingen (Germany); Stauder, Heidrun [Eberhard-Karls-University, Department of Thoracic and Cardiovascular Surgery, Tuebingen (Germany); Blumenstock, Gunnar [Eberhard-Karls-University, Department of Medical Information Processing, Tuebingen (Germany)

    2006-11-15

    The objective of this study was to evaluate the accuracy of electrocardiography (ECG)-gated 16-slice multidetector-row computed tomography (MDCT) in detection of stenosis of bypass grafts and native coronary arteries in patients who have undergone coronary artery bypass grafting (CABG). ECG-gated contrast-enhanced MDCT using 12 x 0.75-mm collimation was performed in 20 patients with recurrent angina 4.75 years after undergoing CABG. A total of 50 grafts, 16 arterial and 34 venous, were examined. All graft and coronary segments were evaluated for stenosis in comparison with conventional coronary angiography (CCA). Among the 80 arterial graft segments, 62 could be assessed (77.5%). Sensitivity, specificity, and positive and negative predictive values for stenosis were 96.2%, 97.2%, 96.2%, and 97.2%, respectively. In a total of 180 venous graft segments, 167 could be assessed. Sensitivity, specificity, and positive and negative predictive values for stenosis were 98.5%, 93.9%, 91.8%, and 98.9%, respectively. MDCT could assess 179 of 260 native coronary artery segments (68.8%).Sensitivity, specificity, and positive and negative predictive values for stenosis were 92.1%, 76.9%, 87.5%, and 84.7%, respectively. Sixteen-slice MDCT provides excellent image quality and diagnostic accuracy in detection of graft and coronary artery lesions in patients with suspected graft dysfunction. (orig.)

  15. Effects of low-dose aspirin (50-mg/day), low-dose aspirin plus dipyridamole, and oral anticoagulant agents after internal mammary artery bypass-grafting : Patency and clinical outcome at 1 year

    NARCIS (Netherlands)

    van der Meer, J; de la Rivière, Aart Brutel; van Gilst, Wiek H.; Hillege, Hans L.; Pfisterer, M; Kootstra, G. J.; Dunselmann, P. H. J. M.; MULDER, BJM; Lie, Kong I.

    1994-01-01

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

  16. Coronary Artery Bypass Grafting

    Science.gov (United States)

    ... Health Topics / Coronary Artery Bypass Grafting Coronary Artery Bypass Grafting What Is Coronary artery bypass grafting (CABG) ... multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of the ...

  17. Effects of low dose aspirin (50 mg/day), low dose aspirin plus dipyridamole, and oral anticoagulant agents after internal mammary artery bypass grafting: patency and clinical outcome at 1 year. CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands. Prevention of Coronary Artery Bypass Graft Occlusion by Aspirin, Dipyridamole and Acenocoumarol/Phenprocoumon Study

    NARCIS (Netherlands)

    van der Meer, J.; Brutel de la Rivière, A.; van Gilst, W. H.; Hillege, H. L.; Pfisterer, M.; Kootstra, G. J.; Dunselman, P. H.; Mulder, B. J.; Lie, K. I.

    1994-01-01

    This study was performed to compare the efficacy and safety of aspirin, aspirin plus dipyridamole, and oral anticoagulant agents in the prevention of internal mammary artery graft occlusion. Antithrombotic drugs increase vein graft patency after coronary artery bypass surgery. Their benefit after

  18. Relationship of femorodistal bypass patency to clinical outcome. Iloprost Bypass International Study Group

    DEFF Research Database (Denmark)

    Watson, H R; Schroeder, T V; Simms, M H

    1999-01-01

    To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures.......To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures....

  19. Preliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft.

    Science.gov (United States)

    Handa, Takemi; Katare, Rajesh G; Sasaguri, Shiro; Sato, Takayuki

    2009-08-01

    We developed a new color charge-coupled device (CCD) camera for the intraoperative indocyanine green (ICG) angiography. This device consists of a combination of custom-made optical filters and an ultra-high sensitive CCD image sensor, which can detect simultaneously color and near-infrared (NIR) rays from 380 to 1200 nm. We showed a comparison between our system and other devices for the preliminary experience. We routinely performed both transit-time flowmetry (TFM) and color images for intraoperative assessment, thallium-scintigraphy for the early postoperative assessment, and then angiography after 1-year surgery. We also obtained intraoperative graft flows and images in 116 grafts. Although TFM indicated a graft patency, the CCD camera suspected perfusion failures in four grafts. Also the analysis of the ICG fluorescence intensity showed the significant hypoperfusion at the perfusion territory distal to the anastomosis (graft vs. perfusion territory; 230+/-26 vs. 156+/-13 a.u, P=0.02). When the CCD camera suspected a graft failure, CCD camera and angiography showed a comparable graft failure. The unique device that visualized ICG-enhanced structures against a background of natural myocardial color improved the visibility of abnormality in flow and perfusion. Our findings show that this device may become a standard intraoperative graft and perfusion assessment tool in coronary artery bypass graft (CABG).

  20. Long-term patency of on- and off-pump coronary artery bypass grafting with bilateral internal thoracic arteries: the significance of late string sign development in the off-pump technique.

    Science.gov (United States)

    Hayashi, Yasunari; Maekawa, Atsuo; Sawaki, Sadanari; Tokoro, Masayoshi; Yanagisawa, Junji; Ozeki, Takahiro; Usui, Akihiko; Ito, Toshiaki

    2017-11-01

    This study aimed to examine the effect of off-pump coronary artery bypass grafting (CABG) in patients who underwent revascularization with bilateral internal thoracic arteries (ITAs). Between January 2000 and December 2014, 499 patients underwent isolated CABG with bilateral ITAs for complete revascularization of the left coronary system at our institution. On-pump CABG was performed in 137 patients, and off-pump CABG was performed in 362 patients. We retrospectively compared the clinical outcomes and patency of the ITAs. The off-pump group showed less respiratory failure and required a shorter postoperative stay than the on-pump group. The survival probability, freedom from cardiac events and early graft patency were similar in both groups. Five-year patency of the ITA anastomosed to the left anterior descending artery was significantly greater in the on-pump group than in the off-pump group (98.8% vs 91.2%, P = 0.010). The incidence of string change in the off-pump group was higher than that in the on-pump group (P = 0.017). There was no significant difference between the groups in the 5-year patency of the ITA anastomosed to the left circumflex artery (on-pump group: 93.8%, off-pump group: 91.8%; P = 0.46). The early graft patency and the late patency of the ITA anastomosed to the left circumflex artery between the groups were similar, implying an equivalent quality of anastomoses. However, the patency of the ITA anastomosed to the left anterior descending artery in the off-pump group showed late deterioration, mainly because of string sign development.

  1. Artery Bypass Grafting

    African Journals Online (AJOL)

    Unknown

    nary artery disease (CAD) was coronary artery bypass graft (CAB G) using a segment of saphenous vein interposed between the ascend- ing aorta and the coronary artery distal to the obstructing lesion. This was performed by David Sabiston of Duke University in 1962. With the use of the recently developed technique of ...

  2. Graft Patency in Long-term Survivors after Renovisceral Debranching with VORTEC

    Energy Technology Data Exchange (ETDEWEB)

    Winklehner, Anna, E-mail: anna.winklehner@usz.ch; Nguyen-Kim, Thi Dan Linh, E-mail: thidanlinh.nguyen@usz.ch; Pfammatter, Thomas, E-mail: thomas.pfammatter@usz.ch [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology (Switzerland); Rancic, Zoran, E-mail: zoran.rancic@usz.ch; Mayer, Dieter, E-mail: dieter.mayer@usz.ch; Lachat, Mario, E-mail: mario.lachat@usz.ch [University Hospital Zurich, Clinic for Cardiovascular Surgery (Switzerland); Frauenfelder, Thomas, E-mail: Thomas.Frauenfelder@usz.ch [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology (Switzerland)

    2015-06-15

    PurposeThis study was designed to evaluate retrospectively the long-term stent-graft patency after renovisceral revascularization with Viabahn Open Revascularization Technique (VORTEC) using computed tomography angiography (CTA) and magnetic resonance angiography (MRA).MethodsIn 34 patients (seven women; mean age 72 ± 8 years) with aortic aneurysm, 63 renovisceral vessels (i.e., 54 renal, nine visceral arteries) were revascularized with VORTEC between 2004 and 2009. All patients obtained a pre- and postinterventional CTA and at least one follow-up CTA or MRA after 6 or more months following intervention (median follow up: 43 months). Detection of bypass occlusion, bypass stenosis, infolding, stent-graft fractures and dislocations, and kidney shrinkage were noted by two readers in consensus. Furthermore, mortality during follow-up was assessed using the medical report.ResultsDuring follow-up, 12.6 % of stent-grafts occluded. Cumulative patency rate was 95.2 ± 2.7 % at 12 months, 87.7 ± 4.4 % at 24 and 36 months, and 84.7 ± 5.2 % at 48, 60, 72, 84, and 89 months, respectively. Overall, 19 % of stent-grafts (12/63) developed bypass stenosis (<50 %, 10 stent-grafts; > 50 %, 2 stent-grafts), in one case stenosis (>70 %) was suspected to be hemodynamically significant. No secondary dislocation, no infolding of renovisceral stent-grafts, and no stent-graft fracture occurred. Kidney shrinkage occurred in nine patients, primarily in patients with an occluded Viabahn (n = 7). Eleven patients (32.3 %) died within the follow-up time period.ConclusionsIn long-term survivors after VORTEC cumulative patency rate remained high, and no stent-graft fractures or secondary dislocations occurred.

  3. Meta-analysis of polytetrafluoroethylene bypass grafts to infrapopliteal arteries.

    Science.gov (United States)

    Albers, Maximiano; Battistella, Vinicius Marcus; Romiti, Marcello; Rodrigues, Alfredo Augusto Eyer; Pereira, Carlos Alberto Bragança

    2003-06-01

    Reports of polytetrafluoroethylene (PTFE) bypass grafting to the infrapopliteal arteries have often used survival analysis of acceptable quality to describe a wide range of long-term results. In theory, these results may be combined if variability between series and time intervals is considered. Meta-analysis was performed to gain insight into long-term graft patency and foot preservation after PTFE bypass grafting to infrapopliteal arteries. Studies published from 1982 through 2001 were identified from the PubMed database and pertinent original articles. Three investigators selected 43 studies that used survival analysis, reported 2-year patency rates, and included at least 15 bypass procedures. Data extraction and transformation: Based on standard life-tables or survivor curves, an interval success rate was calculated for each month in each series. The monthly success rates were combined across series, enabling construction of pooled survivor curves. Random-effects meta-analysis yielded 5-year pooled estimates (SE) of 30.5% (7.6%) for primary graft patency, 39.7% (5.5%) for secondary graft patency, and 55.7% (5.0%) for foot preservation. During the entire follow-up, pooled estimates were slightly higher for series of PTFE grafts with adjunctive procedures compared with series of PTFE grafts only. Sensitivity analysis: A simulation using only unfavorable assumptions showed a decrease of less than 5% at 5 years for all outcomes, and smaller differences at subgroup meta-analysis. Funnel plots suggested that publication bias was unlikely. This meta-analysis indicated moderate success for PTFE bypass grafts to infrapopliteal arteries, but the role of adjunctive procedures at the distal anastomosis remains uncertain.

  4. Comparação da perviedade entre artéria radial e veia safena em pacientes em pós-operatório de cirurgia de revascularização miocárdica com retorno dos sintomas Comparison of patency between radial artery and saphenous vein in a coronary artery bypass grafting post operative with return of the symptoms

    Directory of Open Access Journals (Sweden)

    Herbert Coelho Hortmann

    2010-06-01

    Full Text Available OBJETIVO: Comparar a perviedade da artéria radial e veia safena em pacientes com retorno dos sintomas após cirurgia de revascularização do miocárdio (CRVM. MÉTODOS: Estudo retrospectivo. No período de janeiro de 1998 a dezembro de 2005, foram realizadas 469 CRVMs com o uso da artéria radial dentre os enxertos, no Hospital Vera Cruz, em Belo Horizonte/MG. Destes, 94 pacientes apresentaram alterações isquêmicas no pós-operatório recente ou tardio e foram reestudados com cineangiocoronariografia. Os enxertos foram divididos em três grupos: artéria torácica interna (ATI, artéria radial (AR e veia safena (VS, e foram estratificados segundo a gravidade das lesões: sem lesão grave (OBJECTIVE: To compare the radial artery and saphenous vein's patency in patients with recurrence of symptoms in a coronary artery bypass grafting (CABG. METHODS: Retrospective study. From January 1998 to December 2005, 469 CABGs were performed using the radial artery as a graft, in Vera Cruz Hospital in Belo Horizonte/ MG. Among the patients who underwent those surgeries, 94 presented ischemic changes in early or late postoperative period, which led them to be re-evaluated by coronary angiography. The grafts were divided in three groups: internal thoracic artery (ITA, radial artery (RA and saphenous vein (SV, and they were stratified according to the severity of injury: uninjured or patent (< 70%, severe obstruction (70 to 99% and occlusion. RESULTS: For the 94 patients in the study, 86 grafts of ITA, 94 of RA and 111 of SV were used. For the 86 ITA grafts, 73 (84.88% were found patent. For the 94 RA grafts, 55 (58.51% were found patent, and for the 111 SV grafts, 73 (65.76% were uninjured. A statistically significant difference (P= 0.001 was found between RA and SV grafts, with a higher patency found for VS graft. For the RA grafts, women presented a worse result concerning the RA patency (65.7% and 40.7%, with P = 0.006. Concerning coronary

  5. Heparin-bonded expanded polytetrafluoroethylene vascular graft for femoropopliteal and femorocrural bypass grafting: 1-year results.

    Science.gov (United States)

    Bosiers, Marc; Deloose, Koen; Verbist, Jürgen; Schroë, Herman; Lauwers, Geert; Lansink, Wouter; Peeters, Patrick

    2006-02-01

    Several prosthetic materials have been used for femoropopliteal bypass grafting in patients with peripheral vascular disease in whom a venous bypass is not possible. Expanded polytetrafluoroethylene (ePTFE) is the most commonly used, but patency results have not always equaled those achieved with vein, especially in below-knee reconstructions. This study assessed the performance of a new heparin-bonded ePTFE vascular graft that was designed to provide resistance to thrombosis and thereby decrease early graft failures and possibly prolong patency. From June 2002 to June 2003, 86 patients (62 men and 24 women; mean age, 70 years; 99 diseased limbs) were enrolled prospectively in a nonrandomized, multicenter study of the heparin-bonded ePTFE graft. Fifty-five above-knee and 44 below-knee (including 21 femorocrural) procedures were performed. Follow-up evaluations consisted of clinical examinations, ultrasonographic studies, and distal pulse assessments. Patency and limb salvage rates were assessed by using life-table analyses. All grafts were patent immediately after implantation. There were no graft infections or episodes of prolonged anastomotic bleeding. During the 1-year follow-up, 10 patients died, 15 grafts occluded, and 5 major amputations were performed. The overall primary and secondary 1-year patency rates were 82% and 97%, respectively. The limb salvage rate in patients with critical limb ischemia (n = 41) was 87%. Primary patency rates according to bypass type were 84%, 81%, and 74% for above-knee femoropopliteal, below-knee femoropopliteal, and femorocrural bypasses, respectively; the corresponding secondary patency rates were 96%, 100%, and 100%. In this study, the heparin-bonded ePTFE graft provided promising early patency and limb salvage results, with no device-related complications, in patients with occlusive vascular disease. Longer-term and randomized studies are warranted to determine whether this graft provides results superior to those achieved

  6. Three-dimensional computed tomography angiography of coronary artery bypass graft with electron beam tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hoshi, Toshiko; Yamauchi, Tatsuo; Kanauchi, Tetsu; Konno, Miyuki; Imai, Kamon; Suwa, Jiro; Onoguchi, Katsuhisa; Hashimoto, Kazuhiro; Horie, Toshinobu [Saitama Cardiovascular and Respiratory Center, Konan (Japan)

    2001-10-01

    Assessment of coronary artery bypass graft patency by three-dimensional reconstructed computed tomography angiography (3D-CTA) derived from electrocardiography-gated contrast-enhanced electron beam tomography (EBT) was evaluated. Thirty-nine patients with 99 grafts (45 arterial grafts and 54 venous grafts) underwent 3D-CTA and selective coronary angiography within a 3-week interval. 3D-CTA images of the coronary bypass grafts were compared with the coronary angiography images used as the control. 3D-CTA defined 42 of 44 arterial grafts as patent (sensitivity: 95%), all 47 venous grafts as patent (sensitivity: 100%) and all 7 venous grafts as occlusive (specificity: 100%). The overall sensitivity and specificity were 98% and 88%, respectively. 3D-CTA is an useful noninvasive technique with adequate sensitivity and specificity to assess coronary artery bypass graft patency. (author)

  7. Artery Bypass Grafting

    African Journals Online (AJOL)

    development of CABG without CPB as occurring in three stages. Figure 1: The early stage: Grafts were limited to ... This interest led to the development of techniques such as mini- mally invasive direct coronary artery surgery (MIDCAB), surgery ... Diazepam 0.1 rng/kg P0. Cyclimorph 0.lmg/kg IMI on call to theatre. Theatre ...

  8. Coronary arteries bypass grafting stenosis

    Directory of Open Access Journals (Sweden)

    Mahmoud Ebrahimi

    2014-12-01

    Full Text Available Coronary artery disease (CAD is a major global problem. In addition, it is higher risk of mortality for women more than men are when develop in female gender Atherosclerotic plaques consist of deposits of fatty material in the tunica intima. The role of inflammatory process in CAD has been known from 1980’s. Several studies investigated the innate immunity and adaptive immunity roles in atherosclerosis and they concluded that it plays a key role in atherosclerosis. Coronary artery bypass grafting (CABG is a widely used method for the treatment of CAD. Based on the literature, CABG is the most common surgical operation done worldwide. In During the first 10 years after CABG, up to 50% of saphenous grafts will occlude. Graft restenosis is beginning with acute thrombosis, intima hyperplasia, and plaque formation. In this review, some molecular pathways of graft failure and restenosis such as apoptosis and nuclear factor kappa B (NF-ĸB are described.

  9. Impact of proximal radiopaque coronary bypass graft markers on postbypass surgery coronary angiography.

    Science.gov (United States)

    Pingpoh, Clarence; Siepe, Matthias; Burger, Katharina; Zietak, Thomas; Valina, Christian M; Ferenc, Miroslav; Beyersdorf, Friedhelm; Neumann, Franz-Josef; Hochholzer, Willibald

    2017-12-19

    Implantation of radiopaque bypass graft markers during coronary artery bypass surgery (CABG) has the potential of facilitating subsequent coronary angiography. This study sought to investigate the impact of proximal coronary bypass graft markers on angiographic outcomes during subsequent coronary angiography in a large cohort. Between 2005 and 2016, we enrolled 1378 patients (331 with and 1047 without bypass graft markers) with a history of CABG who underwent their first subsequent coronary angiography at our institution. Primary endpoints were radiation time and absolute amount of contrast media used. In unadjusted analyses, radiation time, duration of angiography, dose area product, and the amount of contrast agent were significantly lower in patients with proximal bypass graft markers (P bypass graft markers remained a significant predictor for less radiation time and a lower consumption of contrast agent but not for dose area product, which was mainly associated with body mass index and sex. Bypass graft markers were not associated with a lower graft patency. Radiopaque coronary bypass graft markers can improve the detection of bypass grafts during subsequent coronary angiography and are associated with a lower radiation time and less consumption of contrast agent. Thus, this easy and cost-efficient technique might significantly reduce the risk of coronary angiography after CABG. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  10. Clinical trials and graft patency data in coronary artery surgery--a 30-year perspective.

    Science.gov (United States)

    Buxton, Brian F; Fuller, John

    2004-01-01

    The treatment of coronary artery disease, initially by medical and surgical and subsequently using percutaneous interventions, has evolved rapidly over the last 50 years. Randomized controlled clinical trials and observational studies of large cohorts have been instrumental in the evolution of the current practice of coronary artery revascularisation. This paper traces some of the historic trials of medical versus surgical therapy, surgical versus percutaneous intervention and graft patency studies. Medical therapy and percutaneous intervention are now the primary therapeutic modalities. However, there was an early recurrence rate with percutaneous intervention which has decreased with the use of drug-eluting stents. Coronary artery bypass surgery remains a major option for treating advanced coronary artery disease. Furthermore, it remains the treatment of first choice in most patients with left main coronary artery disease and those with extensive three-vessel proximal coronary artery disease, especially when associated with poor left ventricular function. The choice of a coronary artery bypass conduit is of major importance in developing a single long-term strategy for the surgical treatment of coronary artery disease. Bilateral internal thoracic artery grafting is now accepted as the treatment of choice, although not universally practiced. The role of other arterial conduits is being defined.

  11. 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

  12. Do distal arteriovenous fistulae improve patency rates of prosthetic infrapopliteal arterial bypasses?

    Science.gov (United States)

    Syrek, J R; Calligaro, K D; Dougherty, M J; Raviola, C A; Rua, I; DeLaurentis, D A

    1998-03-01

    We retrospectively analyzed if distal anastomotic adjunctive arteriovenous fistulae (AVF) improved patency rates of prosthetic bypasses to infrapopliteal arteries. Between July 1, 1991 and June 30, 1996, we performed 43 polytetrafluoroethylene (PTFE) bypasses to infrapopliteal (19 peroneal, 13 anterior tibial, 11 posterior tibial) arteries. All bypasses were performed for limb salvage when autologous vein was not available for a conduit. Adjunctive AVFs were performed in 21 bypasses (PTFE-AVF) and 22 bypasses did not have a fistula (PTFE-ONLY). Patients were allocated to the PTFE-AVF or PTFE-ONLY groups at the discretion of the surgeons, with adjunctive AVFs being performed for small arteries with poor run-off. There were no significant differences in age, sex, site of the proximal anastomosis, or indication for surgery (p > 0.05). There were statistically significant differences in the site of distal anastomosis and quality of arterial run-off based on the Society for Vascular Surgery Ad Hoc Committee on Reporting Standards criteria (p 0.05) and secondary (61% versus 48%) (p > 0.05) patency rates in the PTFE-AVF group versus the PTFE-ONLY group, although limb salvage rates were similar (74% versus 71%) (p > 0.05). Two AVFs required ligation because of steal resulting in diminished distal perfusion. These results support the use of adjunctive distal AVFs to improve overall two-year patency rates of prosthetic infrapopliteal arterial bypasses.

  13. Prospective randomized study of carbon-impregnated polytetrafluoroethylene grafts for below-knee popliteal and distal bypass: results at 2 years. The Association Universitaire de Recherche en Chirurgie.

    Science.gov (United States)

    Bacourt, F

    1997-11-01

    The purpose of this prospective randomized multicenter study is to compare patency for a new carbon-impregnated polytetrafluoroethylene (PTFE) graft and standard PTFE grafts. One hundred and sixty patients presenting severe chronic ischemia of the lower extremity were recruited at 17 centers of the French Association Universitaire de Recherche en Chirurgie. Eighty-one carbon-impregnated graft and 79 standard grafts were implanted. The procedure consisted of below-knee femoropopliteal bypass in 83 cases and femorodistal bypass in 77 cases. The minimum duration of the follow-up period was 2 years. Twenty-four patients died during the study. The actuarial primary patency rate, actuarial secondary patency rate, and limb salvage rate were 45%, 53%, and 57% respectively in the carbon-impregnated PTFE group and 35%, 36%, and 47% respectively in the standard PTFE group. The carbon-impregnated graft appeared to achieve better patency than the standard graft but the difference was not statistically significant. Since there was no difference up to 12 months, the study will be continued to determine if further follow-up confirms these findings. In this study we also assessed factors contributing to patency of below-knee prosthetic bypass grafts. Only two factors had a significant influence on patency, i.e., ankle/arm pressure difference greater than 0.25 as opposed to ankle/arm pressure difference less than 0.25 (p < 0.01) and below-knee femoropopliteal bypass as opposed to femorodistal bypass (p < 0.001).

  14. Prevalence of claustrophobia and magnetic resonance imaging after coronary artery bypass graft surgery

    OpenAIRE

    Katznelson, Rita; Djaiani, George N; Minkovich, Leonid; Fedorko, Ludwik; Carroll, Jo; Borger, Michael A; Cusimano, Robert J; Karski, Jacek

    2008-01-01

    Background The purpose of this study was to determine the prevalence of claustrophobia in patients undergoing magnetic resonance imaging (MRI) after coronary artery bypass graft (CABG) surgery. Methods After IRB approval, we conducted a substudy of a prospective randomized controlled clinical trial of 311 patients evaluating administration of tranexamic acid and early saphenous vein graft patency with MRI after conventional CABG surgery. Chest tube drainage was measured at 6, 12, and 24 hours...

  15. A 16-slice multidetector computed tomography protocol for evaluation of the gastroepiploic artery grafts in patients after coronary artery bypass surgery

    NARCIS (Netherlands)

    Dorgelo, J; Willems, TP; van Ooijen, PMA; Panday, GFV; Boonstra, PW; Zijlstra, F; Oudkerk, M

    Arterial coronary bypass grafts [internal mammary arteries and gastroepiploic artery (GEA)] are in widespread use for coronary surgery. Since selective catheterisation of the GEA graft to monitor patency, is often unsuccessful, a non-invasive protocol to visualise the GEA-graft from origin to

  16. Flow characteristics in narrowed coronary bypass graft

    Energy Technology Data Exchange (ETDEWEB)

    Bernad, S. I. [Romanian Academy – Timisoara Branch, Mihai Viteazul Str. 24, RO-300223, Timisoara (Romania); Bosioc, A.; Totorean, A. F. [University Politehnica of Timisoara, Department of Hydraulic Machinery, Mihai Viteazul Str. 1, RO-300222, Timisoara (Romania); Bernad, E. S.; Petre, I. [University of Medicine and Pharmacy Victor Babes Timisoara, P-ta Eftimie Murgu, 2, Timisoara (Romania)

    2016-06-08

    Tortuous saphenous vein graft (SVG) hemodynamics was investigated using computational fluid dynamics (CFD) techniques. Computed tomography (CT) technology is used for non-invasive bypass graft assessment 7 days after surgery. CT investigation shown two regions with severe shape remodelling first is an elbow type contortion and second is a severe curvature with tortuous area reduction. In conclusion, the helical flow induced by vessel torsion may stabilize the blood flow in the distal part of the SVG, reducing the flow disturbance and suppressing the flow separation, but in the distal end of the graft, promote the inflammatory processes in the vessels.

  17. Infrascrotal, perineal, femorofemoral bypass for arterial graft infection at the groin.

    Science.gov (United States)

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

    2004-12-01

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

  18. Minimally invasive coronary artery bypass grafting: a systematic review.

    Science.gov (United States)

    Kikuchi, Keita; Mori, Makoto

    2017-06-01

    To minimize surgical morbidity in coronary artery bypass grafting, minimally invasive cardiac surgery has gained popularity. Minimally invasive coronary artery bypass grafting offers unique advantages compared to conventional off-pump coronary artery bypass or minimally invasive direct coronary artery bypass in that it enables the surgeon to harvest and graft bilateral internal thoracic arteries via a small thoracotomy while being conducted completely off-pump. This review focuses on current evidence behind off-pump coronary artery bypass, multi-arterial revascularization, patient populations that would most benefit from bilateral internal thoracic artery minimally invasive coronary artery bypass grafting, the surgical technique, and early outcomes. By overcoming the perceived inability to utilize bilateral internal thoracic arteries in minimally invasive coronary artery bypass grafting, the new technique further expands the armamentarium of surgeons and cardiologists. Hybrid coronary revascularization with bilateral internal thoracic artery minimally invasive coronary artery bypass grafting further augments the appeal of the next generation of minimally invasive cardiac surgery.

  19. Transit-time flow measurement as a predictor of coronary bypass graft failure at one year angiographic follow-up

    DEFF Research Database (Denmark)

    Lehnert, Per; Møller, Christian H; Damgaard, Sune

    2015-01-01

    BACKGROUND: Transit-time flow measurement (TTFM) is a commonly used intraoperative method for evaluation of coronary artery bypass graft (CABG) anastomoses. This study was undertaken to determine whether TTFM can also be used to predict graft patency at one year postsurgery. METHODS: Three hundred...... forty-five CABG patients with intraoperative graft flow measurements and one year angiographic follow-up were analyzed. Graft failure was defined as more than 50% stenosis including the "string sign." Logistic regression analysis was used to analyze the risk of graft failure after one year based...

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

    Science.gov (United States)

    2013-01-01

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

  1. [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.

  2. 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.

  3. [Indices of intraoperative flowmetry, determining patency of grafts in the remote period after revascularization of the right coronary artery].

    Science.gov (United States)

    Bazylev, V V; Nemchenko, E V; Pavlov, A A; Karnakhin, V A

    2016-01-01

    The authors studied the threshold values of ultrasound flowmetry concerning composite T-grafts, combined I-grafts, and autovenous shunts during revascularization of the right coronary artery (RCA), determining high risk for the development of shunt occlusion in the remote postoperative period. The retrospective study included a total of 223 patients subjected to revascularization of the RCA's basin with the help of composite T-grafts, combined I-grafts, and autovenous shunts. Depending on the method of bypass grafting of the RCA and its branches, all patients were subdivided into 3 groups: Group 1 was composed of 65 patients in whom the RCA basin was revascularized by a branch of the composite T-graft, Group 2 comprised 112 patients who endured autovenous aortocoronary bypass grafting, and Group 3 consisted of 46 patients in whom the RCA basin was shunted by a combined mammarovenous I-graft. The groups had no statistically significant differences on the main clinical and demographic parameters. Intraoperative assessment of the blood flow through the coronary shunts was carried out by means of ultrasound flowmetry. The remote results were evaluated based on the findings of the control coronaroshuntography which was carried out in all patients within the terms varying from 16 to 43 months. In the remote period in Group 1 patients (T-graft), 59 (90%) mammary shunts were patent, in Group 2 - 99 (88.4%) autovenous shunts, and in Group 3 (I-graft) 42 (95.5%) shunt were patent. Cumulative probability of freedom from shunt occlusion within the terms up to 3 years after surgery in Group 1 amounted to 82±0.5%, in Group 2 to 58±2.1%, and in Group 3 to 86±1.9%, with the differences between Group 2 and other groups being statistically significant (p=0.01). The Poisson regression analysis showed that the risk for graft occlusion increased by 10% with the resistance index in the branch of the T-graft from 4.0; by 8% with the resistance index in the autovein from 2.9; and by 3

  4. Bioabsorbable bypass grafts biofunctionalised with RGD have enhanced biophysical properties and endothelialisation tested in vivo

    Directory of Open Access Journals (Sweden)

    Larisa V Antonova

    2016-05-01

    Full Text Available Small diameter arterial bypass grafts are considered as unmet clinical need since the current grafts have poor patency of 25% within 5 years. We have developed a 3D scaffold manufactured from natural and synthetic biodegradable polymers, poly(3-hydroxybutyrate-co-3-hydroxyvalerate (PHBV and poly(ε-caprolactone (PCL, respectively. Further to improve the biophysical properties as well as endothelialisation, the grafts were covalently conjugated with arginine-glycine-aspartic acid (RGD bioactive peptides. The biophysical properties as well as endothelialisation of PHBV/PCL and PCL 2 mm diameter bypass grafts were assessed with and without biofunctionalisation with RGD peptides in vitro and in vivo. Morphology of the grafts was assessed by scanning electron microscopy, whereas physico-mechanical properties were evaluated using a physiological circulating system equipped with a state of art ultrasound vascular wall tracking system. Endothelialisation of the grafts in vitro and in vivo were assessed using a cell viability assay and rat abdominal aorta replacement model, respectively. The biofunctionalisation with RGD bioactive peptides decreased mean fiber diameter and mean pore area in PHBV/PCL grafts; however, this was not the case for PCL grafts. Both PHBV/PCL and PCL grafts with RGD peptides had lower durability compared to those without; these durability values were similar to those of internal mammary artery. Modification of PHBV/PCL and PCL grafts with RGD peptides increased endothelial cell viability in vitro by a factor of 8 and enhanced the formation of an endothelial cell monolayer in vivo one month postimplantation. In conclusion, PHBV/PCL small-caliber graft can be a suitable 3D scaffold for the development of a tissue engineering arterial bypass graft.

  5. Robotically-Assisted Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Thierry A. Folliguet

    2010-01-01

    Full Text Available Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB, and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB grafting. Nine patients (16% were converted to open techniques. The mean total operating time for TECAB was 372±104 minutes and for MIDCAB was 220±69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50% in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results.

  6. Computational model of blood flow in the aorto-coronary bypass graft

    Directory of Open Access Journals (Sweden)

    Ghista Dhanjoo N

    2005-03-01

    Full Text Available Abstract Background Coronary artery bypass grafting surgery is an effective treatment modality for patients with severe coronary artery disease. The conduits used during the surgery include both the arterial and venous conduits. Long- term graft patency rate for the internal mammary arterial graft is superior, but the same is not true for the saphenous vein grafts. At 10 years, more than 50% of the vein grafts would have occluded and many of them are diseased. Why do the saphenous vein grafts fail the test of time? Many causes have been proposed for saphenous graft failure. Some are non-modifiable and the rest are modifiable. Non-modifiable causes include different histological structure of the vein compared to artery, size disparity between coronary artery and saphenous vein. However, researches are more interested in the modifiable causes, such as graft flow dynamics and wall shear stress distribution at the anastomotic sites. Formation of intimal hyperplasia at the anastomotic junction has been implicated as the root cause of long- term graft failure. Many researchers have analyzed the complex flow patterns in the distal sapheno-coronary anastomotic region, using various simulated model in an attempt to explain the site of preferential intimal hyperplasia based on the flow disturbances and differential wall stress distribution. In this paper, the geometrical bypass models (aorto-left coronary bypass graft model and aorto-right coronary bypass graft model are based on real-life situations. In our models, the dimensions of the aorta, saphenous vein and the coronary artery simulate the actual dimensions at surgery. Both the proximal and distal anastomoses are considered at the same time, and we also take into the consideration the cross-sectional shape change of the venous conduit from circular to elliptical. Contrary to previous works, we have carried out computational fluid dynamics (CFD study in the entire aorta-graft-perfused artery domain

  7. Patency rates of three arterial grafting patterns to the left anterior descending and diagonal coronary arteries in symptomatic patients.

    Science.gov (United States)

    Brueck, Martin; Kramer, Wilfried; Vogt, Paul R; Daniel, Werner G; Tillmanns, Harald; Ludwig, Josef

    2003-04-01

    The use of internal thoracic arteries is an established method for treating coronary artery disease because of their excellent long-term patency rates. However, these results mainly referred to the left internal thoracic artery (LITA) grafted to the left anterior descending coronary artery (LAD). The aim of this study was to compare the patency rate of the LITA after its placement to the diagonal branch. A total of 302 patients (median age 65 years) with previous arterial revascularization were retrospectively enrolled in the study. We compared LITA grafts to the LAD with those to the diagonal branch and with sequential LITA grafts to both vessels with respect to the patency rate over a median follow-up of 39 months after prior operation. Angiography was performed for recurrent angina. The average occlusion/stenosis rate of saphenous vein and LITA grafts were 43.1% and 14.1%, respectively (p < 0.0001). Of the 302 patients, 248 had received a single LITA graft to the LAD; 21 patients, a single LITA graft to the diagonal branch; and 33 patients, a sequential LITA graft to both vessels. Thirty-three LITA grafts to the LAD (13.3%), three LITA grafts to the diagonal branch (14.3%), and six sequential LITA grafts to the LAD and the diagonal branch (18.2%) were occluded or stenosed more than 50%, respectively (p = 0.68). Seventy-nine percent of LITA graft stenoses were located at the peripheral anastomosis. Patency of single LITA grafts to the diagonal branch or sequential LITA grafts to the LAD and diagonal branch were comparable to single LITA grafts to the LAD. Most stenoses of LITA grafts were located at peripheral anastomoses.

  8. What to Expect during Coronary Artery Bypass Grafting

    Science.gov (United States)

    ... an illustration, go to the Health Topics Heart Surgery article. The surgeon will take an artery or vein from your body—for example, from your chest or leg—to use as the bypass graft. For surgeries with several bypasses, both artery and vein grafts ...

  9. Outcomes of coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Anna Louise Hawkes

    2006-12-01

    Full Text Available Anna Louise Hawkes1,3, Madeleine Nowak1, Benjamin Bidstrup2, Richard Speare11School of Public Health, Tropical, Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia (3Currently Queensland Cancer Fund; 2John Flynn Hospital, Gold Coast, Queensland, AustraliaAbstract: This review article summarizes the major studies that have investigated the outcomes of coronary artery bypass graft surgery (CABG. The article includes a review of the literature in the areas of: history of CABG; indications for CABG; and measurement of quality of life following CABG, including prolongation of life, physical functioning (ie, relief from angina and dyspnea, physical activity, as well as complications of surgery and re-hospitalization, psychological functioning, and social functioning. Overall, the literature demonstrates that the outcomes of CABG have historically been measured in terms of mortality and morbidity; however, it has now been well recognized that adjustment to CABG is a multidimensional phenomenon that is not fully explained by medical factors. Therefore, in addition to studying mortality and morbidity outcomes following CABG, many recent studies have identified that it is important to investigate various physical, psychological, and social variables that have a significant impact on post-operative adjustment to CABG. Keywords: coronary artery bypass graft surgery, outcomes, quality of life, recovery

  10. Coronary bypass grafting without use of cardiopulmonary bypass for dextrocardia.

    Science.gov (United States)

    Mujanovic, Emir; Bergsland, Jacob; Tursic, Ademir; Stanimirovic-Mujanovic, Sanja; Kabil, Emir

    2011-01-01

    Dextrocardia is a condition in which the heart is pointed toward the right side of the chest instead of normally pointing to the left. The rate of atherosclerotic heart disease in subjects with this condition is similar to that of the general population. We present a patient with situs inversus totalis with dextrocardia who underwent coronary artery bypass grafting without use of cardiopulmonary bypass (OPCAB). A 74-year-old man who was known to have dextrocardia with situs inversus was admitted to the hospital because of angina. Coronary angiography was performed and showed ostial occlusion of the left anterior descendng artery (LAD) unsuitable for percutaneous coronary interventions but collatereralised from the right coronary artery. Patient underwent OPCAB under general anestesia. Right internal mammary artery was anastomosed to LAD on the beating heart with the surgeon standing on the right side of the patient. The patient's post-operative course was uneventful, and he was discharged on the 6th postoperative day in good condition. Performing OPCAB surgery is not technically more demanding, and present no unusual challenge on patients with dextrocardia.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time pa...

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

    Science.gov (United States)

    Sankaran, Sethuraman; Marsden, Alison

    2010-11-01

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

  13. The efficacy of aspirin and dipyridamole on the patency of arteriovenous fistulae and grafts; Review of the randomized control trials

    Directory of Open Access Journals (Sweden)

    Hasan Ravari

    2014-07-01

    Full Text Available Vascular access failure is known as a principal cause of morbidity of end stage renal disease (ESRD patients. The major reason for vascular access failure is the neointimal hyperplasia which leads to venous thrombosis and stenosis. The efficacy of different pharmacological therapies has been studied in increasing the vascular access patency duration or decreasing the thrombosis of arteriovenous grafts or fistulas. In the current review, we reviewed the results obtained in different randomized control trials considering the efficacy of pharmacotherapy on the thrombosis rate and duration of vascular access grafts patency in HD patients.

  14. Primary and secondary patencies of transposed femoral vein fistulas are significantly greater than with the HeRO graft.

    Science.gov (United States)

    Ladenheim, Eric D; Lulic, Dzenan; Lum, Craig; Agrawal, Sid

    2017-05-15

    For access-challenged patients with bilateral upper extremity central venous stenosis, solutions include the Hemodialysis Reliable Outflow (HeRO) device or an autogenous AV fistula in the lower limb. We evaluated HeRO grafts and transpositions of the femoral vein in maintaining primary and secondary patency. We retrospectively analyzed 40 patients with a HeRO device and 18 patients with superficial femoral artery to transposed femoral vein autogenous arteriovenous fistula (SFA-tFV). All patients had bilateral central venous obstruction. All procedures were outpatient performed by a single surgeon at one center between 2009-2015. Operative details, intraoperative flows, and flows at the first-week postoperative visit were analyzed, as were primary and secondary patency and intervention rates. Complications were compared between groups. The one-year cumulative primary patency was 30% for HeRO grafts and 79% for SFA-tFV fistulas (p = 0.0001); secondary patency was 71% for HeRO grafts and 93% for SFA-tFV fistulas (p = 0.03). To maintain patency, HeRO patients required a mean 2.1 interventions per year and thigh fistula patients required a mean 0.4 interventions per year. Thirty-seven percent of thigh fistula patients had a hematoma or seroma versus 5% of HeRO patients and 17% of thigh fistula patients experienced delayed wound healing versus 2.5% of HeRO patients (pHeRO patients had lower primary and secondary patency rates versus thigh fistula patients and HeRO grafts required five-fold more interventions to maintain secondary patency. However, patients with thigh fistulas had significantly more wound healing problems. Thus, the SFA-tFV has become our access of choice for patients with bilateral central venous stenosis.

  15. Use of arm and lesser saphenous vein compared with prosthetic grafts for infrapopliteal arterial bypass: are they worth the effort?

    Science.gov (United States)

    Calligaro, K D; Syrek, J R; Dougherty, M J; Rua, I; Raviola, C A; DeLaurentis, D A

    1997-12-01

    Arm and lesser saphenous veins (ALSVs) are generally considered to be the best alternative for infrapopliteal arterial bypass grafts when greater saphenous vein is not available. The need for additional incisions and repositioning of the patient, along with occasional use of general anesthesia for arm vein harvesting, led to our perception that the use of ALSVs increased operative time and possibly patient discomfort. Therefore, we compared the outcome of ALSVs with that of prosthetic infrapopliteal arterial bypass procedures performed at our hospital. Between July 1, 1991, and Dec. 31, 1996, we performed 96 infrapopliteal arterial bypass procedures using 45 ALSVs (28 arm vein, 17 lesser saphenous) and 51 polytetrafluoroethylene (PTFE) grafts. Seventy grafts were single-length ALSV or PTFE bypass grafts, and 26 grafts were placed as the distal segment of a sequential or composite bypass graft. Every attempt was made to use ALSV and avoid the use of PTFE, even if a short segment of the vein graft measured less than 4.0 mm in diameter. There were no significant differences between patients with ALSV compared with PTFE grafts in terms of age, sex, indication for surgery, or number of previous revascularization procedures (2.1 vs 1.7), respectively (p > 0.05). However, ALSV grafts had more factors associated with an expected worse outcome: they were more commonly anastomosed to pedal arteries (17% [8 of 45] vs 0%; p = 0.0009), less commonly single-segment grafts (62% [28 of 45] vs 82% [42 of 51]; p = 0.03), had higher average runoff resistance values (2.3 vs 1.5; p = 0.001), and were less frequently treated with lifelong warfarin (65% [29 of 45] vs 95% [48 of 51]; p = 0.0001). The hospital mortality rate was 3.1% (3 of 96; 3 PTFE). All deaths were cardiac-related. Despite the potential factors associated with worse patency rates for ALSVs, 2-year assisted primary patency rates tended to be higher for arm veins (46%) than for lesser saphenous veins (23%) and PTFE grafts

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

    DEFF Research Database (Denmark)

    Kremke, Michael; Jensen, Mariann Tang; 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...

  17. One-dimensional Arterial Network Model for Bypass Grafts Assessment

    CERN Document Server

    Ghigo, Arthur; Wang, Xiaofei; Lagrée, Pierre-Yves; Fullana, Jose-Maria

    2016-01-01

    We propose an arterial network model based on 1D blood hemodynamic equations to study the behavior of different vascular surgical bypass grafts in case of an arterial occlusive pathology: an obliteration or stenosis of the iliac artery. We investigate the performances of three different bypass grafts (Aorto-Femoral, Axillo-Femoral and cross-over Femoral) depending on the degree of obliteration of the stenosis. Numerical simulations show that all bypass grafts are efficient since we retrieve in all cases the normal hemodynamics in the stenosed region while ensuring at the same time a global healthy circulation. We analyze in particular the Axillo-Femoral bypass graft by performing hundreds of simulations by varying the values of the Young's modulus [0.1--50 MPa] and the radius [0.01--5 cm] of the bypass graft. We show that the Young's modulus and radius of commercial bypass grafts are optimal in terms of hemodynamic considerations. The numerical findings prove that this approach could be used to optimize or pl...

  18. Coronary artery bypass grafting in octogenarians.

    Science.gov (United States)

    Sakamoto, S; Matsubara, J; Matsubara, T; Nagayoshi, Y; Nishizawa, H; Shouno, S; Kouno, M; Takeuchi, K; Nonaka, T

    2001-10-01

    Preoperative profiles, postoperative complications, and the early and late results in 32 patients 80 yrs. of age and older (elderly group) who underwent coronary artery bypass grafting were compared with those in patients under 80 yrs. of age (control group). In the elderly group, the prevalence of patients with preoperative creatinine clearance (Ccr.) <50 l/day (34.4%), unstable angina pectoris (78.1%) and left main trunk disease (40.1%) was significantly higher than those in the control group. The incidences of arrhythmia and intensive care unit(ICU) syndrome were also significantly higher in the elderly group than in the control group, however, there was no death due to these complications. In the elderly group, one patient (3.1%) died in the hospital due to low cardiac output syndrome (LOS), while three patients (2.4%) of the control group died in the hospital. As for the long-term results, the 5-yr. survival rates for the elderly group and the control group were 82.6% and 85.2%, respectively, and the effectiveness of surgery was remarkable, with improved postoperative activity in 96.9% of the elderly group. These findings indicate that although the elderly patients have higher risks by undergoing surgery and have a disadvantage in the rate of postoperative complications, the postoperative improvement in activity and survival rate can be similar to those in the younger patients.

  19. Left Atrial Myxoma Following Coronary Artery Bypass Grafting with Patient Coronary Arterial Grafts: a Rarity.

    Science.gov (United States)

    Patel, Kartik; Rahul, Kumar; Tarsaria, Malkesh; Malhotra, Amber

    2017-01-01

    The development of left atrial myxoma after coronary artery bypass graft surgery is a rare entity. A 60-year-old man with previous off-pump coronary artery bypass grafting four years ago with patent coronary grafts was diagnosed with left atrial mass. The patient underwent successful resection of the same through minimally invasive right anterolateral thoracotomy. Histopathology of the atrial mass confirmed the diagnosis of atrial myxoma.

  20. Beating heart axillocoronary bypass for management of the untouchable ascending aorta in coronary artery bypass grafting.

    Science.gov (United States)

    Bonatti, J; Hangler, H; Oturanlar, D; Posch, L; Müller, L C; Voelckel, W; Schwarz, B; Bodner, G

    1999-11-01

    Cannulation and clamping of a severely atherosclerotic ascending aorta during coronary artery bypass grafting (CABG) can lead to cerebral embolization of atheromatous debris and should therefore be avoided whenever possible. A variety of surgical techniques including performance of extraanatomical coronary bypass conduits has been described to solve this problem. We report on a preliminary series of four patients in whom the axillary artery was used as an inflow vessel for venous coronary artery bypass grafts which were performed on the beating heart in order to achieve an aortic no touch concept. The axillary artery was exposed between the pectoralis major muscle and the deltoid muscle via an infraclavicular incision. A saphenous vein graft of at least 40 cm in length was sutured to the axillary artery and then brought into the pericardial cavity following an intercostal and transpleural route. The graft was anastomosed to the target vessel using local coronary occlusion. The procedure was carried out via sternotomy in three patients who also received additional internal mammary artery in situ grafts for adequate coronary revascularization. In one high risk patient an isolated axillocoronary bypass was performed in a minimally invasive fashion via anterolateral minithoracotomy. The procedure was completed without major technical difficulties in all four patients. The mean graft length required was 33.2 +/- 1.6 cm, postoperative ultrasonic duplex scans of the axillocoronary grafts revealed a mean flow of 62.5 +/- 23.6 ml/min. No stroke or brachial plexus injury occurred. Three patients are in angina class I (Canadian Cardiovascular Society Classification), one patient is in class II postoperatively. After a mean follow-up of 11.5 +/- 6.6 months postoperatively all grafts remain patent. Axillocoronary bypass grafting can be easily performed for management of the untouchable ascending aorta. Straightforward surgical technique and the accessibility to noninvasive

  1. Reinforced long saphenous vein bypass graft for infrainguinal reconstruction procedures: case series and literature review.

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2006-03-01

    Poor rehabilitation rates and the high-cost of managing postamputation patients justify an aggressive revascularization policy in critical lower limb ischemia. Endovascular therapy is our first choice for limb salvage in these patients. However there are patients for whom endovascular therapy is not feasible. When bypass is necessary, autologous vein is a superior conduit to synthetic material. However, varicosities usually contraindicate autologous vein bypass because of the risk of aneurysm formation, rupture and increased intimal hyperplasia compared with nonvaricose venous grafts. We report the use of varicosed long saphenous vein (LSV) with external Dacron support in infrainguinal bypass procedures for limb salvage, where endovascular therapy was not feasible. The external Dacron tube was not brought close to the distal anastomotic area itself. With a mean follow-up of 18 months, duplex ultrasonography and computed tomography angiography showed no evidence of stenosis of the reinforced vein segments or aneurysmal degeneration of the residual vein. External reinforcement with Dacron prosthesis allows the use of autogenous greater saphenous veins with varicose dilatation without compromising graft patency and limb salvage.

  2. 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.

  3. 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.

  4. Open aortic stent grafting and prosthetic bypass in a child.

    Science.gov (United States)

    Ono, Takashi; Midorikawa, Hirofumi; Morishima, Shigehiro; Takano, Takashi; Nakazawa, Makoto; Kudo, Yoshimichi

    2011-10-01

    Pseudoaneurysm is a major complication of percutaneous balloon angioplasty to treat recoarctation and restenosis after an interrupted aortic arch repair. Endovascular stent grafting to manage this complication has rarely been performed in children. We used a combination of open stent grafting and a prosthetic ascending aorta-to-descending aorta bypass to treat a pseudoaneurysm and ascending aorta stenosis in a 7-year-old child. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

    Møller, Christian H; Penninga, Luit; Wetterslev, Jørn

    2012-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-01-01

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

  7. Return to the workforce following coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Butt, Jawad H; Rørth, Rasmus; Kragholm, Kristian

    2018-01-01

    BACKGROUND: Returning to the workforce after coronary artery bypass grafting (CABG) holds important socioeconomic consequences not only for patients, but the society as well. Yet data on this issue are limited. We examined return to the workforce and associated factors in patients of working age...

  8. Quantitative Measurements of Competitive Flow in Left Internal Mammary Artery Bypass Grafts

    NARCIS (Netherlands)

    Spoor, Pien; Halfwerk, F.R.; Hagmeijer, Rob; Grandjean, J.G.

    2017-01-01

    OBJECTIVE: A low flow rate with diminished wall shear stress in arteries can cause intima hyperplasia and diameter reduction. In coronary artery bypass grafting (CABG) a low flow rate through the graft can cause graft failure (i.e. the string sign effect and occlusion). Arterial grafts bypassing an

  9. [Flowmetric assessment of coronary bypass grafts in the conditions of artificial circulation and on the beating heart].

    Science.gov (United States)

    Bazylev, V V; Nemchenko, E V; Karnakhin, V A; Pavlov, A A; Mikulyak, A I

    2016-01-01

    Advantages and shortcomings of aortocoronary bypass grafting on the beating heart and in the conditions of artificial circulation (AC) have long been discussed. The data on patency of bypass grafts in the remote period are indicative of comparable results of operations with and without AC or advantages of using AC. In order to determine benefits of each method it is necessary to reveal intraoperative predictors of bypass grafts occlusion in the remote period. We analyzed the results of ultrasound flowmetry of the blood flow through the left internal thoracic artery during bypass grafting of the anterior descending artery with the use of AC and on the beating heart. A retrospective study included a total of 352 patients subdivided into 2 groups: Group One was composed of 120 patients undergoing surgery in the conditions of AC and Group Two comprised 232 patients subjected to similar operations on the beating heart. Blood flow was measured with the help of flowmeter VeryQ MediStim® after termination of AC and inactivation of heparin by protamine, with systolic pressure of 100-110 mm Hg. There were no statistically significant differences between the groups by the diameter and degree of stenosis of the anterior descending artery, diameter of the left internal thoracic artery. The mean volumetric blood flow velocity (Qmean) along the shunts in Group One was higher (p=0.01). No statistically significant differences by the pulsatility index (PI) between the groups were revealed (p=0.2). A conclusion was drawn that coronary bypass grafting of the anterior descending artery by the left internal thoracic artery in the conditions of artificial circulation made it possible to achieve higher volumetric velocity of blood flow through the conduit as compared with operations on the beating heart, with similar resistance index. The immediate results of the operations with the use of the both techniques did not differ.

  10. Reoperative coronary bypass grafting without cardiopulmonary bypass through a small thoracotomy

    NARCIS (Netherlands)

    Boonstra, PW; Grandjean, JG; Mariani, MA

    Background. The danger of coronary reoperations is mainly hidden in the reopening of the sternum and in the manipulation of the heart and the old grafts. Therefore, the minimally invasive direct coronary artery bypass procedure seems an ideal technique for coronary reoperations if only the left

  11. Concomitant aorto-right subclavian artery bypass with off-pump coronary artery bypass grafting: a case report.

    Science.gov (United States)

    Tazume, Hirokazu; Okamoto, Ken; Fukui, Toshihiro

    2017-10-11

    Atherosclerotic stenosis of the brachiocephalic artery sometimes occurs in patients with coronary artery disease, and can cause stroke during the perioperative period of coronary artery bypass grafting. We describe the case of a 77-year old male with severe stenosis of the brachiocephalic artery and severe coronary artery disease. He successfully underwent aorto-right subclavian artery bypass that was performed concomitantly with off-pump coronary artery bypass. Concomitant aorto-subclavian artery bypass with off-pump coronary artery bypass grafting is a therapeutic option that minimizes the risk of perioperative stroke in patients with brachiocephalic artery stenosis and coronary artery disease.

  12. Ticagrelor and aspirin for the prevention of cardiovascular events after coronary artery bypass graft surgery.

    Science.gov (United States)

    Saw, Jacqueline; Wong, Graham C; Mayo, John; Bernstein, Victoria; Mancini, G B John; Ye, Jian; Skarsgard, Peter; Starovoytov, Andrew; Cairns, John

    2016-05-15

    Ticagrelor was shown to reduce mortality in patients who underwent coronary artery bypass grafting (CABG), but its effect on graft patency is unknown. We performed a prospective, randomised, double-blind, placebo-controlled trial, comparing ticagrelor 90 mg twice daily versus placebo for 3 months added to aspirin 81 mg/day, following isolated CABG. Aspirin was started within 12 h, and study medication within 72 h after CABG. Primary outcome was graft occlusion on CT angiography (CTA) performed 3 months post CABG. Patients were followed to 12 months for death, myocardial infarction, stroke, repeat revascularisation and bleeding. The study was terminated prematurely after randomising 70 patients between September 2011 and August 2014 because of slow recruitment. CTA was performed in 56 patients who completed >1 month of study drug. Graft occlusion occurred in 7/25 (28.0%) patients on ticagrelor and 17/31 (48.3%) on placebo, p=0.044. Of 207 analysable grafts, graft occlusion occurred in 9/87 (10.3%) with ticagrelor and 22/120 (18.3%) with placebo, p=0.112. Graft occlusion or stenosis ≥50% occurred in 10/87 (11.5%) ticagrelor vs 32/120 (26.7%) placebo, p=0.007. There was no major bleeding, but minor bleeding was higher with ticagrelor (31.4% vs 2.9%, p=0.003). In univariate analysis, ticagrelor use reduced graft occlusion (OR 0.32, 95% CI 0.10 to 0.97, p=0.047), which remained significant on multivariable analysis (OR 0.25, 95% CI 0.073 to 0.873, p=0.03). Ticagrelor added to aspirin after CABG reduced the proportion of patients with graft occlusion, and was a significant univariate and multivariable predictor of graft occlusion. These results are hypothesis-generating and should be confirmed in larger studies. NCT01373411: Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Constitutive modeling of coronary artery bypass graft with incorporated torsion

    Czech Academy of Sciences Publication Activity Database

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

    2009-01-01

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

  14. Long-Term Patency of Posterior Auricular Artery-Middle Cerebral Artery Bypass for Adult-Onset Moyamoya Disease: Case Report and Review of Literature.

    Science.gov (United States)

    Torazawa, Seiei; Hasegawa, Hirotaka; Kin, Taichi; Sato, Hiroaki; Sora, Shigeo

    2017-12-01

    Direct extracranial-intracranial (EC-IC) bypass is one of the fundamental techniques to prevent recurrent stroke in patients with adult-onset ischemic moyamoya disease. When the standard superficial temporal artery (STA) cannot be used for a graft, the posterior auricular artery (PAA) can be a potential surrogate graft. In this article, the authors reported a 34-year-old female patient suffering from ischemic moyamoya disease. To widely revascularize the anterior half of the hemisphere, direct double EC-IC bypass was considered beneficial; however, she had only a single-branched STA but had a prominent branch of the PAA. After discussion, a direct double surgical revascularization was successfully performed using a combination of the STA-middle cerebral artery (MCA) and the PAA-MCA bypass. The authors herein reported the detailed surgical technique of the PAA-MCA bypass with an informative video of the actual procedure. To clearly define the feasibility of PAA-MCA bypass, the authors also conducted a literature review, yielding 3 previous articles describing the bypass. In conclusion, the PAA becomes a potential donor for EC-IC bypass as long as its diameter is approximately 1.0 mm. Even though the PAA-MCA bypass is not primarily considered in the initial revascularization, it can be useful as a combination bypass with other grafts or as a rescue for recurrent ischemia. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Platelet hyperreactivity in response to on- and off-pump coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Bochsen, Louise; Rosengaard, Lisbeth Bredahl; Nielsen, Allan Bybeck

    2009-01-01

    Hypercoagulability has been reported after off-pump coronary artery bypass grafting (OPCAB) compared with patients undergoing standard coronary artery bypass grafting (CABG) with cardiopulmonary bypass. The aim of this study was to evaluate the changes in platelet reactivity in response to cardiac...... and this study identified 23% of patients needing coronary bypass surgery to be at high risk for recurrent ischemic events at 1 month after surgery, based on the MA. These results suggest that a more aggressive antithrombotic treatment might be warranted for patients undergoing coronary artery bypass grafting...

  16. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk

    Energy Technology Data Exchange (ETDEWEB)

    Lotfi, S., E-mail: shamim.lotfi@kcl.ac.uk; Clough, R. E.; Ali, T. [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom); Salter, R. [Guy' s and St. Thomas' NHS Trust, Interventional Radiology (United Kingdom); Young, C. P. [Guy' s and St. Thomas' NHS Trust, Cardiac Surgery (United Kingdom); Bell, R.; Modarai, B.; Taylor, P., E-mail: peter.taylor@gstt.nhs.uk [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom)

    2013-02-15

    Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts. A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997-2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18-90) years with mean follow-up of 15 (range, 0-61) months. Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period. Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency.

  17. Coronary artery bypass grafting in a patient with Gilbert syndrome

    Directory of Open Access Journals (Sweden)

    Kemal Korkmaz

    2012-12-01

    Full Text Available Here in we present a case of a postoperative jaundicedue to Gilbert’s syndrome in a patient who was sufferingfrom coronary artery disease and undergone coronaryartery bypass grafting operation. Signs and symptoms ofjaundice developed on the postoperative first day andresolved spontaneously after 7 days. The diagnosis andcharacteristics of Gilbert’s syndrome and other relatedabnormalities and factors relevant to anesthesia and cardiopulmonaryby-pass, which affect bilirubin metabolism,are discussed. J Clin Exp Invest 2012; 3(4: 555-557Key words: Coronary artery disease, coronary artery bypassgrafting, Gilbert’s syndrome

  18. Análise angiográfica tardia dos enxertos empregados na revascularização miocárdica de pacientes com retorno de sintomas CABG late angiographic grafting patency analysis in patients with recurrent symptoms

    Directory of Open Access Journals (Sweden)

    Roberto Rocha e Silva

    2009-06-01

    artery bypass graft procedure (CABG. In order to optimize the use of LITA or other grats, sequential anastomosis has been used. There is no consensus on equivalence of results between isolated and sequential grafts. The aim of this study is to compare the patency of isolated versus sequential grafts. METHODS: From January 2000 to August 2007, a retrospective patency analysis of the grafts used in 88 symptomatic patients who underwent CABG procedure in our Service was performed through cinecoronariography. Statistical analysis was performed through Student's t test. Each distal anastomosis was considered an independent graft. RESULTS: The mean postoperative period was of 53 + 138 months and mean age was 64 + 11 years. LITA isolated grafts presented patency rate significantly higher than the sequential grafts, respectively 92% (46/50 and 77% (30/39 P = 0.02. However, in injured coronary arteries of > 70%, isolated LITA patency rate was similar to sequential grafts, (95%; 37/39 and (93%; 26/28 respectively; P = 0.37. Mean radial artery patency rate was similar to isolated 71% (5/7 and sequential 90% (19/21 grafts; P = 0.10. Saphenous vein patency rates were similar for isolated 72% (31/43 and sequential 81% (73/90 grafts; P = 0.12. There was no difference between radial artery and saphenous vein patency rates. CONCLUSION: In symptomatic patients, isolated LITA patency is superior than sequential LITA. However, in coronary injuries of > 70%, the isolated and sequential patency rates are similar. Sequential grafts from radial artery and saphenous vein are similar to their respective isolated grafts.

  19. 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. © 2015 Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

    Krannich Jens-Holger

    2012-11-01

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

  1. Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting

    DEFF Research Database (Denmark)

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

    2006-01-01

    It has been suggested that the risk of cerebral dysfunction is less with off-pump coronary artery bypass grafting (OPCAB) than with conventional coronary artery bypass grafting (CCAB). However, evidence for this statement is preliminary, and additional insight is needed.......It has been suggested that the risk of cerebral dysfunction is less with off-pump coronary artery bypass grafting (OPCAB) than with conventional coronary artery bypass grafting (CCAB). However, evidence for this statement is preliminary, and additional insight is needed....

  2. Does interventional therapy prolong the patency of hemodialysis fistulas and grafts?; Verlaengert die radiologisch-interventionelle Therapie die Shuntnutzungsdauer bei haemodialysepflichtigen Patienten?

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, P.J.; Mueller-Huelsbeck, S.; Schaefer, F.K.; Soehne, J.; Charalambous, N.; Heller, M.; Jahnke, T. [Abt. Radiologie, Universitaetsklinikum Schleswig Holstein, Campus Kiel (Germany)

    2006-11-15

    Purpose: To retrospectively evaluate procedural success and patency after endovascular treatment of acute dysfunctional hemodialysis fistulas and grafts in a non-preselected patient cohort. Materials and Methods: 185 angiographies of hemodialysis fistulas and grafts on the upper extremities were analyzed for 120 patients (53 male, 67 female; mean-age 63.1{+-}11.4, range 24-91). 70% (n=130) were native arteriovenous fistulas, 17% (n=31) were prosthetic grafts, and 13% (n=24) were non-specific. In total, 278 lesions requiring endovascular treatment were detected. 13% (n=35) of the lesions were located in the arterial inflow, 18% (n=49) in native arteriovenous anastomoses, 7% (n=19) in prosthetic grafts and 62% (n=171) in the venous outflow. The primary, secondary and cumulative patency after endovascular treatment was calculated. Results: In 51% (n=94) of the cases endovascular treatment could be performed, in 8% (n=14) no lesion requiring treatment was detected, and in 42% (n=77) intervention was not considered possible. In 45% (n=124) of the detected lesions endovascular treatment was successful, in 18% (n=51) the intervention failed, and in 37% (n=103) intervention was not considered possible. The complication rate was 5% (n=10). The primary, secondary, and cumulative patency rates for 50% of the hemodialysis fistulas and grafts after endovascular treatment were 65, 191, and 370 days, respectively. The results differed significantly from each other with p<0.05 in the logrank test and logrank trend test. (orig.)

  3. Off-Pump Coronary Bypass Grafting Causing Stunned Myocardium

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-10-01

    Full Text Available The term “stunned myocardium” refers to abnormalities in the myocardial function following reperfusion and is common in on-pump coronary artery bypass grafting (CABG and is exceedingly rare in off- pump CABG. A 53-year-old man presented with unstable angina due to the severe stenosis of the left anterior descending coronary artery (LAD and the obtuse marginal. Laboratory findings and Chest X-ray revealed nothing abnormal. The intraoperative course was uneventful. The patient left the operating room without any inotropic support. Six hours later, however, he developed low cardiac output .At exploration, cardiac tamponade was excluded and flowmetry showed that the graft had adequate function. Cardiac enzymes were normal. High-dose adrenalin and Dobutamine were administrated and an intra-aortic balloon pump was used. After hemodynamic stabilization, the patient left the Intensive Care Unit without an intra-aortic balloon pump and inotropic support. On the fifth postoperative day, coronary angiography showed patent grafts and correct anastomotic sites. On the seventh postoperative day, the akinetic lateral wall of the left ventricle changed to dyskinesia. Finally after hospital discharge on the thirtieth postoperative day, an echocardiogram showed normal left ventricular function without regional wall motion abnormalities

  4. Prevalence of claustrophobia and magnetic resonance imaging after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Rita Katznelson

    2008-04-01

    Full Text Available Rita Katznelson1, George N Djaiani2, Leonid Minkovich1, Ludwik Fedorko1, Jo Carroll3, Michael A Borger4, Robert J Cusimano5, Jacek Karski21Assistant Professor of Anesthesia; 2Associate Professor of Anesthesia; 3Registered Nurse, Department of Anesthesia and Pain Medicine; 4Associate Professor of Surgery; 5Assistant Professor of Surgery, Division of Cardiac Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, CanadaBackground: The purpose of this study was to determine the prevalence of claustrophobia in patients undergoing magnetic resonance imaging (MRI after coronary artery bypass graft (CABG surgery.Methods: After IRB approval, we conducted a substudy of a prospective randomized controlled clinical trial of 311 patients evaluating administration of tranexamic acid and early saphenous vein graft patency with MRI after conventional CABG surgery. Chest tube drainage was measured at 6, 12, and 24 hours after surgery. The rate of transfusion and the amount of red blood cells (RBC, fresh frozen plasma (FFP, and platelets transfused were recorded.Results: A total of 237(76% patients underwent MRI after surgery. 39 (14%, [95% CI, 10.2 to 18.0] patients experienced severe anxiety caused by a fear of enclosed space in the MRI coil necessitating termination of the procedure. Patients with claustrophobia were on average 5 years younger. They were more likely to have diabetes mellitus and hypertension. Patients with claustrophobia had increased chest tube drainage during the postoperative period. The rate of blood product transfusion was similar between the two groups but patients with claustrophobia who were transfused received significantly more RBC and FFP than patients without claustrophobia.Conclusions: Postoperative claustrophobia and anxiety, leading to inability to undergo MRI, may be more common than previously described.Keywords: Claustrophobia, magnetic resonance imaging, cardiac surgery, bleeding

  5. Plasma magnesium concentration in patients undergoing coronary artery bypass grafting.

    Science.gov (United States)

    Kotlinska-Hasiec, Edyta; Makara-Studzinska, Marta; Czajkowski, Marek; Rzecki, Ziemowit; Olszewski, Krzysztof; Stadnik, Adam; Pilat, Jacek; Rybojad, Beata; Dabrowski, Wojciech

    2017-05-11

    [b]Introduction[/b]. Magnesium (Mg) plays a crucial role in cell physiology and its deficiency may cause many disorders which often require intensive treatment. The aim of this study was to analyse some factors affecting preoperative plasma Mg concentration in patients undergoing coronary artery bypass grafting (CABG). [b]Materials and method[/b]. Adult patients scheduled for elective CABG with cardio-pulmonary bypass (CPB) under general anaesthesia were studied. Plasma Mg concentration was analysed before surgery in accordance with age, domicile, profession, tobacco smoking and preoperative Mg supplementation. Blood samples were obtained from the radial artery just before the administration of anaesthesia. [b]Results. [/b]150 patients were studied. Mean preoperative plasma Mg concentration was 0.93 ± 0.17 mmol/L; mean concentration in patients - 1.02 ± 0.16; preoperative Mg supplementation was significantly higher than in patients without such supplementation. Moreover, intellectual workers supplemented Mg more frequently and had higher plasma Mg concentration than physical workers. Plasma Mg concentration decreases in elderly patients. Patients living in cities, on average, had the highest plasma Mg concentration. Smokers had significantly lower plasma Mg concentration than non-smokers. [b]Conclusions. [/b]1. Preoperative magnesium supplementation increases its plasma concentration. 2. Intellectual workers frequently supplement magnesium. 3. Smoking cigarettes decreases plasma magnesium concentration.

  6. Low serum sodium level during cardiopulmonary bypass predicts increased risk of postoperative stroke after coronary artery bypass graft surgery.

    Science.gov (United States)

    Munoz, Elizandro; Briggs, Holly; Tolpin, Daniel A; Lee, Vei-Vei; Crane, Terry; Elayda, Macarthur A; Collard, Charles D; Pan, Wei

    2014-04-01

    Rapid decreases in serum sodium levels are associated with altered mental status, seizures, and coma. During cardiac surgery, serum sodium levels decrease rapidly when cardiopulmonary bypass is initiated because cardiopulmonary bypass causes hemodilution. However, whether this decrease influences neurologic outcome after cardiac surgery remains unclear. We investigated whether the average serum sodium level during cardiopulmonary bypass is independently predictive of postoperative stroke or 30-day all-cause mortality in patients who undergo primary coronary artery bypass grafting. In a single-institution, retrospective cohort of 2348 consecutive patients who underwent primary, isolated coronary artery bypass grafting, sequential multivariate logistic regression was performed to determine the threshold below which the average serum sodium level during cardiopulmonary bypass independently predicts postoperative stroke or early death. To further test the validity of this threshold and to control for selection bias, stepwise multivariate logistic regression was also performed on propensity score-matched patients (n = 924). An average serum sodium level less than 130 mEq/L during cardiopulmonary bypass was independently predictive of stroke, both in the entire study cohort (1.44% vs 2.92%; odds ratio, 2.09; 95% confidence interval, 1.1-4.1; P = .03) and in the propensity-matched patients (0.9% vs 3.0%; odds ratio, 4.1; 95% confidence interval, 1.3-13.0; P = .02). The average serum sodium level during cardiopulmonary bypass was not independently associated with early death, regardless of what threshold value was used. An average serum sodium level of less than 130 mEq/L during cardiopulmonary bypass is independently associated with an increased risk of postoperative stroke in patients who undergo primary coronary artery bypass grafting. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  7. The experience of totally endoscopic coronary bypass grafting with the robotic system «Da Vinci» in Russia

    Science.gov (United States)

    Efendiev, V. U.; Alsov, S. A.; Ruzmatov, T. M.; Mikheenko, I. L.; Chernyavsky, A. M.; Malakhov, E. S.

    2015-11-01

    A new technology - a thoracoscopic coronary bypass grafting with the use of Da Vinci robotic system in Russia is represented by the experience of NRICP. The technology was introduced in Russia in 2011. Overall, one hundred endoscopic coronary artery bypass procedures were performed. We have compared and analyzed results of coronary artery stenting vs minimally invasive coronary artery bypass grafting. According to the results, totally endoscopic coronary artery bypass grafting has several advantages over alternative treatment strategies.

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

    Directory of Open Access Journals (Sweden)

    Catherine A Waight

    2015-02-01

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

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

    Science.gov (United States)

    Waight, Catherine A; Strodl, Esben; Sheridan, Judith; Tesar, Peter

    2015-01-01

    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. Effects of preoperative treatment with diltiazem on diastolic ventricular function after coronary artery bypass graft surgery

    NARCIS (Netherlands)

    van der Maaten, JMAA; de Vries, AJ; Henning, RH; Epema, AH; van den Berg, MP; Lip, H

    2001-01-01

    Objective: To examine whether preoperative treatment with diltiazem could ameliorate left ventricular (LV) diastolic dysfunction in patients after coronary artery bypass graft (CABG) surgery. Design: Prospective, nonrandomized clinical study. Setting: University hospital. Participants: Thirty-four

  11. Predictive factors of atrial fibrillation after coronary artery bypass grafting.

    Science.gov (United States)

    Folla, Cynthia de Oliveira; Melo, Cinthia Cristina de Santana; Silva, Rita de Cassia Gengo E

    2016-01-01

    To analyze predictive demographic and perioperative variables of postoperative atrial fibrillation in patients who underwent exclusively coronary artery bypass grafting. This was a retrospective cohort. We randomly selected 105 medical records of patients who underwent exclusively coronary artery bypass grafting in 2014. Demographic, clinical (preoperative and immediate postoperative) data and related with surgical procedure were collected from medical records. The occurrence of postoperative atrial fibrillation was considered until the third day after the surgery. Variables were analyzed using descriptive and inferential statistics. To identify predictive factors of postoperative atrial fibrillation we used a decision tree model with Classification and Regression Trees algorithm. Atrial fibrillation incidence was 19.0% (n=20). Patients with left atrial >40.5mm and aged >64.5 years were more likely to develop the arrhythmia during the post-surgical period. Left atrial diameter and advanced age were predictive factors of atrial fibrillation in patients who underwent exclusively coronary artery bypass grafting. Analisar as variáveis demográficas e perioperatórias preditivas de fibrilação atrial pós-operatória em pacientes brasileiros submetidos exclusivamente à cirurgia de revascularização do miocárdio. Trata-se de coorte retrospectiva. A amostra foi constituída de 105 prontuários de pacientes submetidos exclusivamente à revascularização do miocárdio no ano de 2014, selecionados aleatoriamente. Dados demográficos, clínicos (préoperatórios e do pós-operatório imediato) e relacionados ao procedimento cirúrgico foram coletados por meio de consulta ao prontuário. A ocorrência de fibrilação atrial no pós-operatório foi considerada até o terceiro dia após a cirurgia. As variáveis foram analisadas por estatística descritiva e inferencial. Para identificar os fatores preditivos de fibrilação atrial no pós-operatório, utilizou-se um

  12. 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....

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

    OpenAIRE

    Waight, Catherine A; Esben Strodl; Judith Sheridan; Peter Tesar

    2015-01-01

    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 wheth...

  14. Superior epigastric artery pseudoaneurysm- a rare complication of chest drain insertion in coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Ward Nick

    2007-04-01

    Full Text Available Abstract Background Although chest drain insertion during coronary artery bypass grafting is a fairly standard procedure, however it may result in extremely rare complications. Case presentation This is the first case being reported that demonstrates a pseudoaneurysm of superior epigastric artery resulting from chest drain insertion following coronary artery bypass grafting. Conclusion Adequate caution should be used along with good understanding of the anatomical landmarks during apparently simple and standard operative procedures.

  15. Coronary artery bypass grafting on the beating heart using the Octopus method

    NARCIS (Netherlands)

    Thijssens, K. M.; Rodrigus, I. E.; Amsel, B. J.; de Hert, S. G.; Moulijn, A. C.

    2000-01-01

    STUDY OBJECTIVE: To study the usefulness and effectiveness of off-pump coronary bypass grafting with the Octopus heart stabilizing device. METHOD: The files of thirty-one patients undergoing coronary artery bypass with the aid of the Octopus heart stabilizing device between April 1996 and October

  16. 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

    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.

  17. Off-pump Coronary Artery Bypass Graft in a High Risk Patient ...

    African Journals Online (AJOL)

    On-pump coronary artery bypass graft (CABG) entails the use of cardiopulmonary bypass (CPB). The procedure is safe but it's not without complications like neurocognitive deficits, cerebrovascular accidents, myocardial ischemic injury and activation of inflammatory pathways that contribute to pulmonary, renal, hematologic ...

  18. A one-dimensional arterial network model for bypass graft assessment.

    Science.gov (United States)

    Ghigo, A R; Abou Taam, S; Wang, X; Lagrée, P-Y; Fullana, J-M

    2017-05-01

    We propose an arterial network model based on one-dimensional hemodynamic equations to study the behavior of different vascular surgical bypass grafts in the case of an arterial occlusive pathology: a stenosis of the Right Iliac artery. We investigate the performances of three different bypass grafts (Aorto-Femoral, Axillo-Femoral and cross-over Femoral) depending on the degree of obstruction of the stenosis. Numerical simulations show that all bypass grafts are efficient since we retrieve in each case the healthy hemodynamics downstream of the stenosed region while ensuring at the same time a global healthy circulation. We analyze in detail the behavior of the Axillo-Femoral bypass graft by performing hundreds of simulations where we vary the values of its Young's modulus [0.1-50 MPa] and radius [0.01-5 cm]. Our analysis shows that Young's modulus and radius of commercial bypass grafts are optimal in terms of hemodynamic considerations. Our numerical findings prove that this model approach can be used to optimize or plan patient-specific surgeries, to numerically assess the viability of bypass grafts and to perform parametric analysis and error propagation evaluations by running extensive simulations. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  19. Pattern and predictors of dual antiplatelet use after coronary artery bypass graft surgery.

    Science.gov (United States)

    Mori, Makoto; Shioda, Kayoko; Yun, James J; Mangi, Abeel A; Darr, Umer; Geirsson, Arnar

    2018-02-01

    Resumption of dual antiplatelet therapy after coronary artery bypass grafting in patients presenting with acute coronary syndrome is recommended, but the current practice pattern in the United States remains unknown. We aimed to investigate the current pattern of dual antiplatelet therapy use after coronary artery bypass grafting at the Yale-New Haven Hospital. We conducted a single-center retrospective review of patients who presented with acute coronary syndrome and underwent coronary artery bypass grafting between 2014 and 2016. The primary outcome was hospital discharge with dual antiplatelet therapy. Mixed-effect multivariate logistic regression was used to evaluate predictors of dual antiplatelet therapy use or nonuse, accounting for surgeon-specific preference. The discriminatory ability of the model was evaluated with receiver operating characteristics analysis. Of 572 patients included, only 29% were discharged with dual antiplatelet therapy. In the mixed-effect multivariate model isolating surgeon preferences, increase in age (odds ratio, 0.95; 95% confidence interval, 0.92-0.98; P bypass grafting compared with on-pump coronary artery bypass grafting was associated with increased odds of dual antiplatelet therapy use (odds ratio, 31.5; 95% confidence interval, 12.8-77.2; P bypass grafting was low and variable among surgeons. The use or nonuse was guided by previously established risk factors of recurrent ischemia and bleeding, along with surgeon preference. Published by Elsevier Inc.

  20. Awake subxyphoid minimally invasive direct coronary artery bypass grafting yielded minimum invasive cardiac surgery for high risk patients.

    Science.gov (United States)

    Watanabe, Go; Yamaguchi, Shohjiro; Tomiya, Shigeyuki; Ohtake, Hiroshi

    2008-10-01

    Off-pump coronary artery bypass graft (CABG) surgery has become a widely used modality and has received recognized as a minimally invasive surgery with few complications. However, for patients with severely impaired pulmonary function, further considerations have to be given to reduce the complications associated with general anesthesia. We have accumulated experience in awake off-pump surgery combined with high thoracic epidural anesthesia. In this report we describe the use of alternative subxiphoid approach in patients with severe pulmonary dysfunction. A catheter for high thoracic epidural anesthesia was inserted one day before surgery. After obtaining an adequate level of anesthesia, a small subxiphoid incision was made and the pericardium was opened to expose the left anterior descending branch. The conduit for bypass, gastroepiploic artery was accessed through a minilaparotomy, and separated under the same surgical field and anatomozed under beating heart. This procedure was performed in three patients. Patency was confirmed by postoperative angiography in all three cases. All patients were discharged after an uneventful postoperative course. Awake subxiphoid approach has the advantages that both thoracotomy and sternotomy can be avoided thus permitting surgery with extremely low invasiveness. This method is recommended for patients with severe pulmonary dysfunction.

  1. Risk factors for mediastinitis after coronary artery bypass grafting surgery.

    Science.gov (United States)

    Sá, Michel Pompeu Barros de Oliveira; Soares, Evelyn Figueira; Santos, Cecília Andrade; Figueiredo, Omar Jacobina; Lima, Renato Oliveira Albuquerque; Escobar, Rodrigo Renda; de Rueda, Fábio Gonçalves; Lima, Ricardo de Carvalho

    2011-01-01

    Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. The aim of this study is to identify risk factors for mediastinitis in patients undergoing coronary artery bypass grafting (CABG), without the use of bilateral internal thoracic artery (ITA), at the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. A retrospective study of 500 consecutive patients operated on between May 2007 and April 2010. Ten preoperative variables, seven intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were performed. The incidence of mediastinitis was 5.6% (n=28), with a lethality rate of 32.1% (n=9). In multivariate analysis using logistic regression, five variables remained as independent risk factors: obesity (OR 2.60, 95% CI 1.11 to 6.68), diabetes (OR 2.71, 95% CI 1.18 to 6.65), smoking (OR 2.10, 95% CI 1.12 to 4.67), use of pedicled internal thoracic artery (OR 5.17, 95% CI 1.45 to 18.42) and on-pump CABG (OR 2.26, 95% CI 1.14 to 5.85). This study identified the following independent risk factors for mediastinitis after CABG: obesity, diabetes, smoking, use of pedicled ITA and on-pump CABG.

  2. Thrombosed aneurysm of saphenous vein coronary artery bypass grafting

    Energy Technology Data Exchange (ETDEWEB)

    Queiroz, Rodolfo Mendes; Nastri Filho, Rogerio; Ferez, Marcus Antonio; Costa, Mauro Jose Brandao da; Laguna, Claudio Benedini; Valentin, Marcus Vinicius Nascimento, E-mail: rod_queiroz@hotmail.com [Documenta - Hospital Sao Francisco, Ribeirao Preto, SP (Brazil). Departamento de Radiologia e Diagnostico por Imagem; Hospital Sao Francisco, Ribeirao Preto, SP (Brazil). Centro de Terapia Intensiva

    2017-06-15

    We describe the case of a male patient, aged 76 years, referred for cardiac investigation due to retrosternal chest pain and dyspnea. He had a history of acute myocardial infarction and angioplasties in the last 30 years, including a saphenous vein coronary artery bypass grafting (SVCABG). Echocardiogram showed hypoechoic oval formation near the right ventricle, suggesting a pericardial cyst. Computed angiotomography revealed a predominantly fusiform and thrombosed aneurysmal dilation of the SVCABG to the right coronary artery. SVCABG aneurysms are very rare and potentially fatal. They usually appear in the late postoperative period, and patients are often asymptomatic. On radiography, it is frequently presented as enlargement of the mediastinum, with echocardiography, computed tomography and magnetic resonance imaging being very useful for diagnosis. Coronary angiography is the gold standard to detect these cases. Our report illustrates a rare situation arising late from a relatively common surgery. Due to its severity, proper recognition in the routine assessment of patients with a similar history is essential. (author)

  3. The Impact of Lung Ventilation on Some Cytokines after Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Toikkanen, V; Rinne, T; Nieminen, R; Moilanen, E; Laurikka, J; Porkkala, H; Tarkka, M; Mennander, A

    2017-03-01

    Cardiopulmonary bypass induces a systematic inflammatory response, which is partly understood by investigation of peripheral blood cytokine levels alone; the lungs may interfere with the net cytokine concentration. We investigated whether lung ventilation influences lung passage of some cytokines after coronary artery bypass grafting. In total, 47 patients undergoing coronary artery bypass grafting were enrolled, and 37 were randomized according to the ventilation technique: (1) No-ventilation group, with intubation tube detached from the ventilator; (2) low tidal volume group, with continuous low tidal volume ventilation; and (3) continuous 10 cm H2O positive airway pressure. Ten selected patients undergoing surgery without cardiopulmonary bypass served as a referral group. Representative pulmonary and radial artery blood samples were collected for the evaluation of calculated lung passage (pulmonary/radial artery) of the pro-inflammatory cytokines (interleukin 6 and interleukin 8) and the anti-inflammatory interleukin 10 immediately after induction of anesthesia (T1), 1 h after restoring ventilation/return of flow in all grafts (T2), and 20 h after restoring ventilation/return of flow in all grafts (T3). Pulmonary/radial artery interleukin 6 and pulmonary/radial artery interleukin 8 ratios ( p = 0.001 and p = 0.05, respectively) decreased, while pulmonary/radial artery interleukin 10 ratio ( p = 0.001) increased in patients without cardiopulmonary bypass as compared with patients with cardiopulmonary bypass. The pulmonary/radial artery equation is an innovative means for the evaluation of cytokine lung passage after coronary artery bypass grafting. The mode of lung ventilation has no impact on some cytokines after coronary artery bypass grafting in patients treated with cardiopulmonary bypass.

  4. The composite aortic wall graft technique: an option for a short coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    João Bosco de Oliveira

    2009-01-01

    Full Text Available SUMMARY: During coronary artery bypass graft (CABG surgery, the saphenous vein is sutured through its proximal segment to the aorta. Intimal hyperplasia is one of the possible causes of graft occlusion. Notably, blood turbulence can induce wall shear stress that may also play an important role in this process. OBJECTIVE: We propose a new technique for performing proximal anastomosis to avoid CABG failure. METHOD: An 80 kg pig was subjected to open heart surgery. Four stitches were placed in the anterior ascending aorta, which formed a 2 cm by 4 cm patch. This patch was isolated through the application of a tangential clamp that was oriented parallel to the axis of the aorta. After releasing the patch, which was held to the aorta through its cranial end pedicle, the rims were sutured to each other creating a conduit with a length of 4 cm and an internal diameter of 4 mm. The rest of the aortotomy was closed by placing a direct suture between its rims. RESULT: This novel technique created an "in situ" aortic wall graft that was 4 cm long and characterized as being of uniform 4 mm caliber.

  5. Right ventricle contractility during early postoperative period after coronary artery bypass grafting with cardiopulmonary bypass

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    А. Е. Баутин

    2015-10-01

    Full Text Available Emphasis in this research was placed on contractility of the right ventricle with regard to its relationship with systemic hemodynamics in patients undergoing coronary artery bypass grafting (CABG under cardiopulmonary bypass (CPB. The study included 25 patients (14 males, 11 females, mean age was 587 years admitted to ICU after CABG under CPB. All patients required inotropic therapy. The criterion for prescribing inotropic support in the postoperative period was a drop of the stroke volume index of the left ventricle below 35 ml/m 2 provided that the values of this indicator were normal before the perfusion period. Patients with previous pathology of the right ventricle or right coronary artery were excluded from the study. To evaluate the right ventricular function and systemic hemodynamics indicators, use was made of the PiCCO plus system and VoLEF addon device. It was found out that reduced contractility of the right ventricle may cause the reduction in stroke volume of the left ventricle with normal contractility. It was also observed that the increase of preload in patients with right ventricular ejection fraction less than 30% does not improve its function but leads to the increase of its end-diastolic volume. In 68% of cases, the need in inotropic agents in the early postoperative period after CABG was associated with the drop in right ventricle contractility, in 40% - with isolated right ven-tricular dysfunction. Patients with isolated reduction in right ventricle contractility required a longer period of inotropic support and ICU stay as compared with those with left ventricular failure.

  6. Comparison of 4% Succinylated Gelatin with 6% Hydroxyethyl Starch 130/0.4 for Preloading Prior to Cardiopulmonary Bypass in Coronary Artery Bypass Grafting Patients

    OpenAIRE

    Deshmukh, Amit; Dave, Sona; Gujjar, Pinakin

    2016-01-01

    Aims and Objective: The present study was carried out with an objective to compare 4% succinylated gelatin with 6% hydroxyethyl starch 130/0.4 for preloading prior to cardiopulmonary bypass in coronary artery bypass grafting patients with respect to haemodynamics status, blood loss, transfusion requirement, ICU stay and complication. Methods: The study enrolling 60 patients of either sex, aged between 30-70 years undergoing elective coronary artery bypass grafting. These patients were randoml...

  7. Obesity paradox in coronary artery bypass grafting: myth or reality?

    Science.gov (United States)

    Benedetto, Umberto; Danese, Carla; Codispoti, Massimiliano

    2014-05-01

    A high body mass index has been suggested to be protective in patients with coronary artery disease and in those undergoing coronary artery bypass grafting (CABG). However, these conflicting results might be related to the different risk profiles among the various body mass index categories. We sought to clarify the effect of varying degrees of excessive body weight on hard clinical outcomes in patients undergoing CABG. A retrospective analysis of prospectively collected data was conducted to investigate the effect of a high body mass index on early and late mortality after first-time isolated CABG. Propensity score matching was used to adjust for confounding factors. The study sample consisted of 3269 normal weight, 6662 overweight, 3821 obese, and 211 morbidly obese patients. After matching, early mortality was not affected by overweight (mean difference, 0.7%; 95% confidence interval [CI], -0.2% to 1.5%), obesity (mean difference, 0.5%; 95% CI, -0.7% to 1.7%), and morbid obesity (mean difference, 1.6%; 95% CI, -1.0% to 1.0%), regardless of the patients' risk profile according to the European system for cardiac operative risk evaluation. Overweight status was not protective for late death (hazard ratio, 1.05; 95% CI, 0.9-1.08; P = .4). Compared with normal weight patients, both obese and morbidly obese patients had a higher risk of late death (hazard ratio, 1.22; 95% CI, 1.07-2.66; P = .006 for obese patients; hazard ratio, 1.36; 95% CI, 0.74-2.49; P = .3 for morbidly obese patients). Obesity did not increase operative mortality, but it was associated with reduced late survival in patients undergoing primary isolated CABG. Our results raise concerns in supporting any protective effect of obesity in cardiovascular disease, specifically in patients undergoing surgical myocardial revascularization. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  8. 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.

  9. Effects of intraoperative diltiazem infusion on flow changes in arterial and venous grafts in coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Ozan Erdem

    2015-08-01

    Full Text Available Abstract Objective: This study aimed to show the effects of intra-operative diltiazem infusion on flow in arterial and venous grafts in coronary artery bypass graft surgery. Methods: Hundred fourty patients with a total of 361 grafts [205 (57% arterial and 156 (43% venous] underwent isolated coronary surgery. All the grafts were measured by intraoperative transit time flow meter intra-operatively. Group A (n=70 consisted of patients who received diltiazem infusion (dose of 2.5 microgram/kg/min, and Group B (n=70 didn't receive diltiazem infusion. Results: Mean graft flow values of left internal mammary artery were 53 ml/min in Group A and 40 ml/min in Group B (P<0.001. Pulsatility index (PI values of left internal mammary artery for Group A and Group B were 2.6 and 3.0 respectively (P<0.001. No statistically significant difference was found between venous graft parameters. Conclusion: We recommend an effect of diltiazem infusion in increasing graft flows in coronary artery bypass graft operations.

  10. Safety of Simultaneous Coronary Artery Bypass Grafting and Carotid Endarterectomy Versus Isolated Coronary Artery Bypass Grafting: A Randomized Clinical Trial.

    Science.gov (United States)

    Weimar, Christian; Bilbilis, Konstantinos; Rekowski, Jan; Holst, Torulv; Beyersdorf, Friedhelm; Breuer, Martin; Dahm, Manfred; Diegeler, Anno; Kowalski, Arne; Martens, Sven; Mohr, Friedrich W; Ondrášek, Jiri; Reiter, Beate; Roth, Peter; Seipelt, Ralf; Siggelkow, Markus; Steinhoff, Gustav; Moritz, Anton; Wilhelmi, Mathias; Wimmer-Greinecker, Gerhard; Diener, Hans-Christoph; Jakob, Heinz; Ose, Claudia; Scherag, Andre; Knipp, Stephan C

    2017-10-01

    The optimal operative strategy in patients with severe carotid artery disease undergoing coronary artery bypass grafting (CABG) is unknown. We sought to investigate the safety and efficacy of synchronous combined carotid endarterectomy and CABG as compared with isolated CABG. Patients with asymptomatic high-grade carotid artery stenosis ≥80% according to ECST (European Carotid Surgery Trial) ultrasound criteria (corresponding to ≥70% NASCET [North American Symptomatic Carotid Endarterectomy Trial]) who required CABG surgery were randomly assigned to synchronous carotid endarterectomy+CABG or isolated CABG. To avoid unbalanced prognostic factor distributions, randomization was stratified by center, age, sex, and modified Rankin Scale. The primary composite end point was the rate of stroke or death at 30 days. From 2010 to 2014, a total of 129 patients were enrolled at 17 centers in Germany and the Czech Republic. Because of withdrawal of funding after insufficient recruitment, enrolment was terminated early. At 30 days, the rate of any stroke or death in the intention-to-treat population was 12/65 (18.5%) in patients receiving synchronous carotid endarterectomy+CABG as compared with 6/62 (9.7%) in patients receiving isolated CABG (absolute risk reduction, 8.8%; 95% confidence interval, -3.2% to 20.8%; PWALD=0.12). Also for all secondary end points at 30 days and 1 year, there was no evidence for a significant treatment-group effect although patients undergoing isolated CABG tended to have better outcomes. Although our results cannot rule out a treatment-group effect because of lack of power, a superiority of the synchronous combined carotid endarterectomy+CABG approach seems unlikely. Five-year follow-up of patients is still ongoing. URL: https://www.controlled-trials.com. Unique identifier: ISRCTN13486906. Copyright © 2017 The Author(s).

  11. Endoscopic Vein Harvesting for Coronary Bypass Grafting: A Blessing or a Trojan Horse?

    Directory of Open Access Journals (Sweden)

    Ryan Accord

    2011-01-01

    Full Text Available Conventional open harvest of the great saphenous vein (GSV during CABG results in approximately 7% donor-site complications. Using endoscopic vein harvesting (EVH the full GSV length can be harvested through a 3 cm incision. This nonsystematic review discusses several key issues concerning EVH, based on an extensive Pubmed search. Found studies show that EVH results in reduced number of wound complications, less postoperative pain, earlier postoperative mobilisation, reduced length of hospital stay, and is more cost-effective. Initial studies did not find significant differences in graft histology, patency, or clinical outcome. However, in 2009 convincing evidence of inferior histological graft properties became available. Furthermore, an observational study showed that EVH resulted in significantly more graft stenosis, was associated with higher mortality, more myocard infarction, and more reinterventions. Most recent publications could not confirm these findings, however larger randomised controlled trials focusing on graft quality are being awaited.

  12. Residual SYNTAX score following coronary artery bypass grafting.

    Science.gov (United States)

    Melina, Giovanni; Angeloni, Emiliano; Refice, Simone; Benegiamo, Cristian; Lechiancole, Andrea; Matteucci, Maria; Roscitano, Antonino; Bianchini, Roberto; Capuano, Fabio; Comito, Cosimo; Spitaleri, Pietro; Tonelli, Euclide; Speciale, Giulio; Pristipino, Christian; Monti, Francesco; Serdoz, Roberto; Paneni, Francesco; Sinatra, Riccardo

    2017-03-01

    To quantify residual coronary artery disease measured using the SYNTAX score (SS) and its relation to outcomes after coronary artery bypass grafting (CABG). We conducted a retrospective analysis on a consecutive series of 1608 patients [mean age 68 years, standard deviation (SD): 7, F:M, 242:1366] undergoing first-time isolated CABG from 2004 to 2015. The baseline SS was retrospectively determined from preoperative angiograms, and the residual SS (rSS) was measured during assessment of the actual operative report for each patient after CABG. Patients were then stratified according to tercile cut points of low (rSS low 0-11, N  = 537), intermediate (rSS mid  >11-18.5, N  = 539) and high residual SS (rSS high  >18.5, N  = 532). The Cox regression model was used to investigate the impact of rSS on major adverse cardiac and cerebrovascular events (MACCE) at 1 year. The mean preoperative SS was 26.6 (SD: 9.4) (range 10.1-53), and the residual SS after CABG was 15.3 (SD: 8.4) (range 0-34) ( P  rSS was 1.5% ( N  = 8/537), 4.5% ( N  = 24/539) in the intermediate and 8.8% ( N  = 47/532) in the high rSS group. Kaplan-Meier analysis showed a statistically significant difference of MACCE-free survival between the three groups (log-rank test, P  rSS low , 95.5% (SE: 1.9) for the rSS mid , and 90.5% (SE: 1.3) for the rSS high group, respectively. After multivariable adjustment, the rSS high group was independently associated with a higher incidence of MACCE at 1 year (hazard ratio 1.92, 95% confidence interval 1.21-3.23) compared to the rSS low group. These unanticipated findings suggest that a residual SS may be a useful tool for risk stratification of patients undergoing isolated first-time CABG. Our study may set the stage for further investigations addressing this important clinical question.

  13. Is there an indication for computed tomography and magnetic resonance imaging in the evaluation of coronary artery bypass grafts?

    NARCIS (Netherlands)

    Dikkers, R.; van der Zaag-Loonen HJ, [No Value; Willems, T.P.; Post, W.J.; Oudkerk, M.

    2009-01-01

    This meta-analysis evaluates the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for bypass graft occlusion and stenosis detection compared with coronary angiography in post-coronary artery bypass graft patients. The indication for noninvasive

  14. 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.......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....

  15. Temporary diabetes insipidus in 2 men after on-pump coronary artery bypass grafting.

    Science.gov (United States)

    Uyar, Ihsan Sami; Sahin, Veysel; Akpinar, Besir; Yurtman, Volkan; Abacilar, Feyzi; Okur, Faik Fevzi; Ates, Mehmet

    2013-01-01

    Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used.

  16. Cardiopulmonary bypass increases the risk of vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure.

    Science.gov (United States)

    Hossne Junior, Nelson Américo; Miranda, Matheus; Monteiro, Marcus Rodrigo; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; Pestana, José Osmar Medina de Abreu; Gomes, Walter José

    2015-01-01

    Coronary artery bypass grafting is currently the best treatment for dialysis patients with multivessel coronary artery involvement. Vasoplegic syndrome of inflammatory etiology constitutes an important postoperative complication, with highly negative impact on prognosis. Considering that these patients have an intrinsic inflammatory response exacerbation, our goal was to evaluate the incidence and mortality of vasoplegic syndrome after myocardial revascularization in this group. A retrospective, single-center study of 50 consecutive and non-selected dialysis patients who underwent myocardial revascularization in a tertiary university hospital, from 2007 to 2012. The patients were divided into 2 groups, according to the use of cardiopulmonary bypass or not (off-pump coronary artery bypass). The incidence and mortality of vasoplegic syndrome were analyzed. The subgroup of vasoplegic patients was studied separately. There were no preoperative demographic differences between the cardiopulmonary bypass (n=20) and off-pump coronary artery bypass (n=30) group. Intraoperative data showed a greater number of distal coronary arteries anastomosis (2.8 vs. 1.8, Pcardiopulmonary bypass group. Vasoplegia incidence was statistically higher (P=0.0124) in the cardiopulmonary bypass group (30%) compared to the off-pump coronary artery bypass group (3%). Vasoplegia mortality was 50% in the cardiopulmonary bypass group and 0% in the off-pump coronary artery bypass group. The vasoplegic subgroup analysis showed no statistically significant clinical differences. Cardiopulmonary bypass increased the risk for developing postoperative vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure.

  17. Combination of minimally invasive coronary bypass and percutaneous transluminal coronary angioplasty in the treatment of double-vessel coronary disease: Two-year follow-up of a new hybrid procedure compared with "on-pump" double bypass grafting.

    Science.gov (United States)

    de Cannière, D; Jansens, J L; Goldschmidt-Clermont, P; Barvais, L; Decroly, P; Stoupel, E

    2001-10-01

    Percutaneous transluminal coronary angioplasty (PTCA) or surgery can be chosen as first-line therapies in multiple-vessel coronary disease. A mammary-to-left anterior descending (LAD) graft is the most important statistical determinant of a favorable outcome after coronary artery bypass grafting (CABG) and can be performed with lower morbidity off pump through a minithoracotomy. PTCA and stenting of the "non-LAD" vessels compete with CABG in terms of patency rates. Our purpose was to compare a combination of minimally invasive direct coronary artery bypass (MIDCAB) and PTCA with double CABG as a treatment for double-vessel coronary artery disease involving the proximal LAD. Two matched groups of 20 patients with double-vessel coronary disease undergoing either sequential MIDCAB and PTCA (group 1) or double CABG on cardiopulmonary bypass (group 2) were compared. Angiographic control, complications, hospital costs, quality of life, and 2-year follow-up of ischemia are reported. All bypasses were patent at early control. Three adverse events were noted in group 1 and 17 in group 2. The hybrid-procedure group exhibited a shorter intensive care unit stay, fewer blood products transfused, less pain, better early quality of life, faster return to work, and similar cost. Three patients required a second PTCA in group 1, one of which for restenosis. At 2 years all the patients are asymptomatic with no residual ischemia. We conclude from this pilot study that the hybrid procedure is feasible and appears to be a safe therapy for double-vessel coronary artery disease and that it appears to generate less perioperative morbidity than classic double CABG does. Therefore we believe that there is room to undertake prospective randomized studies on a larger-scale basis.

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

    Directory of Open Access Journals (Sweden)

    Kerim Çağlı

    2011-12-01

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

  19. Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial.

    Science.gov (United States)

    Carranza, Christian L; Ballegaard, Martin; Werner, Mads U; Hasbak, Philip; Kjær, Andreas; Kofoed, Klaus F; Lindschou, Jane; Jakobsen, Janus Christian; Gluud, Christian; Olsen, Peter Skov; Steinbrüchel, Daniel A

    2014-04-23

    Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique. The NEO Trial is a randomised clinical trial with a 2 × 2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group.The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively.We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the

  20. Imaging findings of myocardial revascularization at multidetector computed tomography: where are the bypass grafts?: an iconographic essay

    Energy Technology Data Exchange (ETDEWEB)

    Ripari, Marcelo Targa; Santaniello, Rogerio; Sasdelli Neto, Roberto; Nomura, Cesar Higa; Chate, Rodrigo Caruso; Passos, Rodrigo Bastos Duarte; Kay, Fernando Uliana; Funari, Marcelo Buarque de Gusmao [Hospital Albert Einstein, Sao Paulo, SP (Brazil). Dept. of Imaging], e-mail: mtripari@uol.com

    2009-09-15

    Multidetector coronary computed tomography angiography is a precise method for evaluating post-coronary revascularization arterial and venous bypass grafts, and is somehow superseding coronary catheterization that is an invasive and more expensive technique. The present iconographic essay is aimed at anatomically demonstrating the bypass grafts most frequently utilized, how to differentiate between arterial and venous grafts and how to find them. The studies were performed in 64-row multidetector computed tomography equipment, with breath hold, controlled heart rate and appropriate protocols with later MPR, MIP and 3D reconstructions according to electrocardiogram. The localization of the bypass grafts and anastomoses at computed tomography studies focused on chest and coronary arteries may represent a difficulty in the images analysis by the radiologist who is not familiar with the matter, so the knowledge of the surgical techniques adopted and possible courses of the saphenous bypass grafts and arterial grafts can aid in the analysis of both studies, avoiding diagnostic errors. (author)

  1. 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 a...

  2. Are femorodistal bypass grafts for acute limb ischemia worthwhile? Vantagem associada ao uso de enxertos femorodistais para isquemia aguda de membros

    Directory of Open Access Journals (Sweden)

    Nader Khandanpour

    2009-12-01

    Full Text Available Background: It has been shown that autogenous veins are associated with the best limb salvage rates for femorodistal bypass surgery. However, in emergency settings, when an autogenous vein is unavailable, use of synthetic graft material or amputation is a critical decision to make. Objective: To assess the appropriateness of femorodistal bypass grafts for acute limb ischemia in emergency settings. Methods: Patients who underwent emergent bypass and elective femorodistal bypass surgery between 1996 and 2006 were reviewed retrospectively in a single center. Results: There were 147 patients of which 84 had elective and 63 had emergent bypass. The graft patency rates for elective admissions were 44 and 25% vs. 25 and 23% for admissions for acute femorodistal graft surgery at 2 and 4 years, respectively (p Contexto: Já foi mostrado que veias autógenas estão associadas às melhores taxas de salvamento de membros para a cirurgia de bypass femorodistal. No entanto, em cenários de emergência, quando não há uma veia autógena disponível, é crítica a decisão entre o uso de material de enxerto sintético ou a amputação. Objetivo: Avaliar a adequação de enxertos femorodistais para isquemia aguda de membros em cenários de emergência. Métodos: Pacientes submetidos a cirurgia de bypass de urgência e cirurgia de bypass femorodistal eletiva entre 1996 e 2006 foram retrospectivamente revisados em um único centro. Resultados: Havia 147 pacientes, dentre os quais 84 haviam sido submetidos à cirurgia de bypass eletiva e 63 à cirurgia de bypass de urgência. As taxas de patência dos enxertos para internações eletivas foram 44 e 25% versus 25 e 23% para internações para cirurgia aguda de enxerto femorodistal a dois e quatro anos, respectivamente (p < 0,004. Internações por isquemia aguda que foram tratadas com enxertos prostéticos tiveram patência primária de 24 versus 27% para enxertos venosos a 2 anos e 24 versus 23% a 4 anos (p = 0

  3. Profile and length of stay of coronary artery bypass graft patients in ...

    African Journals Online (AJOL)

    Study aim. To describe the profile and selected outcomes of coronary artery bypass graft (CABG) patients admitted to both private and public hospitals in the Cape metropolitan area. Design. A prospective descriptive study design with a multi-centre observational approach was followed. Method. Only patients undergoing ...

  4. Coronary artery bypass grafting-related bleeding complications in patients treated with dual antiplatelet treatment.

    NARCIS (Netherlands)

    Tomsic, A.; Schotborgh, M.A.; Manshanden, J.S.; Li, W.W.L.; Mol, B.A. de

    2016-01-01

    OBJECTIVES: To evaluate the relationship between the timing of either ticagrelor or clopidogrel discontinuation and bleeding-related complications in patients undergoing isolated on-pump coronary artery bypass grafting (CABG). METHODS: Between January 2012 and December 2014, 705 consecutive patients

  5. Short-term Outcome of Coronary Artery Bypass Grafting in Patients ...

    African Journals Online (AJOL)

    Introduction: Coronary artery disease is a major cause of death in patients on maintenance hemodialysis (HD). The morbidity and mortality of coronary artery bypass grafting (CABG) for patients on chronic HD are reported to be high. In the present study, the outcome of CABG in a group of HD patients was examined.

  6. Low Incidence of Early Postoperative Cerebral Edema After Coronary Artery Bypass Grafting

    NARCIS (Netherlands)

    Ottens, Thomas H.; Hendrikse, J|info:eu-repo/dai/nl/266590268; Slooter, Arjen J. C.|info:eu-repo/dai/nl/173059740; van Herwerden, LA; Dieleman, Stefan|info:eu-repo/dai/nl/304817902; van Dijk, Diederik|info:eu-repo/dai/nl/241616301

    Objective: Using magnetic resonance imaging, the authors studied the influence of a single high dose of intraoperative dexamethasone on the severity of cerebral edema that can occur early after coronary artery bypass grafting (CABG). It was hypothesized that high-dose intraoperative dexamethasone

  7. Effect of diabetes on outcome and changes in quality of life after coronary artery bypass grafting.

    Science.gov (United States)

    Järvinen, Otso; Julkunen, Juhani; Saarinen, Timo; Laurikka, Jari; Tarkka, Matti R

    2005-03-01

    An increasing proportion of patients undergoing coronary artery bypass grafting are diabetics who are known to carry a higher mortality and morbidity in association with operation, but data on whether health-related quality of life improves similarly after coronary artery bypass grafting in diabetic and nondiabetic patients are limited. We assessed in detail changes in health-related quality of life (RAND-36 Health Survey) during the first year after coronary artery bypass grafting. Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared to nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 12 months later. Thirty-day mortality was 2.7% versus 1.6% (p = 0.511) and one-year survival was 94.6% versus 97.0% (p = 0.287) in the diabetics and nondiabetics, respectively. Diabetics improved significantly (p diabetics as well as in nondiabetics. Both groups experienced closely similar freedom from anginal symptoms at one year (86.2% vs 90.5%, p = 0.280). Although diabetic patients differ from nondiabetics having slightly inferior quality of life before and one year after coronary artery bypass grafting, they gain similar improvement of quality of life in one year after surgery when compared to nondiabetics.

  8. Erectile dysfunction and pcsychoemotional state in ischemic heart disease patients undergone coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Ye. V. Pomeshkin

    2012-01-01

    Full Text Available The impact of erectile dysfunction on psychoemotional state of patients undergone coronary artery bypass graft surgery was evaluated. The International Index of Erectile Function, postcompression cavernous artery dilation test, nocturnal penile tumescence recording and psychophysiological exam were used. It was found that ischemic heart disease patients have higher incidence of associated psychoemotional and erectile dysfunctions.

  9. 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 (Elisabeth); 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

  10. Prognostic information in administrative co-morbidity data following coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Abildstrøm, Steen Zabell; Hvelplund, Anders; Rasmussen, Søren

    2010-01-01

    The aim of this study was to evaluate the prognostic information obtainable from administrative data with respect to 30-day mortality following coronary artery bypass grafting (CABG) and to compare it with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) recorded in a clinical...

  11. A new beating-heart off-pump coronary artery bypass grafting training model

    NARCIS (Netherlands)

    Bouma, Wobbe; Kuijpers, Michiel; Bijleveld, Aanke; De Maat, Gijs E.; Koene, Bart M.; Erasmus, Michiel E.; Natour, Ehsan; Mariani, Massimo A.

    OBJECTIVES: Training models are essential in mastering the skills required for off-pump coronary artery bypass grafting (OPCAB). We describe a new, high-fidelity, effective and reproducible beating-heart OPCAB training model in human cadavers. METHODS: Human cadavers were embalmed according to the

  12. 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.

  13. Analysis of risk factors for occlusions of a synthetic femoropopliteal bypass graft

    Directory of Open Access Journals (Sweden)

    Mirković Nikola

    2015-01-01

    Full Text Available Background/Aim. Femoropopliteal bypass is a revascularization technique of lower extremities with excellent outcome. The great saphenous vein is the best graft material, but if it is not adequate or has been removed, synthetic grafts are an useful alternative. Graft occlusion is the most significant complication with the most serious consequences. The aim of this study was to analyse predictive factors for the synthetic femoropopliteal bypass occlusions. Methods. This retrospective case-control study included all patients who underwent synthetic femoropopliteal bypass due to peripheral arterial occlusive disease at the Vascular Surgery Center, Clinical Center of Kragujevac, Serbia, from 2007 to 2013. The cases group were the patients with femoropopliteal graft occlusion (n = 44, with the control group consisted of the patients without such an outcome (n = 88. Results. Significant effects to occlusion were: concomitant cardiovascular disease (adjustedOR 27.05; 95% CI 4.74; 154.35, a type of femoropopliteal bypass (adjustedOR 16.50; 95% CI 4.05; 67.24, previous vascular intervention (adjustedOR 4.67; 95% CI 1.20; 18.14, clinical stage of the disease (adjustedOR 3.73; 95% CI 1.94; 7.18, administration of postoperative oral anticoagulant therapy (adjustedOR 0.05; 95% CI 0.01; 0.23 and the use of angiotensin converting enzyme inhibitors (adjustedOR 0.14; 95% CI 0.03; 0.70. A significant synergism was shown for the following combinations of the observed risk factors: type of femoropopliteal bypass and cardiovascular disease, type of femoropopliteal bypass and previous vascular intervention, previous vascular intervention and cardiovascular disease, previous vascular intervention and beta blockers, cardiovascular disease and diabetes, type of femoropopliteal bypass and antiaggregant therapy, clinical stage of disease and cardiovascular disease, previous vascular intervention and antiaggregant therapy. Conclusion. Concomitant cardiovascular disease

  14. Myocardial Scar Identified by Magnetic Resonance Imaging Can Predict Left Ventricular Functional Improvement after Coronary Artery Bypass Grafting

    Science.gov (United States)

    Sun, Han-Song; Tang, Yue; Pan, Shi-Wei; Zhao, Shi-Hua

    2013-01-01

    Background Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG). Methods From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF) referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA) 6 months post-CABG. Predictors for global functional recovery were analyzed. Results The baseline LVEF was 32.7±9.2%, which improved to 41.6±11.0% 6 months later and 32/52 patients improved LVEF by ≥5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172–6.996, p = 0.021). Receiver-Operator-Characteristic (ROC) analysis demonstrated that ≤4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, pscar tissue was superior to viable myocardium in predicting cardiac functional recovery (pscar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization. PMID:24358136

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

    Directory of Open Access Journals (Sweden)

    Tao Yang

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

  16. Myocardial ischaemia during coronary artery bypass graft surgery: a ...

    African Journals Online (AJOL)

    Multiorgan dysfunction as a result of the effects of the neurohumoral system, triggered by surgery, anaesthesia, cardiopulmonary bypass, hypothermia and blood transfusion, can lead to prolonged intensive care unit and hospital stay. In this article, a literature review was embarked upon, to understand the pathophysiology ...

  17. 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.

  18. Enterobacter cloacae infection of an expanded polytetrafluoroethylene femoral-popliteal bypass graft: a case report

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    Schilling Jolyon

    2010-05-01

    Full Text Available Abstract Introduction Enterobacter cloacae infections are common among burn victims, immunocompromised patients, and patients with malignancy. Most commonly these infections are manifested as nosocomial urinary tract or pulmonary infections. Nosocomial outbreaks have also been associated with colonization of certain surgical equipment and operative cleaning solutions. Infections of an aortobifemoral prosthesis, an aortic graft, and arteriovenous fistulae are noted in the literature. To our knowledge, this is the first isolated account of an E. cloacae infection of a femoral-popliteal expanded polytetrafluoroethylene bypass graft. Case presentation A 68-year-old Caucasian man presented with fever and rest pain in the right lower extremity five months after the placement of a vascular expanded polytetrafluoroethylene graft for femoral-popliteal bypass. Computed tomography angiography demonstrated peri-graft fluid that was aspirated percutaneously with image guidance and cultured to reveal E. cloacae. The graft was revised and then removed. The patient completed a six-week course of ceftazidime and is currently without signs of infection. There were no other reports of E. cloacae graft infections in any patients receiving treatment in the same surgical suite within a month of this report. Conclusion Isolated cases of E. cloacae infection of surgical bypass grafts are rare (unique in this setting. Clinicians should have a high index of suspicion for device contamination in such cases and should consider testing for possible microbial reservoirs. Graft removal is required due to the formation of biofilm and the recent emergence of Enterobacteriaceae producing extended-spectrum beta-lactamase in community acquired infections.

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

    Directory of Open Access Journals (Sweden)

    Shahzad G. Raja

    2013-01-01

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

  20. 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....

  1. Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft.

    Science.gov (United States)

    Yoon, Sung Sil; Bang, Jung Hee; Jeong, Sang Seok; Jeong, Jae Hwa; Woo, Jong Soo

    2017-10-01

    Off-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an on-pump bypass. However, some cases unexpectedly require conversion to cardiopulmonary bypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed. This retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups. Of the 283 patients scheduled for OPCABG, 47 (16%) were switched to on-pump coronary artery bypass grafting (CABG). The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF) (odds ratio [OR], 3.5; p=0.029), ejection fraction (EF) pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG.

  2. [Coronary artery bypass grafting on the beating heart in high-risk patients].

    Science.gov (United States)

    Rastan, Ardawan Julian; Walther, Thomas; Falk, Volkmar; Lehmann, Sven; Kempfert, Jörg; Mohr, Friedrich Wilhelm

    2007-09-01

    Since the introduction of off-pump coronary artery bypass grafting (OPCAB) for coronary multivessel disease there was growing interest to evaluate the impact of OPCAB surgery compared to conventional coronary artery bypass grafting (CCAB) with cardiopulmonary bypass and cardioplegic arrest. However, subsequent prospective randomized studies and meta-analyses comparing OPCAB and CCAB surgery were performed on low-risk patients or mixed-risk populations. They usually failed to demonstrate a significant benefit of OPCAB surgery on early mortality or perioperative major cardiac and cerebrovascular events. In recent years, efforts were made to analyze the meaning of beating-heart concepts for patients with specific cardiac and extracardiac risks like ischemic cardiomyopathy, older age, renal failure, acute coronary syndrome, left main stenosis and others. For these subsets of patients several mono- and multicenter studies are available today. Even if most of them were nonrandomized and thus failed to reach evidence level A according to the AHA/ACC (American Heart Association/American College of Cardiology) definition, they still allow analyzing interim results for each specific perioperative risk factor. Particularly multi-risk patients and patients with severely reduced left ventricular function seem to benefit in terms of perioperative mortality and major morbidity by avoiding cardiopulmonary bypass and cardioplegic arrest. Analyzing early results and long-term follow-up of 364 patients with severely reduced ejection fractioncardiac ischemia and maintaining native coronary blood flow. Follow-up results were comparable for these patients. In conclusion, beating-heart coronary artery bypass grafting seems to be advantageous in various risk populations and should be considered for patients with more than average risks for cardiopulmonary bypass and cardioplegic arrest.

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

    Directory of Open Access Journals (Sweden)

    Sanjay Orathi Patangi

    2012-01-01

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

  4. A comparison between the HeRO graft and conventional arteriovenous grafts in hemodialysis patients.

    Science.gov (United States)

    Nassar, George M; Glickman, Marc H; McLafferty, Robert B; Croston, J Kevin; Zarge, Joseph I; Katzman, Howard E; Peden, Eric K; Lawson, Jeffrey H; Martinez, Jeffrey M; Thackeray, Lisa

    2014-01-01

    Venous stenosis and occlusion are a major cause of vascular access dysfunction and failure. The HeRO Graft bypasses occlusion and traverses stenosis with outflow directly into the central venous circulation. A randomized, multicenter study was conducted to evaluate the efficacy and safety of the HeRO Graft relative to conventional AV grafts. The design was to enroll 143 patients in a 2:1 randomization ratio between HeRO and conventional AV control groups. Data on 72 subjects (52 HeRO Graft and 20 AV graft controls) were obtained. The HeRO Graft and control cohorts were comparable in baseline characteristics. Adequacy of dialysis, bacteremia rates, and adverse events were consistent between groups. Twelve month Kaplan-Meier estimates for primary and secondary patency rates were 34.8% and 67.6% in the HeRO Graft cohort, and 30.6% and 58.4% in the control cohort. There was no statistical difference in terms of patency between groups. The rates of intervention were 2.2/year for HeRO Graft and 1.6/year for the control (p = 0.100). Median days to loss of secondary patency was 238 for HeRO Graft versus 102 for the control (p = 0.032). The HeRO Graft appears to provide similar patency, adequacy of dialysis, and bacteremia rates to those of conventional AV grafts. © 2014 Wiley Periodicals, Inc.

  5. Transient dilutional acidosis but no lactic acidosis upon cardiopulmonary bypass in patients undergoing coronary artery bypass grafting.

    Science.gov (United States)

    Teloh, Johanna Katharina; Dohle, Daniel-Sebastian; Sönmez, Serhat; Tsagakis, Konstantinos; Verhaegh, Rabea; Petersen, Miriam; Jakob, Heinz; de Groot, Herbert

    2017-04-01

    Dilutional acidosis may result from the introduction of a large fluid volume into the patients' systemic circulation, resulting in a considerable dilution of endogenous bicarbonate in the presence of a constant carbon dioxide partial pressure. Its significance or even existence, however, has been strongly questioned. Blood gas samples of patients operated on with standard cardiopulmonary bypass (CPB) were analyzed in order to provide further evidence for the existence of dilutional acidosis. Between 07/2014 and 10/2014, a total of 25 consecutive patients scheduled for elective isolated coronary artery bypass grafting with CPB were enrolled in this prospective observational study. Blood gas samples taken regularly after CPB initiation were analyzed for dilutional effects and acid-base changes. After CPB initiation, hemoglobin concentration dropped from an average initial value of 12.8 g/dl to 8.8 g/dl. Before the beginning of CPB, the mean value of the patients' pH and base excess (BE) value averaged 7.41 and 0.5 mEq/l, respectively. After the onset of CPB, pH and BE values significantly dropped to a mean value of 7.33 (p < 0.0001) and -3.3 mEq/l (p < 0.0001), respectively, within the first 20 min. In the following period during CPB they recovered to 7.38 and -0.5 mEq/l, respectively, on average. Patients did not show overt lactic acidosis. The present data underline the general existence of dilutional acidosis, albeit very limited in its duration. In patients undergoing coronary artery bypass grafting it seems to be the only obvious disturbance in acid-base homeostasis during CPB.

  6. Minimally invasive coronary artery bypass grafting versus coronary angioplasty for isolated type C stenosis of the left anterior descending artery

    NARCIS (Netherlands)

    Mariani, MA; Boonstra, PW; Grandjean, JG; Monnink, SHJ; denHeijer, P; Crijns, HJGM

    Background: Isolated stenosis of the left anterior descending coronary artery can be treated with medication, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. Recently a new treatment has been developed, which is called minimally invasive direct coronary artery

  7. Klebsiella pneumoniae Pseudoaneurysm of the Ascending Aorta after Coronary Artery Bypass Graft

    Directory of Open Access Journals (Sweden)

    Seyed Khalil Forouzannia

    2010-05-01

    Full Text Available "nMycotic pseudoaneurysm of the ascending aorta is rare in patients undergoing coronary artery bypass graft (CABG and usually caused by staphylococcus aureus. We describe a patient with a mycotic pseudoaneurysm of the ascending aorta at the proximal vein graft anastomosis site after CABG. Culture from the sinus tract of the sternum and from the aneurysm sac was Klebsiella pneumoniae. Surgical technique was patch repair of aorta under hypothermic circulatory arrest. He is asymptomatic at 24 months follow-up.

  8. 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 ...

  9. Magnitude of muscle wasting early after on-pump coronary artery bypass graft surgery and exploration of aetiology

    OpenAIRE

    Hansen, Dominique; Linsen, Loes; Verboven, Kenneth; Hendrikx, Marc; Rummens, Jean-Luc; Van Erum, Monique; Op 't Eijnde, Bert; Dendale, Paul

    2015-01-01

    New Findings What is the central question of this study? It remains uncertain whether significant fat-free mass wasting occurs early after coronary artery bypass graft surgery, and the aetiology of this wasting in these particular conditions is unexplored. What is the main finding and its importance? Significant fat-free mass wasting is present after coronary artery bypass graft surgery, and this wasting effect is greater in younger patients and in patients with greater increments in blood co...

  10. Cardiopulmonary bypass increases the risk of vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure

    Directory of Open Access Journals (Sweden)

    Nelson Américo Hossne Junior

    2015-08-01

    Full Text Available Abstract Objective: Coronary artery bypass grafting is currently the best treatment for dialysis patients with multivessel coronary artery involvement. Vasoplegic syndrome of inflammatory etiology constitutes an important postoperative complication, with highly negative impact on prognosis. Considering that these patients have an intrinsic inflammatory response exacerbation, our goal was to evaluate the incidence and mortality of vasoplegic syndrome after myocardial revascularization in this group. Methods: A retrospective, single-center study of 50 consecutive and non-selected dialysis patients who underwent myocardial revascularization in a tertiary university hospital, from 2007 to 2012. The patients were divided into 2 groups, according to the use of cardiopulmonary bypass or not (off-pump coronary artery bypass. The incidence and mortality of vasoplegic syndrome were analyzed. The subgroup of vasoplegic patients was studied separately. Results: There were no preoperative demographic differences between the cardiopulmonary bypass (n=20 and off-pump coronary artery bypass (n=30 group. Intraoperative data showed a greater number of distal coronary arteries anastomosis (2.8 vs. 1.8, P<0.0001 and higher transfusion rates (65% vs. 23%, P=0.008 in the cardiopulmonary bypass group. Vasoplegia incidence was statistically higher (P=0.0124 in the cardiopulmonary bypass group (30% compared to the off-pump coronary artery bypass group (3%. Vasoplegia mortality was 50% in the cardiopulmonary bypass group and 0% in the off-pump coronary artery bypass group. The vasoplegic subgroup analysis showed no statistically significant clinical differences. Conclusion: Cardiopulmonary bypass increased the risk for developing postoperative vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure.

  11. Early physical training and psycho-educational intervention for patients undergoing coronary artery bypass grafting

    DEFF Research Database (Denmark)

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

    2016-01-01

    , no randomized clinical trials have tested a comprehensive rehabilitation programme consisting of both physical exercise and psycho-education in the early rehabilitation phase. AIMS: The aims of the present SheppHeart pilot randomized clinical trial were to evaluate the feasibility of patient recruitment......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......, patient acceptance of the intervention, safety and tolerability of the intervention. METHODS AND DESIGN: Sixty patients admitted for coronary artery bypass graft were randomized 1:1:1:1 to: 1) physical exercise plus usual care, or 2) psycho-educational intervention plus usual care, or 3) physical exercise...

  12. Impact of metabolic syndrome on mortality and morbidity after coronary artery bypass grafting surgery.

    Science.gov (United States)

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

    2014-08-01

    The prevalence of Metabolic syndrome (MetS) has been increased in Asian countries. It represents a cluster of cardiovascular risk factors including obesity, insulin resistance, lipid abnormality and hypertension. The purpose of this study was to assess the association between MetS and outcome in patients undergoing coronary artery bypass grafting surgery (CABG). This prospective study was performed on patients scheduled for coronary artery bypass grafting surgery (CABG). All the patients were followed up in hospital and three months afterward. Patients were excluded if they were younger than 18 years or had severe comorbidities, a history of valvular heart disease, and low ejection fraction. A total of 235 patients (135 women) with a mean age of 59 ± 9.3 years were included. MetS was more prevalent in women (P 5 days) and atelectasia (P atelectasia.

  13. Attachment anxiety predicts depression and anxiety symptoms following coronary artery bypass graft surgery.

    OpenAIRE

    Kidd, T.; L. Poole; Ronaldson, A.; Leigh, E.; Jahangiri, M.; Steptoe, A.

    2016-01-01

    OBJECTIVE: Depression and anxiety are associated with poor recovery in coronary artery bypass graft (CABG) patients, but little is known about predictors of depression and anxiety symptoms. DESIGN: We tested the prospective association between attachment orientation, and symptoms of depression and anxiety in CABG patients, 6-8 weeks, and 12 months following surgery. METHOD: One hundred and fifty-five patients who were undergoing planned CABG surgery were recruited. Patients completed question...

  14. Post-Myocardial Infarction Ventricular Septal Defect Six Months following Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Fiedler, Amy G; Sundt Iii, Thoralf M; Tolis, George

    2017-08-25

    Mechanical complications following acute myocardial infarction are associated with high mortality. We present the first reported case of a new post myocardial infarction ventricular septal defect (VSD) within six months of coronary artery bypass grafting. The patient underwent successful surgical correction of the VSD with the assistance of mechanical circulatory support (MCS). This case highlights the importance of mechanical circulatory support in the management of cardiogenic shock associated with rare complications of myocardial infarction, even after surgical revascularization.

  15. Resection of Celiac Artery Aneurysm with Bypass Grafting to the Splenic and Common Hepatic Arteries.

    Science.gov (United States)

    Pattakos, Gregory; Tolpin, Daniel; Ott, David A

    2017-02-01

    Celiac artery aneurysms are rare and typically warrant surgical treatment. Atherosclerosis is their chief cause. Symptomatic patients usually present with abdominal pain. Surgical resection of celiac artery aneurysms is associated with low morbidity and mortality rates. We report the case of a patient whose 2.2-cm celiac artery aneurysm we resected, with subsequent saphenous vein bypass grafting from the celiac trunk to the splenic and common hepatic arteries. In addition, we briefly discuss other treatment options.

  16. Idiopathic pulmonary artery aneurysm treated with surgical correction and concomitant coronary artery bypass grafting.

    Science.gov (United States)

    Arnaoutakis, George; Nwakanma, Lois; Conte, John

    2009-07-01

    Idiopathic pulmonary artery aneurysm is a rare clinical entity, and therefore the natural course and clinical management are not well established. We present the case of an elderly woman with a symptomatic idiopathic pulmonary artery aneurysm who underwent surgical repair along with simultaneous coronary artery bypass grafting. With long-term follow-up presented in this report, we describe the safety and durability of surgical repair.

  17. 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...

  18. Outcome of coronary endarterectomy with off-pump coronary artery bypass grafting: A retrospective study

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    Redoy Ranjan

    2017-09-01

    Full Text Available In this study, we assessed the outcome of surgical revascularization technique, coronary artery bypass grafting (CABG with or without coronary endarterectomy for patients with diffuse coronary artery disease in a single surgeon’s practice on 2,189 patients from January 2009 and December 2016. The variables like intubation time, ICU stay, postoperative myocardial infarction, arrhythmia, renal impairment, stroke and ICU mortality were compared. Among these patients, 1,000 patients required coronary endarterectomy in addition to off-pump coronary artery bypass grafting (OPCABG. Initially, the mortality and incidence of postoperative blood transfusion were higher in the group of patients who had coronary endarterectomy in addition to CABG. However, postoperative combined use of heparin, warfarin and double anti-platelet agent was associated with decreased mortality significantly in our study. In comparison to other group, the patients in the combined coronary endarterectomy with CABG group had a higher incidence of male sex, past myocardial infarction and poor left ventricular function. Total myocardial revascularization is attainable when coronary endarterectomy is performed in addition to off-pump coronary artery bypass graft surgery in diffuse coronary artery disease.

  19. Atrial fibrillation and flutter following coronary artery bypass graft surgery: A retrospective study and review

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    Shyamal Premaratne

    2016-04-01

    Full Text Available Introduction and objectives Atrial fibrillation is a common arrhythmia following coronary artery bypass graft surgery. Its incidence can range from 10 to 60% of patients undergoing coronary artery bypass graft. This rhythm can result in shorter or longer intervals between beats. Methods Medical records of 143 patients from the Queen’s Medical Center, Kuakini Medical Center, Saint Francis Medical Center, and Straub Hospital and Clinic, all of which are located in Honolulu, Hawaii were reviewed. An additional 39 records of patients who did not develop these complications were also reviewed as a control group. Patients were selected according to the ICD codes for atrial fibrillation/flutter and coronary artery bypass graft. Both anomalies can lead to increased health care costs, morbidity, and mortality. In this study, possible predisposing factors to these complications were investigated. The time of onset, weight gain, elapsed time, fluid status (in/out, hematocrit, and drug regimens were compared between the two groups. Results The differences in weight gain, fluid status, and hematocrit between the groups were not significant. There were a total of 17 different drugs prescribed to the group as a whole but not every patient received the same regimen. Conclusions Atrial fibrillation and flutter were found to be more common in males, particularly between the ages of 60 and 69 years. There were no other significant findings.

  20. Coronary artery bypass grafting and concomitant excision of chest wall chondrosarcoma

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    Ganti Somsekhar

    2009-02-01

    Full Text Available Abstract Coexistence of coronary artery disease and cancer with both requiring surgical treatment at the same time is rare. A 52 year male undergoing elective coronary artery bypass grafting was incidentally discovered to have a large soft tissue mass of variable consistency with cartilaginous elements arising from the right costal margin and adjoining ribs by a broad attachment and protruding into right pleural cavity. Frozen section suggested it to be either a chondrosarcoma or a teratoma. A wide excision of the mass with the adjoining muscle and periosteum along with quadruple coronary artery bypass grafting was done. This report is unusual on account of a being the first reported case in world literature of concomitant excision of chondrosarcoma and coronary artery bypass grafting and b the conservative management of the incidentally discovered chondrosarcoma by wide excision rather than chest wall resection with no local recurrence to date. Pathology of chondrosarcoma, in particular, and various management strategies when coronary artery disease and cancer coexist, in general, is discussed.

  1. Early postoperative cognitive dysfunction and blood pressure during coronary artery bypass graft operation.

    Science.gov (United States)

    Gottesman, Rebecca F; Hillis, Argye E; Grega, Maura A; Borowicz, Louis M; Selnes, Ola A; Baumgartner, William A; McKhann, Guy M

    2007-08-01

    To determine the relationship between change in blood pressure during coronary artery bypass graft operations and early cognitive dysfunction. Cohort study. Quaternary care facility. Patients Fifteen patients undergoing coronary artery bypass graft operations who were at high risk for postoperative stroke. Preoperative and intraoperative mean arterial pressures (MAPs) were measured in all patients. Intervention A subset of patients underwent preoperative and postoperative magnetic resonance imaging. Main Outcome Measure Change in cognitive performance, using the Mini-Mental State Examination and other simple cognitive tests. A drop in MAP (preoperatively to intraoperatively) predicted a decrease in Mini-Mental State Examination score. When change in MAP was dichotomized (after excluding an outlier), subjects with a small decrease improved on the Mini-Mental State Examination by 1 point, whereas those with a large drop in MAP worsened by 1.4 points (P = .04). A drop in MAP from a preoperative baseline may put patients at risk for early cognitive dysfunction after a coronary artery bypass graft operation.

  2. Acute kidney injury after coronary artery bypass grafting: assessment using RIFLE and AKIN criteria.

    Science.gov (United States)

    Nina, Vinicius José da Silva; Matias, Maryanne Miranda; Brito, Dyego José de Araújo; Figueiredo Neto, José Albuquerque de; Coutinho, Léa Barroso; Rodrigues, Rayssa Fiterman; Mendes, Vinícius Giuliano Gonçalves; Gaspar, Shirlyne Fabianni Dias

    2013-06-01

    To compare the RIFLE (Risk, Injury, Failure, Loss and End-stage Renal Failure) and AKIN (Acute Kidney Injury Network) criteria for diagnosis of acute kidney injury after coronary artery bypass grafting. Retrospective cohort. 169 patients who underwent coronary artery bypass grafting from January 2007 through December 2008 were analyzed. Information was entered into a database and analyzed using STATA 9.0. Patients' mean age was 63.43 1 9.01 years old. Predominantly male patients (66.86%) were studied. Acute Kidney Injury was present in 33.14% by AKIN and in 29.59% by RIFLE. Hemodialysis was required by 3.57% and 4.0% of the patients when AKIN and RIFLE were applied respectively. There was 4.0% and 3.57% mortality of patients with Acute Kidney Injury according to the RIFLE and AKIN criteria, respectively. In 88.76% of the cases, there was good agreement between the two methods in the detection (kappa=0.7380) and stratification (kappa=0.7515) of Acute Kidney Injury. This study showed that the RIFLE and AKIN criteria have a good agreement in the detection and stratification of acute kidney injury after coronary artery bypass grafting.

  3. Acute kidney injury after coronary artery bypass grafting: assessment using RIFLE and AKIN criteria

    Directory of Open Access Journals (Sweden)

    Vinicius José da Silva Nina

    2013-06-01

    Full Text Available OBJECTIVE: To compare the RIFLE (Risk, Injury, Failure, Loss and End-stage Renal Failure and AKIN (Acute Kidney Injury Network criteria for diagnosis of acute kidney injury after coronary artery bypass grafting. METHODS: Retrospective cohort. 169 patients who underwent coronary artery bypass grafting from January 2007 through December 2008 were analyzed. Information was entered into a database and analyzed using STATA 9.0. RESULTS: Patients' mean age was 63.43 1 9.01 years old. Predominantly male patients (66.86% were studied. Acute Kidney Injury was present in 33.14% by AKIN and in 29.59% by RIFLE. Hemodialysis was required by 3.57% and 4.0% of the patients when AKIN and RIFLE were applied respectively. There was 4.0% and 3.57% mortality of patients with Acute Kidney Injury according to the RIFLE and AKIN criteria, respectively. In 88.76% of the cases, there was good agreement between the two methods in the detection (kappa=0.7380 and stratification (kappa=0.7515 of Acute Kidney Injury. CONCLUSION: This study showed that the RIFLE and AKIN criteria have a good agreement in the detection and stratification of acute kidney injury after coronary artery bypass grafting.

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

    Science.gov (United States)

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

    2013-01-01

    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. 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 Pventilated 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). 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.

  5. Surgical management for achalasia after coronary artery bypass graft using the right gastroepiploic artery: a case report.

    Science.gov (United States)

    Muranushi, Ryo; Miyazaki, Tatsuya; Saito, Hideyuki; Kuriyama, Kengo; Yoshida, Tomonori; Kumakura, Yuji; Honjyo, Hiroaki; Yokobori, Takehiko; Sakai, Makoto; Sohda, Makoto; Kuwano, Hiroyuki

    2017-12-01

    The right gastroepiploic artery is commonly used in coronary artery bypass grafting. Appropriate strategies are required when performing upper abdominal surgeries after the right gastroepiploic artery has been used in coronary artery bypass grafting because compressing or injuring the graft may cause myocardial ischemia and fatal arrhythmias. To our knowledge, this is the first reported case of surgery for achalasia performed after coronary artery bypass grafting using the right gastroepiploic artery. We have discussed the surgical procedure and particular intraoperative considerations. A 62-year-old man who had undergone coronary artery bypass grafting using the right gastroepiploic artery presented with achalasia. Because medication and balloon dilation had been ineffective and he was having difficulty ingesting food, we performed a Heller-Dor procedure via laparotomy. The right gastroepiploic artery was not damaged during this surgery, and there were no perioperative cardiovascular complications. Adequate control of symptoms was achieved. When performing upper abdominal surgeries after coronary artery bypass grafting with the right gastroepiploic artery, it is necessary to investigate the patient carefully preoperatively and adapt the intraoperative procedure to minimize risk of injury to the graft and consequent cardiovascular complications.

  6. Minimally Circulatory-Assisted On-Pump Beating Coronary Artery Bypass Grafting for Patients With Complex Conditions for Off-Pump Surgery.

    Science.gov (United States)

    Mizuno, Tomohiro; Egi, Koso; Sakai, Kenji; Oi, Keiji; Hachimaru, Tsuyoshi; Makita, Tohru; Oishi, Kiyotoshi; Arai, Hirokuni

    2017-03-01

    Off-pump coronary artery bypass grafting (OPCAB) in patients with acute myocardial infarction (AMI) is difficult because of circulatory deterioration during displacement of the heart. At our institution, we performed minimally circulatory-assisted on-pump beating coronary artery bypass grafting (MICAB) in these patients. During MICAB, support flow was controlled at a minimal level to maintain a systemic blood pressure of approximately 100 mm Hg and a pulmonary arterial systolic pressure of bypass grafts, perioperative renal function, and early and mid-term morbidity and mortality were compared between the patients who received MICAB and the 37 consecutive patients who underwent OPCAB during the study period at our hospital. The assist flow indices (actual support flow/body surface area) during anastomosis to the left anterior descending artery, left circumflex artery, and right coronary artery were 0.95 ± 0.48 L/min/m2 , 1.32 ± 0.53 L/min/m2 , and 1.15 ± 0.47 L/min/m2 , respectively, in the emergent and urgent patients following AMI, and 0.44 ± 0.39 L/min/m2 , 1.25 ± 0.39 L/min/m2 , and 1.14 ± 0.43 L/min/m2 , respectively, in the elective patients with either dilated LVs or small target vessels. The lowest mixed venous oxygen saturation during pump support in the MICAB group was significantly higher than that in the OPCAB group (83.8 ± 10.8%, 71.6 ± 7.5%, P bypass grafts for both groups was 4 (25th, 75th percentile: 3, 4) (P = 0.558); the complete revascularization rates were 94.6 and 97.3%, respectively (not significant [NS]); the acute patency rates were 98.9 and 99.2%, respectively (NS); and the 30-day mortality rates were 2.7 and 0%, respectively (NS). No instances of either cerebrovascular complications or newly occurring postoperative renal failure were noted in either group. There were no statistically significant differences between the groups with respect to early and mid-term results (freedom from all

  7. Focal necrosis mimicking breast cancer following coronary bypass grafting.

    Science.gov (United States)

    Coufal, Oldřich; Ostřížek, Tomáš; Krsička, Petr; Lžičařová, Eva; Nenutil, Rudolf; Procházková, Monika; Bencsiková, Beatrix; Grell, Peter; Šefr, Roman

    2017-05-30

    Breast cancer can be diagnosed easily in most cases. However, occasionally, we are faced with some conditions that can mimic it. These may include inflammations, benign tumors, cysts, hematomas, or, more rarely, focal necrosis. This report presents a case of focal breast necrosis following myocardial revascularization with the left internal mammary artery, which is a very rare condition, with only few cases described in the literature. The necrosis becomes usually apparent a few days or weeks after the surgery and is often coincidental with the dehiscence of sternotomy with necrosis of wound edges. As it mostly affects the skin, it can be easily recognized. Also, our patient developed a dehisced sternotomy shortly after the surgery but there were no obvious objective changes on the breast. The condition was first dominated only by non-specific subjective symptom-pain. Later, a lump in the breast occurred, when the sternotomy had already healed. Moreover, an enlarged lymph node was palpable in the axilla. Because of non-typical symptoms, the condition was suggestive of breast cancer for a relatively long time. The patient had suffered from a very strong pain until she was treated by mastectomy with a good clinical result. Mammary necrosis following the coronary artery bypass is rare. In most cases, it manifests on the skin shortly after the surgery concurrently with dehisced sternotomy, so it can be easily diagnosed. However, in sporadic cases, the symptoms may occur later and may mimic breast cancer. Our objective is to raise awareness of this rare condition.

  8. Segmental wall motion abnormalities during telerobotic totally endoscopic coronary artery bypass grafting.

    Science.gov (United States)

    Mierdl, Stephan; Byhahn, Christian; Dogan, Selami; Aybek, Tayfun; Wimmer-Greinecker, Gerhard; Kessler, Paul; Meininger, Dirk; Westphal, Klaus

    2002-04-01

    In addition to single-lung ventilation (SLV), intrathoracic CO2 insufflation is mandatory for adequate exposure during totally endoscopic coronary artery bypass grafting. With transesophageal echocardiography, we investigated biventricular myocardial wall motion in 25 patients with isolated disease of the left anterior descending coronary artery who underwent totally endoscopic coronary artery bypass grafting with the "Da Vinci" robotic surgical system. At distinct time points during the operation, a cine loop of both ventricles was registered from a transgastric mid-short-axis view. Myocardial wall motion analysis was performed according to an established segmentation model of the left ventricle and to an established five-point scale for wall motion (1, normal; 5, dyskinesia). Significant alterations from preoperative baseline wall motion were visible in the septal, inferior, and anterior segments of the left ventricle at some time during the prebypass period, combined with a markedly decreased PaO2 under SLV and increased intrathoracic pressure. The same findings applied to the right ventricle; however, wall motion abnormalities were more pronounced here. After myocardial revascularization, weaning from cardiopulmonary bypass, CO2 deflation, and return to double-lung ventilation, myocardial wall motion recovered to baseline values. Clinically significant hemodynamic instability did not occur. The data suggest that robot-assisted coronary artery bypass grafting leads to significant prebypass alterations of biventricular segmental wall motion. On the basis of our data, it cannot be definitively stated whether the observed results were due to reduced oxygenation during SLV and thus "real" myocardial ischemia, intrathoracic CO2 insufflation with positive pressure leading to mechanical compromise of the heart, absolute or relative hypovolemia, or a combination of these factors. However, in this cohort, which consisted of patients with single-vessel disease and good

  9. Quantitative assessment technique of HyperEye medical system angiography for coronary artery bypass grafting.

    Science.gov (United States)

    Yamamoto, Masaki; Nishimori, Hideaki; Handa, Takemi; Fukutomi, Takashi; Kihara, Kazuki; Tashiro, Miwa; Sato, Takayuki; Orihashi, Kazumasa

    2017-02-01

    The HyperEye Medical System (HEMS) uses indocyanine green (ICG) to visualize blood vessels in coronary artery bypass grafting (CABG). We performed quantitative HEMS assessment to detect grafts at risk of occlusion. We assessed the HEMS angiograms of 177 grafts from 69 patients who underwent CABG and compared the results with those of fluoroscopic coronary angiography, by measuring the increasing rate of ICG intensity, average acceleration value, and time to peak luminance intensity. Grafts in the patent and failed groups showed significant differences in their increasing rate of intensity and average acceleration value. The average accelerations value of ICG intensity of internal thoracic artery (ITA) and saphenous vein (SV) grafts were 112.3 and 144.9 intensity/s 2 in the patent group, and 71.0 and 91.8 intensity/s 2 in the failed group. The time to peak luminance intensity was 1.7 and 1.4 s in the patent group and 2.3 and 1.9 s in the failed group; these values were not significantly different. Significant reductions in the ICG intensity rate and average acceleration value can occur in failed grafts. Therefore, quantifiable changes in ICG intensity may help detect minute changes in blood flow.

  10. ACUTE ATORVASTATIN RECAPTURE THERAPY IN CORONARY ARTERY BYPASS GRAFTING

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    A. V. Panov

    2017-01-01

    Full Text Available Aim. To assess the safety of the application of high-dose atorvastatin and its effect on metabolic parameters, such as the total level of nitric oxide and homocysteine in the blood plasma in patients with ischemic heart disease during a coronary artery bypass surgery (CABG.Material and methods. The study included 42 patients with stable effort angina II-IV functional class. A special criterion for selection was the taking atorvastatin at a dose of 20 mg/day for at least 30 days before patient was directed to surgical revascularization of the myocardium. Immediately before the intervention, the dose of atorvastatin was increased to the maximum allowed with subsequent taking of 40 mg/day. Complications after CABG, indicators of lipid metabolism and biochemical safety of statin use were analyzed. The duration of observation of results of the acute atorvastatin recapture therapy was 3 weeks during hospital period. We used modern enzymatic method for nitrogen oxides determination with the application of nitrate reductase. Determination of total homocysteine was performed by high performance liquid chromatography.Results. It was found that atorvastatin 80 mg for 12 hours and 2 hours before CABG in patients previously treated with atorvastatin 20 mg/day is well tolerated and leads to decrease in total levels of nitric oxide by 1.6 (0.18-10.8 μmol/l and homocysteine by 0.9 (0.17-2.69 μmol/l (p< 0.05 for bothConclusion. It is assumed that the metabolic effects of high-dose therapy with atorvastatin may have a positive influence on the immediate postoperative period.

  11. Reproduction of superior sagittal sinus animal model by bypass transplantation of biomaterial graft

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    Qing-yong LUO

    2011-03-01

    Full Text Available Objective To establish the beagles model of superior sagittal sinus bypass graft,and explore the feasibility of reconstruction of superior sagittal sinus with biomaterials using this model.Methods Eight adult male beagles(weight: 12.5-22.0kg were involved in the present study.The superior sagittal sinus was exposed and blocked via bone window,and then anastomosed side-to-end to the biomaterial graft under the dedicated microscope of neurosurgery surgery,expectant treatment such as anti-inflammatory was given for the animals.The digital subtraction venography(DSV and color Doppler flow imaging(CDFI of superior sagittal sinus were performed in 1,2,4 and 8 weeks after the operation.Eight weeks after the operation,all the animals were sacrificed and the material graft was examined histologically.Results The DSV and CDFI of superior sagittal sinus showed that the stomas of 2 beagles were with slight stenosis and high flow velocity,of 1 beagle with small leakage and low flow velocity,while of other 5 beagles were normal.The histological examination showed endothelial cells were growing on the graft and superior sagittal sinus,and crawling toward the lumen of graft 8 weeks after the operation.Conclusion The beagles model of superior sagittal sinus bypass graft was established successfully.The short-term effect of the model was satisfactory,while further work should be performed to determine the long-term effects.

  12. Heart bypass surgery - discharge

    Science.gov (United States)

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

  13. 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 - ...

  14. Does a skeletonized internal thoracic artery give fewer postoperative complications than a pedicled artery for patients undergoing coronary artery bypass grafting?

    Science.gov (United States)

    Fouquet, Olivier; Tariel, François; Desulauze, Pierre; Mével, Gwenaël

    2015-05-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does a skeletonized internal thoracic artery (ITA) give fewer postoperative complications than a pedicled artery for patients undergoing coronary artery bypass grafting?' Altogether, 98 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. Papers about patency of skeletonized versus pedicled internal thoracic artery were excluded. The analysed complications were essentially mediastinitis, superficial sternal infection, wound infection, chest pain and pulmonary function. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Grafts used were either single ITA (LITA or RITA, left or right, respectively) or bilateral ITAs (BITAs). One prospective randomized controlled trial was identified, which found that benefits of skeletonized harvesting included increased graft length, increased graft flow and decreased incidence of mediastinitis. All of the six studies concerning wound infection demonstrate fewer complications when ITA is skeletonized. One of the three papers describing postoperative mortality demonstrated lower 30-day mortality, but there was no long-term analysis. Three studies describing postoperative chest pain reported a lower score on the visual analogue scale (VAS) within 30 days. One of them indicates that the pedicled group has a significantly greater VAS, pain disability index and short-form McGill Pain questionnaire score at 1 and 3 months. The hospital stay was shorter for three studies conducted on this subject. One study about pulmonary function reported a better ratio of pre- versus postoperative values of forced vital capacity. Despite longer operating times, skeletonization leads to fewer wound infections, reduced chest pain, allows a shorter hospital stay and better

  15. Preserved Renal Function in Kidney Transplantation over a Thrombosed Aortobifemoral Bypass Graft: The Role of Retrograde Flow and Early Thrombolysis

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    Saúl Pampa-Saico

    2016-01-01

    Full Text Available Aortobifemoral bypass (ABFB thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries. This unusual situation not previously reported in a kidney transplant setting, together with an early diagnosis, allowed graft survival until an early local thrombolysis resolved the problem. Two years later, renal function remains normal.

  16. 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

  17. Bypass Surgery after Endovascular Therapy for Infrapopliteal Lesion Is Not a Poor Outcome Compared with Initial Bypass Surgery by Vascular Surgeons.

    Science.gov (United States)

    Morisaki, Koichi; Yamaoka, Terutoshi; Iwasa, Kazuomi; Ohmine, Takahiro

    2017-11-01

    It is unclear whether prior endovascular therapy (EVT) adversely affects bypass surgery. The aim of this study is to investigate treatment outcomes between initial bypass (bypass-first) and bypass surgery after EVT (EVT-first). We conducted a retrospective analysis of critical limb ischemia patients undergoing infrapopliteal bypass between November 2006 and December 2015. Graft patency, limb salvage (LS), amputation-free survival (AFS), and overall survival (OS) were examined between bypass-first and EVT-first groups. The subjects in this study were 75 patients and 82 limbs in the bypass-first group and 24 patients and 24 limbs in the EVT-first group. The average age was higher in EVT-first group (P = 0.03). The percentage of inframalleolar bypass was higher in the EVT-first group (P = 0.002). Primary patency at 1 and 2 years was 72.0% and 67.5% for the bypass-first group and 53.1% and 47.2% for the EVT-first group, respectively (P = 0.04). Inframalleolar bypass was a risk factor for lower primary patency (hazard ratio 3.07, 95% confidence interval 1.18-8.51, P = 0.02) in multivariate analysis, while there were no differences in secondary patency, LS, AFS, and OS. Bypass surgery after EVT has lower primary patency rates in comparison with primary bypass in patients submitted to infrapopliteal revascularization. Although very heterogeneous study population with a lot of bias in the indication of the revascularization, LS, OS and AFS are not affected by previous EVT. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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    Suprakash Chaudhury

    2016-01-01

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

  19. Thoracic endovascular aortic repair and off-pump coronary artery bypass grafting after renal transplantation: a case report.

    Science.gov (United States)

    Yanase, Yohsuke; Muraki, Satoshi; Koyanagi, Tetsuya; Watanabe, Noriyasu; Kurimoto, Yoshihiko

    2011-01-01

    Twelve years after receiving a renal transplant, a 50-year-old woman developed asthmatic symptoms. Chest CT revealed a descending thoracic aortic aneurysm. She had undergone percutaneous coronary intervention to treat the left anterior descending artery 10 years earlier. Coronary artery angiography revealed restenosis of the left anterior descending artery (99%, #6 in-stent). Because cardiopulmonary bypass may cause problems for transplanted kidney, we performed off-pump coronary artery bypass grafting (left internal thoracic artery to left anterior descending artery) and thoracic endovascular graft placement to treat the aortic aneurysm. Considering that the artery of the transplanted kidney was attached to the right iliac artery, and then the left common femoral artery was selected as the access root for GORE TAG(®) endografts (34 × 200 and 34 × 150 mm) (stentgrafts were deployed for the descending aortic artery). Postoperative angiography showed a patent bypass graft. Postoperative CT confirmed the absence of endoleaks. The postoperative course was uneventful, and she was discharged without complications. Ischemic heart disease and descending thoracic aortic aneurysm in recipients of kidney transplants can be treated using off-pump coronary bypass grafting and thoracic endovascular graft placement. The transplanted kidney was protected without using cardiopulmonary bypass (CPB).

  20. Perivenous application of cyanoacrylate tissue sealants reduces intimal and medial thickening of the vein graft and inflammatory responses in a rabbit model of carotid artery bypass grafting.

    Science.gov (United States)

    Dai, Longsheng; Gao, Mingxin; Gu, Chengxiong; Zhang, Fan; Yu, Yang

    2016-02-01

    Effective therapies to prevent vein graft failure after coronary artery bypass grafting (CABG) are still lacking. α-Cyanoacrylate (α-CA, 99% n-octyl-α-cyanoacrylate + n-butyl-α-cyanoacrylate) has been increasingly used as a tissue sealant for wound closure because of its bacteriostatic, biodegradable and haemostatic properties. As a strong tissue adhesive, α-CA might prevent an arterial circulation-induced mechanical stretch on vein graft to attenuate intimal hyperplasia. Here, we investigated the effects of perivenous application of α-CA on the vein graft in a rabbit model of carotid artery bypass grafting. Healthy New Zealand white rabbits were randomized into no graft, graft or graft + α-CA group (n = 10 per group). Rabbit carotid artery was bypassed with the jugular vein. α-CA sealants were sprayed on the entire jugular graft including both anastomotic sites after completion of anastomoses. Blood flow parameters and histological characteristics of the vein grafts including vessel wall thickness, number of medial elastic lamina and proliferation index were evaluated 4 weeks after the surgery. The mRNA or protein levels of proinflammatory factors, chemokine (C-C motif) ligand-2 (CCL-2) and tumour necrosis factor-α (TNF-α) were measured 4 weeks after the operation by quantitative reverse transcription polymerase chain reaction or enzyme-linked immunosorbent assay. Compared with the untreated vein grafts at Week 4 after the operation, the α-CA spray significantly improved graft flow (39.4 ± 1.5 vs 27.8 ± 2.9 ml/min, P sealants exerts short-term beneficial effects on the vein graft and reduces inflammatory responses in a rabbit model of carotid artery bypass grafting. Long-term effects of α-CA on vein graft remodelling and the clinical significance of α-CA in CABG remain to be determined in future studies. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  1. 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.

  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. Coronary artery bypass grafting following simultaneous treatment of abdominal aortic aneurysm and peripheral arterial disease.

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    Temizkan, Veysel; Ugur, Murat; Alp, Ibrahim; Ucak, Alper; Yedekci, Erturk; Yilmaz, Ahmet Turan

    2014-01-01

    Atherosclerosis might affect all arterial segments of the vascular system, thus peripheral arterial disease (PAD) accompanying coronary artery disease (CAD) is not uncommon. In addition to this coexistence, abdominal aortic aneurysm (AAA) is frequently associated with CAD. Although treatment strategies of CAD and PAD or CAD and AAA has been reported previously, treatment of these three pathologies has not been reported. The management of a therapeutic strategy is important for avoiding perioperative mortality and morbidity in CAD associated with AAA and PAD. We are reporting our simultaneous treatment strategy of three pathologies with endovascular AAA repair, stent implantation into the superficial femoral artery (SFA) and coronary artery bypass grafting (CABG).

  4. Headache and seizures after cervical epidural injection in a patient undergoing coronary artery bypass grafting

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    Dheeraj Arora

    2012-01-01

    Full Text Available Epidural analgesia is widely used in cardiothoracic surgery. Most of the complications associated with epidural analgesia are related to the insertion techniques of epidural catheter. A 68-year-old obese patient posted for coronary artery bypass grafting surgery developed headache followed by seizures after insertion of the thoracic epidural catheter. Magnetic resonance imaging revealed air in the basal cisterns and in the left frontal region. The patient was managed conservatively and the symptoms subsided after 24 h. Later, the patient underwent coronary angioplasty.

  5. Simultaneous thoracoabdominal aortic aneurysm repair and coronary artery bypass grafting through median sternotomy.

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    Furutachi, Akira; Rikitake, Kazuhisa; Ikeda, Kazuyuki; Nogami, Eijiro; Takaki, Jun

    2014-09-01

    Patients with thoracoabdominal aortic aneurysms (TAAA) often have severe ischemic heart disease. The determination of which condition to treat first is based on disease severity, but in some cases the conditions are equally severe. A 78-year-old woman received a diagnosis of a 59-mm TAAA and coronary artery stenosis. We performed simultaneous TAAA repair, using the patched aortoplasty method, and coronary artery bypass grafting (CABG) through a median sternotomy. No perioperative complications occurred, the patient was discharged in stable condition, and early follow-up visits were uneventful. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Transit Time Flowmetry in Coronary Artery Bypass Grafting-experience at Queen Alia Heart Institute, Jordan

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    Basel Harahsheh

    2012-11-01

    Full Text Available Objectives: To assess the results of transit time flowmetry (TTF on a consecutive group of coronary artery bypass grafting (CABG patients at Queen Alia Heart Institute.Methods: Intraoperative flow measurements of a consecutive group of 436 CABG patients. The flow pattern for each coronary artery system was assessed including mean flows, pulsatility index (PI and the need for revision.Results: A total of 1394 grafts in 436 patients were assessed (3.2 grafts per patient, wherein 100 grafts showed inadequate flowmetry results (7.2%; most of which were in the circumflex and right coronary artery systems with a percentage of 9.4% and the least in the LAD system with a percentage of 4.4%. The mean flow of grafts to the LAD system was 33.4±5.3 mL/min with a PI of 2.4±0.4; while the mean for grafts to the circumflex artery systemwas 35.1±7.2 mL/min with a PI of 3.5±0.7. The mean for theright coronary artery was 38.4±5.9 mL/min with a PI of 2.6±0.6. Revisions occurred in five patients (1.1%. Suboptimal grafts to the LAD system exhibited a flow of 14.1±7.4 mL/min with a PI of 6.9±1.7. While for the circumflex system a flow of 5.5±3.6 mL/min was reported with a PI of 10.4±7.8; and for the right coronary system a flow of 7.2±5.3 mL/min with a PI of 9.1±5.7 was reported.Conclusion: Grafts to the LAD system showed the best flowmetry results compared to grafts to the circumflex and right coronary systems. A proportion of poor grafts were revised.

  7. Stent graft placement for dysfunctional arteriovenous grafts

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    Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2015-07-15

    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

  8. Failure of internal thoracic artery grafts: conclusions from coronary angiography mid-term follow-up.

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    Bezon, Eric; Choplain, Jean N; Maguid, Yasser A; Aziz, Ahmed A; Barra, Jean A

    2003-09-01

    The objective of this study was to identify causes of the failures of internal thoracic artery bypass grafts according to operative technique, the internal thoracic artery used, and the coronary artery grafted. This retrospective study concerns 302 follow-up angiographies performed in patients treated with 512 internal thoracic artery bypass grafts: 115 single grafts, 78 sequential grafts, and 109 grafts with two internal thoracic arteries (61 Y grafts). Postoperative angiography was performed after a mean period of 17.3 +/- 4.1 months. Failures consisted of 11 (2%) occluded grafts and 19 (4%) nonfunctioning grafts (threadlike internal thoracic artery). There was no difference in patency among the various types of left anterior descending artery bypass grafts anastomosed with the left internal thoracic artery. The failure rate was higher with the right internal thoracic artery (13%) than with the left internal thoracic artery (4%; p < 0.05). The failure rate of the left anterior descending artery bypass grafts (3%) was lower than that for the branches of circumflex artery bypass grafts (13%; p < 0.05). The 19 cases of nonfunctioning grafts did not include significant anastomotic stenosis: 14 were related to competitive blood flow, 4 to a poor recipient coronary arterial bed, and 1 to significant distal coronary stenosis. At least two thirds of failures of bypass grafts could have been avoided by more objective analysis of the coronary stenosis on preoperative coronary angiography and better mastery of the surgical technique.

  9. Adventitial cystic disease of the popliteal artery treated by bypass graft utilizing the short saphenous vein: A case report.

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    Miyake, Katsunori; Sawamura, Naoki; Ikegaya, Yuki; Isogai, Naoko; Kawachi, Jun; Shimoyama, Rai; Fukai, Ryuta; Kashiwagi, Hiroyuki; Ogino, Hidemitsu

    2017-01-01

    Adventitial cystic disease is relatively rare vascular disease, frequently occurred in the popliteal artery. No definitive treatment has been established yet. A 53-year-old woman presenting intermittent claudication of the right leg was diagnosed as adventitial cystic disease of popliteal artery. Percutaneous balloon dilation yielded an immediate recurrence. The disease was successfully treated by bypass grafting utilizing the short saphenous vein to replace the part of the popliteal artery containing the adventitial cyst. No postoperative complication was found six months after surgery. Comparing to a great saphenous vein, a short saphenous vein as a material of bypass graft has a significant advantage, as only a single surgical field is necessary. We propose that bypass graft surgery employing a short saphenous vein is worth considering as a treatment of adventitial cystic disease at the popliteal artery. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. Tailored Double-Barrel Bypass Surgery Using an Occipital Artery Graft for Unstable Intracranial Vascular Occlusive Disease.

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    Chung, Yeongu; Lee, Sung Ho; Ryu, Jiwook; Kim, Johnho; Chung, Sang Bong; Choi, Seok Keun

    2017-05-01

    This report describes the need for a tailored approach for intracranial vascular occlusive disease and introduces the usefulness of the OA as a donor artery for interposition graft. A 65-year-old male patient suffered from repeated transient ischemic attack (TIA). Imaging studies revealed complete occlusion of the proximal left side of the internal carotid artery (ICA) and multiple infarction in the watershed zone. We planned superficial temporal artery-middle cerebral artery (STA-MCA) bypass to restore cerebral blood flow and to prevent the progression of infarction. However, the parietal branch of the STA was too small in diameter and not suitable as a single donor for the bypass in order to supply sufficient blood flow. Moreover, the frontal branch of the STA had collateral channels through the periorbital anastomosis into the cerebral cortex that could result in infarction during clamping for anastomosis. We determined that tailored treatment planning was necessary for successful revascularization under these conditions. Thus, we performed a bypass between the parietal branch of the STA and a cortical branch of the MCA as an "insurance bypass." Then we performed another bypass between the frontal branch of the STA and a cortical branch of the MCA using an ipsilateral occipital artery (OA) interposition graft. The patient had no perioperative complications, and postoperative imaging confirmed the restoration of cerebral blood flow. When end-to-side anastomosis in single-branch bypass is not appropriate for cerebral revascularization, a tailored double-barrel "insurance bypass" with an OA interposed graft could be a good alternative treatment modality. In addition, an OA interposition graft is a useful option for double-barrel bypass surgery in such cases of intracranial vascular occlusive disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Effects of therapeutic touch on the vital signs of patients before coronary artery bypass graft surgery.

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    Zare, Zahra; Shahsavari, Hooman; Moeini, Mahin

    2010-01-01

    Currently healthy heart word considered to be the objective of community health applications in many countries of the world because cardiovascular diseases are the most important factor in mortality of humans, worldwide. Coronary artery bypass graft surgery is one of the most common surgery procedures for these patients. The purpose of this study is to assess the impact of therapeutic touch on medical vital signs of patients before coronary artery bypass graft surgery. The present study is a clinical trial with 44 samples that were selected by easy sampling method and based on two separate lists of random numbers for both men and women; they were divided into two groups. In the therapeutic touch group, intervention therapy was applied on patents for 20 minutes. Data was analyzed using descriptive and inferential statistics. Test results showed that there was a significant difference between the mean pulse rate before and after intervention in both groups (p touch therapy as a safe and effective intervention on the patients which were revealed in this study, this technique can be used as a simple, cheap and applicable technique in all health care centers to help these patients.

  12. Factors associated with mortality in patients undergoing coronary artery bypass grafting

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    Cintia Koerich

    Full Text Available ABSTRACT Objective: to investigate the factors associated with mortality in patients undergoing coronary artery bypass grafting in a cardiovascular referral hospital in Santa Catarina. Method: quantitative, exploratory, descriptive and retrospective study. The medical records of 1447 patients, from 2005 to 2013, were analyzed for statistically related variables, these being: profile, hospitalization diagnosis, risk factors for coronary artery disease, complications recorded during the hospitalization, length of hospitalization and cause of death. Results: the mortality rate was 5.3% during the study period. Death was more common in females and those of black skin color, with a mean age of 65 years. Acute myocardial infarction was the most common hospitalization diagnosis. The majority of the complications recorded during hospitalization were characterized by changes in the cardiovascular system, with longer hospitalization periods being directly related to death from septic shock. Conclusion: the data provide subsidies for nursing work with preventive measures and early detection of complications associated with coronary artery bypass grafting. This reinforces the importance of using the data as quality indicators, aiming to guarantee care guided by reliable information to guide managers in planning patient care and high complexity health services.

  13. Change in patient nutritional knowledge following coronary artery bypass graft surgery

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    L. van Rooy

    2017-10-01

    Aim: The aim of this study was to measure the change in nutrition knowledge of coronary artery bypass graft patients by implementation of a lifestyle intervention programme. Methods: The Hawkes andNowak Nutrition Knowledge Questionnaire (1998 was administered to 18 coronary artery bypass graft (CABG patients to assess the change in nutrition knowledge. Results: Significant improvements were noted in the nutrition knowledge score (18.9 ± 3.4–23.2 ± 4.5; p = 0.000. Although all components measured exhibited improvements in knowledge, cholesterol reduction knowledge (5.3 ± 1.8–7.2 ± 1.8; p = 0.0066, low fat food knowledge (3.8 ± 2.3–5.1 ± 2.7; p = 0.011 and high fibre food knowledge (4.1 ± 1.4–4.7 ± 1.1;p = 0.022 exhibited the highest and most significant improvements. Conclusion: Notably, these significant improvements in nutrition knowledge points toward effective education being delivered during the intervention. Cardiac rehabilitation has proved to be effective in changing lifestyle habits in a holistic way and this study further shows an improvement in nutritional knowledge based on sound educational principles.

  14. Primary payer status is associated with mortality and resource utilization for coronary artery bypass grafting.

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

    2012-09-11

    Medicaid and uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes after coronary artery bypass grafting (CABG) in the United States is dependent on primary payer status. From 2003 to 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. Unadjusted mortality for Medicare (3.3%), Medicaid (2.4%), and uninsured (1.9%) patients were higher compared with private insurance patients (1.1%, Paccrued the highest unadjusted total costs ($113 380 ± 386, Pincome, hospital features, and operative volume, Medicaid (odds ratio, 1.82; P<0.001) and uninsured (odds ratio, 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). 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.

  15. Towards Spirituality After Coronary Artery bypass grafting: A Hermeneutic Phenomenological Study

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    Mohammad Abbasi

    2017-03-01

    Full Text Available Abstract Background and Objectives: Patients are oriented towards spirituality after coronary artery bypass grafting (CABG. The aim of this study was to explore the patients’ spiritual experiences after CABG. Methods: This qualitative study was conducted using hermeneutic phenomenology. 11 participants (7 males and 4 females were interviewed in Tehran Heart Center Hospital in 2013 using maximum variation along with purposive sampling methods. The interviews were recorded and then converted to texts word for word. The texts were analyzed using van Manen six-step method. Results: The main theme of the contents which were experienced by the participants was spirituality and its sub contents were: trust in God, Supplicating to the Prophet and Imams, and accepting the will of God. Conclusion: The findings showed that the participants who had undergone surgery on coronary artery bypass grafting had a rise in spirituality. They took advantage of spirituality to handle their problems. Using the research findings, members of the treatment team, especially nurses, can use this study to advance care planning and to train patients and their families better.

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

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    H Dehghani

    2014-08-01

    Full Text Available 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 coronary artery bypass graft was chosen. Incentive spirometry was applied in the experimental group, whereas no special intervention was taken in the control group. Arterial blood gas samples were measured in three stages: Preoperation, the first and second day after surgery. The collected data were analyzed by SPSS software version 16 using descriptive and inferential statistics. Results: In terms of gender, 70% were males and 30% were females whose mean age was 61±9.7. Moreover, the duration of mechanical ventilation was 6.4±1.67. The study results indicated that no significant difference was observed between experimental and control groups in terms of parameters of arterial blood gases in preoperation, first and second postoperative days (P> 0.05. Conclusions: Utilizing incentive spirometry did not have any effects on improving oxygenation in patients in the first and second days after surgery, compared with routine hospital treatment .

  17. Preventing intimal thickening of vein grafts in vein artery bypass using STAT-3 siRNA

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    Sun Jiangbin

    2012-01-01

    Full Text Available Abstract Background Proliferation and migration of vascular smooth muscle cells (VSMCs play a key role in neointimal formation which leads to restenosis of vein graft in venous bypass. STAT-3 is a transcription factor associated with cell proliferation. We hypothesized that silencing of STAT-3 by siRNA will inhibit proliferation of VSMCs and attenuate intimal thickening. Methods Rat VSMCs were isolated and cultured in vitro by applying tissue piece inoculation methods. VSMCs were transfected with STAT 3 siRNA using lipofectamine 2000. In vitro proliferation of VSMC was quantified by the MTT assay, while in vivo assessment was performed in a venous transplantation model. In vivo delivery of STAT-3 siRNA plasmid or scramble plasmid was performed by admixing with liposomes 2000 and transfected into the vein graft by bioprotein gel applied onto the adventitia. Rat jugular vein-carotid artery bypass was performed. On day 3 and7 after grafting, the vein grafts were extracted, and analyzed morphologically by haematoxylin eosin (H&E, and assessed by immunohistochemistry for expression of Ki-67 and proliferating cell nuclear antigen (PCNA. Western-blot and reverse transcriptase polymerase chain reaction (RT-PCR were used to detect the protein and mRNA expression in vivo and in vitro. Cell apoptosis in vein grafts was detected by TUNEL assay. Results MTT assay shows that the proliferation of VSMCs in the STAT-3 siRNA treated group was inhibited. On day 7 after operation, a reduced number of Ki-67 and PCNA positive cells were observed in the neointima of the vein graft in the STAT-3 siRNA treated group as compared to the scramble control. The PCNA index in the control group (31.3 ± 4.7 was higher than that in the STAT-3 siRNA treated group (23.3 ± 2.8 (P Conclusions The STAT-3 siRNA can inhibit the proliferation of VSMCs in vivo and in vitro and attenuate neointimal formation.

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

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    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

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

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

    1990-11-15

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

  20. Descendo-bifemoral bypass grafting and renal artery revascularization to treat complex obliterative arteriopathy.

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    Kondov, Stoyan; Rylski, Bartosz; Kari, Fabian Alexander; Wobser, Rika; Leschka, Simon; Siepe, Matthias; Beyersdorf, Friedhelm; Czerny, Martin

    2017-05-01

    Our goal was to describe a new standardized approach in patients with extensive obliterative arteriopathy aimed at distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass grafting and renal artery revascularization. Three patients with Leriche's syndrome and either a compromised single kidney or unilateral significant renal artery stenosis were treated with a standardized surgical approach, restoration of distal perfusion via descendo-bifemoral bypass with synchronous ( n  = 2) left-sided renal artery revascularization or metachronous ( n  = 1) right-sided renal artery revascularization. The intended surgical aim was achieved successfully in all 3 cases. All patients showed a decline in serum creatinine levels. One patient who needed substitution therapy was free from dialysis 3 months after surgery. Additionally, blood pressure management was substantially reduced because uncontrolled peak systolic episodes were no longer observed and pharmacotherapeutic agents could be partially withdrawn. Distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass and renal artery revascularization is a promising option to treat complex obliterative arteriopathy.

  1. Angina severity predicts worse sleep quality after coronary artery bypass grafting.

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    Yilmaz, Seyhan; Aksoy, Eray; Doğan, Tolga; Diken, Adem İlkay; Yalcınkaya, Adnan; Ozşen, Kelime

    2016-09-01

    We sought to reveal whether the severity of angina pectoris affects sleep quality after elective coronary artery bypass grafting. Patients scheduled to undergo isolated coronary artery bypass grafting were divided into two groups, having a recent myocardial infarction (Group 1, n=22, mean age 59.40±7.79 years) or not having a recent myocardial infarction (Group 2, n=30, mean age 59.73±7.72 years). The assessment included the Canadian Cardiovascular Society Angina Score, the visual analogue scale for postoperative pain and the Pittsburgh Sleep Quality Index (PSQI). The two groups were similar in regard to baseline characteristics. Cross-clamp time was significantly higher (p=0.007) and the use of inotropes was significantly more common (p=0.01) in those patients with recent myocardial infarction compared to those without. Mean Canadian Cardiovascular Society scores were also higher in patients with recent myocardial infarction (p=0.02). Total Pittsburgh Sleep Quality Index score was significantly higher in patients with recent myocardial infarction (8.45±3.50 vs. 5.03±2.32, respectively, psleep quality. The Canadian Cardiovascular Society angina score showed a significant positive correlation with poor sleep duration score (sleep disturbance score (p=0.02), day dysfunction due to sleepiness score (p=0.001), sleep efficiency score (p=0.003), overall sleep quality score (0.03) and total PSQI score (p=0.004). The severity of angina pectoris in the preoperative period is independently associated with worse sleep quality after elective isolated coronary artery bypass surgery. © The Author(s) 2016.

  2. Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft

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    Sung Sil Yoon

    2017-10-01

    Full Text Available Background: Off-pump coronary artery bypass grafting (OPCABG procedures can avoid the complications of an o n-pump b ypass. However, some c ases u nexpectedly require c onversion to c ardiopulmonary b ypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed. Methods: This retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups. Results: Of the 283 patients scheduled for OPCABG, 47 (16% were switched to on-pump coronary artery bypass grafting (CABG. The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF (odds ratio [OR], 3.5; p=0.029, ejection fraction (EF <35% (OR, 4.4; p=0.012, and preoperative beta-blocker (BB administration (OR, 0.3; p=0.007. The use of intraoperative (p=0.007 and postoperative (p=0.021 inotropics was significantly higher in the conversion group. The amount of postoperative drainage (p<0.001 and transfusion (p<0.001 also was significantly higher in the conversion group. There were no significant differences in stroke or cardiovascular complications between the groups over the course of short-term and long-term follow-up. Conclusion: Patients who undergo OPCABG and have CHF or a lower EF (<35% are more likely to undergo on-pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG.

  3. Superior Two-year Results of Externally Unsupported Polyester Compared to Supported Grafts in Above-knee Bypass Grafting : A Multicenter Randomised Trial

    NARCIS (Netherlands)

    Vriens, B. H. R.; van Det, R. J.; Meerwaldt, R.; van der Palen, J.; Gerrits, D. G.; Zeebregts, C. J.; Geelkerken, R. H.

    Objectives: The aim of this study was to compare externally supported thin wall knitted polyester (P-EXS) and externally unsupported thin wall knitted polyester (P-non-EXS) for above-knee (AK) femoro-popliteal bypass grafting. Design: A prospective multicenter randomised clinical trial. Material and

  4. A pilot study of cerebral tissue oxygenation and postoperative cognitive dysfunction among patients undergoing coronary artery bypass grafting randomised to surgery with or without cardiopulmonary bypass*.

    Science.gov (United States)

    Kok, W F; van Harten, A E; Koene, B M J A; Mariani, M A; Koerts, J; Tucha, O; Absalom, A R; Scheeren, T W L

    2014-06-01

    Coronary artery bypass surgery, performed with or without cardiopulmonary bypass, is frequently followed by postoperative cognitive decline. Near-infrared spectroscopy is commonly used to assess cerebral tissue oxygenation, especially during cardiac surgery. Recent studies have suggested an association between cerebral desaturation and postoperative cognitive dysfunction. We therefore studied cerebral oxygen desaturation, defined as area under the cerebral oxygenation curve 10 min.%, with respect to cognitive performance at 4 days (early) and 3 months (late) postoperatively, compared with baseline, using a computerised cognitive test battery. We included 60 patients, of mean (SD) age 62.8 (9.4) years, scheduled for elective coronary artery bypass grafting, who were randomly allocated to surgery with or without cardiopulmonary bypass. Cerebral desaturation occurred in only three patients and there was no difference in cerebral oxygenation between the two groups at any time. Among patients who received cardiopulmonary bypass, 18 (62%) had early cognitive decline, compared with 16 (53%) in the group without cardiopulmonary bypass (p = 0.50). Three months after surgery, 11 patients (39%) in the cardiopulmonary bypass group displayed cognitive dysfunction, compared with four (14%) in the non-cardiopulmonary bypass group (p = 0.03). The use of cardiopulmonary bypass was identified as an independent risk factor for the development of late cognitive dysfunction (OR 6.4 (95% CI 1.2-33.0) p = 0.027. In conclusion, although cerebral oxygen desaturation was rare in our population, postoperative cognitive decline was common in both groups, suggesting that factors other than hypoxic neuronal injury are responsible. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  5. Off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial.

    Science.gov (United States)

    Benedetto, Umberto; Altman, Douglas G; Gerry, Stephen; Gray, Alastair; Lees, Belinda; Flather, Marcus; Taggart, David P

    2017-12-23

    The long-term effects of off-pump coronary artery bypass continue to be controversial because some studies have reported increased adverse event rates with off-pump coronary artery bypass when compared with on-pump coronary artery bypass. The Arterial Revascularization Trial compared survival after bilateral versus single internal thoracic artery grafting. The choice of off-pump coronary artery bypass versus on-pump coronary artery bypass was based on the surgeon's discretion. We performed a post hoc analysis of the Arterial Revascularization Trial to compare 5-year outcomes with 2 strategies. Among 3102 patients enrolled in the Arterial Revascularization Trial, we selected 1260 patients who underwent off-pump coronary artery bypass versus 1700 patients who underwent on-pump coronary artery bypass with cardioplegic arrest for the present comparison. Primary outcomes were 5-year mortality and incidence of major cardiac and cerebrovascular events, including cardiovascular death, myocardial infarction, cerebrovascular accident, and revascularization after index procedure. Propensity score matching selected 1260 pairs for final comparison. Stratified Cox models were used for treatment effect estimate. Hospital mortality was comparable between off-pump coronary artery bypass and on-pump coronary artery bypass groups (12 [1.0%] vs 15 [1.2%]; P = .7). Conversion rate to on-pump during off-pump coronary artery bypass was 29 of 1260 (2.3%). When compared with off-pump coronary artery bypass not converted, off-pump coronary artery bypass converted to on-pump presented a remarkably higher hospital mortality (10.3% vs 0.7%; P pump coronary artery bypass and on-pump coronary artery bypass groups, respectively, with no significant difference (hazard ratio, 1.14; 95% confidence interval, 0.86-1.52; P = .35). Incidence of major cardiac and cerebrovascular events was 175 (14.3) versus 169 (13.8) in the off-pump coronary artery bypass and on-pump coronary artery bypass groups

  6. The relationship between total arterial revascularization and blood transfusion following coronary artery bypass grafting.

    Science.gov (United States)

    Djordjevic, Jasmina; Ngaage, Dumbor L

    2015-05-01

    Blood transfusion adversely affects the outcome of coronary artery bypass grafting (CABG), yet blood transfusion after CABG is still common. Total arterial revascularisation (TAR) is increasingly used in current practice but its impact on postoperative blood transfusion is not known. We reviewed the cardiothoracic and blood bank databases and collected data for isolated primary CABG patients from July 2007 to June 2012, excluding patients who had a single graft (n = 148). Perioperative variables of TAR patients (n = 745) were compared with patients who had one or more venous grafts (SVG, n = 1,761) for first-time isolated CABG. The conduits used in TAR patients were predominantly left internal thoracic and radial arteries. Matched group comparison of TAR and SVG patients was performed. The association of TAR with blood transfusion was investigated using multivariate and matched analysis. Of 2,506 patients, the 745 (29.7 %) that had TAR were generally younger, with less complex coronary artery disease and less often diabetic. After correcting for these by 1:1 matching, the mean chest tube drainage and rates of blood transfusion remained significantly lower (p transfused in TAR patients. By multivariate analysis, TAR had an independent effect on reducing blood transfusion after CABG [odds ratio (OR) 0.67, 95 % confidence interval (CI) 0.47-0.97, p = .03]. TAR achieved predominantly with left internal thoracic and radial arteries substantially reduced blood transfusion rates after primary CABG. Further studies are warranted.

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

    Directory of Open Access Journals (Sweden)

    Hassani E

    2009-12-01

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

  8. Phase analysis of gated myocardial perfusion single-photon emission computed tomography after coronary artery bypass graft surgery: reflection of late reverse remodeling in patients with patent grafts after coronary artery bypass graft surgery.

    Science.gov (United States)

    Park, Sohyun; Cheon, Gi Jeong; Paeng, Jin Chul; Won, Kyoung Sook; Kang, Keon Wook; Kim, Ki-Bong; Chung, June-Key; Lee, Dong Soo

    2016-11-01

    Phase analysis using gated myocardial perfusion single-photon emission computed tomography (GMPS) is a tool used to assess left ventricular (LV) dyssynchrony. We attempted to investigate the role of LV dyssynchrony assessed by GMPS using phase analysis for the late LV function after coronary artery bypass graft surgery (CABG) in patients with patent grafts. A total of 45 patients who received off-pump CABG with patent graft 1 year after CABG and preserved perfusion reserve were enrolled retrospectively. All patients underwent GMPS before and 3 months and 1 year after CABG. Using the Emory Cardiac Toolbox, both phase histogram bandwidth (PBW) and phase SD derived by phase analysis were used for the analysis, in addition to the conventional perfusion parameters. For the evaluation of LV function, transthoracic echocardiography was also performed. All of the patients showed perfusion improvement (paired t-test, Preverse remodeling. Among those patients with reverse remodeling, 19 patients had shown LV 3 months after CABG. Using stepwise logistic regression with forward selection, PBW 3 months after CABG could predict reverse remodeling 1 year after CABG (odds ratio 1.03, Preverse remodeling 1 year after CABG with a cut-off value of 82 (sensitivity 0.95, specificity 0.56, Preverse remodeling and potential of further functional improvement in patients with patent grafts and preserved perfusion reserve after CABG.

  9. Coronary artery bypass graft surgery in acute coronary syndrome: incidence, cost impact, and acute clopidogrel interruption.

    Science.gov (United States)

    Johnston, Stephen S; Bell, Kelly; Gdovin, Joette; Jing, Yonghua; Graham, John

    2012-02-01

    Guidelines stipulate that clopidogrel should be interrupted ≥ 5 days prior to elective coronary artery bypass graft (CABG) surgery to reduce the risk of bleeding unless the need for revascularization and/or the net benefit of the clopidogrel outweighs the potential risks of bleeding. This study describes real-world patterns of acute clopidogrel use, CABG surgery, and inpatient costs among patients with acute coronary syndrome (ACS). The study used the MarketScan® Commercial, Medicare Supplemental, and Hospital Drug databases, comprising health care data for > 63 million individuals in the United States. Acute coronary syndrome episodes, defined as hospitalizations for ACS (primary International Classification of Diseases, Ninth Revision, Clinical Modification codes 410.xx, 411.1x) occurring between January 1, 2005 and June 30, 2009, were identified from patients aged ≥ 18 years. Outcomes included cost of and length of stay (LOS) for ACS episodes and, among patients experiencing ACS episodes treated with acute clopidogrel administration followed by CABG surgery, the duration of clopidogrel interruption prior to CABG surgery. Analyses were descriptive. A total of 160 168 ACS episodes were identified, and the mean patient age was 63.5 years. Coronary artery bypass graft surgery episodes comprised 9.3% (14 896 of 160 168) of all ACS episodes. The mean LOS was 9.8 (standard deviation [SD], 6.8) days per CABG surgery episode, and mean inpatient costs were $71 140 (SD, $68 012) per CABG surgery episode. Among patients experiencing ACS episodes with inpatient drug data and to whom acute clopidogrel was administered followed by CABG surgery (n = 8101), the mean duration of clopidogrel interruption was 3.3 (SD, 2.6) days, and the majority (62.1%) of these patients underwent surgery within 1 to 3 days after their last acute clopidogrel dose. The mean incremental increase in inpatient costs associated with 1 extra LOS day was $1991. Coronary artery bypass graft surgery is

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

    Directory of Open Access Journals (Sweden)

    Mahmoodreza Sarzaeem

    2014-03-01

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

  11. Low dose Colchicine in prevention of atrial fibrillation after coronary artery bypass graft: a double blind clinical trial

    Directory of Open Access Journals (Sweden)

    Mahmoodreza Sarzaeem

    2014-06-01

    Conclusion: Colchicine is an anti-inflammatory medication and has very few side effects at low doses. According to the 48% reduction in the incidence of atrial fibrillation in Colchicine patients undergoing coronary artery bypass grafting surgery, this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation.

  12. 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...

  13. Incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting

    Science.gov (United States)

    Bohatch Júnior, Milton Sérgio; Matkovski, Paula Dayana; Giovanni, Frederico José Di; Fenili, Romero; Varella, Everton Luz; Dietrich, Anderson

    2015-01-01

    Objective To determine the incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting. Methods A retrospective study with analysis of 230 medical records between January 2011 and October 2013 was conducted. Results Fifty-six (24.3%) out of the 230 patients were female. The average age of patients undergoing on-pump coronary artery bypass grafting was 59.91±8.62 years old, and off-pump was 57.16±9.01 years old (P=0.0213). The average EuroSCORE for the on-pump group was 3.37%±3.08% and for the off-pump group was 3.13%±3% (P=0.5468). Eighteen (13.43%) patients who underwent off-pump coronary artery bypass grafting developed postoperative atrial fibrillation, whereas for the onpump group, 19 (19.79%) developed this arrhythmia, with no significant difference between the groups (P=0.1955). Conclusion Off-pump coronary artery bypass grafting did not reduce the incidence of atrial fibrillation in the postoperative period. Important predictors of risk for the development of this arrhythmia were identified as: patients older than 70 years old and presence of atrial fibrillation in perioperative period in both groups, and non-use of beta-blockers drugs postoperatively in the on-pump group. PMID:26313722

  14. Determinants for early mortality in patients awaiting coronary artery bypass graft surgery: a case-control study

    NARCIS (Netherlands)

    Suttorp, M. J.; Kingma, J. H.; Vos, J.; Koomen, E. M.; Tijssen, J. G.; Vermeulen, F. E.; Ascoop, C. A.; Ernst, J. M.

    1992-01-01

    A total of 1124 consecutive patients who were selected for coronary artery bypass graft surgery were studied. Of patients awaiting surgery (mean waiting time 98 days) 25 patients (2.2%) died before operation (mean waiting time 63 days). To assess patient characteristics predictive for early

  15. Acute Compartment Syndrome of the Lower Leg after Coronary Artery Bypass Grafting: A Silent but Dangerous Complication

    NARCIS (Netherlands)

    te Kolste, Henryk Jan; Balm, Ron; de Mol, Bas

    2015-01-01

    Acute compartment syndrome (ACoS) is a serious, limb-threatening condition, but ACoS after coronary artery bypass grafting (CABG) is rare. ACoS is diagnosed with the help of typical symptoms, but due to the use of analgesics in a postoperative setting, these symptoms may vary. Identifying risk

  16. Prognostic factors for perioperative myocardial infarction and immediate mortality in patients who underwent coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Mirtha López Ramírez

    2016-03-01

    Conclusions: Older age and higher body mass index were protective prognostic factors for perioperative acute myocardial infarction events. Prolonged surgical time and complications were independently associated with perioperative infarction and mortality after coronary artery bypass graft surgery. Low preoperative glomerular filtration rate was also associated with mortality.

  17. Effect of Preferred Music Listening on Pain Reduction in Mechanically Ventilated Patients After Coronary Artery Bypass Graft Surgery

    OpenAIRE

    Kyavar; Karkhaneh; Rohanifar; Azarfarin; Sadeghpour; Alizadehasl; Ghadrdoost

    2016-01-01

    Background Pain is a symptom of discomfort or tissue injury experienced by patients. Among patients in intensive care unit (ICU), pain is a common phenomenon. Objectives The purpose of this study was to evaluate the effect of preferred music listening on behavioral measures of pain, as an indicator of pain assessment, in patients undergoing coronary artery bypass graft surgery (CABG). Patients ...

  18. Repeated transluminal endovascular Inoue stent graft placement for progressive dilatation of prosthetic graft that had been repaired with Inoue stent graft placement for dilatation 23 years after extraanatomical bypass.

    Science.gov (United States)

    Anzai, Tomohiro; Shimizu, Hideyuki; Yozu, Ryohei; Hashimoto, Subaru; Kuribayashi, Sachio; Inoue, Kanji

    2007-02-01

    A 76-year-old man had undergone aneurysm exclusion and ascending abdominal aortic extraanatomical bypass for a thoracoabdominal aortic aneurysm in 1978. In 1983 hemoptysis occurred, and resection and closure of the central stump of the aorta and a left lower lobectomy were performed. Dilatation (phi50 mm) of a prosthetic graft (Cooley Graft phi18 mm) used for extraanatomical bypass was noted in 2001 and was repaired by placement of an Inoue stent graft. However, the aneurysm diameter increased further (phi70 mm), although no endoleak was noted: Placement of an Inoue stent graft covering the whole length of the prosthetic graft was repeated in 2006. The postoperative course was smooth, no endoleak occurred, and the patient was discharged 2 weeks after surgery.

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

    Directory of Open Access Journals (Sweden)

    Trethowan Brian A

    2011-11-01

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

  20. Internal Maxillary Bypass for Complex Pediatric Aneurysms.

    Science.gov (United States)

    Wang, Long; Lu, Shuaibin; Qian, Hai; Shi, Xiang'en

    2017-07-01

    Complex pediatric aneurysms (PAs) are an unusual clinicopathologic entity. Data regarding the use of a bypass procedure to treat complex PAs are limited. Internal maxillary artery-to-middle cerebral artery bypass with radial artery graft was used to isolate PAs. Bypass patency and aneurysm stability were evaluated using intraoperative Doppler ultrasound, indocyanine green videoangiography, and postoperative angiography. Modified Rankin Scale was used to assess neurologic function. Over a 5-year period, 7 pediatric patients (≤18 years old) were included in our analysis. Mean age of patients was 14.4 years (range, 12-18 years), and mean size of PAs was 23.6 mm (range, 9-37 mm). All cases manifested with complex characteristics. Proximal artery occlusion was performed in 3 cases, complete excision following aneurysmal distal internal maxillary artery bypass was performed in 2 cases, and combined proximal artery occlusion and aneurysm excision was performed in the 2 remaining cases. Mean intraoperative blood flow was 61.6 mL/minute (range, 40.0-90.8 mL/minute). Graft patency rate was 100% during postoperative recovery and at the last follow-up examination (mean, 20 months; range, 7-45 months). All patients had excellent outcomes except for 1 patient who died of multiple-organ failure. Internal maxillary artery bypass is an essential technique for treatment of selected cases of complex PAs. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

    Moore, R.K.G. [Cardiothoracic Centre, Liverpool (United Kingdom)]. E-mail: moore@roger.go-legend.net; Sampson, C. [Cardiothoracic Centre, Liverpool (United Kingdom); MacDonald, S. [Cardiothoracic Centre, Liverpool (United Kingdom); Moynahan, C. [Cardiothoracic Centre, Liverpool (United Kingdom); Groves, D. [National Refractory Angina Centre, Liverpool (United Kingdom); Chester, M.R. [National Refractory Angina Centre, Liverpool (United Kingdom)

    2005-09-01

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

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    Ziadi Jalel

    2014-01-01

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

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

    Science.gov (United States)

    Jalel, Ziadi; Sobhi, Mleyhi; Skander, Ben Omrane; Adel, Khayati

    2014-01-01

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

  5. Prognostic information in administrative co-morbidity data following coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Abildstrøm, Steen Zabell; Hvelplund, Anders; Rasmussen, Søren

    2010-01-01

    Objectives: The aim of this study was to evaluate the prognostic information obtainable from administrative data with respect to 30-day mortality following coronary artery bypass grafting (CABG) and to compare it with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) recorded...... in a clinical database. Methods: We used a co-morbidity index calculated from administrative data in the Danish National Patient Register by means of all admissions 1 year prior to CABG. In addition, each CABG was categorised as being isolated or not, and acute or not. The prognostic power of the co......-morbidity index was compared to that achieved using EuroSCORE from a clinical database comprising information on all patients treated with CABG in Denmark. The outcome was all-cause mortality within 30 days after CABG and the prognostic power was evaluated using logistic regression analyses. Results: We...

  6. 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.

  7. Two Invasive Thymomas Incidentally Found during Coronary Artery Bypass Graft Surgery

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    Navid Omidifar

    2016-01-01

    Full Text Available Thymoma, the most common neoplasm of the anterior mediastinum, is a rare tumor of thymic epithelium that can be locally invasive. We reported 2 cases of invasive thymoma incidentally found during routine coronary artery bypass graft (CABG surgery at Faghihee Hospital of Shiraz University of Medical Sciences of Iran in a period of about 6 months. The 2 patients were male and above 60 years old. They had no clinical symptoms and radiological evidence of mediastinal mass before detection of the tumor during operation. For both patients mass was completely excised and sent to the laboratory. The ultimate pathological diagnosis of both masses was invasive thymoma (stage 2. There are few reports in which thymomas were found incidentally during cardiac surgery. In spite of rare coincidence, due to being asymptomatic and possibly invasive, special attention to thymus gland during cardiac surgery or other mediastinal surgery and preoperative imaging studies seem to be reasonable approach.

  8. 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

    : 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...... loading dose of 1,800 mg of amiodarone orally. Intravenous infusion of amiodarone was started after induction of anesthesia and was administered at 900 mg over 24 hours for the subsequent 3 days. MEASUREMENTS AND MAIN RESULTS: AF was documented using Holter monitoring. In group E 22 of 44 (50%), in group...

  9. Myasthenia gravis: a careful perioperative anesthetic management of coronary artery bypass grafting.

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    Kowalczyk, Michał; Nestorowicz, Andrzej; Stachurska, Katarzyna; Fijałkowska, Anna; Stążka, Janusz

    2015-06-01

    Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis. We describe successful management without any pulmonary complications of two patients with myasthenia gravis undergoing coronary artery bypass grafting. In addition, antiacetylcholine receptor antibodies concentrations were evaluated during treatment time. In conclusion, we have found that reduced titrated doses of cisatracurium may be safely used in patients with myasthenia gravis undergoing cardiac surgery without anesthesia and respiratory-related complications.

  10. Risk adjustment for coronary artery bypass graft surgery: an administrative approach versus EuroSCORE.

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    Ugolini, Cristina; Nobilio, Lucia

    2004-04-01

    To determine the ability of administrative data in predicting in-hospital mortality for patients undergoing coronary artery bypass graft surgery. Patient data were obtained from the administrative databases on hospital discharge abstracts of the Italian region Emilia Romagna for the years 2000-2001. We used a multivariate logistic regression analysis to compare an ICD-9-CM risk adjustment approach based on administrative variables (such as age, gender, principal diagnosis, combined operation, previous cardiac surgery, emergency admission, and Charlson comorbidity index) with a risk adjustment approach based on the clinical European System for Cardiac Operative Risk Evaluation (EuroSCORE) to predict in-hospital mortality and to assess hospital performance. In order to distinguish complications of care from comorbidities, we linked hospital data across multiple episodes of care up to 1 year before the admission for coronary artery bypass graft (CABG). The risk adjustment approach based on ICD-9-CM data provides good explanatory ability in models assessing in-hospital mortality (the c statistics obtained are very close: c = 0.76 in 2000 and c = 0.80 in 2001 for the administrative model versus 0.78 in 2000 and 0.77 in 2001 for the clinical one) and in those ranking the centres (c = 0.78 in 2000 in both approaches, and c = 0.82 for the administrative model versus c = 0.78 for the clinical one in 2001). Adding some administrative variables considered proxy for clinical complexity to the administrative model and linking hospital data across patients' multiple episodes of care eliminated much of the difference in effectiveness between the clinical and administrative risk adjustment approach. Focusing on the health policy context of measuring CABG death rates, our study strengthened the thesis that, with the growing improvement in accurate coding practice, administrative databases could provide a valuable and economical source for health planning and research.

  11. Attachment anxiety predicts depression and anxiety symptoms following coronary artery bypass graft surgery.

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

    2016-11-01

    Depression and anxiety are associated with poor recovery in coronary artery bypass graft (CABG) patients, but little is known about predictors of depression and anxiety symptoms. We tested the prospective association between attachment orientation, and symptoms of depression and anxiety in CABG patients, 6-8 weeks, and 12 months following surgery. One hundred and fifty-five patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring attachment, depression, and anxiety prior to surgery, then 6-8 weeks, and 12 months after surgery. Attachment anxiety predicted symptoms of depression and anxiety at both follow-up time points, whereas attachment avoidance was not associated with depression or anxiety symptoms. The findings remained significant when controlling for baseline mood scores, social support, demographic, and clinical risk factors. These results suggest that attachment anxiety is associated with short-term and long-term depression and anxiety symptoms following CABG surgery. These results may offer important insight into understanding the recovery process in CABG surgery. Statement of contribution What is already known on this subject? Depression and anxiety symptoms are twice more likely to occur in coronary artery bypass graft (CABG) populations than in any other medical group. Depression and anxiety are associated with poor recovery following cardiac surgery. Predictors of depression and anxiety in CABG patients have been underexplored. What does this study add? This study highlights the importance of close interpersonal relationships on health. Attachment anxiety was prospectively associated with higher levels of depression and anxiety. These results add to understanding mechanisms linked to recovery following CABG. © 2016 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

  12. Comparative effects of propofol and nitroglycerine on efficacy of rewarming in patients undergoing on-pump coronary artery bypass grafting

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    Bhupesh Kumar

    2015-01-01

    Full Text Available Objectives: To compare the effects of propofol and nitroglycerine (NTG on the efficacy of rewarming, extra volume added during cardiopulmonary bypass and extravascular lung water (EVLW in patients undergoing on-pump coronary artery bypass grafting. Materials and Methods: A prospective, randomized, blinded trial, twenty adult patients were randomly assigned to receive either NTG infusion (NTG group or propofol infusion (propofol group during rewarming. Results: After drop in temperature at the end of surgery and till 24 h were significantly less in propofol group compare to NTG group (P < 0.025. Extra volume added during cardiopulmonary bypass and net crystalloid balance till 24 h was less in the propofol group (P < 0.003. There was no difference in EVLW and postoperative outcome. Conclusions: Propofol use during moderate hypothermic cardiopulmonary bypass is associated with less after drop in temperature and less requirement of extra fluid during the perioperative period.

  13. Five Vessel Coronary Arter Bypass Graft Surgery in a Case with Familial Hypercholesterolemia

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    Sureyya Talay

    2014-08-01

    Full Text Available We report a case of a rare and sypmtomatic familyal hypercholesterolemia case with an end-point of coronary artery bypass surgery at the age of 16. Patient was evaluated at the emergency department with chest pain and discomfort. Physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm for 108/ min. Arterial blood pressure was 90/60 mmHg. Lungs and heart were clear to auscultation. Patient was under treatment with a prior diagnosis of familial hypercholesterolemia (FH for one year by daily 40 mgs rosuvastatine. A coronary artery angiography was performed for chest pain. Multivessel coronary artery disease was diagnosed with a total occlusion of left anterior descending artery. Transthoracic echocardiography presented a left ventricular (LV ejection fraction 50%, LV diameters 44/26 mm, aneurysm formation at interatrial septum and mild dyskinesia of anterior wall. Thus, a five vessel emergent coronary artery graft bypass surgery was performed at this early age. FH is with a severe elevation in total cholesterol (TC and low density lipoprotein cholesterol (LDL in an autosomal dominant characteristic disorder that approximately occurs in 1 per 500 persons by its heterozygous form. FH is most certainly associated with premature coronary artery disease (CAD with catasthrophic early age results. [Cukurova Med J 2014; 39(4.000: 872-875

  14. Predictors of Blood Transfusion in Patients Undergoing Coronary Artery Bypass Grafting Surgery

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    Saleh Sandoughdaran

    2013-03-01

    Full Text Available Objectives: The aim of this retrospective study is to identify intraoperative patient’s characteristics predicting the need for blood transfusion during CABG in our local cardiac surgical service. Methods: This study included 1835 consecutive patients, 1311 males and 524 females with mean age 58.8±9.9 years, undergoing coronary artery bypass grafting. Risk factors detected by univariate study were entered in a multivariate logistic regression model of the relationship between preoperative variables and blood transfusion. Results: Blood transfusion was used in 435 patients (29.9%. Univariate analysis identified hemoglobin, smoking, hypertension, sex, diabetes, BMI and use of cardiopulmonary bypass (CPB as significant predictors. Multivariate analysis revealed hemoglobin (OR: 0.8; CI: 0.74-0.86; P<0.001, CPB use (OR: 12.2; CI: 8.2-18.1; P<0.001 and female gender (OR: 2.29; CI:1.72-3.04; P<0.001 as independent risk factors for blood transfusion. Conclusions: The predictors of RBC transfusion after isolated CABG were performing CPB, preoperative hemoglobin and female gender. These factors can be used as a clinical tool to preserve blood bank resources without increasing patient’s risk.

  15. Application of a pharmacokinetics-pharmacodynamics approach to the free propofol plasma levels during coronary artery bypass grafting surgery with hypothermic cardiopulmonary bypass

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    Carlos R. Silva-Filho

    2018-02-01

    Full Text Available OBJECTIVES: The objective of this study was to apply a pharmacokinetics-pharmacodynamics approach to investigate the free propofol plasma levels in patients undergoing coronary artery bypass grafting under hypothermic conditions compared with the off-pump procedure. METHODS: Nineteen patients scheduled for on-pump coronary artery bypass grafting under hypothermic conditions (n=10 or the equivalent off-pump surgery (n=9 were anesthetized with sufentanil and propofol target-controlled infusion (2 μg/mL during surgery. The propofol concentration was then reduced to 1 μg/mL, and a pharmacokinetics-pharmacodynamics analysis using the maximum-effect-sigmoid model obtained by plotting the bispectral index values against the free propofol plasma levels was performed. RESULTS: Significant increases (two- to five-fold in the free propofol plasma levels were observed in the patients subjected to coronary artery bypass grafting under hypothermic conditions. The pharmacokinetics of propofol varied according to the free drug levels in the hypothermic on-pump group versus the off-pump group. After hypothermic coronary artery bypass was initiated, the distribution volume increased, and the distribution half-life was prolonged. Propofol target-controlled infusion was discontinued when orotracheal extubation was indicated, and the time to patient extubation was significantly higher in the hypothermic on-pump group than in the off-pump group (459 versus 273 min, p=0.0048. CONCLUSIONS: The orotracheal intubation time was significantly longer in the hypothermic on-pump group than in the off-pump group. Additionally, residual hypnosis was identified through the pharmacokinetics-pharmacodynamics approach based on decreases in drug plasma protein binding in the hypothermic on-pump group, which could explain the increased hypnosis observed with this drug in this group of patients.

  16. Biomimetic modified clinical-grade POSS-PCU nanocomposite polymer for bypass graft applications: a preliminary assessment of endothelial cell adhesion and haemocompatibility.

    Science.gov (United States)

    Solouk, Atefeh; Cousins, Brian G; Mirahmadi, Fereshteh; Mirzadeh, Hamid; Nadoushan, Mohammad Reza Jalali; Shokrgozar, Mohammad Ali; Seifalian, Alexander M

    2015-01-01

    surface modification procedures of polymeric surfaces can improve the patency rate of POSS-PCU nanocomposites as vascular bypass grafts in the preparation of a range of medical devices ready for pre-clinical and in vivo evaluation. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Refractory spasm of coronary arteries and grafted conduits after isolated coronary artery bypass surgery.

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    Lorusso, Roberto; Crudeli, Elena; Lucà, Fabiana; De Cicco, Giuseppe; Vizzardi, Enrico; D'Aloia, Antonio; Gelsomino, Sandro

    2012-02-01

    Refractory vascular spasm (RVS) concomitantly involving the entire coronary artery system and grafted conduits after coronary artery bypass grafting (CABG) surgery is a rare, but dreadful event. No consensus exists in terms of appropriate management. Between 1986 and 2009, 5,762 patients underwent isolated CABG at our institution, and 7 patients experienced RVS involving the coronary arteries and implanted conduits. Mean age was 65.6 years and 3 were female. All patients received from 3 to 5 distal anastomoses, including use of the left internal mammary artery. During the same time period, 18 patients experienced perioperative vasospasm of a single coronary artery or of a grafted conduit. All diffuse RVS events occurred between 3 and 8 hours after surgery. All patients had diffuse ischemic-like electrocardiographic changes, and 5 patients rapidly developed cardiogenic shock in the intensive care unit. Angiography was quickly performed in all patients and showed diffuse RVS involving either the native coronary arteries or the anastomosed arterial and venous conduits. The first 5 patients of this series died in the catheterization lab due to rapidly evolving refractory cardiogenic shock and unresponsive cardiac arrest, despite intraaortic counterpulsation and aggressive pharmacologic interventions (selective vasodilators and systemic inotropes). In the last 2 patients, extracorporeal membrane oxygenation was quickly instituted (1 in the catheterization lab, 1 in the operating room) and RVS could be successfully managed with complete resolution of ongoing vasospasm. In the single vascular spasm, there was only 1 death for refractory cardiac arrest, whereas all the other patients were successfully treated with direct infusion of vasodilators. Diffuse RVS after CABG is a rare but lethal condition. Our experience, although limited, indicates that in such cases an aggressive treatment, that is, prompt extracorporeal membrane oxygenation institution and controlled

  18. Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Agarwal, Nayan; Mahmoud, Ahmed N; Patel, Nimesh Kirit; Jain, Ankur; Garg, Jalaj; Mojadidi, Mohammad Khalid; Agrawal, Sahil; Qamar, Arman; Golwala, Harsh; Gupta, Tanush; Bhatia, Nirmanmoh; Anderson, R David; Bhatt, Deepak L

    2018-01-01

    Although aspirin monotherapy is considered the standard of care after coronary artery bypass grafting (CABG), more recent evidence has suggested a benefit with dual antiplatelet therapy (DAPT) after CABG. We performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of aspirin monotherapy with DAPT in patients after CABG. Subgroup analyses were conducted according to surgical technique (i.e., on vs off pump) and clinical presentation (acute coronary syndrome vs no acute coronary syndrome). Random effects overall risk ratios (RR) were calculated using the DerSimonian and Laird model. Eight randomized control trials and 9 observational studies with a total of 11,135 patients were included. At a mean follow-up of 23 months, major adverse cardiac events (10.3% vs 12.1%, RR 0.84, confidence interval [CI] 0.71 to 0.99), all-cause mortality (5.7% vs 7.0%, RR 0.67, CI 0.48 to 0.94), and graft occlusion (11.3% vs 14.2%, RR 0.79, CI 0.63 to 0.98) were less with DAPT than with aspirin monotherapy. There was no difference in myocardial infarction, stroke, or major bleeding between the 2 groups. In conclusion, DAPT appears to be associated with a reduction in graft occlusion, major adverse cardiac events, and all-cause mortality, without significantly increasing major bleeding compared with aspirin monotherapy in patients undergoing CABG. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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    Poulikakos Dimos

    2007-09-01

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

  20. Aorto-hepatic bypass graft for repair of an inferior pancreatico-duodenal artery aneurysm associated with coeliac axis occlusion: A case report

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    Tom Hughes

    2016-01-01

    Conclusion: Surgical excision with bypass grafting from the supra-coeliac aorta, as reported by our team, represents a satisfactory management option in patients where interventional approaches have failed or are not appropriate.

  1. Factors associated with extubation time in coronary artery bypass grafting patients

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    Abbas Rezaianzadeh

    2015-12-01

    Full Text Available Background and Objectives. Cardiovascular diseases are the leading cause of death worldwide, with coronary artery disease being the most common. With increasing numbers of patients, Coronary Artery Bypass Grafting (CABG has become the most common operation in the world. Respiratory disorder is one of the most prevalent complications of CABG. Thus, weaning off the mechanical ventilation and extubation are of great clinical importance for these patients. Some post-operative problems also relate to the tracheal tube and mechanical ventilation. Therefore, an increase in this leads to an increase in the number of complications, length of hospital stay, and treatment costs. Since a large number of factors affect the post-operative period, the present study aims to identify the predictors of extubation time in CABG patients using casualty network analysis.Method. This longitudinal study was conducted on 800 over 18 year old patients who had undergone CABG surgery in three treatment centers affiliated to Shiraz University of Medical Sciences. The patients’ information, including pre-operative, peri-operative, and post-operative variables, was retrospectively extracted from their medical records. Then, the data was comprehensively analyzed through path analysis using MPLUS-7.1 software.Results. The mean of extubation time was 10.27 + 4.39 h. Moreover, extubation time was significantly affected by packed cells during the Cardiopulmonary Bypass (CPB, packed cells after CPB, inotrope use on arrival at ICU, mean arterial pressure 1st ICU, packed cells 1st ICU, platelets 1st ICU, Blood Urea Nitrogen 1st ICU, and hematocrit 1st ICU.Conclusion. Considering all of the factors under investigation, some peri-operative and post-operative factors had significant effects. Therefore, considering the post-operative factors is important for designing a treatment plan and evaluating patients’ prognosis.

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

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    Burgess SN

    2015-06-01

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

  3. Preoperative aspirin administration improves oxygenation in patients undergoing coronary artery bypass grafting.

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    Gerrah, Rabin; Elami, Amir; Stamler, Alon; Smirnov, Asya; Stoeger, Zeev

    2005-05-01

    Release of thromboxane (Tx) A(2) by platelets may be one of multiple factors that are responsible for lung injury after cardiopulmonary bypass, leading to pulmonary vasoconstriction and impaired oxygenation. In experimental models, the inhibition of Tx receptor or its production improved lung function. The use of aspirin, which is used widely in the treatment of ischemic heart disease because of its antiplatelet activity, is usually discontinued a week before the patient undergoes the operation to restore normal platelet hemostatic function. The purpose of this study was to determine the relationship between the time of cessation of aspirin before coronary artery bypass surgery, and postoperative oxygenation and bleeding. A prospective clinical study comparing the effect of aspirin on postoperative oxygenation in patients who had been treated or had not been treated with aspirin. Tx levels in the pericardial fluid, oxygenation, and bleeding were compared between the two groups. Thirty-two patients with coronary artery disease who were undergoing coronary artery bypass grafting. Fourteen of these patients received aspirin until the day of the operation, whereas 18 patients stopped receiving aspirin at least 1 week before undergoing the operation. Mean (+/- SD) Tx levels in the pericardial fluid were significantly lower in the aspirin group (117 +/- 47 pg/mL) compared to those in the control group (1,306 +/- 2,048 pg/mL; p = 0.02). The duration of ventilation after the operation was significantly longer in the nonaspirin group (9.6 +/- 5.6 h vs 3.8 +/- 1.4 h, respectively; p = 0.0004). Po(2) reached a higher level while patients breathed 100% O(2) in the aspirin group (235 +/- 54 mm Hg vs 176 +/- 27 mm Hg, respectively; p = 0.001). The mean amount of bleeding during the first 24 h after surgery was increased in the aspirin group (710 +/- 202 mL) compared with the nonaspirin group (539 +/- 143 mL; p = 0.01), but these patients did not require more transfusions. The

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

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    Yin, Yi-qing; Luo, Ai-lun; Guo, Xiang-yang; Li, Li-huan; Huang, Yu-guang

    2007-11-20

    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). 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. 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. The incidence of

  5. Internal Maxillary Artery to Upper Posterior Circulation Bypass Using a Superficial Temporal Artery Graft: Surgical Anatomy and Feasibility Assessment.

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    Tayebi Meybodi, Ali; Lawton, Michael T; Rodriguez Rubio, Roberto; Yousef, Sonia; Guo, Xiaoming; Feng, Xuequan; Benet, Arnau

    2017-11-01

    Revascularization of the upper posterior circulation (UPC), including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA), may be necessary as part of the surgical treatment of complex UPC aneurysms or vertebrobasilar insufficiency. The existing bypass options have relative advantages and disadvantages. However, the use of a superficial temporal artery graft (STAg) in a bypass from the internal maxillary artery (IMA) to the UPC has not been previously assessed. We studied the surgical anatomy and assessed the technical feasibility of the IMA-STAg-UPC bypass. Fourteen cadaver heads were studied. The STAg was harvested proximally from about 15 mm below the zygomatic arch. The IMA was exposed through the lateral triangle of the middle fossa. The IMA-STAg-UPC bypass was completed using a subtemporal approach. The bypass was successfully performed in all specimens. The average length of the STAg from the donor to the recipient was 46.4 mm for the s2 SCA, and 49.5 mm for the P2 PCA. The average distal diameter of the STAg was 2.3 mm. More than 83% of STAgs had a diameter of ≥2 mm distally. At the point of anastomosis, the average diameter of the SCA was 1.9 mm, and the average diameter of the PCA was 3.0 mm. The proposed bypass is anatomically feasible and provides a suitable caliber match between the bypass components. Our results provide the anatomic basis for clinical assessment of the bypass in tackling complex lesions of the vertebrobasilar system requiring revascularization. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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    Borst, C; Jansen, E W; Tulleken, C A; Gründeman, P F; Mansvelt Beck, H J; van Dongen, J W; Hodde, K C; Bredée, J J

    1996-05-01

    This study assessed the feasibility of coronary artery bypass grafting on the beating heart without interruption of native coronary blood flow using a novel anastomosis site restraining device. Recently, an end-to-side bypass technique was described that does not require interruption of flow in the recipient artery. By means of a suction device ("Octopus"), in 31 pigs the epicardium was grasped and immobilized through an arm contraption fixed to the operating table. In the first 15 consecutive pigs (study I), the two-dimensional motion of an epicardial beacon was monitored. In 16 subsequent pigs (study II), an internal mammary artery was grafted under the microscope in two steps to a proximal coronary artery segment, without cardiopulmonary bypass. First, the internal mammary artery was sutured end-to-side to the outside of the coronary artery. Secondly, an orifice was punched in the partitioning coronary wall by an excimer laser catheter introduced through a temporary side-branch of the internal mammary artery. Study II: During 43 suction periods in four anastomosis areas, immobilization was achieved for 15 to 169 min (>30 h in total) in 13 open- and 9 closed-chest procedures without hemodynamic deterioration. The area circumscribed by the edges of the beacon trajectory (area in which the anastomosis is to be tracked) was reduced from 73.0 +/- 43.0 mm(2) (mean +/- SD) to 1.3 +/- 0.5 mm(2) (p<0.001) in the open-chest and to 0.2 +/- 0.2 mm(2) in the closed-chest procedure. At 6 weeks, no myocardial or coronary suction lesions were found. Study II: Nonocclusive anastomosis surgery required 25 +/- 3 min. No leakage, serious arrhythmias, graft closure or hemodynamic deterioration occurred during the procedure or for 2 h after ligating the coronary artery proximally. At 6 weeks, all seven grafts were patent. Coronary bypass on the beating heart without interruption of coronary flow is feasible. In both open- and in closed-chest procedures, the "Octopus" reduced

  7. Investigating the Effect of Swedish massage on Thoracic Pain in Patients Undergoing Coronary Artery Bypass Graft Surgery

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    Zahra Pishkarmofrad

    2016-05-01

    Full Text Available Pain is one of the common complications after coronary artery bypass graft surgery. The current study aimed to investigate the effect of Swedish massage on thoracic pain in patients undergoing coronary artery bypass graft surgery at Ali-ibn Abi Talib Hospital of Zahedan, Iran in 2015. This study was performed on 50 patients undergoing coronary artery bypass graft surgery at Ali-ibn Abi Talib Hospital of Zahedan in 2015 in a randomized controlled clinical trial method. The patients were randomly divided into two massage and control groups with 25 cases in each group. The intervention group received Swedish massage for 20 minutes on the first day of transferring to cardiac surgical ward; however, the control group went under the routine control of the ward. Patients’ pain intensity were measured and recorded 15 minutes before and after the intervention using Visual Analog Scale (VAS. Statistical analysis was done using Chi-square test, independent t-test and paired t-test and SPSS Software version 21. There was no statistical significant difference between the two groups in terms of pain intensity before the intervention. The mean pain score before and after intervention was 60.80±11.46 and 44.32±11.58 in the massage group and 58.64±14.42 and 58.60±14.40 in th e control group, respectively. The result of covariance test showed that the mean pain score after intervention was significantly lower in the massage group than the control group (P=0.0001. Considering the effect of Swedish massage on reducing pain in patients undergoing coronary artery bypass graft, massage therapy can be used as a safe and low-cost non-drug method for reducing pain in these patients.

  8. Patients? and partners? health-related quality of life before and 4 months after coronary artery bypass grafting surgery

    OpenAIRE

    Thomson, Patricia; Niven, Catherine A; Peck, David F; Eaves, Jennifer

    2013-01-01

    Background Patients having coronary artery bypass grafting (CABG) often depend on their partners for assistance before and after surgery. Whilst patients? physical and mental health usually improves after surgery little is known about the partners? health-related quality of life (HRQoL) in CABG. If the partners? physical and emotional health is poor this can influence their caregiving role and ability to support the patient. This study aimed: to increase understanding of patients? and partner...

  9. Off-pump coronary artery bypass grafting in an octogenarian with situs inversus and dextrocardia: report of a case.

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    Takahashi, Hiroaki; Okada, Kenji; Matsumori, Masamichi; Okita, Yutaka

    2011-08-01

    Dextrocardia associated with situs inversus totalis is a rare condition. A small number of patients with the condition have been reported after undergoing myocardial revascularization. We experienced a case of this rare disorder in an 83-year-old man. He was successfully treated by off-pump coronary artery bypass grafting with bilateral internal thoracic arteries and a saphenous vein. Except for the mirror-image anatomy, the surgical technique was similar to that used for a patient with situs solitus.

  10. Conversion after off-pump coronary artery bypass grafting: the CORONARY trial experience.

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    Stevens, Louis-Mathieu; Noiseux, Nicolas; Avezum, Alvaro; Ayapati, Dharma Rakshak; Chen, Xin; Lucchese, Fernando Antonio; Cacheda, Horacio; Parvathaneni, Sirish; Ou, Yongning; Lamy, André

    2017-03-01

    Emergent and late conversions form OFF-to-ON pump coronary artery bypass grafting (CABG) have been associated with worse outcomes, however, it remains unclear as to which risk factors are associated with conversion and how to prevent them. Among 4718 patients who randomly underwent off- or on-pump CABG, the incidence of off-pump to on-pump cross-over, or 'OFF-to-ON conversion', was 7.9% (186/2356). The primary outcome was a composite of death, stroke, myocardial infarction, or new renal failure requiring dialysis. We assessed the risk factors and outcomes of converted patients. Emergent OFF-to-ON conversions, defined as conversions for hypotension or ischaemia, were required for 3.2% of patients ( n  = 75), while most elective conversions were due to small or intramuscular coronaries ( n  = 83). OFF-to-ON converted patients required increased surgery time, blood transfusions, intensive care unit stay, and presented a higher incidence at 1 year of the composite outcome compared with non-converted off-pump patients (all P pump patients ( P  = 0.35). Independent predictors of emergent conversions included higher heart rate or chronic atrial fibrillation, urgent surgery, more grafts planned and surgeon experience with off-pump CABG. Emergent OFF-to-ON conversion is associated with worse outcomes compared with elective conversion or no conversion. In the presence of risk factors for emergent conversion, an early and elective conversion approach is a judicious strategy.

  11. Development and Evaluation of Care Programs for the Delirium Management in Patients after Coronary Artery Bypass Graft Surgery (CABG

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    Safoora Fallahpoor

    2016-07-01

    Full Text Available Delirium is one of the common problems of cognitive impairment after coronary artery bypass graft surgery (CABG that its prevention, timely detection, and treatment require a care and management program to be controlled. The present research has studied a care program for the management of delirium in patients after coronary artery bypass graft surgery. This research was performed by action research methodology during a fivestage cycle in two groups of 50 persons (without interference and with intervention. In both groups, the patients were evaluated every 8 hours by CAM-ICU tool in hours (6, 14 and 22 for the occurrence of delirium after surgery until they were in Intensive Care Unit (ICU. In the intervention group, the developed program was implemented in three areas of delirium management before, during, and after the surgery. Then, the collected information was analyzed in two groups using descriptive and analytical statistics in SPSS 20 software. Delirium was observed at least once in 68% of patients without the intervention and 38% of patients with intervention after surgery. The ratio of delirium incidence was significantly lower in the intervention group (P<0.05. In addition, the total number of delirium in ICU was significantly lower for patients in the intervention group (P<0.05.The developed program for reducing the incidence of delirium in hospitalized patients after coronary artery bypass graft surgery (CABG was confirmed. This means that its applying will lead to a reduction in delirium.

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

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    Hunold, Peter; Schlosser, Thomas; Nassenstein, Kai; Barkhausen, Joerg [University Hospital Essen, University of Duisburg-Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Massoudy, Parwis; Boehm, Claudia; Knipp, Stephan; Thielmann, Matthias; Jakob, Heinz [West German Heart Center Essen, University of Duisburg-Essen, Department of Thoracic and Cardiovascular Surgery, Essen (Germany); Eggebrecht, Holger; Erbel, Raimund [West German Heart Center Essen, University of Duisburg-Essen, Department of Cardiology, Essen (Germany)

    2008-12-15

    The aim of the study was to relate the extent of myocardial late gadolinium enhancement (LGE) in cardiac MRI to intraoperative graft flow in patients undergoing coronary artery bypass graft (CABG) surgery. Thirty-three CAD patients underwent LGE MRI before surgery using an inversion-recovery GRE sequence (turboFLASH). Intraoperative graft flow in Doppler ultrasonography was compared with the scar extent in each coronary vessel territory. One hundred and fourteen grafts were established supplying 86 of the 99 vessel territories. A significant negative correlation was found between scar extent and graft flow (r = -0.4, p < 0.0001). Flow in grafts to territories with no or small subendocardial scar was significantly higher than in grafts to territories with broad nontransmural or transmural scar (75 {+-} 39 vs. 38 {+-} 26 cc min{sup -1}; p < 0.0001). In summary, the extent of myocardial scar as defined by contrast-enhanced MRI predicts coronary bypass graft flow. Beyond the probability of functional recovery, preoperative MRI might add value to surgery planning by predicting midterm bypass graft patency. (orig.)

  13. Safety of Continuous Infusion Ketorolac in Postoperative Coronary Artery Bypass Graft Surgery Patients

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    Meredith L. Howard

    2016-06-01

    Full Text Available Background:Continuous infusion ketorolac is sometimes utilized for analgesia in postoperative coronary artery bypass graft (CABG patients despite contraindications for use. Limited literature surrounds this topic; therefore, this study was conducted to evaluate the safety of this practice. Methods: This retrospective cohort study evaluated the primary outcome of mortality and secondary outcomes of incidence of bleeding and myocardial infarction (MI. All patients who underwent isolated CABG surgeries and received continuous infusion ketorolac during the study period were included. An equal number of randomly selected isolated CABG patients served as control patients. Electronic medical records and the Society of Thoracic Surgeons (STS database were utilized to determine baseline characteristics and outcomes; Results: One hundred and seventy-eight patients met inclusion; 89 in each group. More patients in the control group underwent on-pump surgeries (78.6% vs. 29.2%, p = 0.01 and had higher STS risk scores (1.1% vs. 0.6%, p = 0.003. There was no difference in mortality between the ketorolac group and control group (2.2% vs. 3.3%, p = 0.605. Additionally, no patients experienced a MI and there was no difference in bleeding incidence (5.5% vs. 6.7%, p = 0.58; Conclusions: No association was found between continuous infusion ketorolac and increased risk of mortality, MI, or bleeding events in postoperative CABG patients. Considerations to differences in baseline characteristics must be made when interpreting results.

  14. The effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery

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    Mohammad Javad Amiri

    2017-11-01

    Full Text Available Abstract Background This study aims to investigate the effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery (CABG. Methods In this clinical trial, 90 patients, who were candidates for CABG in an urban area of Iran, were selected and randomly assigned to intervention and control groups by the minimization method. In the intervention group, natural sounds were broadcast through headphones for 30 min. In the control group, headphones connected to a silent device were used. The research instruments were a demographic questionnaire and the Spielberger State-Trait Anxiety Inventory (STAI. These were used before the intervention, 30 min after the music, and before the surgery in the waiting room for both groups. Data was analyzed using SPSS software. Results The mean anxiety level of the intervention group has been found to be significantly lower than that of the control group half an hour after the intervention as well as in the waiting room in the preoperative period (p = 0.001. Moreover, the mean anxiety of the intervention group decreases, while it increases for the control group over time (p < 0.001. Conclusion Natural sounds can be used as a non-pharmacological way to reduce the anxiety of patients undergoing CABG. Trial registration I RCT2017011723190N3 , Registered 1 March 2017.

  15. Risk factors for low cardiac output syndrome after coronary artery bypass grafting surgery.

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    Sá, Michel Pompeu Barros de Oliveira; Nogueira, Joana Rosa Costa; Ferraz, Paulo Ernando; Figueiredo, Omar Jacobina; Cavalcante, Wagner Cid Palmeira; Cavalcante, Thiago Cid Palmeira; Silva, Hugo Thiago Torres da; Santos, Cecília Andrade; Lima, Renato Oliveira de Albuquerque; Vasconcelos, Frederico Pires; Lima, Ricardo de Carvalho

    2012-01-01

    Low cardiac output syndrome (LCOS) is a serious complication after cardiac surgery and is associated with significant morbidity and mortality. The aim of this study is to identify risk factors for LCOS in patients undergoing coronary artery bypass grafting (CABG) in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE (Recife, PE, Brazil). A historical prospective study comprising 605 consecutive patients operated between May 2007 and December 2010. We evaluated 12 preoperative and 7 intraoperative variables. We applied univariate and multivariate logistic regression analysis. The incidence of LCOS was 14.7% (n = 89), with a lethality rate of 52.8% (n = 47). In multivariate analysis by logistic regression, four variables remained as independent risk factors: age > 60 years (OR 2.00, 95% CI 1.20 to 6.14, P = 0.009), on-pump CABG (OR 2.16, 95% CI 1.40 to 7.08, P = 0.006), emergency surgery (OR 4.71, 95% CI 1.34 to 26.55, P = 0.028), incomplete revascularization (OR 2.62, 95% CI 1.32 to 5.86, P = 0.003), and ejection fraction 60 years of off-pump CABG, emergency surgery, incomplete CABG and ejection fraction <50%.

  16. Minimally invasive compared to conventional approach for coronary artery bypass grafting improves outcome

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    Jitumoni Baishya

    2017-01-01

    Full Text Available Introduction: Minimally invasive (MI cardiac surgery is a rapidly gaining popularity, globally as well as in India. We aimed to compare the outcome of MI to the conventional approach for coronary artery bypass graft (CABG surgery. Methods: This prospective, comparative study was conducted at a tertiary care cardiac surgical center. All patients who underwent CABG surgery via MI approach (MI group from July 2015 to December 2015 were enrolled and were compared against same number of EuroSCORE II matched patients undergoing CABG through conventional mid-sternotomy approach (CON group. Demographic, intra- and post-operative variables were collected. Results: In MI group, duration of the surgery was significantly longer (P = 0.029. Intraoperative blood loss lesser (P = 0.002, shorter duration of ventilation (P = 0.002, shorter Intensive Care Unit stay (P = 0.004, shorter hospital stay (P = 0.003, lesser postoperative analgesic requirements (P = 0.027, and lower visual analog scale scores on day of surgery (P = 0.032 and 1 st postoperative day (P = 0.025. No significant difference in postoperative blood loss, blood transfusion, or duration of inotrope requirement observed. There was no conversion to mid-sternotomy in any patients, 8% of patients had desaturation intraoperatively. There was no operative mortality. Conclusion: MI surgery is associated with lesser intraoperative blood loss, better analgesia, and faster recovery.

  17. Preoperative Proteinuria Predicts Adverse Renal Outcomes after Coronary Artery Bypass Grafting

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    Huang, Tao-Min; Wu, Vin-Cent; Young, Guang-Huar; Lin, Yu-Feng; Shiao, Chih-Chung; Wu, Pei-Chen; Li, Wen-Yi; Yu, Hsi-Yu; Hu, Fu-Chang; Lin, Jou-Wei; Chen, Yih-Sharng; Lin, Yen-Hung; Wang, Shoei-Shen; Hsu, Ron-Bin; Chang, Fan-Chi; Chou, Nai-Kuan; Chu, Tzong-Shinn; Yeh, Yu-Chang; Tsai, Pi-Ru; Huang, Jenq-Wen; Lin, Shuei-Liong; Chen, Yung-Ming

    2011-01-01

    Whether preoperative proteinuria associates with adverse renal outcomes after cardiac surgery is unknown. Here, we performed a secondary analysis of a prospectively enrolled cohort of adult patients undergoing coronary artery bypass grafting (CABG) at a medical center and its two affiliate hospitals between 2003 and 2007. We excluded patients with stage 5 CKD or those who received dialysis previously. We defined proteinuria, measured with a dipstick, as mild (trace to 1+) or heavy (2+ to 4+). Among a total of 1052 patients, cardiac surgery–associated acute kidney injury (CSA-AKI) developed in 183 (17.4%) patients and required renal replacement therapy (RRT) in 50 (4.8%) patients. In a multiple logistic regression model, mild and heavy proteinuria each associated with an increased odds of CSA-AKI, independent of CKD stage and the presence of diabetes mellitus (mild: OR 1.66, 95% CI 1.09 to 2.52; heavy: OR 2.30, 95% CI 1.35 to 3.90). Heavy proteinuria also associated with increased odds of postoperative RRT (OR 7.29, 95% CI 3.00 to 17.73). In summary, these data suggest that preoperative proteinuria is a predictor of CSA-AKI among patients undergoing CABG. PMID:21115618

  18. Passion for Life: Lived Experiences of Patients after Coronary Artery Bypass Graft

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    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.

  19. Percutaneous coronary intervention versus coronary artery bypass grafting: where are we after NOBLE and EXCEL?

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    Fortier, Jacqueline H; Shaw, Richard E; Glineur, David; Grau, Juan B

    2017-11-01

    The publication of the NOBLE and EXCEL trials, with seemingly conflicting results, brought into question whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is better for low-risk patients with left main coronary artery stenosis (LMCAS). This review appraises the methods and results of NOBLE and EXCEL, contextualizes them within the literature, and determines how they may affect clinical practice. We appraised the trials and describe differences in methodology and results. NOBLE recruited primarily isolated LMCAS, and found that CABG was superior to PCI. EXCEL's population included patients LMCAS in the context of multivessel CAD, and found PCI and CABG were comparable. Both trials enrolled young patients with few comorbidities, and there was more protocol-mandated consistency in the procedural techniques and medical therapy of patients receiving PCI. The generalizability of these trials is limited by the use of young, healthy patients at highly skilled centres that rarely reflect typical clinical practice. If these studies are to maintain relevance, trialists must address the lack of protocolization of surgical interventions and inconsistent medical therapies. Unfortunately, the limitations of NOBLE and EXCEL mean that we are no closer to answering the question of what is the optimal treatment for patients with LMCAS.

  20. Clinical and metabolic results of fasting abbreviation with carbohydrates in coronary artery bypass graft surgery.

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    Feguri, Gibran Roder; Lima, Paulo Ruiz Lúcio; Lopes, Andréa Mazoni; Roledo, Andréa; Marchese, Miriam; Trevisan, Mônica; Ahmad, Haitham; Freitas, Bruno Baranhuk de; Aguilar-Nascimento, José Eduardo de

    2012-01-01

    Limited information is available about preoperative fasting abbreviation with administration of liquid enriched with carbohydrates (CHO) in cardiovascular surgeries. To evaluate clinical variables, security of the method and effects on the metabolism of patients undergoing fasting abbreviation in coronary artery bypass graft (CABG) surgery. Forty patients undergoing CABG were randomized to receive 400 ml (6 hours before) and 200 ml (2 hours before) of maltodextrin at 12.5% (Group I, n=20) or just water (Group II, n=20) before anesthetic induction. Perioperative clinical variables were evaluated. Insulin resistance (IR) was evaluated by Homa-IR index and also by the need of exogenous insulin; pancreatic beta-cell excretory function by Homa-Beta index and glycemic control by tests of capillary glucose. Deaths, bronchoaspiration, mediastinitis, stroke and acute myocardial infarction did not occur. Atrial fibrillation occurred in two patients of each group and infectious complications did not differ among groups (P=0.611). Patients of Group I presented two days less of hospital stay (P=0.025) and one day less in the ICU (P0.05). A decline in the endogenous production of insulin was observed in both groups (P<0.001). Preoperative fasting abbreviation with the administration of CHO in the CABG was safe. The glycemic control improved in the ICU; there was less time in the use of dobutamine and length of hospital and ICU stay was reduced. However, neither IR nor morbimortality during hospital phase were influenced.

  1. [Coronary artery bypass graft surgery with bilateral internal mammary artery. Short-term results].

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    Ríos Ortega, Josías Caleb; Castañeda Castillo, Paul; Talledo Paredes, Luisa; Soplopuco Palacios, Franz; Aranda Pretell, Necemio; Pérez Valverde, Yemmy; Morón Castro, Julio; Reyes Torres, Andrés

    2017-01-05

    Coronary artery bypass graft (CABG) surgery remains the reference standard in the treatment of multivessel coronary disease. Several studies have shown that CABG with bilateral internal mammary arteries (BIMA) has better results in long-term survival. A retrospective study was conducted on CABG surgeries with BIMA from January 2012 to December 2015 in the National Cardiovascular Institute, INCOR, EsSalud, Peru. The objectives were to determine the mortality and major cardiovascular events at 30 days follow-up. Of the 36 patients subjected to CABG surgery with BIMA, the 30-day mortality was 0%, with major cardiovascular events occurring in 5.56% of patients (Stroke 0%, postoperative myocardial infarction 5.56%, need of new coronary intervention 0%). The incidence of mediastinitis and/or sternal reconstruction was 0%. Superficial wound infection was observed in 7 patients, with there being no significant difference between diabetics and non-diabetics (25% vs. 16.66%, OR=3.3, P=.88), or between patients with or without overweight (19.23% vs. 20%, respectively, OR=.95; 95% CI, P=.68). CABG surgery with BIMA is a safe procedure, with low rates of mortality and major cardiovascular events in the short-term. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

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

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

    2012-09-01

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

  3. How Older Female Spouses Cope with Partners’ Coronary Artery Bypass Graft Surgery

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    Suzanne Marnocha

    2013-01-01

    Full Text Available This research sought to better understand how older female spouses cope with a partner’s coronary artery bypass graft surgery and to explore coping’s relationships with life-change stress, cognitive appraisal, resilience, social support, and aspects of spouse’s surgery. A sample of 96 women, aged from 55 to 81 years, completed surveys after their partner’s surgery. Folkman and Lazarus’ ways of coping (WCQ scales yielded two factors in this sample—reactive coping and adaptive coping. Reactive coping, including more emotion-focused ways of coping from the WCQ, was associated only with more time spent anticipating spouses’ surgeries. Women described the greatest use of ways of coping labeled adaptive, which in turn had significant relationships with greater resilience, social support, and positive appraisal of the surgical experience. Stepwise multiple regression found greater resilience, more frequent religious participation, and fewer children to be distinct predictors of adaptive coping. Nursing staff are encouraged to accept and normalize reactive coping, while facilitating adaptive coping with surgical stresses.

  4. Electrocardiographic Changes in Certain Cardiovascular Physiological and Pathological Settings. Impact on Coronary Artery Bypass Grafting

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    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.

  5. The effects of ocean sounds on sleep after coronary artery bypass graft surgery.

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    Williamson, J W

    1992-07-01

    To investigate the influence of ocean sounds (white noise) on the night sleep pattern of postoperative coronary artery bypass graft (CABG) patients after transfer from an intensive care unit. A before and after trial with an experimental and a control group was used in this intervention study. A large public hospital with primary, secondary, and tertiary care facilities. A consecutive sample of 60 first-time CABG patients was systematically assigned to the experimental or the control group. For the experimental group, the sounds were played on the Marsona Sound Conditioner (Marpac Corporation, Wilmington, NC) for three consecutive nights posttransfer from the ICU. No control of environment, except for the elimination of white noise, was done for the control group. The Richards-Campbell Sleep Questionnaire, a visual analog scale, provided self-reported sleep scores on six variables. Analysis of covariance was used to test the difference between the posttest scores of the groups, with the pretest used as the covariate. There were significant differences in sleep depth, awakening, return to sleep, quality of sleep, and total sleep scores; the group receiving ocean sounds reported higher scores, indicating better sleep. There was no difference in the falling asleep scores. The use of ocean sounds is a viable intervention to foster optimal sleep patterns in postoperative CABG patients after transfer from the ICU.

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

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

    2012-01-01

    Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients. Participants completed a survey assessing sexual activity, mental health and physical health at baseline (3-5-day post-surgery; n=60) and 2-month post-surgery (n=42). Sexual quality of life showed moderate difficulties at baseline and did not improve by follow-up (p values≥0.09). At follow-up, greater patient fear was associated with lower sexual quality of life in some domains; receiving information was related to lower fear (p values≤0.03) and greater sexual satisfaction and interest (p values≤0.04). Suggestive of mediation, there was a significant indirect effect of information on patient fear and of patient fear on sexual interest (p=0.05). Though data were cross-sectional, findings suggest that fears of sexual activity may play a role in lowering CABG patients' motivation for sexual activity and that receiving information from a medical provider may assist in hastening sexual rehabilitation. Prospective and intervention studies are needed to support findings.

  7. "Risk factors in mortality after coronary artery bypass graft - Imam Hospital (1996-1999 "

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    "Radmehr H

    2002-08-01

    Full Text Available Introduction: Ischemic heart disease is the most common cause of mortality in developed countries. CABG (Coronary Artery Bypass Graft is one of the therapeutic methods in ischemic heart disease. Methods and Materials: Considering the increased incidence of coronary artery disease in Iran, and with increased rate of CABG, we performed a cross sectioned study (1996-1999. In 635 patients 467 male (73.5 percent, 168 female (26.5 percent about risk factors of mortality after CABG in cardiac surgery department "Imam Khomeini hospital. 20 risk factors were included in our study: age, gender, smoking, family history, diabetes mellitus, morbid obesity, hypercholesterolemia, hypertension, palpitation, renal failure COPD, (chronic obstructive pulmonary disease, history of myocardial infarction, CHF, angina, cerebral vascular disease, pace maker, Ejection fraction<40 percent, history of PTCA, history of CPR, and coronary endarterectomy. Results: Cigarette smoking (P=0.40, CHF in female (P=0.003. Endarterectomy in both gender (P=0.0001. Pace maker in both gender (P=0.00006, palpitation in both gender (P=0.0001. CPR in both gender (P=0.0000001, were associated with increased risk of mortality after CABG. Conclusion: We found that, endarterctomy, cigarette smoking, CHF. Pace maker, CPR, and palpitation are important risk factors for mortality after CABG.

  8. Postoperative arrhythmias and myocardial electrolytes in patients undergoing coronary artery bypass grafting.

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    Jensen, B M; Alstrup, P; Klitgård, N A

    1996-01-01

    Electrolyte changes in right atrial and skeletal muscle pre- intra- and postoperatively, and their relationship to the development of postoperative atrial fibrillation or flutter were evaluated in 31 patients with coronary artery bypass grafting (CABG). Such postoperative arrhythmias occurred in 14 patients (45%). Before CABG the skeletal muscle potassium concentration was lower in these patients than in the others: median 261.4 (range 148.2-329.5) vs 298.6 (167.1-416.4) mumol/g dry weight, p = 0.017. The right atrial potassium concentration was normal, but sodium levels were higher in the patients with, than in those without postoperative arrhythmias: median 340.3 (263.7-454.9) vs 296.3 (203.9-355.0) mumol/g dry weight, p = 0.008, indicating disturbed transmembrane electrolyte transfer. During CABG the potassium levels fell and sodium increased in both right atrium and skeletal muscle, and on postoperative day 2 the potassium content in skeletal muscle was not yet restored. Magnesium levels showed no changes in right atrium or skeletal muscle, but serum magnesium declined postoperatively. As the observed electrolyte derangements may be important in the development of postoperative arrhythmias, concomitant potassium and magnesium supplement postoperatively may be beneficial in restoring cellular potassium concentration.

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

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    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.

  10. Evaluation of taste sensitivity in patients undergoing coronary artery bypass graft surgery.

    Science.gov (United States)

    Keith, Mary; Mokbel, Rose; San Emeterio, Mario; Song, Jacquelin; Errett, Lee

    2010-07-01

    Patients report changes in their perception of food tastes following cardiac surgery. This study was designed to explore changes in taste sensitivity following coronary artery bypass graft (CABG) surgery. Detection and recognition thresholds for sweet (sucrose), salty (sodium chloride), sour (citric acid), and bitter (quinine hydrochloride) were determined using the multiple forced-choice ascending concentration series method at baseline (presurgical), discharge, 5 weeks, and 16 weeks post-CABG. Demographic and gastrointestinal data were also obtained. Mixed-model analyses for repeated measures were performed using the baseline scores as reference. Thirty-three patients (mean age=61.8+/-8 years), consented to participate in the study between January 2003 and January 2006, with 13 completing all visits. Detection and recognition thresholds for sweet were significantly lower at discharge compared with baseline (1.7+/-1.2 vs 2.43+/-1.4 and 5.1+/-1.8 vs 5.5+/-1.3, respectively; Pvs 1.8+/-1.5; Pvs 4.2+/-2.2; Pfood intake will help to clarify the clinical impact of taste changes and subsequently to guide clinical nutrition care. Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

  11. Emergency coronary bypass grafting for evolving myocardial infarction. Effects on infarct size and left ventricular function

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    Flameng, W.; Sergeant, P.; Vanhaecke, J.; Suy, R.

    1987-07-01

    Emergency aorta-coronary bypass grafting was performed early in the course of evolving myocardial infarction in 48 patients. The time interval between the onset of symptoms and reperfusion was 169 +/- 80 minutes. Quantitative assessment of postoperative thallium 201 myocardial scans in 19 patients revealed a significant salvage of myocardium after surgical reperfusion: The size of the residual infarction was less than 50% of that in a matched, medically treated, prospective control group (n = 39) (p less than 0.05). Postoperative equilibrium-gated radionuclide blood pool studies (technetium 99m) showed an enhanced recovery of regional and global ejection fraction after operation as compared to after medical treatment (p less than 0.05). Ultrastructural evaluation of biopsy specimens obtained during the operation delineated subendocardial necrosis in the majority of cases (72%), but subepicardial necrosis was found in only 6% of instances. Q-wave abnormalities were observed on the postoperative electrocardiogram in 50% of cases. Operative mortality was 0% in low-risk patients (i.e., hemodynamically stable condition, n = 26) and 18% in high-risk patients (i.e., cardiogenic shock including total electromechanical dysfunction, n = 22). Survival rate at 18 months was 92% +/- 4%, and 95% +/- 4% of the survivors were event free. It is concluded that early surgical reperfusion of evolving myocardial infarction limits infarct size significantly, enhances functional recovery, and may be a lifesaving operation in patients having cardiogenic shock associated with unsuccessful resuscitation.

  12. 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.

  13. Assessment of hibernating myocardium following coronary artery bypass grafting using resting {sup 201}Tl myocardial SPECT

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    Oshima, Motoo; Higashi, Shizuka; Yasukochi, Hiroshi [Teikyo Univ., Tokyo (Japan). Faculty of Medicine; Hayase, Shuhei

    1995-03-01

    In this study, the effect of coronary artery bypass grafting (CABG) in 35 patients (pts) (male 29, female 6) with fixed defects were evaluated before and one month after surgery using resting {sup 201}Tl SPECT. Nine pts (7 old myocardial infarction; OMI) had 2 vessel disease (VD) and 26 pts (19 OMI) had 3 VD. Pts ages ranged from 41 to 75 (mean 61.4{+-}8.4) years. All 35 pts were divided into 4 groups according to the results of {sup 201}Tl SPECT and left ventriculogram pre- and post-CABG. Thirteen pts who improved of both {sup 201}Tl SPECT and wall motion scores post-CABG were considered as hibernating myocardium (group I). Nine patients who improved of {sup 201}Tl SPECT score but no change of wall motion were group II. Seven pts who improved of wall motion but no change of {sup 201}Tl SPECT score were group III. Six pts who had no improvement of both {sup 201}Tl SPECT and wall motion scores were group IV and considered as myocardial infarction. (author).

  14. Maori have worse outcomes after coronary artery bypass grafting than Europeans in New Zealand.

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    Wang, Tom Kai Ming; Ramanathan, Tharumenthiran; Stewart, Ralph; Crengle, Sue; Gamble, Greg; White, Harvey

    2013-08-02

    Disparities for Maori exist in New Zealand for cardiovascular risk factors, events and access to revascularisation. We compared characteristics and outcomes of coronary artery bypass grafting (CABG) between Maori and Europeans in New Zealand. Patients undergoing isolated CABG at Auckland City Hospital from July 2010-June 2012 were retrospectively analysed. Of 818 patients, 82 were Maori and 444 were Europeans. Maori were younger (60.0 vs 67.9 years, pMaori ethnicity was independently associated with 30-day mortality, odds ratio (OR) 6.35, 95% confidence interval 1.01-39.9, p=0.046; and surgical morbidity OR 2.05, 1.04-4.04, p=0.040. Maori had a trend for higher mortality at 1.4 plus or minus 0.6 years (hazards ratio 2.91, 0.92-9.20, p=0.069), 1-year mortality 6.3% vs 1.5%. Despite being younger, Maori undergoing CABG had more comorbidities and socioeconomic deprivation. Maori had higher mortality and complication rates. Maori should have earlier access to CABG.

  15. Hemodynamic effects of osteopathic manipulative treatment immediately after coronary artery bypass graft surgery.

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    O-Yurvati, Albert H; Carnes, Michael S; Clearfield, Michael B; Stoll, Scott T; McConathy, Walter J

    2005-10-01

    Coronary artery bypass graft (CABG) surgery is a common procedure for patients with coronary artery disease. The physiologic effects of postoperative osteopathic manipulative treatment (OMT) following CABG have not been documented previously. To determine the effects of OMT on cardiac hemodynamics post-CABG surgery. Pilot prospective clinical study (N=29). Treatment subjects (n=10) undergoing CABG surgery were recruited for postoperative OMT. The primary assessment compared, pre-OMT versus post-OMT, measurements of thoracic impedance, mixed venous oxygen saturation (SvO2), and cardiac index. Records of control subjects (n=19) who underwent CABG surgery--but who did not receive OMT--were assessed for SvO2 and cardiac index at 1 hour and 2 hours postsurgery. Immediately following CABG surgery (treatment occurred while subjects were completely anesthetized. A post-OMT increase in thoracic impedance (P cardiac index (P cardiac index (P cardiac function and perfusion indicated that OMT had a beneficial effect on the recovery of patients after CABG surgery. The authors conclude that OMT has immediate, beneficial hemodynamic effects after CABG surgery when administered while the patient is sedated and pharmacologically paralyzed.

  16. Underestimation of the incidence of new-onset post-coronary artery bypass grafting atrial fibrillation and its impact on 30-day mortality.

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    Filardo, Giovanni; Pollock, Benjamin D; da Graca, Briget; Phan, Teresa K; Sass, Danielle M; Ailawadi, Gorav; Thourani, Vinod; Damiano, Ralph

    2017-10-01

    Inconsistent definitions of atrial fibrillation after coronary artery bypass grafting have caused uncertainty about its incidence and risk. We examined the extent to which limiting the definition to post-coronary artery bypass grafting atrial fibrillation events requiring treatment underestimates its incidence and impact on 30-day mortality. We assessed in-hospital atrial fibrillation and 30-day mortality in 9268 consecutive patients without preoperative atrial fibrillation who underwent isolated coronary artery bypass grafting at 5 US hospitals (2004-2010). Patients who experienced 1 or more episode of post-coronary artery bypass grafting atrial fibrillation detected via continuous in-hospital electrocardiogram/telemetry monitoring were divided into those for whom Society of Thoracic Surgeons data (applying the definition "atrial fibrillation/flutter requiring treatment") also indicated atrial fibrillation versus those for whom it did not. Risk-adjusted 30-day mortality was compared between these 2 groups and with patients without post-coronary artery bypass grafting atrial fibrillation. Risk-adjusted incidence of post-coronary artery bypass grafting atrial fibrillation incidence was 33.4% (27.0% recorded in Society of Thoracic Surgeons data, 6.4% missed). Patients with post-coronary artery bypass grafting atrial fibrillation missed by Society of Thoracic Surgeons data had a significantly greater risk of 30-day mortality (odds ratio, 2.08, 95% confidence interval, 1.17-3.69) than those captured. By applying the significant underestimation of post-coronary artery bypass grafting atrial fibrillation incidence we observed (odds ratio [Society of Thoracic Surgeons vs missed], 0.78; 95% confidence interval, 0.72-0.83) to the approximately 150,000 patients undergoing isolated coronary artery bypass grafting in the United States each year estimates this increased risk of mortality is carried by 9600 patients (95% confidence interval, 9420-9780) annually. Defining post

  17. Use of cardiopulmonary pump support during coronary artery bypass grafting in the high-risk: a meta-analysis.

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    Yousif, A; Addison, D; Lakkis, N; Rosengart, T; Virani, S S; Birnbaum, Y; Alam, M

    2017-09-21

    Data from randomized trials evaluating the efficacy of on- versus off-pump coronary artery bypass grafting remain inconclusive, particularly in high-risk populations. The aim of this study is to compare the outcomes associated with on- versus off-pump coronary artery bypass grafting among high-risk patients. We performed a meta-analysis of randomized control trials comparing on- versus off-pump coronary artery bypass grafting, focusing on high-risk populations. Studies focusing on "high-risk" features: European System of Cardiac Operative Risk Evaluation (EuroSCORE) ≥ 5, age > 70 years, preexisting renal insufficiency, history of stroke(s), and the presence of left ventricular dysfunction were included. MEDLINE, Scopus, and Embase were searched for all publications between January 1, 2000 and August 1, 2016, using the following terms: on-pump, off-pump, coronary artery bypass, high-risk, left ventricular dysfunction, elderly, aged, and renal insufficiency. Endpoints included cardiovascular and all-cause mortality, non-fatal myocardial infarction, stroke, need for revascularization, renal failure, and length of hospital stay. Nine studies incorporating 11,374 patients with a mean age of 70 years were selected. There was no statistical difference in cardiovascular mortality, all-cause mortality, non-fatal myocardial infarction, and renal failure between the two groups. There was a decrease in further revascularization at 1 year with on-pump (OR 0.67 (0.50-0.89)). However, there was an increase in length of hospital stay by 2.24 days (p = 0.03) among the on-pump group with no difference in stroke (OR 1.34 (1.00-1.80)). On-pump is associated with a decreased risk of additional revascularization by 1 year. However, this appears to be a cost of longer hospitalization.

  18. Predictors of early return to work after a coronary artery bypass graft surgery (CABG

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    Ramin Mehrdad

    2016-12-01

    Full Text Available Objectives: Identifying factors predictive of early return to work in patients who underwent a coronary artery bypass graft surgery (CABG. Material and Methods: Two hundred twenty-six working patients who volunteered and underwent a primary coronary artery bypass surgery between September 2013 and May 2014 were selected for the study and followed up for 6 months. Predictors of early return to work (RTW (within 2 months were analyzed from variables in a prospectively collected database and the 36-Item Short Form Health Survey (SF-36 questionnaire carried out in the hospital and rehabilitation center as well as from the follow-up performed via the phone. Results: One hundred and two (45.1% and 155 (68.9% patients returned to work within 2 and 3 months after the surgery, respectively. Furthermore, 196 patients (87.1% returned to work within 6 months after the surgery. In the univariate analysis, demographic or socioeconomic factors (such as age, level of education, income, occupational factors (such as occupation type, working hours per week, duration of the preoperative absence from work, psychological factors (such as a patient’s concern about adverse health effects of RTW, feeling depressed, a patient’s attitude towards his/her ability to RTW and a patient’s perception of his/her job stress level and medical factors (such as serum troponin T and creatine kinase MB (CKMB level, pump time in surgery, co-surgery and dyslipidemia history had a statistically significant correlation with early return to work. The patients who early returned to work had significantly higher scores in 3 domains on the SF-36 questionnaire (used for assessing the patients’ quality of life, compared to those who did not return to work early (including physical functioning, role limitations due to physical health and pain. Conclusions: In the present study we identified 4 new medical factors that could be used as predictors of early return to work after CABG. These

  19. Implantation of transcatheter aortic valve prosthesis through the ascending aorta concomitant with coronary artery bypass grafting without cardiopulmonary bypass

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    João Carlos Ferreira Leal

    2014-12-01

    Full Text Available Introdution: The transcatheter aortic valve implantation in the treatment of high-risk symptomatic aortic stenosis has increased the number of implants every year. The learning curve for transcatheter aortic valve implantation has improved since the last 12 years, allowing access alternatives. Objective: The aim of this study is to approach the implantation of transcatheter aortic valve through transaortic via associated with off-pump cardiopulmonary bypass surgery in a 67-year-old man, with chronic obstructive pulmonary disease, arterial hypertension and kidney transplant. Methods: Off-pump coronary artery bypass surgery was performed and the valve in the aortic position was released successfully. Results: There were no complications in the intraoperative and postoperative period. Gradient reduction, effective orifice increasing of the prosthesis and absence of valvular regurgitation after implantation were observed by transesophageal echocardiography. Conclusion: Procedural success demonstrates that implantation of transcatheter aortic valve through the ascending aorta associated with coronary artery bypass surgery without CPB is a new option for these patients.

  20. Usefulness of one-stage coronary artery bypass grafting on the beating heart and abdominal aortic aneurysm repair.

    Science.gov (United States)

    Morimoto, Keisuke; Taniguchi, Iwao; Miyasaka, Shigeto; Aoki, Tetsuya; Kato, Ippei; Yamaga, Takeshi

    2004-02-01

    Abdominal aortic aneurysm (AAA) is commonly associated with coronary artery disease (CAD). Simultaneous coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) under cardiac arrest and AAA repair may be considerably invasive. Recently CABG under the beating heart without CPB has been reported as a less invasive method. We report the combined operation of CABG on a beating heart and AAA repair for AAA patients with CAD, and compare it with a separate operation. A retrospective review of the records of consecutive patients who underwent elective combined procedure or single operation for CABG on a beating heart and/or repair of the AAA between May 1999 and October 2001 was carried out. Ten patients underwent combined procedures. A single operation, CABG on a beating heart or repair of AAA, were performed in 27 or 19 patients. There were no significant differences with regard to intraoperative blood loss, transfusion and postoperative intubation time among the three groups. There was no operative mortality for any of the three groups. All cases were discharged without severe complications and with patent coronary bypass grafts. There was a decrease in mean total hospital costs for the combined operation group compared with the CABG group plus AAA repair group (3.34 million versus 5.87 million yen). Combined CABG on a beating heart and AAA repair on a one-step approach appears to be a safe and useful therapeutic strategy for AAA patients with CAD.

  1. Effects of Seasonal Variations on the Outcome of Coronary Artery Bypass Graft Surgery

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    Mohammad Hassan Nemati

    2013-06-01

    Full Text Available Background: For all the reports on the association between seasons and coronary artery disease, there is a paucity of information on the possible effects of seasonal variations on the outcome of patients after coronary artery bypass grafting surgery (CABG. The aim of this study was to assess the short-term outcome of post-CABG patients in the four different seasons to find any correlation between seasonal variations and the outcome of such patients. Methods: Data on patients who underwent cardiac surgery between 2007 and 2009 were analyzed. In-hospital mortality, length of Intensive Care Unit (ICU stay, and length of hospital stay in the four different seasons were considered as outcome measures. The EuroSCORE was calculated for all the patients, and the Kruskal-Wallis, Mann-Whitney, Student t, and chi square tests were used as appropriate. Results: Of a total of 402 patients, who underwent CABG during the mentioned period, 292 patients were male (M/F ratio=2.65. There were no differences in terms of mean age, sex ratio, and mean EuroSCORE of the patients between the seasons. The mean length of ICU stay was significantly more in the spring than that of the other seasons (P<0.001, while the difference between the four seasons regarding the mean length of hospital stay did not constitute statistical significance (P=0.22. No effect of seasonal variations was found for the lengths of ICU and hospital stay in the presence of the EuroSCORE after multiple logistic regression analysis (P=0.278, 0.431.Conclusion: Psychological mood changes caused by regional cultural differences rather than environmental factors should be considered in the optimal management of patients after CABG.

  2. Validation of MagedanzSCORE as a predictor of mediastinitis after coronary artery bypass graft surgery.

    Science.gov (United States)

    Sá, Michel Pompeu Barros de Oliveira; Figueira, Evelyn Soares; Santos, Cecília Andrade; Figueiredo, Omar Jacobina; Lima, Renato Oliveira Albuquerque; Rueda, Fábio Gonçalves de; Escobar, Rodrigo Renda de; Soares, Alexandre Magno Macário Nunes; Lima, Ricardo de Carvalho

    2011-01-01

    The aim of this study is to evaluate the applicability of a new score for predicting mediastinitis - MagedanzSCORE - in patients undergoing coronary artery bypass graft (CABG) surgery in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Retrospective study involving 500 patients operated between May/2007 and April/2010. The registers contained all the information used to calculate the MagedanzSCORE. The outcome of interest was mediastinitis. We calculated sensitivity, specificity, positive predictive value, negative predictive value, concordance and accuracy. The accuracy of the model was evaluated by ROC (receiver operating characteristic) curve. The incidence of mediastinitis was 5.6%, with a lethality rate of 32.1%. In univariate analysis, the five variables of the MagedanzSCORE were predictors of postoperative mediastinitis: chronic obstructive pulmonary disease (OR 6.42; 95.0% CI 2.76-14.96; P<0.001), obesity (OR 3.06; 95.0% CI 1.32-7.09; P=0.009), surgical reintervention (OR 82.40; 95.0% CI 30.40-223.30; P<0.001), multiple transfusion (OR 3.33; 95.0% CI 1.52-7.29; P=0.003) and stable angina class IV or unstable (OR 2.59; 95.0% CI 1.19-7.64; P=0.016) according to Canadian Cardiovascular Society. The score had a sensitivity of 96.4%, specificity of 90.0%, positive predictive value of 36.5%, negative predictive value of 99.8% and 90.4% concordance. The accuracy measured by the area under the ROC curve was 96.2% (95.0% CI 94.5%-97.9%). The MagedanzSCORE proved to be a simple and objective index, revealing a satisfactory predictor of development of postoperative mediastinitis in patients undergoing CABG surgery at our institution.

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

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    MSoltanzadeh

    2011-09-01

    Full Text Available Background: One of the most common complaints after coronary artery bypass graft (CABG is post-operative pain. Gabapentin is an anticonvulsant and antineuralgic agent. Objective: To evaluate the analgesic effect of preemptive gabapentin on post-operative pain and morphine consumption after cardiac surgery. Methods: A double-blind randomized clinical trial was conducted on 60 male candidates for CABG. The patients were divided into two groups—the gabapentin (n=30 and the control group (n=30. The test group received 800 mg gabapentin orally two hours before the surgery followed by 400 mg of the drug two hours post-extubation. The control group received placebo instead. Then severity of pain was recorded according to an 11-point visual analog pain scale. The amount of morphine consumed, its side effects and hemodynamic changes were also recorded during and at 2, 6, 12, 18 and 24 hours after extubation. Results: The mean±SD cumulative morphine consumption at the first 24 hours after extubation in gabapentin group was 0.9±1.5 mg while it was 1.5±4 mg for the control group. Therefore, gabapentin group consumed 38% less than the control group (P=0.01. The pain scores during rest and coughing at 2, 6, and 12 hours after extubation were also significantly lower in the gabapentin group compared with the control group (P=0.02. The mean±SD mechanical ventilation time was 5.4±1.7 hours for gabapentin group and 1.6±4.4 hours for the control group (P=0.035. The other variables including hemodynamic changes (HR, SBP and DBP, and incidence of nausea, vomiting and respiratory depression showed no significant difference between the studied groups within 24 hours after extubation. Conclusion: Oral pre-medication with gabapentin before CABG significantly reduces post-operative pain and morphine consumption in adult cardiac surgery.

  4. Repeated, Close Physician Coronary Artery Bypass Grafting Teams Associated with Greater Teamwork.

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    Everson, Jordan; Funk, Russell J; Kaufman, Samuel R; Owen-Smith, Jason; Nallamothu, Brahmajee K; Pagani, Francis D; Hollingsworth, John M

    2017-05-04

    To determine whether observed patterns of physician interaction around shared patients are associated with higher levels of teamwork as perceived by physicians. Michigan Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) procedures at 24 hospitals in the state between 2008 and 2011. We assessed hospital teamwork using the teamwork climate scale in the Safety Attitudes Questionnaire. After aggregating across CABG discharges at these hospitals, we mapped the physician referral networks (including both surgeons and nonsurgeons) that served them and measured three network properties: (1) reinforcement, (2) clustering, and (3) density. We then used multilevel regression models to identify associations between network properties and teamwork at the hospitals on which the networks were anchored. In hospitals where physicians repeatedly cared for patients with the same colleagues, physicians perceived better teamwork (β-reinforcement = 3.28, p = .003). When physicians who worked together also had other colleagues in common, the reported teamwork was stronger (β clustering = 1.71, p = .001). Reported teamwork did not change when physicians worked with a higher proportion of other physicians at the hospital (β density = -0.58, p = .64). In networks with higher levels of reinforcement and clustering, physicians perceive stronger teamwork, perhaps because the strong ties between them create a shared understanding; however, sharing patients with more physicians overall (i.e., density) did not lead to stronger teamwork. Clinical and organizational leaders may consider designing the structure of clinical teams to increase interactions with known colleagues and repeated interactions between providers. © Health Research and Educational Trust.

  5. Continuous Procedural Full-Lung Ventilation During Minimally Invasive Coronary Bypass Grafting.

    Science.gov (United States)

    Sixt, Stephan; Aubin, Hug; Kalb, Robert; Rellecke, Philipp; Lichtenberg, Artur; Albert, Alexander

    2017-12-01

    In the past, minimally invasive cardiac surgery (MICS)- coronary artery bypass graft surgery (CABG) alternatives have been introduced that dramatically reduce the invasiveness of standard operative procedures while still showing excellent clinical outcomes. However, in patients with high morbidity, reduced lung function impeding single-lung ventilation is one of the major concerns for MICS-CABG procedures, although those patients might reap the largest benefit from a procedure of reduced invasiveness. Here, we describe a simple surgical technique-the fan technique-that allows for continuous full-lung ventilation with unimpeded surgical view during common MICS-CABG procedures. To evaluate the procedural feasibility of this technique, we analyzed intraoperative ventilation measurements of 22 consecutive MICS-CABG patients in whom the fan technique was used. This study demonstrates a significant improvement of standard respiratory measurements during procedural full-lung ventilation using the fan technique as compared with conventional single-lung ventilation (ventilation pressure 21.4 ± 3.2 versus 26.6 ± 3 mbar, p ventilation 294.9 ± 74.6 versus 153.2 ± 71 mm Hg, p single-lung ventilation owing to reduced pulmonary function, but also may soon also become a standard procedure for MICS-CABG surgery, especially with regard to procedures involving complex and time-consuming multivessel revascularizations. However, further studies are strongly warranted to assess whether the fan technique may also decrease postoperative pulmonary complications and benefit clinical outcome indicators. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. The effect of calcium dobesilate on venous function following saphenectomy in coronary artery bypass grafting.

    Science.gov (United States)

    Cagli, Kerim; Ozisik, Kanat; Emir, Mustafa; Yurdakok, Okan; Gurkahraman, Sami; Bakuy, Vedat; Tola, Muharrem; Pac, Mustafa; Cobanoglu, Adnan

    2006-01-01

    The aim of this study was to determine whether prophylactic use of calcium dobesilate (CD) can improve venous function after saphenous vein harvest in coronary artery bypass graft (CABG). A total of 100 patients who underwent elective CABG were divided into four equal groups. In Group A, the greater saphenous vein (GSV) was harvested below the knee and, in Group B, through the knee till the groin. These patients remained untreated. Group C received CD in a dosage of 1500 mg po daily after the GSV was harvested below the knee. Group D received same dosage of CD after the GSV was harvested through the knee till the groin. Venous function of ipsilateral leg was evaluated clinically and by Doppler ultrasonography in the postoperative first week and second month. Clinical findings of venous insufficiency were observed with a similar rate between groups at both early and late periods. In Groups A and B, after 2 months, flow velocities decreased and reflux periods increased significantly. In groups C and D, treatment with CD for 2 months after saphenectomy resulted in a significant increase in flow velocities and a significant decrease in reflux periods. Patients in Groups B and D have significantly more impaired venous functions. Saphenectomy results in ipsilateral leg venous dysfunction, which seems to be unrelated to leg swelling and to be more prominent in patients with high-level saphenectomy. In addition, to be careful about the restriction of the saphenectomy procedure into the most appropriate level, prophylactic use of CD can prevent this deterioration when it was added to varice socks.

  7. Agreement and Correlation between Arterial and Central Venous Blood Gas Following Coronary Artery Bypass Graft Surgery.

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    Esmaeilivand, Masoumeh; Khatony, Alireza; Moradi, Gholamreza; Najafi, Farid; Abdi, Alireza

    2017-03-01

    Arterial blood sampling, used to assess patients in acute conditions, may result in complications such as thrombosis and embolism. However, it can be replaced by venous blood sampling, but there is a dearth of information on this. To assess the correlation and agreement between the arterial and central venous blood gases analyses in patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery. In this cross-sectional study, 100 ICU patients undergoing elective CABG surgery were recruited. 2 mm arterial and a 2 mm venous blood samples were obtained from each patient's arterial and central venous lines, respectively. To predict Arterial Blood Gas (ABG) values based on central Venous Blood Gas (VBG) values, the linear regression analysis was used and for evaluating their agreement Bland-Altman method was used. In total of 200 samples were obtained. The mean and Standard Deviation (SD) of age was 58.9±9.1 years and 51% of the participants were female. There was a strong correlation between ABG and central VBG values regarding pH, partial Pressure of Carbon Dioxide (PCO2), Bicarbonate (HCO3) and Base Excess (BE) (r= 0.73, r=0.74, r=0.67 and r=0.71, respectively; panalysis showed an excellent agreement between all the variables (panalysis cannot replace ABG analysis in measuring exact PO2 status, necessitating arterial sampling in some matters, but with respect to the accuracy of pulse oximetry measurements in determining the exact PO2 status, for the rest of the indices a central VBG rather than an ABG can be utilised for determining patient's acid-base status. Particularly in patients who are hospitalised for a long time and have a central venous catheter in place like patients who have undergone CABG, thus reducing the risk and need for invasive arterial sampling.

  8. Coronary aspirate TNFα reflects saphenous vein bypass graft restenosis risk in diabetic patients

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    Baars Theodor

    2013-01-01

    Full Text Available Abstract Background Patients with diabetes mellitus (DM have an increased risk for periprocedural complications and adverse cardiac events after percutaneous coronary intervention. We addressed the potential for coronary microvascular obstruction and restenosis in patients with and without DM undergoing stenting for saphenous vein bypass graft (SVG stenosis under protection with a distal occlusion/aspiration device. Methods SVG plaque volume and composition were analyzed using intravascular ultrasound before stent implantation. Percent diameter stenosis was determined from quantitative coronary angiography before, immediately after and 6 months after stent implantation. Coronary aspirate was retrieved during stent implantation and divided into particulate debris and plasma. Total calcium, several vasoconstrictors, and tumor necrosis factor (TNFα in particulate debris and coronary aspirate plasma were determined. Results Patients with and without DM had similar plaque volume, but larger necrotic core and greater particulate debris release in patients with than without DM (20.3±2.7 vs. 12.7±2.6% and 143.9±19.3 vs. 75.1±10.4 mg, Pvs. 5.1±2.4 pmol/mg and 2.2±0.7 vs. 1.1±0.2 pmol/L, Pvs. 6.34±1.11%, PP Conclusion In diabetics, particulate debris and coronary aspirate plasma contained more TNFα, which might reflect the activity of the underlying atherosclerotic process. Trial registration URL: http://www.clinicaltrials.gov/ct2/results?term=NCT01430884; unique identifier: NCT01430884

  9. Use of the guidelines directed medical therapy after coronary artery bypass graft surgery in Saudi Arabia

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    Khalid A. Alburikan

    2017-09-01

    Full Text Available Background: incidence of cardiovascular diseases in Saudi Arabia is growing and more patients are expected to have cardiac revascularization surgery. Optimal pharmacotherapy management with Guideline Directed Medical Therapy (GDMT post coronary artery bypass grafting (CABG plays an important role in the prevention of adverse cardiovascular outcomes. The objective of this study was to assess the utilization of GDMT for secondary prevention in CABG patients and determine whether specific patients' characteristics can influence GDMT utilization. Method: A retrospective chart review of patients discharged from the hospital after CABG surgery from April 2015 to April 2016. The primary outcome was the utilization of secondary prevention GDMT after CABG surgery - aspirin, B-blockers, statin and angiotensin-converting enzyme inhibitors (ACEI (or angiotensin receptor blockers (ARB in ACEI-intolerant patients. The proportions of eligible and ideal patients who received treatment were calculated, and mixed-effects logistic regression was used to estimate odds ratios (OR for the association of age, gender or patient nationality with the use of GDMT. Results: A total number of 119 patients included in the analysis. The median age of the cohort was 57.3 ± 11 years, and 83% were male (83.2%. Nearly 69.7% of patients had diabetes, and 82% had a previous diagnosis of hypertension. Nearly 91% received aspirin therapy and the rate was lower for B-blocker and statin. The rate of GDMT utilization did not change with the change in patient’s age, gender or nationality. Conclusion: Despite adjustments for contraindications to GDMT, the rate of GDMT utilization was suboptimal.

  10. [Correlation between serum uric acid level and acute renal injury after coronary artery bypass grafting].

    Science.gov (United States)

    Xu, D Q; Du, J; Zheng, Z; Tang, Y; Zou, L; Zhang, Y H; Zhang, H T

    2017-07-11

    Objective: To evaluate whether early postoperative serum uric acid level can predict postoperative acute renal injury (AKI) among patients undergoing coronary artery bypass grafting (CABG). Methods: The study retrospectively enrolled 1 306 patients undergoing CABG in Fuwai Hospital between September 2012 and December 2013. The patients were divided into 5 groups by the concentrations of serum uric acid measured on the morning of the first postoperative day, and uric acid categories were as follow: less than 195 μmol/L (Q1 group, 262 cases), 195-236 μmol/L (Q2 group, 263 cases), 237-280 μmol/L (Q3 group, 260 cases), 281-336 μmol/L (Q4 group, 261 cases), more than 336 μmol/L (Q5 group, 260 cases). The primary end points were AKI (RIFLE criteria), severe AKI (AKI≥stage Ⅰ), postoperative continuous renal replacement therapy (CRRT) requirement, in-hospital death, length of stay in hospital and intensive care unit(ICU). The area under the receiver-operating characteristic (ROC) curve (AUC) was used to determine the ability of the early postoperative serum uric acid level as a risk factor for postoperative AKI prediction. Results: Among the 1 306 patients enrolled in the study, AKI was found in 335 patients (25.65%). After adjusting for variables that were different between the 5 groups, the Q5 group had significantly higher risk of AKI, AKI≥ stage Ⅰ and the requirement of CRRT ( P uric acid levels alone were used (both P uric acid was a better predictor than serum creatinine( P uric acid concentration within 12 hours after operation is an independent predictor of postoperative AKI in patients undergoing CABG, which could be used to identify patients at high risk for AKI.

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

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    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.

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

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    Sbarouni, Eftihia; Georgiadou, Panagiota; Chatzikyriakou, Sofia; Analitis, Antonis; Chaidaroglou, Antigoni; Degiannis, Demitris; Voudris, Vassilis

    2016-01-01

    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.

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

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    K Muralidhar

    2010-01-01

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

  14. Determinants of Variation in Pneumonia Rates After Coronary Artery Bypass Grafting.

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    Brescia, Alexander A; Rankin, J Scott; Cyr, Derek D; Jacobs, Jeffrey P; Prager, Richard L; Zhang, Min; Matsouaka, Roland A; Harrington, Steven D; Dokholyan, Rachel S; Bolling, Steven F; Fishstrom, Astrid; Pasquali, Sara K; Shahian, David M; Likosky, Donald S

    2018-02-01

    Although conventional wisdom suggests that differences in patient risk profiles drive variability in postoperative pneumonia rates after coronary artery bypass grafting (CABG), this teaching has yet to be empirically tested. We determined to what extent patient risk factors account for hospital variation in pneumonia rates. We studied 324,085 patients undergoing CABG between July 1, 2011, and December 31, 2013, across 998 hospitals using The Society of Thoracic Surgeons Adult Cardiac Database. We developed 5 models to estimate our incremental ability to explain hospital variation in pneumonia rates. Model 1 contained patient demographic characteristics and admission status, while Model 2 added patient risk factors. Model 3 added measures of pulmonary function, Model 4 added measures of cardiac anatomy and function and medications, and Model 5 further added measures of intraoperative and postoperative care. Although 9,175 patients (2.83%) experienced pneumonia, the median estimated distribution of pneumonia rates across hospitals was 2.5% (25th to 75th percentile: 1.5% to 4.0%). Wide variability in pneumonia rates was evident, with some hospitals having rates more than 6 times higher than others (10th to 90th percentile: 1.0% to 6.1%). Among all five models, Model 2 accounted for the most variability at 4.24%. In total, 2.05% of hospital variation in pneumonia rates was explained collectively by traditional patient factors, leaving 97.95% of variation unexplained. Our findings suggest that patient risk profiles only account for a fraction of hospital variation in pneumonia rates; enhanced understanding of other contributory factors (eg, processes of care) is required to lessen the likelihood of such nosocomial infections. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. 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.

  16. Metamizole and Platelet Inhibition by Aspirin Following On-Pump Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Wilczyński, Mirosław; Wybraniec, Maciej T; Sanak, Marek; Góral, Joanna; Mizia-Stec, Katarzyna

    2017-06-07

    The purpose of the study was to evaluate the impact of intravenous metamizole on platelet inhibition by aspirin in patients with coronary artery disease early after on-pump coronary artery bypass grafting (CABG). Prospective, single-blind, randomized trial. Tertiary referal hospital. The study comprised 43 patients with multivessel coronary artery disease undergoing CABG. Patients were randomized to postoperative intravenous metamizole ± opioids (study group; n = 23) or opioids alone (control group; n = 20). Aspirin was withheld at least 7 days before the surgery and reinitiated (300 mg) immediately after the procedure prior to metamizole use, and continued daily thereafter (150 mg). Platelet function was evaluated using multielectrode impedance aggregometry (acid-induced platelet activation [ASPI] and collagen-induced platelet activation [COL] test), P-selectin expression and urinary 11-dehydro-thromboxane B2 (11-DTXB2) level at baseline, postoperative day (POD) 0, POD 1, POD 2, and POD 6. Residual platelet reactivity (RPR) was defined as ASPI test >400 AU*min. In all study participants, postoperative ASPI test value moderately decreased (1058.2 v 966.6 AU*min, p = 0.047), urinary 11-DTXB2 level increased (923.4 v 4367.3 pg/mg, p metamizole use did not predict the fluctuations of ASPI and COL test values and P-selectin expression, yet it independently predicted postoperative change of 11-DTXB2 level (b = -0.518, p = 0.001). Intravenous metamizole preceded by a loading dose of aspirin did not modify platelet response to aspirin in the postoperative period after CABG. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Quality of life in elderly patients following coronary artery bypass grafting

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    Bak E

    2014-03-01

    Full Text Available Ewelina Bak,1 Czesław Marcisz2 1Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biala, 2Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland Background: Surgical revascularization of the coronary arteries leads to changes in quality of life (QoL for patients with coronary heart disease. The aim of this work was to monitor QoL, considering cognitive function, depression, and activities of daily living in elderly patients after coronary artery bypass grafting (CABG. Methods: This study included 65 patients (29 women and 36 men aged 61–74 years with stable coronary heart disease who underwent CABG. The control group included 29 women and 36 men aged 61–74 years who were not suffering from coronary heart disease. The questionnaires used in the study canvassed QoL (Nottingham Health Profile, cognitive function, depression, and basic and instrumental activities of daily living. The research was conducted before surgery and repeated 6 and 12 months after surgery. Results: QoL was comparable between women and men and was lower than in the control group (P<0.05. After CABG, the values for particular domains of QoL improved more in men than in women. There was a reduction in the severity of depression 6 months after surgery in men and 12 months after surgery in women. Conclusion: Elderly patients with coronary heart disease have decreased QoL, which normalizes in men and improves in women after CABG. Keywords: coronary heart disease, depression, cognitive function, activities of daily living

  18. Monitoring platelet reactivity during prasugrel or ticagrelor washout before urgent coronary artery bypass grafting.

    Science.gov (United States)

    Orvin, Katia; Barac, Yaron D; Kornowski, Ran; Perl, Leor; Wasserstrum, Yishay; Rubchevsky, Victor; Sharony, Ram; Snir, Eitan; Aravot, Dan; Lev, Eli I

    2017-09-01

    Patients with acute myocardial infarction pretreated with prasugrel or ticagrelor may require urgent coronary artery bypass grafting (CABG). However, prasugrel and ticagrelor withdrawal period is recommended for 5-7 days before planned CABG to enable full platelet recovery. We hypothesized that monitoring sequential platelet reactivity (PR) could identify patients with early platelet recovery who may benefit from earlier surgery before the guideline-recommended 5-7 day delay. We performed preoperative PR assays in 35 patients with acute myocardial infarction who received prasugrel (60%) or ticagrelor (40%) and required an urgent CABG. When platelet inhibition levels were favorable, on the basis of the VerifyNow assay, surgery was endorsed. CABG-related bleeding parameters were collected and compared with two matched control groups composed of patients who received fewer potent antiplatelet regimens. On the basis of platelet function monitoring, we identified 21 (56.7%) patients with a relatively earlier platelet recovery who underwent CABG before the end of the conventional washout period (5-7 days). For these patients, the washout periods were shortened to an average time of 2.6±1.0 days for ticagrelor and 3.8±1.5 days for prasugrel. CABG-related bleeding parameters were comparable with the two matched control groups. A strategy of performing preoperative PR assays can identify patients who recover platelet function in less than 5-7 days after ticagrelor or prasugrel discontinuation. This strategy may provide the basis for performing urgent CABGs earlier than the currently recommended delay. Future, larger studies are required to establish these preliminary findings.

  19. Coronary artery bypass grafting with minimal versus conventional extracorporeal circulation; an economic analysis.

    Science.gov (United States)

    Anastasiadis, K; Fragoulakis, V; Antonitsis, P; Maniadakis, N

    2013-10-15

    This study aims to develop a methodological framework for the comparative economic evaluation between Minimal Extracorporeal Circulation (MECC) versus conventional Extracorporeal Circulation (CECC) in patients undergoing coronary artery bypass grafting (CABG) in different healthcare systems. Moreover, we evaluate the cost-effectiveness ratio of alternative comparators in the healthcare setting of Greece, Germany, the Netherlands and Switzerland. The effectiveness data utilized were derived from a recent meta-analysis which incorporated 24 randomized clinical trials. Total therapy cost per patient reflects all resources expensed in delivery of therapy and the management of any adverse events, including drugs, diagnostics tests, materials, devices, blood units, the utilization of operating theaters, intensive care units, and wards. Perioperative mortality was used as the primary health outcome to estimate life years gained in treatment arms. Bias-corrected uncertainty intervals were calculated using the percentile method of non-parametric Monte-Carlo simulation. The MECC circuit was more expensive than CECC, with a difference ranging from €180 to €600 depending on the country. However, in terms of total therapy cost per patient the comparison favored MECC in all countries. Specifically it was associated with a reduction of €635 in Greece, €297 in Germany, €1590 in the Netherlands and €375 in Switzerland. In terms of effectiveness, the total life-years gained were slightly higher in favor of MECC. Surgery with MECC may be dominant (lower cost and higher effectiveness) compared to CECC in coronary revascularization procedures and therefore it represents an attractive new option relative to conventional extracorporeal circulation for CABG. © 2013.

  20. A new beating-heart off-pump coronary artery bypass grafting training model.

    Science.gov (United States)

    Bouma, Wobbe; Kuijpers, Michiel; Bijleveld, Aanke; De Maat, Gijs E; Koene, Bart M; Erasmus, Michiel E; Natour, Ehsan; Mariani, Massimo A

    2015-01-01

    Training models are essential in mastering the skills required for off-pump coronary artery bypass grafting (OPCAB). We describe a new, high-fidelity, effective and reproducible beating-heart OPCAB training model in human cadavers. Human cadavers were embalmed according to the 'Thiel method' which allows their long-term and repeated use. The training model was constructed by bilateral ligation of the pulmonary veins, cross-clamping of the aorta, positioning of an intra-aortic balloon pump (IABP) in the left ventricle (LV) through the apex (tightened with pledget-reinforced purse strings) and finally placing of a fluid line in the LV through the left atrial appendage (tightened with a pledget-reinforced purse string). The LV was filled with saline to the desired pressure through the fluid line and the IABP was switched on and set to a desired frequency [usually 60-80 beats per minute (bpm)]. A high-fidelity simulation has known limitations, but a more complex, realistic training environment with an actual beating (human) heart strengthens the entire training exercise and is of incremental value. All types of coronary artery anastomosis can be trained with this model. Training should be performed under the supervision of an experienced OPCAB surgeon and training progress is best evaluated with serial Objective Structured Assessment of Technical Skills (OSATS). A score of at least 48 points on the final OSATS ('good' on all components) is recommended before trainees can start their training on patients. The entire set-up provides a versatile training model to help develop and improve the skills required to safely perform beating heart OPCAB anastomoses. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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

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    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.

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

    Science.gov (United States)

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

    1988-01-01

    The degree of cutaneous sensory deficit in the leg was assessed after removal of the long saphenous vein in 50 consecutive patients undergoing coronary artery bypass vein grafts randomly assigned subcutaneous sutures or a single layer of sutures. Removal of the vein and repair of the leg incision were done by the same team of surgeons. In group 1 (25 patients) the leg incision was repaired with "00" Dexon subcutaneous and "00" prolene subcuticular sutures while in group 2 (25 patients) closure was effected by a single layer of interrupted "00" nylon sutures. All had crepe pressure bandage from the base of the toes to the groin for the first 24 hours followed by TED stockings for six to eight weeks. Sutures were removed on the eighth postoperative day. Cutaneous sensation in the leg and ankle was assessed 48 hours, seven days, and six to eight weeks after surgery, and a final comparison of the cosmetic effects and sensory perception after one year or more was made in 37 patients. There were no major differences between the groups at 48 hours in sensory abnormalities (anaesthesia, hyperaesthesia, and pain) but sensory recovery was significantly better in group 2 at the second and third assessments. There was some reduction in sensory abnormalities at the final review in group 1. No appreciable difference was noted in the quality of the scar between the two groups. We conclude that cutaneous sensation is better preserved by repairing the leg incision in a single layer. Subcutaneous sutures may produce neuropraxia of the long saphenous nerve by direct pressure as healing progresses. PMID:3281308

  3. Effect of prior cardiac operations on survival after coronary artery bypass grafting.

    Science.gov (United States)

    Likosky, Donald S; Surgenor, Stephen D; Kramer, Robert S; Russo, Louis; Leavitt, Bruce J; Sorensen, Meredith J; Helm, Robert E; Sardella, Gerald L; Dipierro, Francis V; Baribeau, Yvon R; Malenka, David J; Mackenzie, Todd A; Brown, Jeremiah R; Ross, Cathy S

    2011-10-01

    We examined a recent regional experience to determine the effect of a prior cardiac operation on short-term and midterm outcomes after coronary artery bypass grafting (CABG). We identified 20,703 patients who underwent nonemergent CABG at 8 centers in northern New England from 2000 to 2008, of whom 818 (3.8%) had undergone prior cardiac operations. Prior CABG using a minimal or full sternotomy was considered a prior sternotomy. Survival data out to 4 years were obtained from a link with the Social Security Administration Death Index. Hazard ratios were estimated using a Cox proportional hazards regression model, and adjusted survival curves were estimated using inverse probability weighting. In a separate analysis, 1,182 patients were matched 1:1 by a patient's propensity for having undergone prior CABG. Patients with prior sternotomies had a greater burden of comorbid diseases and increased acuity and had a greater likelihood of returning to the operating room for bleeding and low cardiac output failure. Prior sternotomy was associated with an increased risk of death out to 4 years for patients undergoing CABG, with an unmatched hazard ratio of 1.34 (95% confidence interval, 1.10 to 1.64) and a matched hazard ratio of 1.36 (95% confidence interval, 1.01 to 1.81). Analyses of our recent regional experience with nonemergent CABG showed that a prior cardiac operation was associated with a nearly twofold increased hazard of death at up to 4 years of follow-up. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Labetalol, nebivolol, and propranolol relax human radial artery used as coronary bypass graft.

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    Korkmaz, Ozge; Saraç, Bülent; Göksel, Sabahattin; Yildirim, Sahin; Berkan, Ocal; Bagcivan, Ihsan

    2015-04-01

    Beta-blockers are a heterogeneous class of agents that are used in the treatment of many cardiovascular diseases, especially hypertension and atherosclerosis, and that are commonly prescribed after cardiac surgery. In the present study, the aim is to investigate the vasorelaxant effects of some common beta-adrenoceptor blockers on the human radial artery in vitro, as well as their relaxation mechanisms. Radial artery rings sourced from human patients were mounted in an organ bath and tested for changes in isometric tension in relaxation response to labetalol, nebivolol, and propranolol in the presence and absence of NG-nitro-L-arginine methyl ester (3 × 10(-5) mol/L) and tetraethyl ammonium (3 × 10(-4) mol/L). The labetalol (10(-8) to 10(-4) mol/L), nebivolol (10(-8) to 10(-4) mol/L), and propranolol (10(-8) to 10(-4) mol/L) induced concentration-dependent relaxations on the radial artery rings, which had been precontracted with phenylephrine (10(-6) mol/L). The relaxation response induced by labetalol in the isolated radial artery rings was significantly higher when compared with the nebivolol and propranolol samples (P labetalol, nebivolol, and propranolol (P labetalol, nebivolol, and propranolol was due partly to the Ca(2+)-activated K(+) channels. In addition, the relaxation induced by nebivolol was largely related with nitric oxide release. Nebivolol, and partly propranolol, may provide significant therapeutic benefit, but labetalol can be a good alternative for coronary artery bypass grafting with radial artery use. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  5. STA-ACA bypass using the ipsilateral free STA graft as an interposition graft and A3-A3 anastomosis for treatment of bilateral ACA steno-occlusive ischemia.

    Science.gov (United States)

    Horiuchi, Tetsuyoshi; Ichinose, Shunsuke; Agata, Masahiro; Ito, Kiyoshi; Hongo, Kazuhiro

    2018-01-18

    Anterior cerebral artery (ACA)-related ischemia is a rare entity in patients with atherosclerosis. Some surgical treatments are reported to date. We present the modification of intracranial-intracranial and intracranial-extracranial bypasses for symptomatic bilateral ACA steno-occlusive disease. The A3-A3 bypass followed by the superficial temporal artery-ACA bypass using the ipsilateral free superficial temporal artery graft is useful without harvesting of the radial artery. Bilateral ACA steno-occlusive induced ischemia can be treated with tailored bypass procedures.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    Background: We investigated in a porcine model whether measuring both the flow distal to an anastomosis and the graft transit time flow (TTF) gives a more accurate picture of the true blood flow in the left anterior descending artery (LAD) than graft TTF measurement alone.Methods: We performed off...

  7. A SINGLE CENTRE EXPERIENCE WITH CORONARY ENDARTERECTOMY IN PATIENTS UNDERGOING OFF-PUMP CORONARY ARTERY BYPASS GRAFTING

    Directory of Open Access Journals (Sweden)

    Chirag Doshi

    2017-02-01

    Full Text Available BACKGROUND Coronary Artery Bypass Grafting (CABG is one of the most frequently done cardiac surgical procedures. However, with the advancements in catheter-based interventional procedures, the category of patients taken up for CABG is gradually being restricted to more high-risk group. Additional surgical procedures like Coronary Endarterectomy (CE are needed for treating such high-risk coronary artery disease to achieve complete revascularisation. Off-pump coronary endarterectomy can be performed safely with morbidity and mortality comparable with those of conventional coronary endarterectomy. MATERIALS AND METHODS This is a single institutional retrospective study with 480 patients underwent concomitant off-pump CE and CABG. Average number of coronary bypass grafts were 2.4±0.8. There were 321 cases of LAD endarterectomy with 246 receiving LIMA as the arterial graft. 2.9% patients were converted to on-pump surgery intraoperatively because of intraoperative hypotension. RESULTS The incidence of postoperative MI was 0.8%. The 30-day mortality was 0.8% from complications of bowel ischaemia and three patients with septicaemia associated with prolonged intubation. The mean operating time was 118±22 minutes. CONCLUSION We have shown that the effect of OPCABG with CE appears to be safe and early outcomes are encouraging. Hence, diffuse disease requiring endarterectomy should not be considered a contraindication to OPCABG. Surgical skills and the suitability criteria of the patients are very important in this regard.

  8. Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass: The LICORN Randomized Clinical Trial.

    Science.gov (United States)

    Cholley, Bernard; Caruba, Thibaut; Grosjean, Sandrine; Amour, Julien; Ouattara, Alexandre; Villacorta, Judith; Miguet, Bertrand; Guinet, Patrick; Lévy, François; Squara, Pierre; Aït Hamou, Nora; Carillion, Aude; Boyer, Julie; Boughenou, Marie-Fazia; Rosier, Sebastien; Robin, Emmanuel; Radutoiu, Mihail; Durand, Michel; Guidon, Catherine; Desebbe, Olivier; Charles-Nelson, Anaïs; Menasché, Philippe; Rozec, Bertrand; Girard, Claude; Fellahi, Jean-Luc; Pirracchio, Romain; Chatellier, Gilles

    2017-08-08

    Low cardiac output syndrome after cardiac surgery is associated with high morbidity and mortality in patients with impaired left ventricular function. To assess the ability of preoperative levosimendan to prevent postoperative low cardiac output syndrome. Randomized, double-blind, placebo-controlled trial conducted in 13 French cardiac surgical centers. Patients with a left ventricular ejection fraction less than or equal to 40% and scheduled for isolated or combined coronary artery bypass grafting with cardiopulmonary bypass were enrolled from June 2013 until May 2015 and followed during 6 months (last follow-up, November 30, 2015). Patients were assigned to a 24-hour infusion of levosimendan 0.1 µg/kg/min (n = 167) or placebo (n = 168) initiated after anesthetic induction. Composite end point reflecting low cardiac output syndrome with need for a catecholamine infusion 48 hours after study drug initiation, need for a left ventricular mechanical assist device or failure to wean from it at 96 hours after study drug initiation when the device was inserted preoperatively, or need for renal replacement therapy at any time postoperatively. It was hypothesized that levosimendan would reduce the incidence of this composite end point by 15% in comparison with placebo. Among 336 randomized patients (mean age, 68 years; 16% women), 333 completed the trial. The primary end point occurred in 87 patients (52%) in the levosimendan group and 101 patients (61%) in the placebo group (absolute risk difference taking into account center effect, -7% [95% CI, -17% to 3%]; P = .15). Predefined subgroup analyses found no interaction with ejection fraction less than 30%, type of surgery, and preoperative use of β-blockers, intra-aortic balloon pump, or catecholamines. The prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%), and other adverse events did not significantly differ between levosimendan and placebo. Among patients with low ejection fraction

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

    Science.gov (United States)

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

    2013-01-01

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

  10. Surgical Technique for High-Flow Internal Maxillary Artery to Middle Cerebral Artery Bypass Using a Superficial Temporal Artery Interposition Graft.

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    Feng, Xuequan; Meybodi, Ali Tayebi; Rincon-Torroella, Jordina; El-Sayed, Ivan H; Lawton, Michael T; Benet, Arnau

    2017-04-01

    Extracranial-to-intracranial high-flow bypass often requires cranial, cervical, and graft site incisions. The internal maxillary artery (IMA) has been proposed as a donor to decrease invasiveness, but its length is insufficient for direct intracranial bypass. We report interposition of a superficial temporal artery (STA) graft for high-flow IMA to middle cerebral artery (MCA) bypass using a middle fossa approach. To assess the feasibility of an IMA-STA graft-MCA bypass using a new middle fossa approach. Twelve specimens were studied. A 7.5-cm STA graft was obtained starting 1.5 cm below the zygomatic arch. The calibers of STA were measured. After a pterional craniotomy, the IMA was isolated inside the infratemporal fossa through a craniectomy within the lateral triangle (lateral to the posterolateral triangle) in the middle fossa and transposed for proximal end-to-end anastomosis to the STA. The Sylvian fissure was split exposing the insular segment of the MCA, and an STA-M2 end-to-side anastomosis was completed. Finally, the length of graft vessel was measured. Average diameters of the proximal and distal STA ends were 2.3 ± 0.2 and 2.0 ± 0.1 mm, respectively. At the anastomosis site, the diameter of the IMA was 2.4 ± 0.6 mm, and the MCA diameter was 2.3 ± 0.3 mm. The length of STA graft required was 56.0 ± 5.9 mm. The STA can be used as an interposition graft for high-flow IMA-MCA bypass if the STA is obtained 1.5 cm below the zygomatic arch and the IMA is harvested through the proposed approach. This procedure may provide an efficient and less invasive alternative for high-flow EC-IC bypass.

  11. Saphenous vein graft bypass in the treatment of giant cavernous sinus aneurysms: report of two cases Anastomose intra-extracraniana com enxerto de veia safena no tratamento de aneurismas gigantes do seio cavernoso: relato de dois casos

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    RICARDO RAMINA

    2000-03-01

    Full Text Available Two cases of giant intracavernous aneurysms treated by high flow bypass with saphenous vein graft between the external carotid artery (ECA and branches of the middle cerebral artery (MCA are presented. Very often these aneurysms are unclippable because they are fusiform or have a large neck. Occlusion of the internal carotid artery (ICA is the treatment of choice in many cases. This procedure has however a high risk of brain infarction. Revascularization of the brain by extra-intracranial anastomosis between the superficial temporal artery (STA and branches of the MCA is frequently performed. This procedure provides however a low flow bypass and brain infarction may occur. We report two cases of giant cavernous sinus aneurysms treated by high flow bypass and endovascular balloon occlusion of the ICA. Immediate high flow revascularization of MCA branches was achieved and the patients showed no ischemic events. Follow-up of 8 and 14 months after operation shows patency of the venous graft and no neurological deficits. Angiographic control examination showed complete aneurysm occlusion in both cases.Aneurismas gigantes da porção intracavernosa da artéria carótida interna frequentemente são inoperáveis por serem fusiformes ou apresentarem colo muito largo. Ligadura da artéria carótida interna é muitas vezes o tratamento de escolha para esses pacientes. Esse procedimento apresenta no entanto alta incidência de complicações isquêmicas agudas e tardias. Dois casos de aneurismas gigantes da porção intracavernosa são apresentados. Esses aneurismas foram tratados com cirurgia de "bypass"com enxerto de veia safena magna entre a artéria carótida externa e ramo M2 da artéria cerebral média e oclusão endovascular da artéria carótida interna. Revascularização com enxerto de alto fluxo sanguineo ocorreu nos dois pacientes não se observando nenhuma alteração isquêmica no período pós-operatório. O seguimento desses pacientes ap

  12. IMPACT OF PREOPERATIVE METOPROLOL ON THE OCCURRENCE OF NEW-ONSET ATRIAL FIBRILLATION AFTER CORONARY ARTERY BYPASS GRAFTING

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    Salla Surya Prakasarao

    2016-09-01

    Full Text Available BACKGROUND Postoperative Atrial fibrillation (POAF is the most frequent arrhythmia observed after Coronary artery bypass grafting (CABG. Worldwide incidence is documented to be 20-30% in patients undergoing isolated Coronary artery bypass grafting (CABG. There is no published data for Indian population so far. Hence, the objective of our study is to analyse the occurrence of newonset POAF in our Indian population and to assess whether the preoperative beta-blocker therapy has any role in its prevention. MATERIAL AND METHODS This is a retrospective and prospective observational study of coronary artery disease patients in Andhra Medical College, Visakhapatnam, who underwent coronary artery bypass grafting at various institutions between August 2013 and August 2014. The patients with documented AF during the preoperative period and patients undergoing associated cardiac procedures have been excluded from the study. Data has been collected from the patients’ medical records and the relative clinical variables were analysed. Chi-square test used for statistical analysis. RESULTS 227 patients with coronary artery disease (followed up at our centre were found to have undergone CABG during the study period. Among the 227 patients, 191 (84.14% were males and 36 (15.85% were females. The mean age of patients developing AF was 61.9±8.7 and for patients in sinus rhythm was 58.7±7.9 years (range: 37-80 years. 159 patients received preoperative Metoprolol and 68 patients were free from Metoprolol usage. The overall incidence of AF was 6.16%. 3.1% of patients with Metoprolol were noted to have AF while 13.23% of patients with no Metoprolol coverage developed new-onset AF (p<0.05. 14.28% of patients developing AF were with LV function <40%. The mean duration of ICU stay for patients who had POAF was 73.74±39.33 hours and 34.47±19.39 hours for patients in sinus rhythm. CONCLUSION The incidence of Postoperative Atrial fibrillation in Indian patients is

  13. Distal polytetrafluoroethylene bypasses in patients older than 75 years.

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    Illuminati, G; Bertagni, A; Caliò, F G; Papaspyropoulos, V

    2000-07-01

    Polytetrafluoroethylene (PTFE) alone is justified for infrapopliteal arterial grafting in elderly patients with critical ischemia of the lower limbs who lack a suitable, autogenous saphenous vein. A consecutive sample clinical study with a mean follow-up of 16 months. The surgical department of an academic tertiary care center and an affiliated secondary care center. Thirty-one patients older than 75 years with critical ischemia of the lower limbs received 34 PTFE bypass grafts to the infrapopliteal arteries: 12 patients to the anterior tibial, 8 to the peroneal, 8 to the posterior tibial, and 2 to the dorsalis pedis artery. Cumulative survival, primary graft patency, and limb salvage rates expressed by standard life-table analysis. Operative mortality rate was 3%. Cumulative survival rate was 80% at 2 years (SE, 9.2%) and 43% at 3 years (SE, 11.4%). Cumulative primary patency rate was 67% at 2 years (SE 9.1%), and 61% at 3 years (SE, 12.7%). Cumulative limb salvage rate was 77% at 2 years (SE, 8.7%) and 70% at 3 years (SE, 12.8%). Polytetrafluoroethylene alone is justified as graft material for infrapopliteal bypass grafts in elderly patients with critical ischemia of the lower limbs and without a suitable autogenous saphenous vein.

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

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    Sambhunath Das

    2015-01-01

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

  15. Biomimetic modified clinical-grade POSS-PCU nanocomposite polymer for bypass graft applications: A preliminary assessment of endothelial cell adhesion and haemocompatibility

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    Solouk, Atefeh [Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of); Cousins, Brian G., E-mail: brian.cousins@ucl.ac.uk [Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London (United Kingdom); Mirahmadi, Fereshteh [Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of); Mirzadeh, Hamid [Polymer Engineering Faculty, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of); Nadoushan, Mohammad Reza Jalali [Department of Pathology, School of Medicine, Shahed University, Tehran (Iran, Islamic Republic of); Shokrgozar, Mohammad Ali [National Cell Bank of Iran, Pasteur Institute of Iran, Tehran (Iran, Islamic Republic of); Seifalian, Alexander M. [Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London (United Kingdom)

    2015-01-01

    increased on Low, Med and High samples due to more carboxylic acid (–COOH) groups at the surface forming amide (–NH{sub 2}) bonds. The amount of –COOH groups on each of the Low, Med and High nanocomposites correlated with Poly-AA grafting density at 14.7 ± 0.9, 18.9 ± 0.9, and 34.2 ± 2.4 μg/cm{sup 2}. Immobilisation of collagen type I on to nanocomposite surface was also found to increase significantly on the Low, Med and High samples from 22 ± 4, 150 ± 15, and 219 ± 17 μg/cm{sup 2}, respectively. The level of ECs and their adhesion efficiency were improved with increasing amounts of grafted collagen I. The maximum adhesion of ECs was found on the highest collagen type I coated nanocomposites. Platelet adhesion and activation also increased with increasing collagen density. The obtained HR values for all of the treated samples were well within the acceptable standards for biomaterials (< 5% HR). Conclusion: Poly-AA-g-POSS-PCU surfaces offer binding sites for the covalent bonding of collagen type I and other biomolecules such as fibronectin by exposure of RGD cell binding domains and growth factors using EDC cross-linking chemistry. Collagen type I modification can yield accelerated EC growth and enhance the endothelialisation of POSS-PCU nanocomposites, and the amount of immobilised collagen can control the level of platelet adhesion on functionalized POSS-PCU via TSPT and poly acrylic acid (poly-AA) treatment. Such surface modification procedures of polymeric surfaces can improve the patency rate of POSS-PCU nanocomposites as vascular bypass grafts in the preparation of a range of medical devices ready for pre-clinical and in vivo evaluation. - Highlights: • By combining a TSPT method, the level of immobilised collagen can be controlled. • Immobilised collagen minimises platelet adhesion, and retains anti-thrombogenic properties. • EC fate is significantly improved with increasing collagen and enhances endothelialisation. • Haemolysis tests for all of

  16. Myocardial protection during elective coronary artery bypasses grafting by pretreatment with omega-3 polyunsaturated fatty acids

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    Veljović Milić

    2013-01-01

    Full Text Available Background/Aim. Despite recent advances in coronary artery bypass grafting (CABG, cardioplegic cardiac arrest and cardiopulmonary bypass (CPB are still associated with myocardial injury. Accordingly, the efforts have been made lately to improve the outcome of CPB by glucose-insulinpotassium, adenosine, Ca2+-channel antagonists, L-arginine, N-acetylcysteine, coenzyme Q10, diazoxide, Na+/H+ exchange inhibitors, but with an unequal results. Since omega-3 polyunsatutated fatty acids (PUFAs have shown remarkable cardioprotection in preclinical researches, the aim of our study was to check their effects in prevention of ischemia reperfusion injury in patients with CPB. Methods. This prospective, randomized, placebo-controlled study was performed with parallel groups. The patients undergoing elective CABG were randomized to receive preoperative intravenous omega-3 PUFAs infusion (n = 20 or the same volume of 0.9% saline solution infusion (n = 20. Blood samples were collected simultaneously from the radial artery and the coronary sinus before starting CPB and at 10, 20 and 30 min after the release of the aortic cross clamp. Lactate extraction/excretion and myocardial oxygen extraction were calculated and compared between the two groups. The levels of troponin I (TnT and creatine kinase-myocardial band (CK-MB were determined before starting CPB and 4 and 24 h postoperatively. Results. Demographic and operative characteristics, including CPB and aortic cross-clamp time, were similar between the two groups of patients. The level of lactate extraction 10 and 20 min after aortic cross-clamp time has shown negative values in the control group, but positive values in the PUFAs group with statistically significant differences (-19.6% vs 7.9%; p < 0.0001 and -19.9% vs 8.2%; p < 0.0008, respectively. The level of lactate extraction 30 minutes after reperfusion was not statistically different between the two groups (6.9% vs 4.2%; p < 0.54. Oxygen extraction in the

  17. Autologous alternative veins may not provide better outcomes than prosthetic conduits for below-knee bypass when great saphenous vein is unavailable.

    Science.gov (United States)

    Avgerinos, Efthymios D; Sachdev, Ulka; Naddaf, Abdallah; Doucet, Dannielle R; Mohapatra, Abhisekh; Leers, Steven A; Chaer, Rabih A; Makaroun, Michel S

    2015-08-01

    There is a need to better define the role of alternative autologous vein (AAV) segments over contemporary prosthetic conduits in patients with critical limb ischemia when great saphenous vein (GSV) is not available for use as the bypass conduit. Consecutive patients who underwent bypass to infrageniculate targets between 2007 and 2011 were categorized in three groups: GSV, AAV, and prosthetic. The primary outcome was graft patency. The secondary outcome was limb salvage. Cox proportional hazards regression was used to adjust for baseline confounding variables. A total of 407 infrainguinal bypasses to below-knee targets were analyzed; 255 patients (63%) received a single-segment GSV, 106 patients (26%) received an AAV, and 46 patients (11%) received a prosthetic conduit. Baseline characteristics were similar among groups, with the exception of popliteal targets and anticoagulation use being more frequent in the prosthetic group. Primary patency at 2 and 5 years was estimated at 47% and 32%, respectively, for the GSV group; 24% and 23% for the AAV group; and 43% and 38% for the prosthetic group. Primary assisted patency at 2 and 5 years was estimated at 71% and 55%, respectively, for the GSV group; 53% and 51% for the AAV group; and 45% and 40% for the prosthetic group. Secondary patency at 2 and 5 years was estimated at 75% and 60%, respectively, for the GSV group; 57% and 55% for the AAV group; and 46% and 41% for the prosthetic group. In Cox analysis, primary patency (hazard ratio [HR], 0.55; P prosthetic grafts except for the primary patency, for which prosthetic was protective (HR, 0.38; P Limb salvage was similar among groups. AAV conduits may not offer a significant patency advantage in midterm follow-up over prosthetic bypasses. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  18. Long-term results of coronary artery bypass grafting in patients with dialysis-dependent renal failure.

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    Hsu, H L; Hsu, H P; Yu, B F; Lu, T M; Huang, C Y; Shih, C C; Cheng, B C; Hsu, C P

    2015-10-01

    Coronary artery disease is the main cause of mortality and morbidity in dialysis-dependent renal failure patients. Both the prevalence and incidence of renal failure are high in Taiwan. However, there were few reports exploring the outcome of coronary aortic bypass grafting (CABG) in these patients. The aim of this study was to determine the survival outcome and risk factors for mortality from CABG in this population. The operative, early postoperative and late results of 170 dialysis patients undergoing isolated coronary artery bypass grafting from January, 2000 to January, 2012 were retrospectively reviewed. Operative mortality, long-term survival, and risk factors were analyzed. One hundred and seventeen patients (68.8%) were male, and the mean age was 61.5±10.3 years (range, 34-86 years). Follow-up was 40.3±32.1 months. Operative mortality was 8.2%. Actuarial survival, including operative mortality, was 81±3% at 1 year, 68±4% at 3 years, 58±5% at 5 years and 49±6% at 10 years, better than the natural course of dialysis-dependent renal failure patients. Age, emergent operation, postoperative ventricular tachycardia or fibrillation, postoperative intra-aortic balloon pump insertion, gastrointestinal bleeding, and left internal mammary artery graft were significant predictors of operative or long term mortality. Most causes of late death were due to infection or cardiac events. CABG in dialysis patients is associated with a higher incidence of complications, but has acceptable mortality. CABG is beneficial in this population. Internal mammary artery grafting may provide more favorable long term outcomes.

  19. Infrainguinal vein graft stenosis: cutting balloon angioplasty as the first-line treatment of choice.

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    Schneider, Peter A; Caps, Michael T; Nelken, Nicolas

    2008-05-01

    The optimal treatment for hemodynamically significant infrainguinal vein bypass graft stenosis is not known. This study compares three options as first choice for the revision of failing infrainguinal vein grafts: cutting balloon angioplasty (CBA), standard percutaneous transluminal balloon angioplasty (PTA), and open surgical revision (OS). Infrainguinal vein bypass graft lesions treated in a single institution during a 12-year period were evaluated. Of these, 161 lesions in 124 infrainguinal bypasses (101 patients) were treated with OS (n = 42), PTA (n = 57), or CBA (n = 62). The initial indication for the bypass in these patients was limb salvage in 73% and claudication in 27%. The primary outcome of interest was the development of vein graft occlusion or significant stenosis (>or=70%) as detected by surveillance duplex ultrasound scanning or arteriography some time after repair. The stenosis-free patency rates at 48 months for OS, CBA, and PTA were 74%, 62%, and 34%, respectively. PTA was associated with an increased risk of treatment failure compared with both OS (hazard ratio [HR], 3.9; P difference between OS and CBA (HR, 1.3 for CBA vs OS, P = .6). Pseudoaneurysms developed in two CBA patients. One ruptured and required interposition graft, and one was monitored. Cutting balloon angioplasty is a reasonable, initial treatment for infrainguinal vein graft stenosis in most patients. It is a safe, minimally invasive, outpatient procedure with patency rates that are comparable to OS and superior to PTA.

  20. Medication adherence following coronary artery bypass graft surgery: assessment of beliefs and attitudes.

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    Khanderia, Ujjaini; Townsend, Kevin A; Erickson, Steven R; Vlasnik, Jon; Prager, Richard L; Eagle, Kim A

    2008-02-01

    The medication management of patients following coronary artery bypass graft (CABG) surgery may include antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors, and statins. However, poor adherence is common, and patient attitudes and beliefs play a role in adherence. To evaluate the association between self-reported adherence and the beliefs patients have about cardiovascular medicines used after CABG. Adults were surveyed 6-24 months following CABG. The validated Beliefs about Medicines Questionnaire (BMQ) assessed attitudes concerning the Specific Necessity, Specific Concerns, General Harm, and General Overuse of medicines. The validated medication adherence scale assessed self-reported adherence. Analysis included univariate comparison (BMQ scales) and multivariate logistic regression (identification of adherence predictor variables). Of 387 patients surveyed, 132 (34%) completed the questionnaire. Nonparticipants were more likely to be female and have undergone 1- or 2-vessel CABG procedures compared with 3- or 4-vessel procedures. Subjects were primarily English-speaking, white, and male. Adherent behavior was reported in 73 of 132 patients (55%). The average period between CABG and the survey was 16 months. Nonadherent patients were in stronger agreement on the General Overuse (p = 0.01) and General Harm (p = 0.04) scales. The adjusted odds of adherent behavior were significantly lower, with an increasing General Overuse score (OR 0.83; 95% CI 0.72 to 0.95; p = 0.007); an annual income of $50,000 to $100,000 relative to less than $20,000 (OR 0.36; 95% CI 0.14 to 0.91; p = 0.031), and a living status of "alone" compared with "with adults and no children" (OR 0.20; 95% CI 0.06 to 0.65; p = 0.007). The odds ratio of self-reported adherence was higher with increasing age (OR 1.05; 95% CI 1.01 to 1.09; p = 0.023). In summary, patient beliefs and attitudes regarding medications, along with other social, economic, and demographic factors, help

  1. Return to the workforce following coronary artery bypass grafting: A Danish nationwide cohort study.

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    Butt, Jawad H; Rørth, Rasmus; Kragholm, Kristian; Kristensen, Søren L; Torp-Pedersen, Christian; Gislason, Gunnar H; Køber, Lars; Fosbøl, Emil L

    2018-01-15

    Returning to the workforce after coronary artery bypass grafting (CABG) holds important socioeconomic consequences not only for patients, but the society as well. Yet data on this issue are limited. We examined return to the workforce and associated factors in patients of working age undergoing CABG. Using Danish nationwide administrative registries, we identified 6031 patients of working age (18-60years) undergoing isolated CABG (1998-2011) who were part of the workforce 30days prior to admission and alive at discharge. One year after discharge for CABG, 4827 (80.0%) patients had returned to the workforce, 614 (10.2%) were on paid sick leave, 267 (4.4%) received disability pension, 250 (4.1%) were on early retirement, 57 (0.9%) had died, and 16 (0.3%) had emigrated. Factors associated with return to the workforce were identified using multivariable logistic regression. Younger age (18-45 versus 56-60years; odds ratio, 1.89; 95% confidence interval, 1.48-2.42), male sex (1.51, 1.24-1.84), and higher level of education (higher educational level versus basic school; 1.53, 1.05-2.23) and income (highest quartile versus lowest; 3.01, 2.42-3.75) were associated with return to the workforce. Urgency of surgery (emergency versus elective; 0.65, 0.49-0.88), cardiovascular comorbidity, a history of chronic kidney disease (0.49, 0.29-0.84) and liver disease (0.47, 0.28-0.80), as well as additional hospital admissions within the first year post-discharge (>2 versus none; 0.25, 0.19-0.32) were associated with a lower likelihood of returning to the workforce. One year after discharge for CABG, four out of five patients were part of the workforce and mortality was low. Younger age, male sex, higher socioeconomic status, and absence of major comorbidities were associated with return to the workforce. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Stents versus coronary-artery bypass grafting for left main coronary artery disease.

    Science.gov (United States)

    Seung, Ki Bae; Park, Duk-Woo; Kim, Young-Hak; Lee, Seung-Whan; Lee, Cheol Whan; Hong, Myeong-Ki; Park, Seong-Wook; Yun, Sung-Cheol; Gwon, Hyeon-Cheol; Jeong, Myung-Ho; Jang, Yangsoo; Kim, Hyo-Soo; Kim, Pum Joon; Seong, In-Whan; Park, Hun Sik; Ahn, Taehoon; Chae, In-Ho; Tahk, Seung-Jea; Chung, Wook-Sung; Park, Seung-Jung

    2008-04-24

    Several studies have compared the treatment effects of coronary stenting and coronary-artery bypass grafting (CABG). However, there are limited data regarding the long-term outcomes of these two interventions for patients with unprotected left main coronary artery disease. We evaluated 1102 patients with unprotected left main coronary artery disease who underwent stent implantation and 1138 patients who underwent CABG in Korea between January 2000 and June 2006. We compared adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization) with the use of propensity-score matching in the overall cohort and in separate subgroups according to type of stent. In the overall matched cohort, there was no significant difference between the stenting and CABG groups in the risk of death (hazard ratio for the stenting group, 1.18; 95% confidence interval [CI], 0.77 to 1.80) or the risk of the composite outcome (hazard ratio for the stenting group, 1.10; 95% CI, 0.75 to 1.62). The rates of target-vessel revascularization were significantly higher in the group that received stents than in the group that underwent CABG (hazard ratio, 4.76; 95% CI, 2.80 to 8.11). Comparisons of the group that received bare-metal stents with the group that underwent CABG and of the group that received drug-eluting stents with the group that underwent CABG produced similar results, although there was a trend toward higher rates of death and the composite end point in the group that received drug-eluting stents. In a cohort of patients with unprotected left main coronary artery disease, we found no significant difference in rates of death or of the composite end point of death, Q-wave myocardial infarction, or stroke between patients receiving stents and those undergoing CABG. However, stenting, even with drug-eluting stents, was associated with higher rates of target-vessel revascularization than was CABG. Copyright 2008

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

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    H Esmaily

    2008-10-01

    Full Text Available Introduction: Sleep disturbance is common in patients undergoing Coronary Artery Bypass Graft surgery and has been recognized for more than 30 years. New literature suggests the importance of sleep and rest for restoration, protection and promotion of function and wellbeing of these patients. Because of the importance of the role of nurses in diagnosis and treatment of sleep disorders, this study was conducted to determine possible effective factors on sleep quality and sleep quantity of patients after CABG. Methods: This longitudinal, descriptive and correlational study was conducted on 91 patients admitted to Imam Reza Hospital in Mashad City in 2005-2006. Subjects were selected according to inclusion and exclusion criteria. Data was collected by interview in three stages: 24 hours before surgery, as well as 6 weeks and 10 weeks after surgery. Subjective sleep quality was measured with PSQI and sleep quantity was measured with sleep log. The first two interviews were done at the hospital clinic and the last via telephone. Data was analyzed in SPSS using student T test, Pearson correlation coefficient and General Linear Model. Results: According to Univariable analysis, variables such as age (p=0.03, aorta clamp time (p=0.003, mechanical ventilation time (p=0.01, staying time in hospital (p=0.04 can affect sleep quantity 10 weeks after surgery. Previous history of sleep disorder (p=0.005, diabetes (p=0.02, use of diuretic drugs before surgery (p=0.04 and ACEI drugs after surgery (p=0.01 can affect sleep quality 10 weeks after surgery. Conclusion: Sleep disorder history (p=0.01, use of diuretic drugs before surgery (p=0.04 and sleep quantity 6 weeks after surgery (p=0.01 have been the most effective factors on sleep quality 10 weeks after surgery, whereas quality of life 10 weeks after surgery (p=0.04 has been the most effective factor on sleep quantity 10 weeks after surgery. There is therefore a necessity for presenting approaches in order to

  4. Coronary artery bypass grafting with or without surgical ventricular restoration: a comparison.

    Science.gov (United States)

    Prucz, Roni B; Weiss, Eric S; Patel, Nishant D; Nwakanma, Lois U; Baumgartner, William A; Conte, John V

    2008-09-01

    Coronary artery bypass grafting (CABG) is an effective treatment for ischemic cardiomyopathy. However, patients with ventricular enlargement are known to have inferior outcomes. We assessed whether surgical ventricular restoration (SVR) with CABG (SVR + CABG) leads to improved outcomes versus CABG alone for patients with ischemic cardiomyopathy and ventricular enlargement. We conducted a case-control study comparing patients with ischemic cardiomyopathy and ejection fraction less than 0.35 who underwent SVR + CABG versus CABG alone from June 2002 to December 2005. Patients who underwent SVR + CABG were compared with control patients who met criteria for SVR + CABG by ventriculogram or echocardiogram but received CABG alone. End points included survival, rehospitalization for heart failure, and New York Heart Association class. During the study period 120 patients underwent SVR + CABG (n = 62) versus CABG alone (n = 58). Patients in the SVR + CABG group were younger (60 versus 64 years; p = 0.04) and more likely to be New York Heart Association class III or IV preoperatively (98% versus 86%; p = 0.01). Operative mortality was similar between groups (6.4% versus 5.2%; p = 1.00). Ejection fraction was similar preoperatively (0.22 versus 0.24; p = 0.31) and postoperatively (0.34 versus 00.32; p = 0.40). The SVR + CABG patients experienced fewer rehospitalizations for heart failure (24% [13 of 54] versus 55% [24 of 44]; p = 0.006) but had similar 4-year survival (p = 0.60). At follow-up, 80% (50 of 62) of SVR + CABG versus 57% (27 of 47) of CABG alone patients improved to New York Heart Association class I or II (p = 0.01). Patients with ischemic cardiomyopathy and ventricular enlargement experience similar early survival after SVR + CABG or CABG alone. However, SVR + CABG resulted in fewer rehospitalizations and better improvements in New York Heart Association class. Surgical ventricular restoration with CABG should be offered to eligible patients with ischemic

  5. [Vacuum-assisted Closure for Mediastinitis Caused by Methicillin-resistant Staphylococcus aureus after Coronary Artery Bypass Grafting;Report of a Case].

    Science.gov (United States)

    Suzuki, Hitoshi; Shomura, Shin; Maeshiro, Ryou; Inoue, Kentaro; Yada, Masaki; Kondo, Chiaki

    2017-10-01

    A 78-year-old man underwent off-pump coronary artery bypass grafting in our hospital. Purulent discharge from a sternotomy wound appeared 8 days after the operation of sternal re-fixation for sternal fracture. Methicillin-resistant Staphylococcus aureus(MRSA) was identified by the culture of the wound exudate. He underwent a surgical revision with the removal of the sternal wires and necrotic tissues. After sufficient irrigation, vacuum-assisted closure therapy was adopted and finally the wound was naturally healed. Vacuum-assisted closure therapy was an effective treatment for MRSA mediastinitis after coronary artery bypass grafting.

  6. 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

    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......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...

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

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    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.

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

    Science.gov (United States)

    Hansen, Dominique; Roijakkers, Ruben; Jackmaert, Lore; Robic, Boris; Hendrikx, Marc; Yilmaz, Alaaddin; Frederix, Ines; Rosseel, Michael; Dendale, Paul

    2017-02-01

    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. 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 gas exchange ratio, end-tidal O2 and CO2 pressures, equivalents for O2 uptake and CO2 output, heart rate, O2 pulse, expiratory volume, tidal volume, respiratory rate, at peak exercise and ventilatory threshold. In patients, forced expiratory volume and forced vital capacity were measured. Oxygen uptake, CO2 output, expiratory and tidal volume, equivalents for O2 uptake and CO2 output, end-tidal O2 and CO2 pressures at peak exercise (matched peak respiratory gas exchange ratio between patient groups), and ventilatory threshold were significantly worse in patients versus healthy controls (P power, >0.80). All these parameters, and lung function, were, however, comparable between CABG and endo-ACAB surgery patients (P > 0.10). Exercise tolerance and ventilatory function during exercise seems, in contrast to expectation, equally compromised early after endo-ACAB surgery as opposed to after CABG surgery. These data may signify the need for exercise-based rehabilitation intervention early after endo-ACAB surgery.

  9. PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery

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    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.

  10. Surgical problems and complex procedures: issues for operative time in robotic totally endoscopic coronary artery bypass grafting.

    Science.gov (United States)

    Wiedemann, Dominik; Bonaros, Nikolaos; Schachner, Thomas; Weidinger, Felix; Lehr, Eric J; Vesely, Mark; Bonatti, Johannes

    2012-03-01

    Robotically assisted totally endoscopic coronary artery bypass grafting (TECAB) is a viable option for closed chest coronary surgery, but it requires learning curves and longer operative times. This study evaluated the effect of extended operation times on the outcome of patients undergoing TECAB. From 2001 to 2009, 325 patients underwent TECAB with the da Vinci telemanipulation system. Correlations between operative times and preoperative, intraoperative, and early postoperative parameters were investigated. Receiver operating characteristic analysis was used to define the threshold of the procedure duration above which intensive care unit stay and ventilation time were prolonged. Demographic data, intraoperative and postoperative parameters, and survival data were compared. Patients with prolonged operative times more often underwent multivessel revascularization (P 445 minutes and >478 minutes to predict prolonged (>48 hours) intensive care unit stay and mechanical ventilation, respectively. Patients with procedures >478 minutes had longer hospital stays and higher perioperative morbidity and mortality. Kaplan-Meier analysis revealed decreased survival among patients with operative times >478 minutes. Multivessel revascularization and conversions lead to prolonged operative times in totally endoscopic coronary artery bypass grafting. Longer operative times significantly influence early postoperative and midterm outcomes. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  11. Nuclear DNA as Predictor of Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Graft: A Pilot Study.

    Science.gov (United States)

    Likhvantsev, Valery V; Landoni, Giovanni; Grebenchikov, Oleg A; Skripkin, Yuri V; Zabelina, Tatiana S; Zinovkina, Liudmila A; Prikhodko, Anastasia S; Lomivorotov, Vladimir V; Zinovkin, Roman A

    2017-12-01

    To measure the release of plasma nuclear deoxyribonucleic acid (DNA) and to assess the relationship between nuclear DNA level and acute kidney injury occurrence in patients undergoing cardiac surgery. Cardiovascular anesthesiology and intensive care unit of a large tertiary-care university hospital. Prospective observational study. Fifty adult patients undergoing cardiac surgery. Nuclear DNA concentration was measured in the plasma. The relationship between the level of nuclear DNA and the incidence of acute kidney injury after coronary artery bypass grafting was investigated. Cardiac surgery leads to significant increase in plasma nuclear DNA with peak levels 12 hours after surgery (median [interquartile range] 7.0 [9.6-22.5] µg/mL). No difference was observed between off-pump and on-pump surgical techniques. Nuclear DNA was the only predictor of acute kidney injury between baseline and early postoperative risk factors. The authors found an increase of nuclear DNA in the plasma of patients who had undergone coronary artery bypass grafting, with a peak after 12 hours and an association of nuclear DNA with postoperative acute kidney injury. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Effects of progressive muscular relaxation training on quality of life in anxious patients after coronary artery bypass graft surgery.

    Science.gov (United States)

    Dehdari, Tahereh; Heidarnia, Alireza; Ramezankhani, Ali; Sadeghian, Saeed; Ghofranipour, Fazlollah

    2009-05-01

    Evidences suggest that relaxation therapy may improve psychological outcomes in heart patients. We evaluated the effect of progressive muscular relaxation (PMR) training in decreasing anxiety and improving quality of life among anxious patients after coronary artery bypass graft surgery (CABG). This study was an open uncontrolled trial. The sample included 110 anxious patients referred to the cardiac rehabilitation clinic of Tehran Heart Center, Tehran, Iran, during six weeks after coronary artery bypass graft (CABG). Patients were allocated to receive both exercise training and lifestyle education plus relaxation therapy (relaxation group; n=55) or only exercise training beside lifestyle education (control group or the recipient of usual care group; n=55). Duration of the relaxation therapy was 6 wk and in the case of usual care was 8 wk. Both the groups were followed up one month after completion of intervention. Anxiety and quality of life in the two treatment groups were compared. There were no significant differences in overall QOL, state anxiety and trait anxiety scores between the two groups before intervention. Significant reductions in state anxiety (Prelaxation group after intervention compared to control group. Women had high state anxiety and a low quality of life than men in the two groups before intervention. After intervention, there was no difference between men and women in the relaxation group. Our findings show that progressive muscular relaxation training may be an effective therapy for improving psychological health and quality of life in anxious heart patients.

  13. IL-6 anti-inflammatory activity in pleural effusion post-coronary artery bypass graft surgery

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    António M S Chibante

    2007-05-01

    Full Text Available Introduction: The local inflammatory reaction aspects of pleural behaviour post-coronary artery bypass graft surgery (PCABG are not completely evident, demanding further study and observation. Aim: To evaluate the behaviour of some cytokines and the possible anti-inflammatory activity of IL-6 (a protein involved in cortisone synthesis on acute PCABG pleural fluid, since this cytokine is usually considered as an acute phase reaction protein associated to high concentrations of TNF-alpha and IL-1beta in immediate inflammatory reactions. Material and methods: The concentrations of the TNFalpha, IL-1beta, IL-2, IL-6, IL-8, VEGF and TGF-beta cytokines in 16 transudates and 43 exudates in acute PCABS pleural fluid of patients were analysed by the ELISA method 2, 24 and 48 hours after surgery at the Instituto do Coração and Serviço de Pneumologia da USP, Brazil. Results: While no increase was seen in either TNF-alpha or IL-2 in any of the three tests, IL-1beta increased after 24 until 48 hours, coinciding with the TGF-beta curve decline which fell from the beginning to reach the transudates levels. IL-8 reminded higher from the beginning and through the two subsequent tests while VEGF levels were elevated from the first test and continued high for the following 24 and 48 hours. IL-6 had high concentrations from the beginning, suggesting an anti-inflammatory activity at the three times of testing. Conclusions: We conclude that IL-6 seems to play an important anti-inflammatory part which is superior to the anti-inflammatory activity of TGF-beta in PCABG pleural effusions. This performance of IL-6 breaks with the traditional idea of it being a pro-inflammatory acute phase reaction cytokine, at least in this type of pleural effusion. This seems to be the first study involving the favourable behaviour of IL-6 in the inflammatory reaction of pleura in the acute phase of PCABG surgery. Resumo: Introdução: O comportamento pleural p

  14. Factors associated with mortality in patients undergoing coronary artery bypass grafting.

    Science.gov (United States)

    Koerich, Cintia; Lanzoni, Gabriela Marcellino de Melo; Erdmann, Alacoque Lorenzini

    2016-08-08

    to investigate the factors associated with mortality in patients undergoing coronary artery bypass grafting in a cardiovascular referral hospital in Santa Catarina. quantitative, exploratory, descriptive and retrospective study. The medical records of 1447 patients, from 2005 to 2013, were analyzed for statistically related variables, these being: profile, hospitalization diagnosis, risk factors for coronary artery disease, complications recorded during the hospitalization, length of hospitalization and cause of death. the mortality rate was 5.3% during the study period. Death was more common in females and those of black skin color, with a mean age of 65 years. Acute myocardial infarction was the most common hospitalization diagnosis. The majority of the complications recorded during hospitalization were characterized by changes in the cardiovascular system, with longer hospitalization periods being directly related to death from septic shock. the data provide subsidies for nursing work with preventive measures and early detection of complications associated with coronary artery bypass grafting. This reinforces the importance of using the data as quality indicators, aiming to guarantee care guided by reliable information to guide managers in planning patient care and high complexity health services. conhecer os fatores associados à mortalidade de pacientes submetidos à cirurgia de revascularização do miocárdio em hospital referência cardiovascular em Santa Catarina. estudo quantitativo, exploratório, descritivo e retrospectivo. Foram analisados os prontuários de 1447 pacientes, entre 2005 e 2013, e as variáveis relacionadas estatisticamente, sendo estas: perfil, diagnóstico da internação, fatores de risco para doença arterial coronariana, intercorrências registradas na internação, tempo de internação e causa do óbito. a taxa de mortalidade foi de 5,3% no período do estudo. Os óbitos foram mais frequentes em negros, do sexo feminino e média de

  15. Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

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    Martens Elisabeth J

    2010-04-01

    Full Text Available Abstract Background Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting. Methods Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation. Results and Discussion One hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285, the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of 50%, long-term survival exceeded expected survival. Conclusions The severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was

  16. 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

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    Carlos Junior Toshiyuki Karigyo

    Full Text Available Abstract 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.

  17. The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran

    Directory of Open Access Journals (Sweden)

    Sharif Farkhondeh

    2012-06-01

    Full Text Available Abstract Background Many patients experience anxiety and depression after cardiac bypass surgery. The aim of this study was to examine the effect of cardiac rehabilitation on anxiety and depression in patients undergoing coronary artery bypass grafting in hospitals affiliated to Shiraz University of Medical Sciences in southern Iran. Methods For this randomized controlled trial, 80 patients who met the inclusion criteria were recruited and randomly assigned to case and control groups. Anxiety was measured with the Spielberger Anxiety Scale and depression was measured using Beck’s Depression Inventory at three points in time: on discharge from the hospital, immediately after the intervention, and 2 months after cardiac rehabilitation. After measuring anxiety and depression in both groups upon discharge, the experimental group participated in 8 cardiac rehabilitation sessions over a 4-week period. The control group received only the routine follow-up care. Results There was a statistically significant difference in depression scores between groups at all three time-points (Mean score from 19.6 to 10 in the intervention group and from 19.5 to 14 in the control group, P = 0.0014. However, no significant difference was seen in anxiety scores between the groups (Mean score from 37 to 28 in the intervention group and from 38 to 32 in the control group, P = 0.079. Conclusions Cardiac rehabilitation was effective in reducing depression 2 months after surgery in patients undergoing coronary artery bypass grafting. Trial registration IRCTN201203262812N8

  18. Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization.

    Science.gov (United States)

    Tayebi Meybodi, Ali; Huang, Wendy; Benet, Arnau; Kola, Olivia; Lawton, Michael T

    2017-09-01

    OBJECT Management of complex aneurysms of the middle cerebral artery (MCA) can be challenging. Lesions not amenable to endovascular techniques or direct clipping might require a bypass procedure with aneurysm obliteration. Various bypass techniques are available, but an algorithmic approach to classifying these lesions and determining the optimal bypass strategy has not been developed. The objective of this study was to propose a comprehensive and flexible algorithm based on MCA aneurysm location for selecting the best of multiple bypass options. METHODS Aneurysms of the MCA that required bypass as part of treatment were identified from a large prospectively maintained database of vascular neurosurgeries. According to its location relative to the bifurcation, each aneurysm was classified as a prebifurcation, bifurcation, or postbifurcation aneurysm. RESULTS Between 1998 and 2015, 30 patients were treated for 30 complex MCA aneurysms in 8 (27%) prebifurcation, 5 (17%) bifurcation, and 17 (56%) postbifurcation locations. Bypasses included 8 superficial temporal artery-MCA bypasses, 4 high-flow extracranial-to-intracranial (EC-IC) bypasses, 13 IC-IC bypasses (6 reanastomoses, 3 reimplantations, 3 interpositional grafts, and 1 in situ bypass), and 5 combination bypasses. The bypass strategy for prebifurcation aneurysms was determined by the involvement of lenticulostriate arteries, whereas the bypass strategy for bifurcation aneurysms was determined by rupture status. The location of the MCA aneurysm in the candelabra (Sylvian, insular, or opercular) determined the bypass strategy for postbifurcation aneurysms. No deaths that resulted from surgery were found, bypass patency was 90%, and the condition of 90% of the patients was improved or unchanged at the most recent follow-up. CONCLUSIONS The bypass strategy used for an MCA aneurysm depends on the aneurysm location, lenticulostriate anatomy, and rupture status. A uniform bypass strategy for all MCA aneurysms does not

  19. Evaluation of myocardial flow reserve using pharmacological stress thallium-201 single-photon emission computed tomography: is there a difference between total arterial off-pump coronary artery bypass grafting and conventional coronary artery bypass grafting?

    Science.gov (United States)

    Lee, Jae Won; Ryu, Sang Wan; Song, Hyun; Kim, Kyung Sun; Yang, Yu Jung; Moon, Dae Hyeuk

    2004-01-01

    The advantage of total arterial off-pump coronary bypass grafting (OPCAB) over conventional onpump coronary artery bypass grafting with 1 internal thoracic artery and veins (CCAB) in terms of myocardial flow reserve has not been studied. We studied these procedures using thallium- 201 perfusion single-photon emission computed tomography (Tl-201 perfusion SPECT). Between 1997 and 2001, 152 patients were recruited from our database (OPCAB, n = 100; CCAB, n = 52). All patients underwent pharmacological stress Tl-201 perfusion SPECT 3 to 12 months after bypass surgery. Myocardial perfusion was analyzed semiquantitatively with a 5-point scoring system in a 20-segment model (0, normal, to 4, absence of uptake). Summed stress (SSS), rest (SRS), and difference score (SDS) of the entire myocardium as well as average scores (ASS, ARS, ADS) of individual walls (anterior, septal, lateral, and inferior) were compared by Student t test as well as by repeated-measures analysis of variance with Bonferroni correction. The SSS, SRS, and SDS of OPCAB versus those of CCAB were 6.86 +/- 0.72 versus 7.17 +/- 0.92, 3.95 +/- 0.57 versus 3.75 +/- 0.73, and 2.91 +/- 0.47 versus 3.42 +/- 0.74 (P > .05). However, the lateral wall showed lower scores in OPCAB (ASS, 0.18 versus 0.41, P = .015; ARS, 0.12 versus 0.20, P = .168; ADS, 0.06 versus 0.21, P = .031). The septal wall had higher scores in OPCAB (ASS, 0.33 versus 0.12, P = .003; ARS, 0.18 versus 0.07, P = .037; ADS, 0.14 versus 0.04, P = .030). The anterior and inferior walls were not different between the 2 groups. OPCAB led to results similar to those of CCAB. The better results in the lateral wall have been the effect of grafting radial artery rather than vein. The similarity in myocardial reserve in the inferior wall between the 2 groups needs further study. There was no deleterious effect of off-pump as opposed to on-pump CAB.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-12-11

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

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

    Science.gov (United States)

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

    2014-11-01

    Background: Coronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective: This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods: Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) - 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) - 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ≤ 0.05 were considered significant. Results: Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ≤ 0.01). Conclusion: Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.Fundamento: A cirurgia de revascularização miocárdica (CRM) é a opção cirúrgica padrão para pacientes com placas arteriais difusas e significativas. Tal procedimento, no entanto, não é desprovido de complicações pós-operatórias, especialmente distúrbios pulmonares e cognitivos. Objetivo: Comparar o impacto de duas abordagens fisioterap

  2. On-pump versus off-pump coronary artery bypass graft surgery among patients with type 2 diabetes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial†

    Science.gov (United States)

    Singh, Ashima; Schaff, Hartzell V.; Mori Brooks, Maria; Hlatky, Mark A.; Wisniewski, Stephen R.; Frye, Robert L.; Sako, Edward Y.

    2016-01-01

    OBJECTIVES Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. METHODS The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. RESULTS On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. CONCLUSIONS Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG. PMID:25968885

  3. The Patency Rate of Arteriovenous Fistulas

    Directory of Open Access Journals (Sweden)

    Aşkın Ender Topal

    2004-01-01

    Full Text Available The purpose of this investigation is to determine the patency of thearteriovenous (A-V fistulas, created in patients with chronic renal failure, inthe early and late periods according to sex.The A-V fistulas created for hemodialisis were investigated retrospectively.Of 238 patients, there were 130 male.269 operations were made to 238 patients. Of these, 198 (73.6 % wereradiochephalic, 56 (20.8 % were brachiochephalic, 8 (3 % were brachiobasilicA-V fistulas. In 3 (1.1 % patients loop graft between brachial artery and vein,in 1 (0.37 % patient graft between radial artery and brachial vein, in 1 patientgraft between brachial artery and basilic vein, in 1 patient graft betweensuperficial femoral artery and saphenous vein were placed. Of 198radiochephalic A-V fistulas 24 (12.1 % in early period and 3 (1.5 % in lateperiod became inactive. Of 56 brachiochephalic A-V fistulas 4 (7.1 % and of 8brachiobasilic A-V fistulas 2 (25 % became unsuccessful in early period. 1 of 6A-V fistulas with prosthetic graft failed in late period because of thrombosis. Inradial level patency rate of A-V fistulas in females were lower than in males(82.3 %-89.8 %.The patency rate of A-V fistulas in radial and brachial levels were similar,but in radial level rate of successful of A-V fistulas decreased in femalesaccording to males. Use of graft in A-V fistula didn’t give superiority to A-Vfistulas without graft.

  4. Target ballon-assisted antegrade and retrograde approach for recanalization of thrombosed fem-pop bypass graft using the outbreak catheter

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Jung Won; Chung, Hwan Hoon; Lee, Seung Hwa; Yeom, Suk Keu; Cha, Sang Hoon [Dept. of Radiology, Korea University College of Medicine, Ansan Hospital, Ansan (Korea, Republic of)

    2016-01-15

    The subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique is reportedly effective in severe peripheral vascular disease that cannot be treated with standard endovascular techniques including subintimal angioplasty. In this report, we used a target balloon with the Outback catheter to recanalize a thrombosed bypass graft that could not be treated successfully with SAFARI.

  5. 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

  6. 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.

  7. 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.…

  8. Predictors of long-term outcomes after bypass grafting versus drug-eluting stent implantation for left main or multivessel coronary artery disease

    NARCIS (Netherlands)

    Chang, Mineok; Lee, Cheol Whan; Ahn, Jung-Min; Cavalcante, Rafael; Sotomi, Yohei; Onuma, Yoshinobu; Han, Minkyu; Park, Seong-Wook; Serruys, Patrick W.; Park, Seung-Jung

    2017-01-01

    Background: We assessed predictors of long-term outcomes after coronary artery bypass grafting (CABG) versus those after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,230 patients with left main or multivessel coronary artery disease (CAD). Methods and Results: Data

  9. Decline in health-related quality of life 6 months after coronary artery bypass graft surgery the influence of anxiety, depression, and personality traits

    NARCIS (Netherlands)

    Middel, B.; El Baz, N.; Pedersen, S.S.; van Dijk, J.P.; Wynia, K.; Reijneveld, S.A.

    2014-01-01

    Background: 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. Objective: The aim of this study was to test the direct and indirect influence of

  10. Ischemia management with accupril post bypass graft via inhibition of angiotensin coNverting enzyme (IMAGINE) : A multicentre randomized trial - design and rationale

    NARCIS (Netherlands)

    Warnica, JW; Van Gilst, W; Baillot, R; Johnstone, D; Block, P; Myers, MG; Chocron, S; Dalle, S; Martineau, P; Rouleau, JL

    2002-01-01

    BACKGROUND: Coronary artery bypass grafting (CABG) remains the revascularization treatment of choice for patients with severely symptomatic or life-threatening coronary artery disease (CAD). However, 9% to 25% of the patients undergoing CABG will suffer a recurrent ischemic event such as death,

  11. Obturator or "lateral" bypass in the management of infected vascular prostheses at the groin

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2002-01-01

    above the knee popliteal artery in 4 subjects. After both types of reconstruction, extirpation of infected grafts from the groin was performed (Figure 2. The control examination was performed using physical and Doppler ultrasonographic examinations, one, 3, 6, 12 months, and then every year after the operation. In cases with suspected graft infection or thrombosis, control angography was also performed. One intraoperative perforation of the urinary bladder has been done accidentally during obturator bypass reconstruction. The mean follow-up period for patients with obturator bypasses was 2.3 years, while 2.1 years for patients with "lateral" bypasses. Comparing with "lateral" bypass, obturator bypass showed statistically significant lower (p < 0.05 30- day mortality and early graft infection rate, as well as statistically significant better early and total limb salvage rate. There were no statistically significant differences (p > 0.05 between obturator and "lateral" bypass procedures having in mind, late graft infection rate, as well as early and late graft patency (Figures 3 and 4. In cases with infected vascular prostheses in the groin, the authors recommend obturator bypass comparing with "lateral" bypass.

  12. A 10-year institutional experience with open branched graft reconstruction of aortic aneurysms in connective tissue disorders versus degenerative disease.

    Science.gov (United States)

    Hicks, Caitlin W; Lue, Jennifer; Glebova, Natalia O; Ehlert, Bryan A; Black, James H

    2017-11-01

    Aortic reconstruction for complex thoracoabdominal aortic aneurysms (TAAAs) can be challenging, especially in patients with connective tissue disorders (CTDs) in whom tissue fragility is a major concern. Branched graft reconstruction is a more complex operation compared with inclusion patch repair of the aorta but is frequently necessary in patients with CTDs or other pathologies because of anatomic reasons. We describe our institutional experience with open branched graft reconstruction of aortic aneurysms and compare outcomes for patients with CTDs vs degenerative pathologies. We retrospectively analyzed all patients undergoing open aortic reconstruction using branched grafts at our institution between July 2006 and December 2015. Postoperative outcomes, including perioperative morbidity and mortality, midterm graft patency, and the development of new aneurysms, were compared for patients with CTD vs degenerative disease. During the 10-year study period, 137 patients (CTD, 29; degenerative, 108) underwent aortic repair with branched graft reconstruction. CTD patients were significantly younger (39 ± 1.9 vs 68 ± 1.0 years; P graft patency occurred in 0 of 99 grafts (0%) in CTD patients and in 13 of 167 grafts (7.8%) in degenerative disease patients (P = .005). Loss of branch graft patency occurred most commonly in left renal artery bypass grafts (77%) and was clinically asymptomatic (creatinine: 1.77 ± 0.13 mg/dL currently vs 1.41 ± 0.25 preoperatively; P = .22). CTD patients with aortic aneurysms who undergo open branched graft reconstruction have reasonable outcomes compared with patients with degenerative pathology, including better branched graft patency and a similar risk of perioperative mortality and complications. Open repair of aortic aneurysms with branched graft reconstruction can be performed safely in both populations with low perioperative mortality, but ongoing surveillance is critical for the detection of new aneurysms, especially

  13. Dacron® vs. PTFE as bypass materials in peripheral vascular surgery – systematic review and meta-analysis

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    Eidt Daniela

    2008-12-01

    Full Text Available Abstract Background In peripheral vascular bypass surgery different synthetic materials are available for bypass grafting. It is unclear which of the two commonly used materials, polytetrafluoroethylene (PTFE or polyester (Dacron® grafts, is to be preferred. Thus, the aim of this meta-analysis and systematic review was to compare the effectiveness of these two prosthetic bypass materials (Dacron® and PTFE. Methods We performed a systematic literature search in MEDLINE, Cochrane-Library – CENTRAL, EMBASE and other databases for relevant publications in English and German published between 1999 and 2008. Only randomized controlled trials were considered for inclusion. We assessed the methodological quality by means of standardized checklists. Primary patency was used as the main endpoint. Random-effect meta-analysis as well as pooling data in life table format was performed to combine study results. Results Nine randomized controlled trials (RCT were included. Two trials showed statistically significant differences in primary patency, one favouring Dacron® and one favouring PTFE grafts, while 7 trials did not show statistically significant differences between the two materials. Meta-analysis on the comparison of PTFE vs. Dacron® grafts yielded no differences with regard to primary patency rates (hazard ratio 1.04 (95% confidence interval [0.85;1.28], no significant heterogeneity (p = 0.32, I2 = 14%. Similarly, there were no significant differences with regard to secondary patency rates. Conclusion Systematic evaluation and meta-analysis of randomized controlled trials comparing Dacron® and PTFE as bypass materials for peripheral vascular surgery showed no evidence of an advantage of one synthetic material over the other.

  14. Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction.

    Science.gov (United States)

    Kukulski, Tomasz; She, Lilin; Racine, Normand; Gradinac, Sinisa; Panza, Julio A; Velazquez, Eric J; Chan, Kwan; Petrie, Mark C; Lee, Kerry L; Pellikka, Patricia A; Romanov, Alexander; Biernat, Jolanta; Rouleau, Jean L; Batlle, Carmen; Rogowski, Jan; Ferrazzi, Paolo; Zembala, Marian; Oh, Jae K

    2015-05-01

    Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P < .0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors

  15. The defective protein level of myosin light chain phosphatase (MLCP) in the isolated saphenous vein, as a vascular conduit in coronary artery bypass grafting (CABG), harvested from patients with diabetes mellitus (DM).

    Science.gov (United States)

    Matsuo, Yasuko; Kuwabara, Masachika; Tanaka-Totoribe, Naoko; Kanai, Tasuku; Nakamura, Eisaku; Gamoh, Shuji; Suzuki, Akito; Asada, Yujiro; Hisa, Hiroaki; Yamamoto, Ryuichi

    2011-08-26

    We examined the contractile reactivity to 5-hydroxytryptamine (5-HT) in isolated human saphenous vein (SV), as a vascular conduit in coronary artery bypass grafting (CABG), harvested from patients with diabetes mellitus (DM) and non-DM (NDM). Vascular rings of endothelium-denuded SV were used for functional and biochemical experiments. The vasoconstrictions caused by 5-HT were significantly greater (hyperreactivity) in the DM group than in the NDM group. RhoA/ROCK pathway is activated by various G-protein-coupled receptor agonists and consequently induces phosphorylation of myosin phosphatase target subunit 1 (MYPT1), a subunit of myosin light chain phosphatase (MLCP), which inhibits MLCP activity. In the resting state of the vessels, total tissue protein levels of 5-HT(2A) receptor, 5-HT(1B) receptor, RhoA, ROCK1, and ROCK2 did not differ between NDM and DM groups. However, the total protein level of MYPT1 was significantly lower in the DM group than in the NDM group. Furthermore, the ratio of P(Thr(696))-MYPT1 to total MYPT1 was significantly higher in the DM group than in the NDM group. These results suggest that the hyperreactivity to 5-HT in the SV smooth muscle of patients with DM is due to not only enhanced phosphorylation of MLCP but also defective protein level of MLCP. Thus, we reveal for the first time that the defective protein level of MLCP in the DM group can partially explain the poor patency of SV graft harvested from patients with DM. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. 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

  17. Attachment anxiety predicts IL-6 and length of hospital stay in coronary artery bypass graft surgery (CABG) patients.

    Science.gov (United States)

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

    2014-08-01

    The mechanisms underlying the association between adult attachment and health are not well understood. In the current study, we investigated the relationship between attachment anxiety, attachment avoidance, inflammation, and length of hospital stay in coronary artery bypass graft (CABG) surgery patients. 167 CABG patients completed an attachment questionnaire prior to surgery, and blood samples were taken before and after surgery to assess inflammatory activity. We found that attachment anxiety predicted higher plasma interleukin 6 (IL-6) concentration, and this association was mediated by self-reported sleep quality. Anxious attachment also predicted longer hospital stays following CABG surgery, even after controlling for demographic and clinical factors. These data suggest that increased levels of IL-6 may be a process linking adult attachment anxiety with health outcomes. Copyright © 2014. Published by Elsevier Inc.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  19. 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...... and VAS and the occurrence of subclinical cerebral lesions after CABG verified by magnetic resonance imaging. METHODS: CABG patients were included and CAS and VAS were identified by magnetic resonance angiography. Cerebral magnetic resonance imaging was performed to identify new post-operative subclinical...... cerebral lesions. The associations between CAS/VAS post-operative cerebral lesions were investigated. RESULTS: Forty-six patients were included in the study. 13% had significant CAS and 11% had significant VAS. Thirty-five percent had new cerebral infarction postoperatively. We found a significant...

  20. Comparison of Two Central Venous Pressure Control Strategies to Prevent Atrial Fibrillation After Coronary Artery Bypass Grafting

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    Mario Augusto Cray da Costa

    Full Text Available Abstract Background: Atrial fibrillation (AF takes place in 10-40% of patients undergoing coronary artery bypass grafting (CABG, and increases cardiovascular mortality. Enlargement of atrial chambers is associated with increased AF incidence, so patients with higher central venous pressure (CVP are expected to have larger atrial distension, which increases AF incidence. Objective: To compare post-CABG AF incidence, following two CVP control strategies. Methods: Interventional, randomized, controlled clinical study. The sample comprised 140 patients undergoing CABG between 2011 and 2015. They were randomized into two groups, G15 and G20, with CVP maintained ≤ 15 cmH2O and ≤ 20 cmH2O, respectively. Results: 70 patients were included in each group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with absolute risk reduction of 14.28%, and number needed to treat (NNT of 7 (p = 0.03. Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07, hospital length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36, number of grafts (median: G15 = 3, G2 = 2; p = 0.22 and cardiopulmonary bypass use (G15 = 67.10%; G20 = 55.70%; p = 0.22 were statistically similar. Age (p = 0.04 and hospital length of stay (p = 0.001 were significantly higher in patients who developed AF in both groups. Conclusion: Keeping CVP low in the first 72 post-CABG hours reduces the relative risk of AF, and may be useful to prevent AF after CABG.

  1. Genome-wide assessment for genetic variants associated with ventricular dysfunction after primary coronary artery bypass graft surgery.

    Directory of Open Access Journals (Sweden)

    Amanda A Fox

    Full Text Available BACKGROUND: Postoperative ventricular dysfunction (VnD occurs in 9-20% of coronary artery bypass graft (CABG surgical patients and is associated with increased postoperative morbidity and mortality. Understanding genetic causes of postoperative VnD should enhance patient risk stratification and improve treatment and prevention strategies. We aimed to determine if genetic variants associate with occurrence of in-hospital VnD after CABG surgery. METHODS: A genome-wide association study identified single nucleotide polymorphisms (SNPs associated with postoperative VnD in male subjects of European ancestry undergoing isolated primary CABG surgery with cardiopulmonary bypass. VnD was defined as the need for ≥2 inotropes or mechanical ventricular support after CABG surgery. Validated SNPs were assessed further in two replication CABG cohorts and meta-analysis was performed. RESULTS: Over 100 SNPs were associated with VnD (P2.1 of developing in-hospital VnD after CABG surgery. However, three genetic loci identified by meta-analysis were more modestly associated with development of postoperative VnD. Studies of larger cohorts to assess these loci as well as to define other genetic mechanisms and related biology that link genetic variants to postoperative ventricular dysfunction are warranted.

  2. SUrgical versus PERcutaneous Bypass : SUPERB-trial; Heparin-bonded endoluminal versus surgical femoro-popliteal bypass: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Lensvelt, Mare M. A.; Holewijn, Suzanne; Fritschy, Wilbert M.; Wikkeling, Otmar R. M.; van Walraven, Laurens A.; de Vries, Bas M. Wallis; Zeebregts, Clark J.; Reijnen, Michel M. P. J.

    2011-01-01

    Background: Endovascular treatment options for the superficial femoral artery are evolving rapidly. For long lesions, the venous femoropopliteal bypass considered to be superior above the prosthetic bypass. An endoluminal bypass, however, may provide equal patency rates compared to the prosthetic

  3. SUrgical versus PERcutaneous Bypass: SUPERB-trial; Heparin-bonded endoluminal versus surgical femoro-popliteal bypass: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Lensvelt, M.M.A.; Holewijn, S.; Fritschy, W.M.; Wikkeling, O.R.; Walraven, L.A. van; Wallis de Vries, B.M.; Zeebregts, C.J.A.; Reijnen, M.M.P.J.

    2011-01-01

    BACKGROUND: Endovascular treatment options for the superficial femoral artery are evolving rapidly. For long lesions, the venous femoropopliteal bypass considered to be superior above the prosthetic bypass. An endoluminal bypass, however, may provide equal patency rates compared to the prosthetic

  4. Arterial revascularization in primary coronary artery bypass grafting: Direct comparison of 4 strategies--results of the Stand-in-Y Mammary Study.

    Science.gov (United States)

    Nasso, Giuseppe; Coppola, Roberto; Bonifazi, Raffaele; Piancone, Felice; Bozzetti, Giuseppe; Speziale, Giuseppe

    2009-05-01

    It is unclear (1) whether the use of 2 arterial conduits rather than a single conduit in multivessel coronary artery bypass grafting significantly improves results despite the concomitant use of saphenous vein grafts and (2) whether any among different configurations of composite grafts (left/right thoracic arteries and radial artery) offers an advantage over the others. Eight hundred fifteen patients were randomized to one of 3 different strategies of revascularization by using the left thoracic artery plus the right thoracic artery or using the left thoracic artery plus the radial artery. Venous grafts were used for the remaining targets. Patients randomized to receive 1 arterial graft served as control subjects. Operative mortality and morbidity were comparable among groups. The rate of cerebrovascular complications was not statistically lower among patients receiving 2 arterial grafts. At 2 years, overall survival was not significantly different among groups (P = .59). Cardiac event-free survival was significantly better in patients receiving 2 arterial grafts versus control subjects (P strategies using 2 arterial conduits were similar concerning early and midterm results. Revascularization with 2 arterial conduits offers better midterm event-free survival than a single arterial graft, irrespective of which second-choice arterial conduit is used (radial artery or right thoracic artery), the simultaneous use of saphenous vein grafts, and the patient's age.

  5. New routing alternative for proximal anterior tibial artery bypass in patients with Buerger disease.

    Science.gov (United States)

    Lee, Taeseung; Ra, Hwan Do; Park, Yang Jin; Park, Hyung Sub; Kim, Sang Joon

    2011-12-01

    Femoral-anterior tibial artery bypasses with autogenous grafts are difficult to perform when sufficiently long saphenous veins are not available. We performed 12 bypasses on patients with Buerger disease during a 20-year period using a new intermuscular tunneling technique. The graft is passed from the thigh between the muscle compartments without penetrating the muscle fibers, providing an anatomically superior and shorter path. The primary patency rates were 75% at 5 years and 65% at 10 years. We believe that our tunneling technique is safe and durable and might be a viable alternative for proximal femoral-anterior tibial artery bypass in selected patients. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  6. Feasibility of hybrid off pump artery bypass grafting and transaortic transcatheter aortic valve implantation: A case series.

    Science.gov (United States)

    Manoly, Imthiaz; Hasan, Ragheb; Brazier, Andrew; Farooq, Vasim; Thompson, Thomas; Karunaratne, Devinda; Naylor, Heather; Fraser, Douglas

    2017-06-01

    Patients with complex coronary artery disease and severe aortic stenosis unsuitable for conventional cardiac surgery pose a significant treatment challenge. This is especially difficult for patients where percutaneous revascularization is technically very challenging and/or would not offer as complete revascularisation compared to surgical revascularisation. In addition, patients who are unsuitable for transfemoral transcatheter aortic valve implantation (TAVI) pose an additional technical challenge, particularly with dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). As a potential solution we describe the first case series of hybrid off-pump coronary artery bypass grafting (CABG) combined with transaortic TAVI. Over a ten-month-period, four patients underwent hybrid off-pump CABG combined with transaortic TAVI. A full sternotomy allowed off-pump arterial and vein graft anastomosis to significantly stenosed coronaries. The first three patients had severe aorto-iliac disease precluding femoral access; the fourth patient was deemed unsuitable for PCI. Transaortic TAVI using Edwards Sapien 3 valves were performed without complication in all four patients. The hybrid off-pump CABG and transaortic TAVI procedure allows for more complete coronary revascularization, negates the need for DAPT, and minimizes treatment delay of a TAVI procedure, particularly in patients unsuitable for transfemoral access. We propose this as an important treatment option for the heart team to consider. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

    Shahrbanoo Shahbazi

    2012-12-01

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

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

    OpenAIRE

    Suprakash Chaudhury; Rajiv Saini; Ajay Kumar Bakhla; Jaswinder Singh

    2016-01-01

    Epidemiological studies have shown a high prevalence of coronary artery disease among the Indian Population. Due to increasing availability and affordability of tertiary care in many parts of India, carefully selected patients undergo coronary artery bypass surgery to improve cardiac function. However, the procedure is commonly associated with depression and anxiety which can adversely affect overall prognosis. The objective of this review is to highlight early identifiable symptoms of depres...

  9. Evaluation of venous and arterial conduit patency by 16-slice spiral computed tomography.

    Science.gov (United States)

    Martuscelli, E; Romagnoli, A; D'Eliseo, A; Tomassini, M; Razzini, C; Sperandio, M; Simonetti, G; Romeo, F; Mehta, J L

    2004-11-16

    Computed tomography has been shown to be useful in the evaluation of aortocoronary bypass grafts (CABG). This is the first prospective study to evaluate the accuracy of a new-generation scanner in the detection of patency and significant stenoses (>50% decrease in diameter) of venous and arterial grafts in patients with previous CABG. In 96 patients (80 males, mean age 62 years) with previous CABG, a multislice computed tomography (MSCT) scan was performed (collimation 16x0.625 mm). Patients with atrial fibrillation, renal failure, severe respiratory disease, severe heart failure, heart rate >70 bpm despite therapy, or unstable angina were excluded. A total of 285 conduits implanted on the native coronary arteries at the time of CABG were evaluated. MSCT data were analyzed by 2 independent radiologists and compared with the results of conventional angiography. Three patients were excluded from analysis. All conduits were judged evaluable in 84 patients. Among these patients, MSCT correctly diagnosed 54 occluded grafts and 4 significant stenoses on the body of the grafts. Of the 17 significant anastomotic lesions, MSCT correctly diagnosed 15. For these 84 patients, diagnostic accuracy was 99%, sensitivity was 97%, and specificity was 100%. When all 93 patients were considered, the sensitivity of MSCT in diagnosing significant stenoses was 96%. MSCT with the new-generation scanner allows for accurate assessment of venous and arterial conduits in patients with previous CABG with a high degree of sensitivity and specificity. Exclusion criteria and radiation exposure remain limitations of the method.

  10. The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery.

    Science.gov (United States)

    Yuruk, Koray; Bezemer, Rick; Euser, Mariska; Milstein, Dan M J; de Geus, Hilde H R; Scholten, Evert W; de Mol, Bas A J M; Ince, Can

    2012-09-01

    OBJECTIVES To reduce the complications associated with cardiopulmonary bypass (CPB) during cardiac surgery, many modifications have been made to conventional extracorporeal circulation systems. This trend has led to the development of miniaturized extracorporeal circulation systems. Cardiac surgery using conventional extracorporeal circulation systems has been associated with significantly reduced microcirculatory perfusion, but it remains unknown whether this could be prevented by an mECC system. Here, we aimed to test the hypothesis that microcirculatory perfusion decreases with the use of a conventional extracorporeal circulation system and would be preserved with the use of an miniaturized extracorporeal circulation system. METHODS Microcirculatory density and perfusion were assessed using sublingual side stream dark-field imaging in patients undergoing on-pump coronary artery bypass graft (CABG) surgery before, during and after the use of either a conventional extracorporeal circulation system (n = 10) or a miniaturized extracorporeal circulation system (n = 10). In addition, plasma neutrophil gelatinase-associated lipocalin and creatinine levels and creatinine clearance were assessed up to 5 days post-surgery to monitor renal function. RESULTS At the end of the CPB, one patient in the miniaturized extracorporeal circulation-treated group and five patients in the conventional extracorporeal circulation-treated group received one bag of packed red blood cells (300 ml). During the CPB, the haematocrit and haemoglobin levels were slightly higher in the miniaturized extracorporeal circulation-treated patients compared with the conventional extracorporeal circulation-treated patients (27.7 ± 3.3 vs 24.7 ± 2.0%; P = 0.03; and 6.42 ± 0.75 vs 5.41 ± 0.64 mmol/l; P circulation-treated group from 16.4 ± 3.8 to 12.8 ± 3.3 mm/mm(2) (P circulation-treated group (16.3 ± 2.7 and 15.2 ± 2.9 mm/mm(2) before and during the pump, respectively). Plasma neutrophil

  11. 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

  12. Inhibition of vasoconstriction by AJ-2615, a novel calcium antagonist with alpha(1)-adrenergic receptor blocking activity in human conduit arteries used as bypass grafts.

    Science.gov (United States)

    Liu, M H; Floten, S H; Yang, Q; He, G W

    2001-09-01

    Graft spasm may develop during coronary artery bypass grafting and reversal of spasm is still challenging. The purpose of this study was to investigate the in vitro vascular relaxant properties of AJ-2615 in human internal mammary artery (IMA). We studied 264 IMA rings taken from 65 patients undergoing coronary artery bypass grafting surgery with organ bath technique. The interaction between AJ-2615 and various vasoconstrictors was investigated in two ways. AJ-2615 caused complete relaxation in methoxamine-contracted IMA rings (100.0+/-0.0%; n = 8) and nearly full relaxation in potassium chloride-contracted IMA rings (91.4+/-5.7%; n = 8) or noradrenaline-contracted IMA rings (89.3+/-2.8%; n = 8). AJ-2615 also induced remarkable relaxation in IMA rings contracted by other vasoconstrictors. In comparison with the alpha1-adrenoceptor antagonist prazosin, AJ 2615 showed similar maximal relaxation in IMA rings contracted by methoxamine or norepinephrine. On the other hand, incubation with AJ-2615 (0.1-1 microM) significantly inhibited all the vasoconstrictor-mediated vasoconstriction except endothelin-1 in a concentration-dependent manner. The results suggested that in human IMA, AJ-2615 has an inhibitory effect on vasoconstriction mediated by a variety of vasoconstrictors and the mechanism of relaxation may be related to its calcium antagonism and alpha1-adrenergic receptor blocking activity. AJ-2615 may have important clinical implications for patients undergoing coronary artery bypass surgery for reversing and preventing graft spasm.

  13. Comparison of Outcomes for Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Low-Volume and High-Volume Centers and by Low-Volume and High-Volume Surgeons.

    Science.gov (United States)

    Benedetto, Umberto; Lau, Christopher; Caputo, Massimo; Kim, Luke; Feldman, Dmitriy N; Ohmes, Lucas B; Di Franco, Antonino; Soletti, Giovanni; Angelini, Gianni D; Girardi, Leonard N; Gaudino, Mario

    2018-03-01

    In terms of in-hospital outcomes, controversy still remains whether off-pump coronary artery bypass grafting is superior to on-pump coronary artery bypass surgery. We investigated whether the volume of off-pump coronary artery bypass procedures by hospital and individual surgeon influences patient outcomes when compared with on-pump coronary artery bypass surgery. Discharge records from the Nationwide Inpatient Sample were retrospectively reviewed for in-hospital admissions from 2003 to 2011, including 999 hospitals in 44 states. A total of 2,094,094 patients undergoing on- and off-pump coronary artery bypass surgery were included. In patients requiring 2 or more grafts, off-pump coronary artery bypass compared with on-pump coronary artery bypass was associated with increased risk-adjusted mortality when performed in low-volume centers (pump coronary artery bypass centers (≥164 cases per year) and surgeons (≥48 cases per year), off-pump coronary artery bypass reduced mortality compared with on-pump coronary artery bypass in cases requiring a single graft (OR 0.66, 95% CI 0.49 to 0.89 and OR 0.33, 95% CI 0.22 to 0.47, respectively) or 2 or more grafts (OR 0.82, 95% CI 0.66 to 0.99 and OR 0.63, 95% CI 0.49 to 0.81, respectively). In conclusion, the outcome of off-pump coronary artery bypass grafting procedures is dependent on volume at both the institution and the individual surgeon level. Off-pump coronary artery bypass should not be performed at low-volume centers and by low-volume surgeons. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Midterm follow-up after off-pump versus on-pump coronary artery bypass grafting. Results from a case-matched study

    OpenAIRE

    Lycops, A; Wever, C; Vandekerkhof, J; Mees, Urbain; HENDRIKX, Marc

    2005-01-01

    Objective - Early survival in off-pump coronary artery bypass (OPCAB) patients is reported to be as good as that of conventional coronary artery bypass grafting (CABG). However, it remains unknown whether midterm cardiac outcome after off-pump surgery is similar to that for the on-pump procedure. Methods and results - One hundred OPCAB patients (67.8 (9.3) y) were compared to a case-matched contemporary group of CABG patients (69.4 (8.8) y). In-hospital and midterm outcome data are presented....

  15. Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation

    OpenAIRE

    Shi, Sheng; Gao, Yuan; Wang, Limin; Liu, Jian; Yuan, Zhongxiang; Yu, Min

    2015-01-01

    Background We aimed to investigate the relationship between increased free fatty acid (FFA) level and early postoperative hypoxemia after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods Ninety-eight consecutive patients undergoing CABG were enrolled. Early postoperative hypoxemia was defined as the lowest of the ratio of arterial oxygen tension (PaO2) to inspired oxygen fraction (FiO2) ≤ 200 mm Hg within 24 h without pleural effusion and pneumothorax. The 26 ...

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

    Directory of Open Access Journals (Sweden)

    Emre Gazyakan, MD, MSc

    2015-04-01

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

  17. Thrombelastographic haemostatic status and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial)

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Johansson, Pär I; Zacho, Mette

    2012-01-01

    , 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: This is a prospective randomized clinical trial, with an open......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......-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...

  18. Long-term graft occlusion in aortobifemoral position

    Directory of Open Access Journals (Sweden)

    Vasić Novak

    2013-01-01

    Full Text Available Background/Aim. Aortobifemoral (AFF bypass is still the most common surgical procedure used in treatment of aortoiliac occlusive disease. One of the most common complications of AFF bypass procedure is long-term graft occlusion. The aim of this study was to determine the cause of long-term graft occlusion in AFF position, as well as the results of early treatment of this complication. Methods. This retrospective study, performed at the Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia in Belgrade, involved 100 patients treated for long-term occlusion of bifurcated Dacron graft which was ensued at least one year after the primary surgical procedure. Results. The most common cause of the longterm graft occlusion was the process at the level of distal anastomosis or below it (Z = 3.8, p = 0.0001. End-to-end type of proximal anastomosis has been associated with a significantly increased rate of long-term graft occlusion (Z = 2.2, p = 0.0278. Five different procedures were used for the treatment of long-term graft occlusion: thrombectomy and distal anastomosis patch plasty (46% of the cases; thrombectomy and elongation (26% of the cases; thrombectomy and femoropopliteal bypass (24% of the cases; crossover bypass (2% of the cases and a new AFF bypass (2% of the cases. The primary early graft patency was 87%. All 13 early occlusions occurred after the thrombectomy associated with patch plasty of distal anastomosis. Thrombectomy with distal anastomosis patch plasty showed a statistically highest percentage of failures in comparison to thrombectomy with graft elongation, or thrombectomy with femoro-popliteal bypass (Z = 2 984, p = 0.0028. Redo procedures were performed in all the cases of early occlusions. In a 30-day follow-up period after the secondary surgery, 90 (90% patients had their limbs saved, and above knee amputation was made in 10 (10% patients. Conclusion. Long-term AFF bypass patency can be obtained by proximal end

  19. Comparison of the Effects of Religious Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT), and Sertraline on Depression and Anxiety in Patients after Coronary Artery Bypass Graft Surgery: A Study Protocol for a Randomized Controlled T

    National Research Council Canada - National Science Library

    Nazanin Vaezzadeh; Seyed Hamzeh Hosseini; Alireza Rafiei; Ali Gaemian; Abdolhakim Tirgari; Aliasghar Zakavi; jamshid Yazdani; Jafar Bolhari; Mahmood Golzari; Zahra Esmaeili Douki

    2017-01-01

    Objectives: Our objective is to compare the effects of RCBT, CBT, and sertraline on depression, anxiety, biomarker levels, and the quality of life in patients after coronary artery bypass graft (CABG) surgery. Method/Design...

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

    Directory of Open Access Journals (Sweden)

    Ayşegül Kunt

    2015-08-01

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

  1. Mixed venous versus central venous oxygen saturation in patients undergoing on pump beating coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Alshaer Ahmad

    2010-01-01

    Full Text Available Objective: To examine the validity of central venous oxygen saturation (ScvO 2 as a numerical substitution of mixed venous oxygen saturation (SvO 2 in adult patients undergoing normothermic on pump beating coronary artery bypass grafting (CABG. Materials and Methods: Prospective clinical observational study was done at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Thirty four adult patients scheduled for coronary artery surgery were included. Patients were monitored by a pulmonary artery catheter (PAC as a part of our routine intraoperative monitoring. SvO 2 and ScvO 2 were simultaneously measured 15 minutes (T1 and 30 minutes (T2 after induction of anesthesia, 15 and 30 minutes after initiation of cardiopulmonary bypass (T3 and T4, and 15 and 30 minutes after admission to intensive care unit (T5 and T6. Results: ScvO 2 showed higher reading than SvO 2 all through our study. Our results showed perfect positive statistically significant correlation between SvO 2 and ScvO 2 at all data points. Individual mean of difference (MOD between both the readings at study time showed MOD of 1.34 and 1.44 at T1 and T2 simultaneously. This MOD was statistically insignificant, but after on pump beating normothermic bypass was initiated; MOD was 5.2 and 4.4 at T3 and T4 with high statistical significance. In ICU, MOD continues to have high statistical significance, MOD was 6.3 at T5 and at T6 it was 4.6. Conclusions: In on pump beating CABG patients; ScvO 2 and SvO 2 are not interchangeable numerically. ScvO 2 is useful in the meaning of trend; our data suggest that ScvO 2 is equivalent to SvO 2 , only in the course of clinical decisions as long as absolute values are not required.

  2. Type of arteriovenous vascular access and association with patency and mortality

    NARCIS (Netherlands)

    Ocak, Gürbey; Rotmans, Joris I.; Vossen, Carla Y.; Rosendaal, Frits R.; Krediet, Raymond T.; Boeschoten, Elisabeth W.; Dekker, Friedo W.; Verduijn, Marion

    2013-01-01

    There are only a few risk factors known for primary patency loss in patients with an arteriovenous graft or fistula. Furthermore, a limited number of studies have investigated the association between arteriovenous access modality and primary patency loss and mortality. The aim of this study was to

  3. Use of four-factor prothrombin complex concentrate for the mitigation of rivaroxaban-induced bleeding in an emergent coronary artery bypass graft.

    Science.gov (United States)

    Liu, Michael; Aguele, Cliff; Darr, Umer

    2017-05-01

    We presented the first case of four-factor prothrombin complex concentrate (4F-PCC) for the alleviation of bleeding for emergent on-pump coronary artery bypass graft (CABG) with the patient discharged by postoperative day (POD) 9 with no sequelae. Until direct antidotes are available, 4F-PCC may play a role in the management of mitigating rivaroxaban-induced bleeding in surgical procedure.

  4. Management of a patient with lupus anticoagulant and antiphospholipid syndrome for off-pump coronary artery bypass grafting using the Hepcon system.

    Science.gov (United States)

    Jervis, Karinne; Senthilnathan, Venkatachalam; Lerner, Adam B

    2009-04-01

    Patients with serum lupus anticoagulant antibodies (LAC) with or without antiphospholipid syndrome who present for cardiac surgery provide a unique set of challenges. Chief among these are the interference with anticoagulation monitoring by LAC. We present a case of such a patient who presented to us for coronary artery bypass grafting. We follow with a review of LAC and antiphospholipid syndrome and present a strategy for ensuring adequate anticoagulation during cardiac surgery in the background of previously published reports.

  5. 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....

  6. Cephalic pancreaticoduodenectomy with preservation of a right coronary artery bypass graft using the right gastro-epiploic artery: a case report.

    Science.gov (United States)

    Homsy, K; Paquay, J-L; Farghadani, H

    2018-02-20

    Pancreatic cancer is a rare disease with a high mortality rate, for which complete surgical resection, when possible, is the preferred therapeutic. Pancreaticoduodenectomy represents the surgical technique of choice. Abdominal surgeons can be faced with the challenge of patients with a history of coronary artery bypass graft in which the right gastro-epiploic artery is used. We report the case of a patient with an adenocarcinoma of the pancreatic head, stage IIA, having previously undergone a triple coronary artery bypass, one of which being a right gastro-epiploic graft. Our challenge was underlined by the necessity of a complete oncological resection through a cephalic pancreaticoduodenectomy while preserving the necessary cardiac perfusion via the right gastro-epiploic artery. We have been able to preserve a right gastro-epiploic artery as a coronary bypass during a cephalic pancreaticoduodenectomy for a cephalic pancreatic adenocarcinoma. We have successfully been able to preserve and re-implant the right gastro-epiploic artery to the origin of the gastroduodenal artery while insuring R0 resection of the tumor. A coronary artery bypass using the right gastro-epiploic artery should therefore not be considered as an obstacle to a Whipple's procedure if total oncological resection is obtainable.

  7. Cardiovascular risk profile before coronary artery bypass graft surgery in relation to depression and anxiety disorders: An age and sex propensity matched study.

    Science.gov (United States)

    Tully, Phillip J; Newland, Richard F; Baker, Robert A

    2015-02-01

    The cardiovascular risk profile and postoperative morbidity outcomes of anxiety disorder patients undergoing coronary artery bypass surgery is not known. In a cross-sectional design, 114 consecutive coronary artery bypass graft surgery patients were evaluated to create four matched groups (30 with anxiety disorder, 27 with depression disorder and 57 age-sex matched coronary artery bypass surgery control patients with no depression or anxiety disorder). By comparison to non-depression disorder age-sex matched controls, depressed patients presented for coronary artery bypass surgery with significantly greater myocardial inflammatory markers (Troponin T>02, 33.3% vs. 11.1%, p=.03), metabolic risk (body surface area>35 (22.2% vs. 0%, p=.03), comorbid cardiovascular risk (peripheral vascular disease 18.5% vs. 0%, p=.05). Depressed patients also recorded longer intraoperative time at higher temperatures >37°C on cardiopulmonary bypass (11.1 ± 9.0 vs. 6.0 ± 4.9, pPatients with anxiety disorder on the other hand presented with significantly higher Creatinine Kinase-Muscle Brain (5 IQR 4-5 ng/ml vs. 4 IQR 3-4 ng/ml, p=.04), higher intraoperative glucose levels (7.8 ± 2.5 mmol/l vs. 7.0 ± 1.2 mmol/l, p=.05), and received fewer grafts (2.1 ± .9 vs. 2.5 ± .9 p=.04). A differential cardiovascular risk profile and postoperative outcome was observed dependent on anxiety and depression disorder status. There were few modifiable cardiovascular risk factors at the time of surgery other than psychiatric status, perioperative management of depression and anxiety may have promise to reduce further cardiac morbidity after coronary artery bypass surgery. Copyright © 2014. Published by Elsevier Ltd.

  8. Large aneurysm in a nonbifurcating cervical carotid artery: an aneurysm associated with a rare anomaly treated with radial artery graft bypass: case report.

    Science.gov (United States)

    Tokugawa, Joji; Yoshida, Kensaku; Yamamoto, Munetaka; Kamiyama, Hiroyasu; Oishi, Hidenori; Arai, Hajime

    2011-03-01

    A nonbifurcating cervical carotid artery is an extremely rare type of carotid artery anomaly. We present a patient with a nonbifurcating cervical carotid artery and a large aneurysm of the cavernous internal carotid artery (ICA). The patient was successfully treated with combined microsurgical and endovascular techniques. We describe this case with reference to the relevant literature. A 66-year-old woman with progressive left external ocular movement dysfunction was found to have a large left cavernous ICA aneurysm. Serial magnetic resonance angiography revealed progressive growth of the lesion. In addition, conventional angiography showed a nonbifurcating cervical carotid artery and a persistent primitive trigeminal artery. The aneurysm was found unsuitable for direct surgery because of its size and location and for endovascular intervention because of extreme tortuosity of both carotid and right vertebral arteries. Surgery was performed in 2 stages. First, we performed an extracranial-intracranial high-flow bypass using radial artery graft, followed by proximal occlusion of the carotid artery. As the second stage, the patient underwent intravascular parent artery occlusion via the radial artery graft bypass to approach the intracranial carotid artery. The carotid artery was successfully coil embolized, and the aneurysm was undetectable on a postprocedure angiogram. Serial follow-up magnetic resonance imaging revealed thrombosis of the aneurysm. We report a rare case that involves the novel use of the radial artery graft bypass as an approach for parent vessel occlusion.

  9. A pilot study to assess the effects of a guided imagery audiotape intervention on psychological outcomes in patients undergoing coronary artery bypass graft surgery.

    Science.gov (United States)

    Stein, Traci R; Olivo, Erin L; Grand, Sandy Hermele; Namerow, Pearila B; Costa, Joseph; Oz, Mehmet C

    2010-01-01

    Depression and anxiety are associated with increased risk of postoperative cardiac events and death in patients who have undergone coronary artery bypass graft surgery. These risks persist even several months after the procedure. Guided imagery has been used with cardiac surgery patients for some time and with numerous anecdotal reports of considerable benefit. In addition, this therapy is low-cost and easy to implement, and the literature holds ample evidence for its efficacy in symptom reduction in various patient populations. It was thus hypothesized that preoperative use of guided imagery would reduce postoperative distress in patients undergoing coronary artery bypass graft. Fifty-six patients scheduled to undergo coronary artery bypass graft at Columbia University Medical Center were randomized into 3 groups: guided imagery, music therapy, and standard care control. Patients in the imagery and music groups listened to audiotapes preoperatively and intraoperatively. All patients completed psychological, complementary medicine therapies use, and other assessments preoperatively and at 1 week and 6 months postoperatively. Only preoperative distress was predictive of postoperative distress at follow-up. Use of complementary medicine therapies was high in all groups and this fact, in addition to the small sample size, may have accounted for the lack of significant relationship between imagery and postoperative distress. Regardless, this complementary and alternative medicine therapy remains palatable to patients. Given its efficacy in other patient populations, it is worth exploring its potential utility for this population with a larger sample.

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

    LENUS (Irish Health Repository)

    Halpenny, M

    2012-02-03

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

  11. Attitudes, subjective norm, perceived behavioral control, and intentions related to adult smoking cessation after coronary artery bypass graft surgery.

    Science.gov (United States)

    Bursey, M; Craig, D

    2000-01-01

    The purpose of this study was to examine the relationships between intention, attitudes, subjective norm, and perceived behavioral control related to smoking cessation in adults after initial coronary artery bypass graft surgery (CABG). The theoretical framework for the study was derived from Ajzen's Theory of Planned Behavior. Intention, the global and belief-based measures of attitude, subjective norm, and perceived behavioral control were measured with the Determinants of Adult Smoking Cessation (DOASC) Questionnaire developed by the investigator. Thirty-two adult smokers completed the questionnaire 2 to 3 weeks following hospital discharge. Four weeks after the questionnaire completion, a follow-up telephone call was used to determine the participants' current smoking status. The study results indicated that there was a statistically significant relationship between the intention to quit smoking after CABG and the global measure of attitude, and perceived behavioral control. This study highlights some of the beliefs about the outcomes of quitting smoking permanently after CABG which may underlie attitudes, subjective norm, and perceived behavioral control in this population. Implications for theory, practice, and research are discussed.

  12. High resolution heart rate variability analysis in patients with angina pectoris during coronary artery bypass graft surgery

    Science.gov (United States)

    Mironov, V. A.; Mironova, T. F.; Kuvatov, V. A.; Nokhrina, O. Yu.; Kuvatova, E. V.

    2017-12-01

    The purpose of the study is approbation of the capabilities of high-resolution rhythmocardiography (RCG) for the determination of the actual cardiovascular status of operated patients with angina pectoris during coronary artery bypass graft surgery (CABGS) for myocardial revascularization. The research was done by means of a KAP-RK-02-Mikor hardware-software complex with a monitor record and the time- and frequency-domain analyses of heart rate variability (HRV). Monitor records were made at each stage of CABGS in 123 patients. As a result, HRV manifested itself as a fairly adequate and promising method for the determination of the cardiovascular status during CABGS. In addition, the data of the HRV study during CABGS testify to the capability of RCG to determine the high risk of life-threatening cardioarrhythmias before and during operation, to different changes in sinoatrial heart node (SN) dysregulation, and contain the HRV symptoms of a high death risk before, during and after shunting. The loss of the peripheral autonomic sympathetic and parasympathetic control in SN in the form of the autonomic cardioneuropathy syndrome is a predictor of the complications related to CABGS. The obtained data on RCG monitoring of HRV recording are suggestive of wide prospects of the high-resolution RCG method to be used in cardiac surgery as a whole. The actual multivariant dysregulations of SN pacemaker activity testify to its adequacy to the pathophysiology of each period of the cardiac operation, according to the initial ischemic damages and localization of cardiosurgical manipulations during CABGS.

  13. Beta-thromboglobulin as a marker of perioperative myocardial infarction in patients undergoing coronary artery bypass grafting following aspirin discontinuation.

    Science.gov (United States)

    Plicner, Dariusz; Ziętkiewicz, Mirosław; Mazur, Piotr; Stąpor, Renata; Sadowski, Jerzy; Undas, Anetta

    2014-01-01

    Perioperative myocardial infarction (PMI) following coronary artery bypass grafting (CABG) is associated with significant morbidity and mortality. The aim of this study was to assess platelet activation and oxidative stress in the setting of PMI in patients undergoing CABG. We studied 108 consecutive patients who stopped taking low-dose aspirin 7-10 days prior to elective isolated on- or off-pump CABG. β-thromboglobulin (β-TG), thromboxane B2 (TXB2) and 8-iso-prostaglandin F2α (8-iso-PGF2α), a marker of oxidative stress, were measured at the baseline and 5-7 days postoperatively. Aspirin (150 mg/d) was administered every morning since 12 hours after CABG. Mean baseline β-TG was 58.5 ± 10.3 IU/ml, TXB2 was 143.6 ± 28.5 ng/ml and 8-iso-PGF2α was 355.2 ± 40.7 pg/ml. Postoperatively, after administration of 4-6 doses of aspirin, β-TG increased by 16.7% and 8-iso-PGF2α increased by 17.2% 5-7 days after surgery (p = 0.005 and p aspirin till the day of CABG, contribute to the occurrence of PMI in early postoperative period.

  14. Relationship between Angiotensin Converting Enzyme, Apelin, and New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Shu Xu

    2017-01-01

    Full Text Available It has been shown that inflammation and oxidative stress are important factors in postoperative atrial fibrillation (POAF. Angiotensin converting enzyme (ACE and apelin have a close relationship with inflammation and oxidative stress. The effect of ACE and apelin on POAF after off-pump coronary artery bypass grafting (OPCABG remains a question. The concentrations of serum ACE, angiotensin II (Ang II, apelin, bradykinin (BK, malondialdehyde (MDA, and C reactive protein (CRP were measured in the perioperative period of OPCABG. The levels of serum ACE in the POAF group were higher than in the no POAF group both preoperatively and postoperatively. Apelin in the POAF group was lower than in the no POAF group. There was a correlation between serum ACE and apelin. Postoperatively, CRP and MDA in the POAF group were higher than in the no POAF group; however, there was no difference before the operation. Preoperative ACE and apelin were both significant and independent risk factors for POAF. In conclusion, the high ACE and low apelin preoperatively led to CRP and MDA being increased postoperatively, which was probably associated with POAF after OPCABG. Apelin may be a new predictor for POAF.

  15. Can preoperative erythrocyte sedimentation rate serve as an indicator for midterm adverse events after coronary bypass grafting?

    Science.gov (United States)

    Togan, Turhan; Günday, Murat; Çiftçi, Özgür; Bingol, Hakan

    2015-04-28

    Erythrocyte sedimentation rate (ESR) may serve as a reasonably good indicator for coronary heart disease as usually ESR is elevated in these patients. The measurement of ESR is a very simple and cheap laboratory test that can be performed in routine blood examinations. In this study, we investigated the association between preoperative erythrocyte sedimentation rate and postoperative midterm adverse events after coronary artery bypass grafting (CABG). In the study, only male patients were included. The patients were divided into two groups: group 1 (preoperative sedimentation rate [<20 mm/h] normal [n = 232, 63.9%]) and group 2 (preoperative sedimentation rate [>20 mm/h] above normal [n = 131, 36.1%]). The hemogram and biochemistry panel values were measured one day before operation, on the postoperative first day, on the postoperative seventh day, and on the postoperative third month. Among the laboratory values, there was a statistically significant difference between the two groups with respect to postoperative first-day ESR and postoperative third-month high-sensitivity C-reactive protein (P < .05). In terms of postoperative morbidity, there was also a statistically significant difference (P < .05) between the two groups with regard to pleural effusion, infection of the soft tissue over the sternum, pulmonary infection, return to the intensive care unit, rehospitalization, and mortality. Elevated preoperative sedimentation rate is associated with postoperative adverse events in patients who undergo CABG. For this purpose, we suggest that patients with higher sedimentation rates undergo detailed examination to prevent mortality and morbidity.

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

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    MA Babaee Beigi

    2009-12-01

    Full Text Available Background: Ischemic left ventricular (LV dysfunction is one of the major causes of LV dyssynchrony. This is indicative of poor prognosis in patients with LV dysfunction and correction of ischemia by Coronary Artery Bypass Grafting (CABG may resynchronize LV contraction. The aim of this study was to evaluate the effect of CABG on LV dyssynchrony, systolic and diastolic function.Patients: The present study comprised 31 patients with ischemic LV dysfunction with Ejection Fraction (EF:25- 50%. Echocardiography with Tissue Doppler Imaging (TDI was performed to assess LV dyssynchrony (calculated by basal LV segment,to evaluate diastolic function by measurement of peak early diastolic mitral annular velocity (Em ,systolic function by measurement of peak early systolic mitral annular velocity (Sm and Ejection Fraction (EF by Simpson method.Results: Mean LV dyssychrony before CABG was 30±16 ms that decreased to 22±14 ms after operation (P=0.04.There was also improved diastolic and systolic function after CABG ( Em 0.04m/s versus 0.05 m/s , P=0.01 and Sm 0.06 m/s versus 0.08 m/s P=0.01.The mean ejection fraction rose from 40±8.6% to 42±8.2% (P=0.01.Conclusion: CABG is associated with improvement of LV dyssynchrony, systolic and diastolic function in patients with ischemic LV dysfunction.

  17. Long-term survival following coronary artery bypass grafting: off-pump versus on-pump strategies.

    Science.gov (United States)

    Kim, Joon Bum; Yun, Sung-Cheol; Lim, Jae Wong; Hwang, Soo Kyung; Jung, Sung-Ho; Song, Hyun; Chung, Cheol Hyun; Lee, Jae Won; Choo, Suk Jung

    2014-06-03

    This study sought to compare long-term survival after off- and on-pump coronary artery bypass grafting (CABG). Although several large-scale clinical trials have compared the surgical outcomes between off- and on-pump CABG, the long-term survival has not been compared between the 2 surgical strategies in a reasonably sized cohort. We evaluated long-term survival data in 5,203 patients (age 62.9 ± 9.1 years, 1,340 females) who underwent elective isolated CABG (off-pump: n = 2,333; on-pump: n = 2,870) from 1989 through 2012. Vital statuses were validated using the Korean National Registry of Vital Statistics. Long-term survival was compared with the use of propensity scores and inverse probability weighting to adjust selection bias. Patients undergoing on-pump CABG had a higher number of distal anastomoses than those undergoing off-pump CABG (3.7 ± 1.2 vs. 3.0 ± 1.1; p compared with those undergoing on-pump CABG. In subgroup analyses, on-pump CABG conferred survival benefits in most demographic, clinical, and anatomic subgroups compared with off-pump CABG. In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Factors associated with sexual quality of life in patients before and after coronary artery bypass grafting surgery.

    Science.gov (United States)

    Lai, Yi-Hung; Hsieh, Shih-Rong; Ho, Wen-Chao; Chiou, Ai-Fu

    2011-01-01

    Successful rehabilitation of patients after coronary artery bypass grafting (CABG) should include psychosocial outcomes such as sexual activity. However, little has been reported regarding the sexual quality of life of patients after CABG. This study aimed to investigate the associations of demographic and disease characteristics, psychosocial factors, and sexual quality of life in patients before and after CABG surgery. A longitudinal, descriptive design was used. A convenient sample of 70 patients with a diagnosis of coronary artery disease and under preparation for CABG surgery was recruited from the cardiovascular units of a medical center in central Taiwan. Participants were interviewed and completed a structured questionnaire before and 3 months after CABG surgery. Instruments used included EuroSCORE (European System for Cardiac Operative Risk Evaluation), Sexual Knowledge Scale, Spouse Communication Scale, Hospital Anxiety and Depression Scale, Perceived health status, and Sexual Quality of Life Scale. Sexual desire and sexual response of patients were significantly limited after CABG. Before surgery, age, disease duration, and spouse communication were all significant predictors, which explained 33.8% of the variance in the sexual quality-of-life scores. Significant predictors after surgery included sexual knowledge, disease duration, and EuroSCORE, which accounted for 25.6% of the variance of sexual quality of life. This study confirms that CABG surgery may have an impact on patients' sexual quality of life. With the numbers of CABG patients increasing, development of appropriate sexual counseling for cardiac patients is necessary to improve their sexual quality of life.

  19. Cardioprotective effects of glucose and insulin administration while maintaining normoglycemia (GIN therapy) in patients undergoing coronary artery bypass grafting.

    Science.gov (United States)

    Carvalho, George; Pelletier, Patricia; Albacker, Turki; Lachapelle, Kevin; Joanisse, Denis R; Hatzakorzian, Roupen; Lattermann, Ralph; Sato, Hiroaki; Marette, André; Schricker, Thomas

    2011-05-01

    Coronary artery bypass grafting (CABG) is complicated by ischemia-reperfusion injury jeopardizing myocyte survival. The aim of the study was to investigate whether glucose and insulin administration, while maintaining normoglycemia (GIN therapy) using a hyperinsulinemic-normoglycemic clamp technique, is cardioprotective in patients undergoing CABG. We conducted a randomized controlled trial at a tertiary care university teaching hospital. We studied 99 patients undergoing elective CABG. Patients were randomly assigned to receive either GIN from the beginning of surgery until 24 h after CABG (GIN, n = 49) or standard metabolic care (control, n = 50). We measured plasma concentrations of cardiac troponin I and free fatty acids, cardiac function as assessed by transesophageal echocardiography, glycogen content, glycogen synthase activity, and the expression of AMP-activated protein kinase (AMPK) and protein kinase B (AKT) in cardiomyocytes. Patients receiving GIN therapy showed an attenuated release of cardiac troponin I (P GIN group, whereas it increased in the control group (P GIN. However, there was no evidence for AKT-dependent AMPK inhibition. GIN therapy protects the myocardium and inhibits ischemia-induced AMPK activation.

  20. Evaluating the Effect of Cardiac Rehabilitation Care Plan on Quality of Life of Patients Undergoing Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Seyedeh Zahra Masoumi

    2017-05-01

    Full Text Available Introduction: Cardiovascular surgeries are among the conventional surgeries aimed at increasing the survival rate and improving the quality of life of patients. This study aimed to evaluate the effect of cardiac rehabilitation on quality of life of patients undergoing Coronary artery bypass graft (CABG surgery.Methods: This was a semi-experimental study performed on 160 patients undergoing CABG surgery. The rehabilitation program was carried out for 13 weeks (three sessions per week in 40 sessions, six weeks after the CABG surgery. The MacNew standard questionnaire and the general health questionnaire (S-f 36 were completed before the beginning of rehabilitation sessions as well as after completion of these sessions by patients.Results: According to the results, the quality of life of patients significantly increased in the physical and emotional areas after the rehabilitation program. The results also indicated that there was a significant difference between various levels of research in the physical functioning variables, dysfunction due to physical health, dysfunction due to emotional health, energy/fatigue of individuals, emotional well-being, social functioning, pain, and general health.Conclusions: The present results indicated the improved quality of life of patients in all the areas after cardiac rehabilitation intervention, compared to before that. Therefore, paying more attention to cardiac rehabilitation is necessary due to its positive effects on increasing the quality of life of patients.

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

    Science.gov (United States)

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

    2015-12-01

    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. This study aimed to investigate the effect of music therapy on anxiety and cardiovascular indices in patients undergoing CABG. 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. 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). 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.

  2. Combined coronary artery bypass grafting and open abdominal aortic aneurysm repair is a reasonable treatment approach: a systematic review.

    Science.gov (United States)

    Spanos, Konstantinos; Saleptsis, Vasileios; Karathanos, Christos; Rousas, Nikolaos; Athanasoulas, Athanasios; Giannoukas, Athanasios D

    2014-08-01

    We reviewed the literature for studies investigating the outcomes of combined 1-stage coronary artery bypass grafting (CABG) and abdominal aortic aneurysm (AAA) open repair (OR) procedures. An electronic search of the English literature was conducted using the PubMed, EMBASE, and Cochrane databases. Age, coronary heart disease severity, AAA size, mean duration from CABG to AAA OR procedures, details of each procedure, mortality, and morbidity rates were analyzed. Between 1994 and 2012, 12 studies (256 patients) with 1-stage treatment fulfilled the inclusion criteria and were analyzed. There were 20 early (30 days) deaths, accounting for a 30-day mortality rate of 7.8%. The early morbidity was 53% (136 of 256). One-stage treatment when necessary can be undertaken with acceptable mortality and reasonable morbidity rates considering the complexity of both the operations. Nowadays, endovascular AAA repair is preferred over OR. The outcomes of combined cardiac surgery and endovascular AAA repair have not been extensively evaluated. © The Author(s) 2013.

  3. The Predictive Value of Integrated Pulmonary Index after Off-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study

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    Evgenia V. Fot

    2017-08-01

    Full Text Available BackgroundThe early warning scores may increase the safety of perioperative period. The objective of this study was to assess the diagnostic and predictive role of Integrated Pulmonary Index (IPI after off-pump coronary artery bypass grafting (OPCAB.Materials and MethodsForty adult patients undergoing elective OPCAB were enrolled into a single-center prospective observational study. We assessed respiratory function using IPI that includes oxygen saturation, end-tidal CO2, respiratory rate, and pulse rate. In addition, we evaluated blood gas analyses and hemodynamics, including ECG, invasive arterial pressure, and cardiac index. The measurements were performed after transfer to the intensive care unit, after spontaneous breathing trial and at 2, 6, 12, and 18 h after extubation.Results and DiscussionThe value of IPI registered during respiratory support correlated weakly with cardiac index (rho = 0.4; p = 0.04 and ScvO2 (rho = 0.4, p = 0.02. After extubation, IPI values decreased significantly, achieving a minimum by 18 h. The IPI value ≤9 at 6 h after extubation was a predictor of complicated early postoperative period (AUC = 0.71; p = 0.04 observed in 13 patients.ConclusionIn off-pump coronary surgery, the IPI decreases significantly after tracheal extubation and may predict postoperative complications.

  4. Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery Outcomes During 6 Years: A Prospective Cohort Study.

    Science.gov (United States)

    Amouzeshi, Ahmad; Amouzeshi, Zahra; Abbasi Teshnizi, Mohammad; Moeinipour, Ali Asghar; Hosseinzadeh Maleki, Mahmood

    2017-09-01

    Given the ongoing controversy over the risks and benefits of on-pump versus off-pump coronary artery bypass graft surgery (CABG), we aimed to compare time trends in off- and on-pump CABG long-term outcomes. In this prospective cohort study, the patients who underwent primary isolated non-emergent CABG in Imam Reza Hospital in Mashhad, Iran, in 2006 were followed for 6 years. The patients were contacted to obtain long-term follow-up data such as death, rehospitalization, myocardial infarction, and normal physical activity. The obtained data were analyzed in SPSS software (V: 16) using t-test, Fisher's Exact, chi-square, and Mann-Whitney tests, and relative risk. The significant level was set at Ppump CABG. The mean age of the patients was 59.0±11.31 years, and n=43 (70.5%) were men. No significant differences were found between the two groups in terms of outcomes during the 6 years (e.g., death, rehospitalization, myocardial infarction, and normal physical activity). There was 1 (5.0%) death, overall. Risk-adjusted death did not differ significantly between the off-pump and on-pump groups during the 6 years (RR, 0.952; 95% CI 0.866 to 1.048).According to the results, the outcomes were similar between off-pump and on-pump CABG in patients who underwent primary isolated non-emergent CABG during the 6-year follow-up phase.

  5. In the queue for coronary artery bypass grafting: patients' perceptions of risk and 'maximal acceptable waiting time'.

    Science.gov (United States)

    Llewellyn-Thomas, H; Thiel, E; Paterson, M; Naylor, D

    1999-04-01

    To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting. Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement. Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, > or = 1.45%) or 6 (upper quartile, > or = 10%) months. However, MAWT scores were related only to expected waiting time (r = 0.47; P queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred.

  6. Is totally endoscopic coronary artery bypass safe, feasible and effective?

    Science.gov (United States)

    Acharya, Metesh Nalin; Ashrafian, Hutan; Athanasiou, Thanos; Casula, Roberto

    2012-12-01

    A best evidence topic was written according to a structured protocol. The question addressed was whether totally endoscopic coronary artery bypass (TECAB) is safe, effective and feasible. A total of 171 papers were found, of which eight represented the best evidence. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The da Vinci robotic system was utilized in seven retrospective studies and one multicentre prospective trial, comprising 724 patients undergoing TECAB. Patient-related outcomes, including the incidence of major adverse cardiac events, graft patency and survival, were investigated. From the studies evaluated, TECAB appears to be safe operation with low complication rates and excellent early- and mid-term graft patencies. The incidence of internal thoracic artery injury was documented in four studies and ranged from 0 to 10%. Re-exploration for bleeding was necessary in 1-15% of patients. Conversion to open techniques was performed in 0-24% of cases. There was no in-hospital mortality in the majority of studies, but this reached 2.1% in a large series of 228 patients. Target-vessel reintervention rates varied between 0 and 12.1% according to the institutional experience. Pre- and post-discharge graft patencies were excellent at 93-100 and 92-100%, respectively. Intraoperative variables, such as time taken for internal thoracic artery harvest, anastomosis, cross-clamp, cardiopulmonary bypass (CPB) and the overall operation were as follows: internal thoracic artery harvest time (range 5-187 min), anastomosis time (range 6-82 min), cross-clamp time (range 30-223 min), CPB time (range 41-268 min) and operative time (range 84-600 min). TECAB is a technically demanding and time-consuming procedure associated with a significant learning curve. Proctoring and structured training programmes are currently supported by European and international societies to encourage wider uptake of the procedure. In conclusion

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

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    Schmidt Thomas

    2009-07-01

    Full Text Available Abstract 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 that are evaluated by independent committees that are blinded with respect to the result of the randomisation. End points include mortality, stroke, myocardial infarction, graft patency, quality of life, and cost-effectiveness. The trial is performed in four different Danish, cardiac surgery centres. Trial registration ClinicalTrials.gov NCT00123981

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

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    Nahid Nazari

    Full Text Available Background: The most common method for improving the quality of life especially in chronic heart disease is rehabilitation. For increasing the level of knowledge about effect of rehabilitation and its' impression on improving the quality of life in patients. This study evaluates effect of one month cardiac rehabilitation on lower limb strength and the static and dynamic balance of CABG patients. Materials and Methods: This study is based on clinical trial before and after rehabilitation. the exercise protocol lasted for one month, three times per week, each session lasting 1 hour, on 30 male patients in two groups in control (N=15 and experimental group (N=15 after CABG in the centre of rehabilitation in Javad-Alaeme Heart Hospital, Mashhad. The strength of lower limb by chair standing test, the static balance by standing on one leg and dynamic balance by time up and go (TUG test, was evaluated before and after 1 month rehabilitation in training group and detraining in control group. Data were analyzed with SPSS-16 and used t-test analysis (p≤0.05.Results: The strength of lower limb (p=0.001, static balance (p=0.023 and dynamic balance (p=0.037 increased significantly after one month of cardiac rehabilitation.Conclusion: The result of this study indicates that cardiac rehabilitation after coronary artery bypass surgery causes significant increase in strength of lower limb and balance in patients, the more muscle strength is associated with an increase in ability of performing daily activities and so it causes improved quality of life.

  9. 56. Endoscopic vein graft harvest for coronary artery bypass surgery: Single center experience in Saudi Arabia

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    M. Algadheeb

    2016-07-01

    Full Text Available Open saphenous vein technique is the standard of care in patients undergoing coronary artery surgery (CABG worldwide and in Saudi Arabia. Endoscopic vein harvest (EVH is an innovative technique that have been recommended by the international society of minimally invasive surgery. Our aim in the current study is to review our preliminary data about endoscopic vein harvest. Would endoscopic vein harvest decrease the incidence of leg wound infections? This is a retrospective study of a single tertiary care center of 94 consecutive patients who underwent CABG with EVH. Preoperative associated risk factors were assessed. Postoperative follow up includes leg wound infection and patient satisfaction with EVH by using a telephone and/or a paper questionnaire. We had 94 consecutive patients who underwent CABG with EVH between October 2014 and October 2015, mean age was 56.7 (33–77 years, 91.5% were male, mean euro score II was 2.47%. The most common presentation was NSTEMI (39.4% followed by STEMI (26.6%, unstable angina (11.7% and stable angina (5.3%. Our cohort had the following characteristics: 85.1% were diabetic, 84% were hypertensive, 46.8% had dyslipidemia, 2.1% had CVA, 7.4% had Carotid artery disease, 2.1% had Congestive heart failure, 4.3% had any renal disease and 4.3% had previous PCI. Most of our patients received 3 grafts (44.7% followed by 4 grafts (42.6% of which only one leg was used for EVH (94.1%. Leg wound infection occurred in one patient only and in this case EVH was converted to open technique. A written and/or telephone questionnaire resulted in a high patient-satisfaction with the cosmetic outcome of EVH as well as very low grade of leg wound pain. EVH is a very promising innovative technique in patient undergoing CABG. Our patients were highly satisfied with their leg wound cosmetic outcome. In this single center experience, in Saudi Arabia, EVH is a promising innovative technique for saphenous vein harvest. It is highly

  10. Results of Protocol-based Perioperative Management in Off-Pump Coronary Artery Bypass Grafting for Patients with Non-dialysis-dependent Chronic Kidney Disease

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    Jeong-Won Kim

    2016-12-01

    Full Text Available Background: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD. To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD. Methods: From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group, and 35 patients had CKD (CKD group. Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group. Results: The risk of acute kidney injury was about ×3 higher in the CKD group than in the normal group (p=0.01. Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases. Conclusion: Off-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.

  11. 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...

  12. Effects of allopurinol and vitamin E on renal function in patients with cardiac coronary artery bypass grafts

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    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. Inhibition of vasoconstriction by AJ-2615, a novel calcium antagonist with α1-adrenergic receptor blocking activity in human conduit arteries used as bypass grafts

    Science.gov (United States)

    Liu, Ming-Hui; Floten, Storm H; Yang, Qin; He, Guo-Wei

    2001-01-01

    Aims Graft spasm may develop during coronary artery bypass grafting and reversal of spasm is still challenging. The purpose of this study was to investigate the in vitro vascular relaxant properties of AJ-2615 in human internal mammary artery (IMA). Methods We studied 264 IMA rings taken from 65 patients undergoing coronary artery bypass grafting surgery with organ bath technique. The interaction between AJ-2615 and various vasoconstrictors was investigated in two ways. Results AJ-2615 caused complete relaxation in methoxamine-contracted IMA rings (100.0±0.0%; n = 8) and nearly full relaxation in potassium chloride-contracted IMA rings (91.4±5.7%; n = 8) or noradrenaline-contracted IMA rings (89.3±2.8%; n = 8). AJ-2615 also induced remarkable relaxation in IMA rings contracted by other vasoconstrictors. In comparison with the α1-adrenoceptor antagonist prazosin, AJ 2615 showed similar maximal relaxation in IMA rings contracted by methoxamine or norepinephrine. On the other hand, incubation with AJ-2615 (0.1–1 µm) significantly inhibited all the vasoconstrictor-mediated vasoconstriction except endothelin-1 in a concentration-dependent manner. Conclusions The results suggested that in human IMA, AJ-2615 has an inhibitory effect on vasoconstriction mediated by a variety of vasoconstrictors and the mechanism of relaxation may be related to its calcium antagonism and α1-adrenergic receptor blocking activity. AJ-2615 may have important clinical implications for patients undergoing coronary artery bypass surgery for reversing and preventing graft spasm. PMID:11560560

  14. Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A Randomized, Placebo-Controlled Trial.

    Science.gov (United States)

    da Silva Guimarães, Sheila; de Souza Cruz, Wanise; da Silva, Licinio; Maciel, Gabrielle; Huguenin, Ana Beatriz; de Carvalho, Monicque; Costa, Bárbara; da Silva, Geisiane; da Costa, Carlos; D'Ippolito, João Alvaro; Colafranceschi, Alexandre; Scalco, Fernanda; Boaventura, Gilson

    2017-01-01

    During cardiac failure, cardiomyocytes have difficulty in using the substrates to produce energy. L-carnitine is a necessary nutrient for the transport of fatty acids that are required for generating energy. Coronary artery graft surgery reduces the plasma levels of L-carnitine and increases the oxidative stress. This study demonstrates the effect of L-carnitine supplementation on the reverse remodeling of patients undergoing coronary artery bypass graft. Patients with ischemic heart failure who underwent coronary graft surgery were randomized to group A - supplemented with L-carnitine or group B controls. Left ventricular ejection fraction, left ventricular systolic and diastolic diameters were assessed preoperatively, 60 and 180 days after surgery. Our study included 28 patients (26 [93.0%] males) with a mean age ± SD of 58.1 ± 10.5 years. The parameters for the evaluation of reverse remodeling did not improve after 60 and 180 days of coronary artery bypass grafting in comparison between groups (p > 0.05). Evaluation within the L-carnitine group showed a 37.1% increase in left ventricle ejection fraction (p = 0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and diastolic diameters, respectively. L-carnitine supplementation at a dose of 50 mg/kg combined with artery bypass surgery did not demonstrate any additional benefit in reverse remodeling. However, evaluation within the L-carnitine group may indicate a clinical benefit of L-carnitine supplementation. © 2017 S. Karger AG, Basel.

  15. Results of Infrageniculate Bypasses Using the Profunda Femoris Artery as Inflow Source.

    Science.gov (United States)

    Illuminati, Giulio; Calio', Francesco G; Pizzardi, Giulia; Pasqua, Rocco; Masci, Federica; Frezzotti, Francesca; Palumbo, Piergaspare; Vietri, Francesco

    2017-09-22

    When the common femoral artery is not accessible for infrainguinal bypass grafting, the profunda femoris artery (PFA) can be a valuable alternative inflow source for distal arterial revascularization. The purpose of this retrospective study was to evaluate the results of infrageniculate bypass grafting via the PFA as inflow source for critical limb ischemia. Between 1994 and 2016, 68 patients, 51 men of a mean age of 74 years, underwent an infrageniculate arterial bypass grafting for critical limb ischemia, using the PFA as inflow site. PFA was exposed at the Scarpa's triangle in 38 patients (56%) and at its medio-crural segment in 30 patients (44%). The distal anastomosis was performed on the infragenicular popliteal artery in 33 patients (48%), the peroneal artery in 14 patients (20%), the tibioperoneal trunk in 8 patients (12%), the posterior tibial artery in 8 patients (12%), and the dorsalis pedis artery in 5 patients (8%). The graft material consisted of a reversed great saphenous vein (GSV) in 62 patients (91%) and a 6-mm polytetrafluoroethylene graft in 6 patients (9%). The median duration of follow-up was 51 months (range, 6-72 months). As main results, postoperative mortality and morbidity, overall late patients' survival, primary grafts' patency, and limb salvage rate were considered. Operative mortality and morbidity were 3% and 4%, respectively. Overall patients' survival, primary patency and limb salvage rate, at 36 and 60 months were, respectively, 62% and 53%, 66% and 59%, and 92% and 77%. The PFA, both exposed at the Scarpa's triangle and at mid-thigh, is an excellent inflow source for infrageniculate revascularizations. It should remain an important part of the technical armamentarium of vascular surgeons, even in the endovascular era. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Comparison of Two Central Venous Pressure Control Strategies to Prevent Atrial Fibrillation After Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Costa, Mario Augusto Cray da; Lirani, Wesley; Wippich, Ana Caroline; Lopes, Luana; Tolentino, Eduardo de Souza; Zampar, Beatriz; Schafranski, Marcelo Derbli

    2017-04-01

    Atrial fibrillation (AF) takes place in 10-40% of patients undergoing coronary artery bypass grafting (CABG), and increases cardiovascular mortality. Enlargement of atrial chambers is associated with increased AF incidence, so patients with higher central venous pressure (CVP) are expected to have larger atrial distension, which increases AF incidence. To compare post-CABG AF incidence, following two CVP control strategies. Interventional, randomized, controlled clinical study. The sample comprised 140 patients undergoing CABG between 2011 and 2015. They were randomized into two groups, G15 and G20, with CVP maintained ≤ 15 cmH2O and ≤ 20 cmH2O, respectively. 70 patients were included in each group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with absolute risk reduction of 14.28%, and number needed to treat (NNT) of 7 (p = 0.03). Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07), hospital length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36), number of grafts (median: G15 = 3, G2 = 2; p = 0.22) and cardiopulmonary bypass use (G15 = 67.10%; G20 = 55.70%; p = 0.22) were statistically similar. Age (p = 0.04) and hospital length of stay (p = 0.001) were significantly higher in patients who developed AF in both groups. Keeping CVP low in the first 72 post-CABG hours reduces the relative risk of AF, and may be useful to prevent AF after CABG. A fibrilação atrial (FA) ocorre em 10-40% dos pacientes submetidos a cirurgia de revascularização miocárdica (RM), e eleva a mortalidade cardiovascular. Como o aumento dos átrios está associado ao aumento da incidência de FA, espera-se que pacientes com pressão venosa central (PVC) mais alta tenham maior distensão atrial, o que eleva a incidência dessa arritmia. Comparar a incidência de FA em pós-operatório de RM, seguindo duas estratégias de controle de PVC. Estudo clínico randomizado controlado intervencionista. A amostra foi composta por 140 pacientes submetidos a RM entre 2011 e 2015. Os

  17. The proliferative cytokines TGF-β and VEGF in pleural effusions post-coronary artery bypass graft

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    António MS Chibante

    2006-07-01

    Full Text Available Coronary artery bypass graft (CABG surgeries can impact on the pericardium and pleural space, leading to inflammation which can cause effusion. Aim: To study the role of the proliferative cytokines TGF-β and VEGF in the fluids of 16 transudates and 43 pleural effusions of patients who underwent CABG at the Heart Unit and Pulmonology Unit of the University Hospital of São Paulo. Levels of cytokines were assessed 2, 24 and 48 hours post-surgery. Results: The pleural effusion after CABG is an exsudative mobilizer of TGF-β and VEGF cytokines immediately after surgery. The TGF-β concentrations were elevated 2 hours after surgery but started to fall soon after, reaching transudate levels after 48 hours. VEGF levels were high in the first 2 hours post surgery and tended to maintain the same concentrations for at least 48 hours after surgery. Conclusions: Based on the results obtained, TGF-β is a cytokine that seems to work as a trigger, leading the pleural mesothelial cell to express VEGF a cause of pleural effusion in CABG surgeries. Resumo: A cirurgia de revascularização do miocárdio envolve o acometimento, tanto do pericárdio como da pleura, conduzindo ao favorecimento de processos inflamatórios responsáveis pelo desenvolvimento de derrames nestes compartimentos. Objectivo: Estudar o comportamento das citocinas proliferativas TGF-β (factor beta de transformação do crescimento e VEGF (factor de crescimento do endotélio vascular nos líquidos de 16 transudatos e de 43 derrames pleurais de doentes submetidos a cirurgias de revascularização do miocárdio provenientes do Instituto de Coração e do Serviço de Pneumologia da Universidade do São Paulo nos intervalos de 2, 24 e 48 horas de pós-operatório. Resultados: O derrame pleural pós-revascularização do miocárdio é um exsudato mobilizador de TGF-β e VEGF no pós-operatório imediato. Os níveis de TGF

  18. A systematic review of outcomes in patients with staged carotid artery stenting and coronary artery bypass graft surgery.

    Science.gov (United States)

    Guzman, Luis A; Costa, Marco A; Angiolillo, Dominick J; Zenni, Martin; Wludyka, Peter; Silliman, Scott; Bass, Theodore A

    2008-02-01

    Although current guidelines state that carotid endarterectomy is probably recommended before or concomitant to coronary artery bypass grafting (CABG) in patients with carotid stenosis, significant controversies to this recommendation still persist. Carotid artery stenting has been recently introduced as an alternative revascularization modality in high-risk patients. The aim of this study was to define, based on the published information, if carotid artery stenting is beneficial in this setting. A search of MEDLINE and a manual search of the literature from selected articles were performed. A total of 6 studies with 277 patients reporting carotid stenting followed by staged CABG were available for this clinical outcome analysis. All were retrospective and single-center studies. The mean age was 69 years; 78% were males. Asymptomatic carotid stenosis was present in 76% of patients. The mean time to CABG was 32 days. The incidence of stroke and death associated with the stent procedure was 4.7%. Only 6 patients (2.2%) developed stroke associated with CABG. The overall combined 30-day event rate after CABG, including all events during carotid artery stenting, were as follows: minor stroke, 2.9%; major stroke, 3.2%; mortality, 7.6%; and combined death and any stroke, 12.3%. In this pooled analysis, the combined incidence of death and stroke in patients undergoing carotid artery stenting and staged CABG remains elevated. These results confirm that the presence of carotid stenosis is per se a marker of risk that might persists independent of its treatment. A systematic or randomized evaluation appears warranted.

  19. Effects of aggressive versus moderate glycemic control on clinical outcomes in diabetic coronary artery bypass graft patients.

    Science.gov (United States)

    Lazar, Harold L; McDonnell, Marie M; Chipkin, Stuart; Fitzgerald, Carmel; Bliss, Caleb; Cabral, Howard

    2011-09-01

    This study sought to determine whether aggressive glycemic control (90-120 mg/dL) would result in more optimal clinical outcomes and less morbidity than moderate glycemic control (120-180 mg/dL) in diabetic patients undergoing coronary artery bypass graft (CABG) surgery. Maintaining serum glucose levels between 120 and 180 mg/dL with continuous insulin infusions decreases morbidity in diabetic patients undergoing CABG surgery. Studies in surgical patients requiring prolonged ventilation suggest that aggressive glycemic control (diabetic CABG patients is unknown. Eighty-two diabetic patients undergoing CABG were prospectively randomized to aggressive glycemic control (90-120 mg/dL) or moderate glycemic control (120-180 mg/dL) using continuous intravenous insulin solutions (100 units regular insulin in 100 mL: normal saline) beginning at the induction of anesthesia and continuing for 18 hours after CABG. Primary end points were the incidence of major adverse events (major adverse events = 30-day mortality, myocardial infarction, neurologic events, deep sternal infections, and atrial fibrillation), the level of serum glucose, and the incidence of hypoglycemic events. There were no differences in the incidence of major adverse events between the groups (17 moderate vs 15 aggressive; P = 0.91). Patients with aggressive control had a lower mean glucose at the end of 18 hours of insulin infusion (135 ± 12 mg/dL moderate vs 103 ± 17 mg/dL aggressive; P control had a higher incidence of hypoglycemic events (4 vs 30; P diabetic patients undergoing CABG surgery, aggressive glycemic control increases the incidence of hypoglycemic events and does not result in any significant improvement in clinical outcomes that can be achieved with moderate control. Clinical Trials.gov (ID #NCT00460499).

  20. Thromboelastograph with Platelet Mapping(TM) predicts postoperative chest tube drainage in patients undergoing coronary artery bypass grafting.

    Science.gov (United States)

    Chowdhury, Mohsin; Shore-Lesserson, Linda; Mais, Alec M; Leyvi, Galina

    2014-04-01

    The goal of this study was to evaluate the ability of Thromboelastograph with Platelet Mapping (TEG-PM(TM)) to predict postoperative bleeding tendency in patients with a history of recent anti-platelet therapy undergoing coronary artery bypass grafting (CABG). A retrospective analysis. Association between predictor variables (MAADP [maximum amplitude produced by adenosine diphosphate], MAAA [maximum amplitude produced by arachidonic acid], percent of platelets inhibited by clopidogrel, percent of platelets inhibited by aspirin) and the outcomes as elevated chest tube drainage (CTD) and blood transfusion were investigated by logistic regression model. CTD was considered elevated if it was ≥ 600 mL within 12 hours after surgery. A university hospital. Patients on antiplatelet therapy scheduled to undergo CABG that had TEG-PM(TM) done as a point-of-care test. None. A total of 78 patients had preoperative TEG-PM(TM) test and on-pump CABG surgeries performed on the same day. Among them, 20 patients (25.6%) had elevated CTD. Decreased MAADP (odds ratio [OR] 0.94), increased percent inhibition of platelets by clopidogrel (OR 1.03), and lower body mass index (BMI) (OR 0.78) were significantly associated with elevated CTD. The same parameters were also associated with platelets transfusion: MAADP (OR 0.94), percent of inhibition of platelets by clopidogrel (OR 1.03) and BMI (OR 0.77). TEG-PM(TM) parameters and BMI are predictive of elevated CTD and platelets transfusion. A 1 mm decrease in MAADP increases the likelihood of elevated CTD and the likelihood of platelets transfusion by 6% whereas 1 unit decrease in BMI is associated with an increased likelihood of elevated CTD and platelets transfusion by 22% and 23% respectively. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Coronary artery bypass graft surgery--care globalization: the impact of national care on fatal and nonfatal outcome.

    Science.gov (United States)

    Ott, Elisabeth; Mazer, C David; Tudor, Iulia C; Shore-Lesserson, Linda; Snyder-Ramos, Stephanie A; Finegan, Barry A; Möhnle, Patrick; Hantler, Charles B; Böttiger, Bernd W; Latimer, Ray D; Browner, Warren S; Levin, Jack; Mangano, Dennis T

    2007-05-01

    In an international, prospective, observational study, we contrasted adverse vascular outcomes among four countries and then assessed practice pattern differences that may have contributed to these outcomes. A total of 5065 patients undergoing coronary artery bypass graft surgery were analyzed at 70 international medical centers, and from this pool, 3180 patients from the 4 highest enrolling countries were selected. Fatal and nonfatal postoperative ischemic complications related to the heart, brain, kidney, and gastrointestinal tract were assessed by blinded investigators. In-hospital mortality was 1.5% (9/619) in the United Kingdom, 2.0% (9/444) in Canada, 2.7% (34/1283) in the United States, and 3.8% (32/834) in Germany (P = .03). The rates of the composite outcome (morbidity and mortality) were 12% in the United Kingdom, 16% in Canada, 18% in the United States, and 24% in Germany (P < .001). After adjustment for difference in case-mix (using the European System for Cardiac Operative Risk Evaluation) and practice, country was not an independent predictor for mortality. However, there was an independent effect of country on composite outcome. The practices that were associated with adverse outcomes were the intraoperative use of aprotinin, intraoperative transfusion of fresh-frozen plasma or platelets, lack of use of early postoperative aspirin, and use of postoperative heparin. Significant between-country differences in perioperative outcome exist and appear to be related to hematologic practices, including administration of antifibrinolytics, fresh-frozen plasma, platelets, heparin, and aspirin. Understanding the mechanisms for these observations and selection of practices associated with improved outcomes may result in significant patient benefit.

  2. Vorapaxar in patients with coronary artery bypass grafting: Findings from the TRA 2°P-TIMI 50 trial.

    Science.gov (United States)

    Kosova, Ethan C; Bonaca, Marc P; Dellborg, Mikael; He, Ping; Morais, Joao; Oude Ophuis, Ton; Scirica, Benjamin M; Tendera, Michal; Theroux, Pierre; Braunwald, Eugene; Morrow, David A

    2017-03-01

    Vorapaxar is a first-in-class protease-activated receptor-1 antagonist indicated for the reduction of cardiovascular death, myocardial infarction, and stroke in stable patients with prior atherothrombosis, who have not had a prior stroke or transient ischemic attack. The aims of this study were to investigate: 1) the role of vorapaxar in patients with severe coronary artery disease treated previously with coronary artery bypass grafting (CABG); and 2) safety in patients undergoing CABG while receiving vorapaxar. TRA 2°P-TIMI 50 was a randomized, double-blinded, placebo-controlled trial of vorapaxar in 26,449 stable patients with prior atherothrombosis followed for a median of 30 months. We 1) investigated the efficacy of vorapaxar among patients with a history of CABG prior to randomization ( n=2942); and 2) assessed the safety among 367 patients who underwent a new CABG during the trial. Patients with a prior CABG were at higher risk for cardiovascular death, myocardial infarction, or stroke at three years compared with patients without a prior CABG (13.7% vs. 7.8%, p<0.001). Among patients with a prior CABG, vorapaxar significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke (11.9% vs. 15.6%, hazard ratio 0.71, 95% confidence interval 0.58-0.88, p=0.001; number-needed-to-treat = 27). In patients undergoing CABG while receiving vorapaxar, the rate of Thrombolysis in Myocardial Infarction CABG major bleeding was 6.3% vs. 4.1% with placebo (hazard ratio 1.53, 95% confidence interval 0.58-4.01, p=0.39). In patients with a prior CABG, vorapaxar significantly reduced the risk of recurrent major cardiovascular events. In patients undergoing CABG while receiving vorapaxar, bleeding risk appeared similar to that seen in the overall trial population.

  3. Food pattern and quality of life in metabolic syndrome patients who underwent coronary artery bypass grafting in Taiwan.

    Science.gov (United States)

    Tung, Heng-Hsin; Tseng, Li-Hua; Wei, Jeng; Lin, Cheng-Hsin; Wang, Tsae-Jyy; Liang, Shu-Yuan

    2011-12-01

    Metabolic syndrome is associated with poor operative outcomes of coronary artery bypass grafting surgery (CABG). A healthy food pattern for metabolic syndrome patients is necessary not only in the initial stage to prevent cardiovascular disease but for those who experience cardiovascular problems and undergo heart surgery. Empirical studies that explore food pattern and quality of life metabolic syndrome patients who undergo CABG are lacking. Therefore, the objectives of this study are to explore the food pattern and quality of life of metabolic syndrome patients who undergo CABG and to examine the relationship between these two variables. A descriptive, correlational and cross section design was conducted. Through convenience sampling, 104 patients were recruited. Data were collected through three instruments: a demographic questionnaire; the Chinese Food Frequency Questionnaire-Short Form (Short C-FFQ), used to assess food pattern; and the Taiwanese version of the Medical Outcomes Study Short Form 36-Health Survey (SF-36), used to assess quality of life. Descriptive analysis, one-way analysis of variance (ANOVA) and Pearson correlation were used to analyze the data. The results indicated that patients who ate fruit more frequently tended to have a better quality of life, while the intake of fried food was more frequently associated with a poor quality of life. The use of these data gives the health care provider a better understanding of food pattern and their impact on quality of life in this population. Such an understanding can be used to develop targeted interventions to promote health in this and in other populations. Copyright © 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  4. A novel technique to prevent intra-operative pneumothorax in awake coronary artery bypass grafting: biomaterial neo-pleura.

    Science.gov (United States)

    Kato, Yosuke; Matsumoto, Isao; Tomita, Shigeyuki; Watanabe, Go

    2009-01-01

    Pneumothorax caused by damaged pleura represents the biggest obstacle in awake coronary artery bypass grafting. In order to safely perform this surgery, a new technique was developed to close the damaged pleura. A rub-and-spray method was employed using polyglycolic acid nonwoven fabric and fibrin glue. At first, some fibrinogen solution was rubbed on the edge of the pleural defect and then the PGA fabric was placed and the fibrinogen and thrombin solutions were sprayed. Using a thorax model, the burst pressure caused by positive pressure and the influence of negative pressure, moisture, time, continuous respiratory movement and pleural defect size were examined. In an animal experiment using pigs, the duration spent on repair was measured and any air leakage from the pleura was also identified. In the thorax model, the burst pressure was 355.9+/-55.8 mmHg with positive pressure and no significant difference in negative pressure, moisture, time and respiratory moment was identified. However, there was a significant difference in the defect size. In the animal model, repair was easily achieved regardless of the defect size or location and air leakage was not seen after repair. The average duration of repair was 21.0s. The present method achieved a strong closure with sufficient durability. Since the fabric is soft and flexible and suturing is not required, moving and fragile pleura can be easily repaired regardless of the defect location and size. Once established, the present method may be used in other forms of awake thoracic surgery or reconstruction of the thorax.

  5. The effect of educational audiotape programme on anxiety and depression in patients undergoing coronary artery bypass graft.

    Science.gov (United States)

    Hoseini, Shirzad; Soltani, Fahimeh; Babaee Beygi, Mohammadali; Zarifsanaee, Nahid

    2013-06-01

    To investigate use of educational audiotape programme on anxiety and depression in patients undergoing coronary artery bypass graft (CABG). Anxiety and depression after CABG are the most common complications, having a negative impact on the prognosis of heart disease, leading to special needs according to their new physical and mental conditions. Randomised clinical trial. This study conducted in Iran, 70 patients undergoing CABG were included and divided into two equal groups, the control group and intervention group. They were followed up for six weeks. An audiotape educational programme was given to the intervention group after surgery in addition to the routine training. But patients in the control group received only routine training. Anxiety and depression were assessed by Hospital Anxiety and Depression Scale, a standardised questionnaire for anxiety and depression. Data were collected before and six weeks after the intervention. For the comparison of mean scores between the groups, the data were analysed in spss, version 16, using independent T-test and paired T-test. The mean scores obtained in both anxiety and depression dimensions were significantly different between the intervention and control groups. Audiotape educational programme used by patients undergoing CABG decreases the level of their anxiety and depression after cardiac surgery. The most significant finding was the importance of audiotape educational programme to meet the needs of the CABG patients, which suggest that patient education through audiotape can be effective in self-care after heart surgery and nurses can use an audiotape containing preparatory information to improve outcomes and reduce anxiety and depression in patients having CABG. © 2013 Blackwell Publishing Ltd.

  6. Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure

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    Nilesh Jain

    2017-01-01

    Full Text Available Background: Patients undergoing coronary artery bypass graft (CABG procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observational study, evaluated the accuracy of the TMHT in predicting difficult laryngoscopy. Methodology: A total of 345 patients undergoing CABG of either sex, in the age group of 35–80 years, American Society of Anesthesiologists 111, undergoing CABG, were studied. Airway assessment was performed with modified Mallampati test with the addition of thyromental distance, sternomental distance, and TMHT. Intraoperatively, direct laryngoscopy was done in accordance with Cormack and Lehane grade of laryngoscopy. The preoperative data and laryngoscopic findings were used together to evaluate the accuracy of TMHT. The sensitivity, specificity, positive and negative predictive values of other three tests were calculated according to standard formula. Results: A total of 345 patients were in the group with mean age of study population at 56.7 (standard deviation 9.1 years (35–80 years. This study showed that almost all tests had good specificity, but sensitivity was poor. However, sensitivity of TMHT was 75% with accuracy of 95%. Receiver operating characteristic curve analysis of TMHT-derived cutoff was 52.17 which increased sensitivity to 81.25% and specificity to 92.3%. Conclusion: TMHT had a higher sensitivity compared to other tests along with good positive and negative predictive value and a very high specificity.

  7. National surveillance of surgical site infections after coronary artery bypass grafting in Norway: incidence and risk factors.

    Science.gov (United States)

    Berg, Thale Cathrine; Kjørstad, Knut E; Akselsen, Per Espen; Seim, Bjørn Edvard; Løwer, Hege Line; Stenvik, Maryann Nesset; Sorknes, Nina Kristine; Eriksen, Hanne-Merete

    2011-12-01

    A mandatory national surveillance system for surgical site infections (SSIs) following certain surgical procedures, including coronary artery bypass grafting (CABG), was introduced in Norway in 2005. The objectives of this study were to measure national baseline incidence rates of SSIs after CABG, describe the characteristics of the patients and procedures, and identify possible risk factors for infection. In 2005-2009, all hospitals that performed CABG were invited to assess all patients undergoing CABG surgery in 3-month periods for SSIs. The hospitals evaluated infection status at discharge and 30 days after surgery by sending post-discharge questionnaires to all patients. We calculated incidence proportions and risk ratios for different risk factors. We applied the National Nosocomial Infection Surveillance (NNIS) risk index to the data. In total, 2440 patients were included. Altogether, 124 sternal and 217 harvest site infections were registered, giving incidence proportions of 5.1% and 8.9%, respectively. Over 95% of infections occurred post-discharge from the hospital. No risk factors were identified. Incidence did not significantly increase with higher NNIS risk index; however, 93% of the patients fell into the same risk category. We have provided a baseline rate for SSIs after CABG procedures in Norway. The results show the importance of post-hospital discharge follow-up. The NNIS risk index did not adequately stratify CABG patients. We recommend that more potential risk variables should be included in the surveillance, such as the European System for Cardiac Operative Risk Evaluation (EuroSCORE), height, weight, and diabetes. Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

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

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    Nakanishi Kazuhiro

    2013-01-01

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

  9. Impact of visceral obesity on cardiac parasympathetic activity in type 2 diabetics after coronary artery bypass graft surgery.

    Science.gov (United States)

    Salamin, Guillaume; Pelletier, Claudine; Poirier, Paul; Després, Jean-Pierre; Bertrand, Olivier; Alméras, Natalie; Costerousse, Olivier; Brassard, Patrice

    2013-08-01

    The association between adiposity and heart rate variability (HRV) in patients with type 2 diabetes (T2D) after coronary artery bypass graft surgery (CABG) is not well documented. We evaluated the associations between indices of adiposity and HRV in patients with T2D with CABG and quantified the relationships of the volume of visceral (VVAT) and subcutaneous adipose tissue (VSAT) to HRV. One hundred and thirty-five men with T2D who underwent CABG participated in this study. HRV, BMI, waist circumference (WC), VVAT, and VSAT were measured. Correlations between indices of HRV and adiposity were evaluated and predictors of HRV modulation were identified. Patients were then divided into quartiles of VVAT and VSAT to further evaluate the influence of adiposity on HRV. Subjects were 65 ± 7 years old (mean ± SD) with a BMI of 30 ± 4 kg/m(2) and a WC of 105 ± 10 cm. BMI (r = -0.19) and WC (r = -0.25) were inversely correlated with low frequencies. VVAT correlated negatively with SD normal-to normal (SDNN) (r = -0.22, P < 0.01), indices of cardiac parasympathetic activity [rMSSD (r = -0.27), NN50 (r = -0.22), pNN50 (r = -0.26; all P < 0.05], and with low (r = -0.37) and high frequencies (r = -0.20; all P < 0.01). Patients with the lowest VVAT had the highest cardiac parasympathetic activity (P < 0.05). VVAT remained the best predictor of cardiac parasympathetic activity after adjustments for confounding parameters (P < 0.01). An increase in visceral adiposity, not BMI, seems to be associated with lower HRV in patients with T2D who had a CABG procedure. Copyright © 2013 The Obesity Society.

  10. Stem cell registry programme for patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting: what benefits does it derive?

    Science.gov (United States)

    Nesteruk, Julia; Voronina, Natalia; Kundt, Guenther; Donndorf, Peter; Klopsch, Christian; Kaminski, Alexander; Duckers, Henrick J; Steinhoff, Gustav

    2017-05-01

    Standardization of stem cell therapy requires application of appropriate methods to evaluate safety and efficacy, including long-term pharmacovigilance. To accomplish this objective, a long-term registry programme was installed. We analysed 150 patients with ischemic cardiomyopathy, who received intramyocardial CD133+ bone marrow mononuclear stem cell treatment combined with coronary artery bypass grafting (CABG) or CABG alone. The mortality rate, major adverse cerebral and cardiac events, and functional outcome parameters were evaluated for the time period up to 14 years follow-up. As a result, we have stratified the patient population (96 patients) into responders and non-responders. Furthermore, the analysis of relevant predictors of good response to CD133+ bone marrow mononuclear stem cell treatment was performed. Several positive tendencies related to stem cells transplantation were demonstrated. First, no significant difference in major adverse cardiovascular and cerebral events was observed between stem cell and control group up to 14 years follow-up. Second, an improvement of left ventricle ejection fraction (LVEF) in stem cell group retained for 5 years in contrast with CABG-only group, where no significant changes in LVEF after 2 years were observed. In addition, LVEF under 30% and left ventricle end diastolic diameter above 60 mm were independent predictors of functional response to CD133+ cell therapy. Participants with overt heart failure benefit most from CABG combined with intramyocardial injection of CD133+ bone marrow mononuclear cell within the group. An improvement LVEF in stem cell group remained for 5 years in contrast with the CABG-only group. The patients, in whom the improvement of both LVEF and LVED was observed, have benefited by increased life expectancy.

  11. Outcomes of On-pump Coronary Artery Bypass Grafting in Patients with Metabolic Syndrome in Mashhad, Iran

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    Aliasghar Moeinipour

    2017-09-01

    Full Text Available Introduction: Metabolic syndrome (MS is considered as an important risk factor for advanced coronary artery disease. This condition can increase the mortality and morbidity in the patients undergoing coronary artery bypass graft (CABG surgery. The aim of the study was compared mortality and morbidity after off Pump- CABG surgery between patients with and without the Metabolic syndrome. Materials & Methods: This prospective cross-sectional study was conducted on 120 patients, who underwent off-pump CABG surgery between October 2014-October 2016. The participants were equally divided into two groups including the patients with and without MS (MS and non-MS, respectively. Results: According to the results, 68 (56.6% patients were male. Furthermore, out of the 60 participants with MS, 36 (60% cases were male. The mean ages of the MS and non-MS groups were 64.96±9.6 and 65.62±10.6 P=0.6 years, respectively. No statistically significant difference was observed between the two groups in terms of the mortality and morbidity (e.g., surgical wound infection, length of Intensive Care Unit and hospital stay, atrial fibrillation rhythm, and bleeding in the first 24 h. The intubation time in patients with Metabolic Syndrome was significantly higher than patients without Metabolic Syndrome (6.66 ± 1.97 vs 5.83 ± 1.93 respectively; P=0.007 Conclusion: Metabolic syndrome was not associated with higher mortality and morbidity after CABG surgery compare to patients without Metabolic syndrome, although patients with Metabolic syndrome had higher risk for long intubation time.

  12. Coronary artery bypass graft patients' perception about the risk factors of illness: Educational necessities of second prevention

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    Ali Soroush

    2017-01-01

    Full Text Available Background: Patients' beliefs about the cause of cardiac disease (perceived risk factors as part of the global psychological presentation are influenced by patients' health knowledge. Hence, the present study aimed to assess the relationship between actual and perceived risk factors, identification of underestimated risk factors, and indication of underestimation of every risk factor. Materials and Methods: In this cross-sectional study, data of 313 coronary artery bypass graft (CABG patients admitted to one hospital in the west of Iran were collected through a demographic interview, actual risk factors' checklist, open single item of perceived risk factors, and a life stressful events scale. Data were analyzed by means of Spearman's correlation coefficients and one-sample Z-test for proportions. Results: Although there are significant relations between actual and perceived risk factors related to hypertension, family history, diabetes, smoking, and substance abuse (P < 0.05, there is no relation between the actual and perceived risk factors, and patients underestimate the role of actual risk factors in disease (P < 0.001. The patients underestimated the role of aging (98.8%, substance abuse (95.2%, overweight and obesity (94.9%, hyperlipidemia (93.1%, family history (90.3%, and hypertension (90% more than diabetes (86.1%, smoking (72.5%, and stress (54.7%. Conclusion: Cardiac patients seem to underestimate the role of aging, substance abuse, obesity and overweight, hyperlipidemia, family history, and hypertension more than other actual risk factors. Therefore, these factors should be highlighted to patients to help them to (i increase the awareness of actual risk factors and (ii promote an appropriate lifestyle after CABG surgery.

  13. Acute-phase proteins and oxidative stress in patients undergoing coronary artery bypass graft: comparison of cardioplegia strategy.

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    Plicner, Dariusz; Stoliński, Jarosław; Rzucidło-Hymczak, Anna; Kapelak, Bogusław; Undas, Anetta

    2017-03-01

    Several strategies are still being introduced to cardiac surgery techniques to reduce the signs of the inflammatory response and oxidative stress. Many efforts have been made to develop the best possible method for myocardial protection. To assess the effect of the cardioplegia strategy on the systemic inflammatory response and oxidative stress. A group of 238 consecutive, elective on-pump coronary artery bypass graft patients (CABG; 183 men, aged 64.6 ±8.1 years) were prospectively studied. Patients were enrolled in two groups: with warm blood cardioplegia (n = 124) and with cold crystalloid cardioplegia (n = 114). In each group, pre- and postoperative levels of plasma C-reactive protein, fibrinogen, interleukin 6 and 8-iso-prostaglandin F2α (8-iso-PGF2α) were measured. All studied markers significantly increased 18-36 h following CABG and then decreased in 5-7 postoperative days but remained above baseline levels. No differences in terms of studied markers and clinical outcomes were noted for the different types of cardioplegia. Regression analysis showed a significant correlation between preoperative level of oxidative stress measured by 8-iso-PGF2α and postoperative myocardial infarction as well as in-hospital cardiovascular death (p = 0.047 and p = 0.041 respectively). This study extends previous reports by showing that the type of cardioplegia does not affect the systemic inflammatory response or oxidative stress, which are associated with the CABG procedure. It might be speculated that preoperative screening of oxidative stress could be helpful in identifying patients at increased risk of an unfavorable course after CABG.

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

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    Reza Karbasi Afshar

    2015-01-01

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

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

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    Soheila Ranjbaran

    2015-10-01

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

  16. The Effect of Aromatherapy with Lavender Essential Oil on Anxiety and Stress in Patients Undergoing Coronary Artery Bypass Graft Surgery

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    Rajai

    2016-09-01

    Full Text Available Background Depression and anxiety are among the most common mental disorders before and after surgery. Aromatherapy is a treatment that has grown substantially in recent years in comparison with other complementary and alternative medicines (CAM to relieve anxiety. Objectives This study investigated the effect of inhaling lavender essence on the physiological and psychological status of patients who are candidates for coronary artery bypass graft (CABG surgery. Methods This randomized clinical trial was performed on 60 patients who were undergoing CABG surgery at the hospitals of Artesh Jomhory Eslami (AJA University of Medical Sciences in Iran. Patients who met specific inclusion criteria were selected and randomly allocated into two groups: a control group that inhaled room air and an experimental group that inhaled from a piece of cotton impregnated with two drops of lavender essence. This intervention was done on the morning of surgery. To evaluate these measures, a Depression Anxiety Stress Scale (DASS questionnaire was filled out by the patient before and after the intervention. The data collected were analyzed using descriptive and analytic statistics. Results After the intervention, the study results showed statistically significant differences between the two study groups in heart rate (mean = 78.83, P = 0.02 and anxiety level (mean = 6.63, P = 0.02. However, the differences between the two groups were not significant regarding stress level (mean = 8.63, P = 0.55 and other physiological variables. Conclusions Inhalation aromatherapy is an effective method for reducing the heart rate and the level of anxiety in patients before CABG surgery. Given that the physiological and psychological health of patients are important responsibilities for nurses, aromatherapy can be considered a safe and effective relaxation method before invasive interventions. Learning this method is recommended for students and nurses.

  17. Estimated glucose disposal rate and long-term survival in type 2 diabetes after coronary artery bypass grafting.

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    Nyström, Thomas; Holzmann, Martin J; Eliasson, Björn; Svensson, Ann-Marie; Kuhl, Jeanette; Sartipy, Ulrik

    2017-03-01

    We performed a nationwide population-based cohort study to investigate the association between estimated glucose disposal rate (eGDR) and long-term survival after coronary artery bypass grafting (CABG) in patients with type 2 diabetes. All patients who underwent primary CABG in Sweden from 2006 to 2013 were identified from the SWEDEHEART register and by record linkage to the National Diabetes Register; all patients with type 2 diabetes were included and formed the study population. Patients were followed until 2013 through national registers for major adverse cardiovascular events and death from any cause. eGDR was calculated using waist circumference, hemoglobin A1c, and presence or the absence of hypertension. The association between eGDR and death was estimated using multivariable Cox regression. A total of 3256 patients were included. During a mean follow-up of 3.1 years (10,227 person-years), in total, 14 % patients died: 17 % (n = 186) in the 1st tertile (lowest eGDR), 14 % (n = 145) in the 2nd tertile, and 13 % (n = 133) in the 3rd tertile (highest eGDR). There was a significant association between eGDR and increased risk of death: adjusted hazard ratio (95 % confidence interval): 1.46 (1.12-1.90) for the 1st eGDR tertile compared to the 3rd and highest eGDR tertile. In conclusion, patients with type 2 diabetes who underwent CABG, a low eGDR, were associated with an increased risk of long-term all-cause mortality that was independent of other cardiovascular and metabolic risk factors. Insulin resistance measured by eGDR could be a useful risk marker in patients with type 2 diabetes and ischemic heart disease.

  18. Frequency of Acute Kidney Injury in Patients Treated With Normal Saline after Off-Pump Coronary Artery Bypass Grafting

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    Shima Sheybani

    2017-03-01

    Full Text Available Introduction: Acute kidney injury (AKI is a common postoperative complication of cardiac surgery, which is associated with an increased risk of morbidity and mortality. This study investigated the frequency of postoperative AKI in low risk adult patients undergoing off-pump coronary artery bypass grafting (CABG.Materials & Methods: All consecutive adult patients of American Society of Anesthesiologists (ASA class II and III, who were transferred to the post-operative cardiac surgery ICU after off-pump CABG and were low risk for AKI from October 2013 to September 2014 at Emam Reza Hospital, Mashhad, Iran were enrolled in this prospective cohort study at a teaching hospital. The patients were explored for AKI development, based on risk-injury-failure-loss- end stage kidney disease (RIFLE and acute kidney injury network (AKIN criteria, frequency of metabolic acidosis, hypernatremia, hyperchloremia, and length of stay in ICU.Results: According to the results of the present study, 479 patients with the mean age of 60.8±10.75 yrs were included. AKI occurred in 22 (4.4% and23 (4.8% patients, based on both the RIFLE and AKIN criteria, respectively with the highest rate of AKI, reported on the third and fourth post-operative days. Additionally, hyperchloremia and hypernatremia were observed in 71 (14.8% and 76 (15.9% patients, respectively. Only one case of mortality occurred during the study. Metabolic acidosis was reported in 112 (23.4% patients with a high anion gap in 60 (12.5% cases.Conclusion: The current study demonstrated that hypernatremia and metabolic acidosis but not AKI are frequently seen in patients receiving normal saline following off pump CABG with low risk for AKI.

  19. Combined Coronary Artery Bypass Grafting and Abdominal Aortic Aneurysm Repair: Presentation of 3 Cases and a Review of the Literature.

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    Williams, Andrew M; Watson, Jennifer; Mansour, M Ashraf; Sugiyama, George T

    2016-01-01

    Coronary artery disease and abdominal aortic aneurysmal disease can occur in a single patient, and a therapeutic conundrum presents when open surgical repair is indicated for both conditions. The traditional standard of care is to conduct coronary artery bypass grafting (CABG) followed by abdominal aortic aneurysm (AAA) repair 2-6 months later, but there is significant risk with staging these 2 major surgeries. An alternative method is to surgically repair both diseases in 1 combined operation. The aim of our study is to review our own experience with the combined procedure and to review the published literature to assess morbidity and mortality of combined CABG and AAA repair. A systematic search for relevant studies was performed in the PubMed/Medline database. Short-term mortality (repair. The mean age was 71 years, the average AAA size was 8.9 cm, and average operative time was 328 min. None experienced any postoperative complications. Two are still alive at 9 and 10 years after surgery, and 1 died of unrelated causes 8 years postoperatively. The results of this systematic review suggest that combined CABG and AAA repair is a viable procedure with low operative mortality. Patients with preserved ejection fractions, large AAA, and limited comorbidities appear to receive the most benefit from a combined approach based on reported data from the literature. We have experienced promising results in our highly selected patient population. More research is warranted to devise criteria to determine which patients would be good surgical candidates for this combined procedure. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Meta-Analysis Comparing ≥10-Year Mortality of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Takagi, Hisato; Ando, Tomo; Mitta, Shohei

    2017-12-01

    Off-pump coronary artery bypass grafting (CABG) is suggested to be associated with an increase in long-term (≥5-year) all-cause mortality. To determine whether off-pump CABG is associated with an increase in very long-term (≥10-year) all-cause mortality, we performed a meta-analysis of propensity-score matched observational comparative studies of off-pump versus on-pump CABG. MEDLINE and EMBASE were searched through May 2017. A hazard ratio of follow-up (including early) all-cause mortality for off-pump versus on-pump CABG was extracted from each individual study. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic hazard ratios in the random-effects model. Of 164 potentially relevant studies, our search identified 16 propensity-score matched observational comparative studies of off-pump versus on-pump CABG with ≥10-year follow-up enrolling a total of 82,316 patients. A pooled analysis of all the 16 studies demonstrated that off-pump CABG was significantly associated with an increase in all-cause mortality (hazard ratio 1.07, 95% confidence interval 1.03 to 1.12, p for effect = 0.0008; p for heterogeneity = 0.30, I 2  = 12%). In a sensitivity analysis, exclusion of any single hazard ratio from the analysis (leave-one-out meta-analysis) did not substantively alter the overall result. There was no evidence of a significant publication bias. In conclusion, off-pump CABG is associated with an increase in very long-term (≥10 years) all-cause mortality compared with on-pump CABG. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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    Abbasi Kyomars

    2007-09-01

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

  2. Percutaneous coronary intervention vs. coronary artery bypass grafting for left main revascularization: an updated meta-analysis.

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    Bajaj, Navkaranbir S; Patel, Nirav; Kalra, Rajat; Marogil, Peter; Bhardwaj, Ashwanikumar; Arora, Garima; Arora, Pankaj

    2017-07-01

    The optimal revascularization strategy for left main coronary artery disease (LMD) remains controversial, especially with two recent randomized controlled trials showing conflicting results. We sought to address this controversy with our analysis. Comprehensive literature search was performed. We compared percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for LMD revascularization using standard meta-analytic techniques. A 21% higher risk of long-term major adverse cardiac and cerebrovascular event [MACCE; composite of death, myocardial infarction (MI), stroke, and repeat revascularization] was observed in patients undergoing PCI in comparison with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05-1.40]. This risk was driven by higher rate of repeat revascularization in those undergoing PCI (RR 1.61, 95% CI 1.34-1.95). On the contrary, MACCE rates at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI 0.39-0.76), which was driven by lower rates of stroke in the PCI arm (RR 0.41, 95% CI 0.17-0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI 0.08-0.59) in the PCI arm were balanced by higher repeat revascularization rates in those undergoing PCI (RR 1.78, 95% CI 1.33-2.37), resulting in a clinical equipoise in MACCE rates between the two revascularization strategies. There was no difference in death or MI between PCI when compared with CABG at any time point. Outcomes of CABG vs. PCI for LMD revascularization vary over time. Therefore, individualized decisions need to be made for LMD revascularization using the heart team approach.

  3. Postoperative wound infection in patients undergoing coronary artery bypass graft surgery: A prospective study with evaluation of risk factors

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    Bhatia J

    2003-01-01

    Full Text Available PURPOSE: Wound infection is an important cause of morbidity and occasional mortality after coronary artery bypass graft surgery (CABG. The aim of this study was to report postoperative wound infection in CABG surgery patients. METHODS: Consecutive patients undergoing CABG surgery between January 1998 and October 1999 have been studied. The exclusion criteria included, age less than 30 years, penicillin / cephalosporin allergy and associated other cardiac pathologies. The parameters studied were age, sex, obesity, hypertension, diabetes, myocardial infarction, chronic renal failure, previous surgeries, alcohol consumption, smoking, length of pre and postoperative hospital stay, antibiotic prophylaxis, MRSA screening, and duration of surgery. Wounds were classified as per modified CDC′s NNIS criteria. Suspected sites of infection were cultured and antibiotic susceptibility of cultured organisms was tested. Postoperative follow up was for two months. RESULTS: Six hundred and fifteen patients were studied. Of these 116 (18.86% developed SSI, involving sternum 75%, leg 21.3%, and forearm sites 3.44%. Organisms isolated at sternum site were MSSE, MRSA, and MRSE, at leg site E. coli and MSSE, and at forearm site MSSE and MSSA. Sternal site, obesity, diabetes mellitus and female sex were associated with significantly higher infection rates (p= 0.001. No antibiotic protocol proved more effective. SSI increased the postoperative hospital stay and the total treatment cost. CONCLUSIONS: Post CABG surgery SSI rate is high. Sternum and leg are the common infection sites. Obesity, uncontrolled diabetes mellitus and female sex are associated with higher infection rates. "Higher" antibiotics do not lower postoperative infection rates.

  4. Preoperative brain magnetic resonance imaging and postoperative delirium after off-pump coronary artery bypass grafting: a prospective cohort study.

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    Omiya, Hiroki; Yoshitani, Kenji; Yamada, Naoaki; Yamada, Naoki; Kubota, Yosuke; Takahashi, Kanae; Kobayashi, Junjiro; Ohnishi, Yoshihiko

    2015-06-01

    Delirium after cardiac surgery is a serious complication, increasing morbidity and mortality. Despite its high expectations, off-pump coronary artery bypass grafting (OPCAB) has largely failed to reduce the incidence of postoperative neurological complications. To further investigate the reasons for this failure, we used perioperative brain magnetic resonance imaging (MRI) to determine the relation between MRI findings and postoperative delirium. Altogether, 98 patients undergoing elective OPCAB were enrolled in this prospective observational study. Patients underwent brain MRI and magnetic resonance angiography (MRA) before and after surgery to identify cerebral infarction, white matter lesions, and intracranial artery stenosis. Postoperative delirium in the intensive care unit was measured using the delirium rating scale. The relation between postoperative delirium and MRI findings was examined using logistic regression. Magnetic resonance imaging and MRA was completed in 88 (90%) of the patients. New ischemic lesions were present in seven (7.9%) patients. Delirium rating scale scores of 0, 1-7, and ≥ 8 were found in 25 (31%), 48 (60%), and seven (9%) patients, respectively. Multivariate logistic regression analysis revealed that new ischemic lesions (odds ratio [OR] 11.07, 95% confidence interval [CI]: 1.53 to 80.03; P = 0.017), carotid artery stenosis (OR 7.06, 95% CI: 1.59 to 31.13; P = 0.010), history of myocardial infarction (OR 3.78, 95% CI: 1.05 to 13.65; P = 0.043), and deep subcortical white matter hyperintensity (OR 3.04, 95% CI: 1.14 to 8.12; P = 0.027) were significantly associated with postoperative delirium. Magnetic resonance imaging findings of new cerebral ischemic lesions, carotid stenosis, and deep subcortical white matter hyperintensity correlated significantly with postoperative delirium in patients who had undergone OPCAB surgery.

  5. 4D flow MRI assessment of extracranial-intracranial bypass: qualitative and quantitative evaluation of the hemodynamics

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    Sekine, Tetsuro [University Hospital Zurich/University of Zurich, Department of Medical Radiology, Division of Nuclear Medicine, Zurich (Switzerland); Nippon Medical School, Department of Radiology, Tokyo (Japan); Takagi, Ryo; Amano, Yasuo; Orita, Erika; Matsumura, Yoshio; Kumita, Shin-ichiro [Nippon Medical School, Department of Radiology, Tokyo (Japan); Murai, Yasuo [Nippon Medical School, Department of Neurological Surgery, Tokyo (Japan)

    2016-03-15

    Our aim was to assess the feasibility of using time-resolved 3D phase-contrast (4D flow) MRI to characterize extracranial-intracranial (EC-IC) bypass. We enrolled 32 patients who underwent EC-IC bypass (15 men, 17 women; mean age 66.4 years). In all, 16 underwent radial artery graft (RAG) bypass and 16 underwent superficial temporal artery (STA) bypass. 4D flow MRI, time-of-flight (TOF) magnetic resonance angiography (MRA), and computed tomography angiography (CTA) were performed. Bypass patency, flow direction, and blood flow volume (BFV) of each artery were determined by 4D flow MRI. Arterial diameters were measured by TOF-MRA and CTA. We compared RAG and STA bypasses by evaluating the flow direction and BFV of each artery. We evaluated the correlation between arterial diameters (measured by CTA or MRA) and the BFV and the detectability of flow direction (measured by 4D flow MRI) of each artery. 4D flow MRI confirmed the patency of each bypass artery. Flow direction of the M1 segment of the middle cerebral artery and BFV in the bypass artery differed between RAG and STA groups (p < 0.01). BFV in the bypass slightly correlated with the diameters on CTA (p < 0.05, R{sup 2} = 0.287). Of the 29 arteries in the circle of Willis, nine were not depicted on 4D flow MRI. Cutoff values for arterial diameters on CTA and TOF-MRA for detecting the artery on 4D flow MRI were 2.4 and 1.8 mm, respectively. 4D flow MRI provided unique information for characterizing EC-IC bypasses, although this detectability is limited when addressing small arteries with slow flow. (orig.)

  6. Ultrasonographic caval indices do not significantly contribute to predicting fluid responsiveness immediately after coronary artery bypass grafting when compared to passive leg raising.

    Science.gov (United States)

    Sobczyk, Dorota; Nycz, Krzysztof; Andruszkiewicz, Pawel; Wierzbicki, Karol; Stapor, Maciej

    2016-06-08

    Appropriate fluid management is one of the most important elements of early goal-directed therapy after cardiothoracic surgery. Reliable determination of fluid responsivenss remains the fundamental issue in volume therapy. The purpose of the study was to assess the usefulness of dynamic IVC-derived parameters (collapsibility index, distensibility index) in comparison to passive leg raising, in postoperative fluid management in mechanically ventilated patients with left ventricular ejection fraction ≥ 30 %, immediately after elective coronary artery bypass grafting. Prospective observational case series study including 35 patients with LVEF ≥ 30 %, undergoingelective coronary artery bypass grafting was conducted. Transthoracic echocardiography, passive leg raising and intravenous administration of saline were performed in all study subjects. Dynamic parameters derived from ultrasonographic assessment of the IVC diameter (collapsibility index-CI and distensibility index-DI), cardiac output There were 24 (68.57 %) responders in the study population. There were no statistical differences between the groups in relation to: clinical parameters, pre- and postoperative LVEF, fluid balance and CVP. Change in cardiac output after passive leg raising correlated significantly with that after the volume expansion (p=0.000, r=0.822). Dynamic IVC derivatives were slightly higher in fluid responders, however this trend did not reach statistical significance. None of the caval indices correlated with fluid responsiveness. Dynamic IVC-derived parameters do not predict fluid responsiveness in mechanically ventilated patients with preserved ejection fraction immediately after elective coronary artery bypass grafting. Passive leg raising is not inferior to volume expansion in differentiating between fluid responders and nonresponders. Immediate fluid challenge after CABG is safe and well tolerated.

  7. Effect of nature-based sound therapy on agitation and anxiety in coronary artery bypass graft patients during the weaning of mechanical ventilation: A randomised clinical trial.

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    Aghaie, Bahman; Rejeh, Nahid; Heravi-Karimooi, Majideh; Ebadi, Abbas; Moradian, Seyed Tayeb; Vaismoradi, Mojtaba; Jasper, Melanie

    2014-04-01

    Weaning from mechanical ventilation is a frequent nursing activity in critical care. Nature-based sound as a non-pharmacological and nursing intervention effective in other contexts may be an efficient approach to alleviating anxiety, agitation and adverse effects of sedative medication in patients undergoing weaning from mechanical ventilation. This study identified the effect of nature-based sound therapy on agitation and anxiety on coronary artery bypass graft patients during weaning from mechanical ventilation. A randomised clinical trial design was used. 120 coronary artery bypass graft patients aged 45-65 years undergoing weaning from mechanical ventilation were randomly assigned to intervention and control groups. Patients in the intervention group listened to nature-based sounds through headphones; the control group had headphones with no sound. Haemodynamic variables, anxiety levels and agitation were assessed using the Faces Anxiety Scale and Richmond Agitation Sedation Scale, respectively. Patients in both groups had vital signs recorded after the first trigger, at 20 min intervals throughout the procedure, immediately after the procedure, 20 min after extubation, and 30 min after extubation. Data were collected over 5 months from December 2012 to April 2013. The intervention group had significantly lower anxiety and agitation levels than the control group. Regarding haemodynamic variables, a significant time trend and interaction was reported between time and group (pmechanical ventilation in coronary artery bypass graft patients. Nurses can incorporate this intervention as a non-pharmacological intervention into the daily care of patients undergoing weaning from mechanical ventilation in order to reduce their anxiety and agitation. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Three-year outcomes after percutaneous coronary intervention and coronary artery bypass grafting in patients with heart failure: from the CREDO-Kyoto percutaneous coronary intervention/coronary artery bypass graft registry cohort-2†.

    Science.gov (United States)

    Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

    2015-02-01

    Ischaemic heart disease is a major risk factor for heart failure. However, long-term benefit of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in those patients has not been well elucidated. Of the 15 939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2, we identified 1064 patients with multivessel and/or left main disease with a history of heart failure (ACC/AHA Stage C or D). There were 672 patients undergoing PCI and 392 CABG. Preprocedural left ventricular ejection fraction was not different between PCI and CABG (46.6 ± 15.1 vs 46.6 ± 14.6%, P = 0.89), but the CABG group included more patients with triple-vessel and left main disease (P < 0.01 each). Three-year outcomes revealed that the risk of hospital readmission for heart failure was higher after PCI than after CABG (hazard ratio [95% confidence interval]; 1.90 [1.18-3.05], P = 0.01). More importantly, adjusted mortality after PCI was significantly higher than after CABG (1.79 [1.13-2.82], P = 0.01). The risk of cardiac death after PCI was also higher than after CABG (1.98 [1.10-3.55], P = 0.02). Stratified analysis using the SYNTAX score demonstrated that risk of death was not different between PCI and CABG in patients with low (<23) and intermediate (23-32) SYNTAX scores (2.10 [0.57-7.68], P = 0.26 and 1.43 [0.63-3.21], P = 0.39, respectively), whereas those with a high (≥ 33) SYNTAX score, the risk of death was far higher after PCI than after CABG (4.83 [1.46-16.0], P = 0.01). In patients with heart failure with advanced coronary artery disease, CABG was a better option than PCI because CABG was associated with better survival benefit, particularly in more complex coronary lesions stratified by the SYNTAX score. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  9. 30-day mortality after coronary artery bypass grafting and valve surgery has greatly improved over the last decade, but the 1-year mortality remains constant

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    Hansen, Laura Sommer; Hjortdal, Vibeke Elisabeth; Andreasen, Jan Jesper

    2015-01-01

    INTRODUCTION: European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was carried out to investigate whether...... artery bypass grafting (CABG) or valve surgery. Analysis was carried out based on EuroSCORE, age and co-morbidity factors (residual EuroSCORE). RESULTS: During the period the average age increased from 65.1 ± 10.0 years to 68.9 ± 10.7 years (P

  10. Methodological Quality of Randomized Clinical Trials of Respiratory Physiotherapy in Coronary Artery Bypass Grafting Patients in the Intensive Care Unit: a Systematic Review.

    Science.gov (United States)

    Lorscheitter, Jaqueline; Stein, Cinara; Plentz, Rodrigo Della Méa

    2017-01-01

    To assess methodological quality of the randomized controlled trials of physiotherapy in patients undergoing coronary artery bypass grafting in the intensive care unit. The studies published until May 2015, in MEDLINE, Cochrane and PEDro were included. The primary outcome extracted was proper filling of the Cochrane Collaboration's tool's items and the secondary was suitability to the requirements of the CONSORT Statement and its extension. From 807 studies identified, 39 were included. Most at CONSORT items showed a better adequacy after the statement's publication. Studies with positive outcomes presented better methodological quality. The methodological quality of the studies has been improving over the years. However, many aspects can still be better designed.

  11. [Evaluation of postoperative myocardial injury by heart-type fatty acid-binding protein in off-pump coronary artery bypass grafting surgery].

    Science.gov (United States)

    Carmona, P; Mateo, E; Montoro, A; Alós, L; Coret, M; Errando, C L; Llagunes, J; De Andrés, J

    2015-01-01

    Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context it is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker « heart-type fatty acid-binding protein » (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers. A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2 month period. Blood samples were drawn for measurement of myocardial ischemic injury biomarkers (h-FABP, troponin, creatine kinase [CK] and CK-MB), at baseline (T1), immediate post-coronary artery bypass grafting (T2), on ICU admission (T3), and after 4 (T4), 8 (T5), 24 (T6) and 48 h (T7). Perioperative ischemic complications, defined according to electrocardiographic, echocardiographic and hemodynamic criteria, were recorded. Earlier biomarkers peak plasma values occurred at T4 with troponin (2.9 ± 5.2 ng/mL), and at T5 with h-FABP (37.9 ± 55.5 ng/mL). Maximum values of CK and CK-MB occurred later, both in T6 (741 ± 779 and 37 ± 51 U/L, respectively). The optimized cut-off obtained for h-FABP was 19 ng/mL, providing a sensitivity and specificity of 77 and 75%, respectively, for diagnosis of perioperative ischemic injury, with an area under the ROC curve for h-FABP of 0.83 (95% CI 0.6-1.0) vs. 0.63 (95% CI 0.33-0.83) for troponin. This cut-off value for h-FABP is reached on average at T2 (mean value of h-FABP at T2: 18.9 ± 21.5 ng/mL). This is the first study evaluating the kinetics of h-FABP biomarker in perioperative off-pump coronary artery bypass grafting, and the cut-off value established could help to extend earlier detection of myocardial ischemia in this context. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S

  12. Which factor is the most effective one in metabolic Sydrome on the outcomes after coronary artery bypass graft surgery? A cohort study of 5 Years.

    Science.gov (United States)

    Wang, Lijuan; Qian, Xiangyang; Wang, Mingya; Tang, Xinran; Ao, Hushan

    2018-01-04

    Metabolic Syndrome and diabetes mellitus are risk factors for cardiovascular disease. However, the effects of Metabolic Syndrome with or without diabetes on perioperative and long-term morbidity and mortality after Coronary Artery Bypass Graft remain unclear. An retrospective study was performed on 1166 patients who received isolated primary Coronary Artery Bypass Graft in Fuwai hospital. They were divided into three groups: control, Metabolic Syndrome of three factors together with diabetes and Metabolic Syndrome of three factors without diabetes (n = 868, 76 and 222 respectively). Analysis of variance, Chi-rank test, Fisher's exact test, Log-rank test, Cox and Logistic regression models were used for data processing. Outcomes were postoperative and 5-year survival and morbidities. There were no significant differences between groups in in-hospital postoperative complications, epinephrine use, stroke, atrial fibrillation, renal failure, coma, myocardial infarction and repeated revascularization. Patients in the Metabolic Syndrome with diabetes, Metabolic Syndrome without diabetes and control groups, respectively, showed significant difference in perioperative Major Adverse Cerebral Cardiovascular Events (30.3% vs. 21.2%, 16.7%, P = 0.0071) and mortality (11.8% vs. 2.7%, 3.11%, P = 0.0003). The Metabolic Syndrome with diabetes group had higher rates of perioperative mortality than Metabolic Syndrome without diabetes (P = 0.0017, P of Fisher Test = 0.0039). Compared with non-diabetic patients with Metabolic Syndrome, those with Metabolic Syndrome and diabetes had increased long-term mortality (Adjusted HR: 4.3; 95% CI: 1.4-13.3; P = 0.0113) and Major Adverse Cerebral Cardiovascular Events (Adjusted OR: 1.7; 95% CI: 1.0-2.8; P = 0.048). Control and non-diabetic Metabolic Syndrome groups did not differ in long-term mortality but controls had lower rates of Major Adverse Cerebral Cardiovascular Events (Adjusted OR: 0.79; 95% CI: 0

  13. Successful endovascular aneurysm repair for abdominal aortic aneurysm in a patient with severe coronary artery disease undergoing off-pump coronary artery bypass grafting.

    Science.gov (United States)

    Kim, Sun Min; Cho, Jae Yeong; Kim, Ju Han; Park, Keun-Ho; Sim, Doo Sun; Hong, Young Joon; Ahn, Youngkeun; Jeong, Myung Ho

    2014-04-01

    It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD.

  14. Radionuclide angiographic assessment of global and segmental left ventricular function at rest and during exercise after coronary artery bypass graft surgery

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    Lim, Y.L.; Kalff, V.; Kelly, M.J.; Mason, P.J.; Currie, P.J.; Harper, R.W.; Anderson, S.T.; Federman, J.; Stirling, G.R.; Pitt, A.

    1982-11-01

    Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The right anterior oblique gated first-pass technique was used to assess LVEF response to maximal exercise (Wmax), while the left anterior oblique equilibrium-gated technique was used to assess LVEF and relative LV volume changes during graded submaximal execise. The five subjects in whom LVEF decreased significantly during exercise postoperatively all had one or more blocked or stenosed grafts. This study documents, by two independent radionuclide techniques, an improved LVEF during exercise at an increased maximal work capacity and rate-pressure product 3 months after successful CABG. (JMT)

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

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    Farzaneh Dastan

    2015-10-01

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

  16. Use of multidetector computed tomography angiography of upper limb circulation in patients undergoing coronary artery bypass grafting surgery

    Directory of Open Access Journals (Sweden)

    Hasan B Altinsoy

    2017-01-01

    Full Text Available Objective: This study aimed to evaluate the bilateral forehand circulation using a 64-channel multidetector computed tomography (MDCT as a noninvasive method to define criteria for an upper extremity arterial anatomy and pathology prior to the use of arterial conduits. Materials and Methods: Fifty-five patients with coronary artery disease who underwent total arterial coronary artery bypass grafting (CABG were randomly selected for this prospective study. MDCT angiography was performed for 110 examinations of forearm and hand arterial anatomy. Prior to MDCT, Allen tests were performed in all patients with a normal result, except four. Thirteen patients had diabetes mellitus (DM, 8 had peripheral artery occlusive disease, and 19 had a history of smoking. Results: All arteries, including axillary, ulnar artery (UA and radial artery (RA, were clearly visualized in all patients. Upper extremity anatomical and pathological results were examined in 16 patients (29.1%. Severely calcified RA and/or UA were found in 6 patients who had a moderate renal failure. Nearly total occlusion of the RA was detected in another two patients. Focal intimal RA calcification was recorded in 1 female and 3 male patients. Ten patients who had severe calcification or intimal sclerosis of the upper extremity arteries had DM. The remaining patients had normal forehand arterial circulation. A persistent median artery with the absence of radial and ulnar arteries and a high bifurcation of RA from the brachial artery was detected as an anatomic variation in seven patients (12.7%. Conclusions: The major advantages of MDCT angiography are its non-invasiveness and the ability to detect calcific subadventitial plaques, which are difficult to diagnose using conventional angiography. MDCT may be used as a safe and non-invasive method to assess RA and UA prior to harvesting the upper limb artery. Preoperative imaging of forehand arteries is a means to avoid unnecessary forearm

  17. Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study.

    Science.gov (United States)

    Oprea, Adriana D; Del Rio, J Mauricio; Cooter, Mary; Green, Cynthia L; Karhausen, Jörn A; Nailer, Patrick; Guinn, Nicole R; Podgoreanu, Mihai V; Stafford-Smith, Mark; Schroder, Jacob N; Fontes, Manuel L; Kertai, Miklos D

    2018-01-01

    Preoperative and postoperative anemia have been identified individually as potential ri