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Sample records for bypass heart surgery

  1. Heart bypass surgery - discharge

    Science.gov (United States)

    ... trouble with short-term memory or feel confused ("fuzzy-headed") Be tired or not have much energy ... or a fever over 101°F (38.3°C). Alternative Names Off-pump coronary artery bypass - discharge; ...

  2. Heart bypass surgery

    Science.gov (United States)

    ... from the hospital. The day before your surgery: Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. Make sure that you dry ...

  3. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    ... revascularization. In: Antman EM, Sabatine MS, eds. Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease . 4th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 11. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline ...

  4. Heart bypass surgery - minimally invasive - discharge

    Science.gov (United States)

    ... invasive direct coronary artery bypass - discharge; MIDCAB - discharge; Robot assisted coronary artery bypass - discharge; RACAB - discharge; Keyhole ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  5. Pediatric heart surgery

    Science.gov (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... Ginther RM, Forbess JM. Pediatric cardiopulmonary bypass. In: ... Care . 5th ed. Philadelphia, PA: Elsevier; 2017:chap 37. LeRoy S, ...

  6. Combined Open-Heart Coronary Artery Bypass Surgery and ...

    African Journals Online (AJOL)

    CASE DETAILS: A 54-year-old woman suffering from dyspnea, chest pain and decreased left ventricular function (EF=40%) was diagnosed with coronary artery disease (3 vessel disease) and became candidate for coronary artery bypass grafting (CABG). Also, she had multinodular goiter with normal thyroid function test.

  7. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  8. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Alessandro Varrica

    2015-01-01

    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

  9. Heart and Lungs Protection Technique for Cardiac Surgery with Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Vladimir Pichugin

    2014-12-01

    Full Text Available Introduction: Cardioplegic cardiac arrest with subsequent ischemic-reperfusion injuries can lead to the development of inflammation of the myocardium, leucocyte activation, and release of cardiac enzymes. Flow reduction to the bronchial arteries, causing low-flow lung ischemia, leads to the development of a pulmonary regional inflammatory response. Hypoventilation during cardiopulmonary bypass (CPB is responsible for development of microatelectasis, hydrostatic pulmonary edema, poor compliance, and a higher incidence of infection. Based on these facts, prevention methods of these complications were developed. The aim of this study was to evaluate constant coronary perfusion (CCP and the “beating heart” in combination with pulmonary artery perfusion (PAP and “ventilated lungs” technique for heart and lung protection in cardiac surgery with CPB.Methods. After ethical approval and written informed consent, 80 patients undergoing cardiac surgery with normothermic CPB were randomized in three groups. In the first group (22 patients, the crystalloid cardioplegia without lung ventilation/perfusion techniques were used. In the second group (30 patients, the CCP and “beating heart” without lung ventilation/perfusion techniques were used. In the third group (28 patients, the CCP with PAP and lung ventilation techniques were used. Clinical, functional parameters, myocardial damage markers (CK MB level, oxygenation index, and lung compliance were investigated.Results. There were higher rates of spontaneous cardiac recovery and lower doses of inotrops in the second and third groups. Myocardial contractility function was better preserved in the second and third groups. The post-operative levels of CK-MB were lower than in control group.  Three hours after surgery CK-MB levels in the second and third  groups were lower by 38.1% and 33.3%, respectively. Eight hours after surgery, CK-MB levels were lower in the second and third groups by 45.9% and

  10. Changes in adhesion molecule expression and oxidative burst activity of granulocytes and monocytes during open-heart surgery with cardiopulmonary bypass compared with abdominal surgery

    DEFF Research Database (Denmark)

    Toft, P; Nielsen, C H; Tønnesen, Else Kirstine

    1998-01-01

    Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal...... surgery, 1, 5, 10 and 20 min after aortic clamping, and then 1, 5, 10 and 20 min and 1, 2 and 3 h after declamping. Samples from eight patients undergoing abdominal surgery were taken before surgery, at the end of surgery, and 2 and 3 h post-operatively. A decrease in number of granulocytes and monocytes...... surgery. The ability to respond with an oxidative burst was measured by means of flow cytometry using 123-dihydrorhodamine. The adhesion molecules CD11a/CD18, CD11c/CD18, CD44 were measured using monoclonal antibodies. Blood samples from eight patients undergoing open-heart surgery were taken before...

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

    Directory of Open Access Journals (Sweden)

    Abdulkadir Ercan

    2011-12-01

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

  12. Gastric bypass surgery

    Science.gov (United States)

    ... Buchwald H, ed. Buchwald's Atlas of Metabolic and Bariatric Surgical Techniques and Procedures . Philadelphia, PA: Elsevier Saunders; 2012:chap 5. Halperin F, Ding SA, Simonson DC, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients ...

  13. Usefulness of low-priming-volume cardiopulmonary bypass circuits and dilutional ultrafiltration in neonatal open-heart surgery.

    Science.gov (United States)

    Fukumura, Fumio; Kado, Hideaki; Imoto, Yutaka; Shiokawa, Yuichi; Minami, Kazu; Murakami, Jun; Yasui, Hisataka

    2004-01-01

    In neonate open-heart surgery, cardiopulmonary bypass (CPB) with extreme hemodilution induces an increased capillary permeability and accumulation of extravascular fluid, resulting in organ dysfunction. We evaluated the effects of a reduced priming volume for CPB and dilutional ultrafiltration (DUF) during neonatal open-heart surgery. Nineteen consecutive neonates with complete transposition of the great arteries who underwent an arterial switch operation were retrospectively assigned into two groups: the high-priming-volume circuit group (group A, n = 9) and the low-priming-volume circuit group (group B, n = 10). Patients in group B underwent surgery with a miniaturized CPB circuit and using the DUF technique. The priming volume of group B was nearly two-thirds that of group A. The water balance value after CPB and surgery was significantly lower in group B (-126 +/- 118 ml, -116 +/- 116 ml) than in group A (88 +/- 218 ml, 83 +/- 165 ml). Systolic blood pressure just after CPB was higher in group B (67.9 +/- 9.1 mmHg) than in group A (55.4 +/- 10.3 mmHg). Postoperative ventilatory support was shorter in group B (45 +/- 19 h) than in group A (68 +/- 27 h). In neonatal cardiac surgery, low-priming-volume CPB circuits and DUF improve the water balance during surgery and may attenuate any inflammatory reaction, which would help preserve postoperative organ function.

  14. Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Toft, P; Tønnesen, Else Kirstine; Zülow, I

    1997-01-01

    -heart surgery and eight with abdominal surgery were studied. The adhesion molecules CD11a/CD18 (LFA-1_, CD11c/CD18 and CD44 and the activation molecules CD25, CD69, CD71 and MHCII were measured, using monoclonal antibodies and flow cytometry. Lymphocytopenia was observed during CPB and for some hours after both...... open-heart and abdominal surgery. The proportion of CD11a/CD18-positive lymphocytes rose from 67.6 +/- 8% to 86.4 +/- 3% after aortic declamping (p ... was associated with increased expression of the adhesion molecule CD11a/CD18 on lymphocytes, while the expression of activation molecules on lymphocytes was unchanged....

  15. Cardioprotection of Electroacupuncture for Enhanced Recovery after Surgery on Patients Undergoing Heart Valve Replacement with Cardiopulmonary Bypass: A Randomized Control Clinical Trial

    Directory of Open Access Journals (Sweden)

    Fangxiang Zhang

    2017-01-01

    Full Text Available We attempted to investigate cardioprotection of electroacupuncture (EA for enhanced recovery after surgery on patients undergoing heart valve replacement with cardiopulmonary bypass. Forty-four patients with acquired heart valve replacement were randomly allocated to the EA group or the control group. Patients in the EA group received EA stimulus at bilateral Neiguan (PC6, Ximen (PC4, Shenting (GV24, and Baihui (GV20 acupoints twenty minutes before anesthesia induction to the end of surgery. The primary end point was cardioprotection effect of electroacupuncture postoperatively and the secondary endpoints were quality of recovery and cognitive functioning postoperatively. The present study demonstrated that electroacupuncture reduced the occurrence of complications and played a role of cardioprotective effect on patients after heart valve replacement surgery with cardiopulmonary bypass, and it benefits patients more comfortable and contributes to recovery after surgery. This trial is registered with ChiCTR-IOC-16009123.

  16. Outcomes after off-pump coronary bypass surgery

    NARCIS (Netherlands)

    Dijk, Diederik van

    2002-01-01

    The complications associated with in coronary artery bypass surgery (CABG) using cardiopulmonary bypass (CPB) have led to a renewed interest in coronary bypass surgery on the beating heart. The primary objective of the Octopus Study was to compare cognitive outcome between patients randomized to

  17. 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.

  18. Endothelial dysfunction mediated by interleukin-18 in patients with ischemic heart disease undergoing coronary artery bypass grafting surgery.

    Science.gov (United States)

    Jadranko, Sokolic; Tokmadzic, Vlatka Sotosek; Danijel, Knezevic; Igor, Medved; Nada, Vukelic Damjani; Sanja, Balen; Marijana, Rakic; Ana, Lanca Bastiancic; Gordana, Laskarin

    2017-07-01

    When medication management or percutaneous coronary intervention is not successful in patients with advanced ischemic heart disease, surgical revascularisation-predominantly coronary artery bypass grafting (CABG)-is considered the gold standard. However, CABG surgery can lead to ischemia/reperfusion injury, which is characterized by a strong inflammatory response. Interleukin (IL)-18, is a strong inflammatory mediator, that is released from cardiomyocytes and can be found in the systemic circulation of patients during and immediately after CABG surgery. The existing damage of endothelial glycocalyx in patients with ischemic heart disease is further impaired concurrently during the surgery due to the anaesthesia-surgical technique used and intravascular fluid loading. This results in the increased incidence of adverse events, including myocardial infarction. IL-18 leads to the activation of lymphocyte cytotoxicity via cytotoxic mediators (Fas ligand, Tumour necrosis factor (TNF)-related apoptosis-inducing ligand, perforin, and granulysin). We hypothesize that IL-18 is released locally in the heart and the systemic circulation in patients undergoing CABG surgery and may be correlated with the level of activity of circulating lymphocytes. In turn, this may lead to lymphocyte-mediated cytotoxicity directed toward damaged and activated endothelial cells. Shear stress glycocalyx, as well as damaged and activated endothelial cells then become the main the source of pro-inflammatory cytokines, chemokines, and adhesion molecules. These attract activated lymphocytes to adhere to the endothelium or enter the subintimal layer, increasing existing or initiating the formation of new plaques, which leads to the development of myocardial infarction during or shortly after surgery. To evaluate our hypothesis, we will measure the local concentration of IL-18 in the sinus coronarius and systemic circulation. These values will then be correlated with immunological and biochemical

  19. What Is Heart Surgery?

    Science.gov (United States)

    ... which could relieve angina. Heart Valve Repair or Replacement For the heart to work well, blood must ... have blood flowing through it. Heart-Lung Bypass Machine The image shows how a heart-lung bypass ...

  20. Influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Shu-Tian Song

    2016-09-01

    Full Text Available Objective: To investigate and analyze the influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass. Methods: A total of 42 patients with open heart surgery with cardiopulmonary bypass during the period of June 2014 to January 2016 were randomly divided into the control group of 21 cases and the observation group of 21 cases. The control group was treated with routine postoperative treatment, and the observation group was treated with recombinant human brain natriuretic peptide on the basic treatment of control group, then the myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes of the two groups before the surgery and at 2 h, 12 h and 24 h after the surgery were respectively detected and compared. Results: There were no significant difference in myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes between two groups before the surgery (all P>0.05, while the myocardial enzymes and serum cardiac function indexes of the observation group at 2 h ,12 h and 24 h after the surgery were all significantly lower than those of control group, the oxygen metabolism indexes were significantly better than the levels of control group (all P<0.05. Conclusions: The recombinant human brain natriuretic peptide can effectively improve the myocardial enzymes, serum cardiac function indexes and oxygen metabolism state of patients with open heart surgery with cardi

  1. Gastric Bypass Surgery

    Science.gov (United States)

    ... gastrointestinal system Death (rare) Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They ... room, where medical staff monitors you for any complications. Your hospital stay may ... of bariatric surgery Each type of bariatric surgery has pros and ...

  2. A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass.

    Science.gov (United States)

    Odaka, Mizuho; Minakata, Kenji; Toyokuni, Hideaki; Yamazaki, Kazuhiro; Yonezawa, Atsushi; Sakata, Ryuzo; Matsubara, Kazuo

    2015-08-01

    This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. This novel protocol was assessed by comparing patients undergoing open heart surgery before (control group; n = 30) and after its implementation (protocol group; n = 31) at Kyoto University Hospital between July 2012 and January 2013. Surgical site infections (SSIs) were observed in 4 control group patients (13.3 %), whereas no SSIs were observed in the protocol group patients (P protocol group (P protocol significantly decreased the total antibiotic dose used in the perioperative period (P protocol group patients required this additional change in the antibiotic regimen (P protocol based on preoperative kidney function effectively prevents SSIs in patients undergoing open heart surgery.

  3. Reduction of cognitive performance by piracetam in patients undergoing coronary bypass surgery using heart-lung maschine

    OpenAIRE

    Alaaraj, Nour

    2015-01-01

    Introduction: The occurrence of cognitive dysfunction after coronary bypass surgery poses a relevant clinical problem. The precise pathophysiological mechanisms underlying post-operative cognitive dysfunction remain to be fully elucidated. However, it seems safe to assume that the etiology is multifactorial. Piracetam is approved for the treatment of chronic cognitive dysfunction in dementia. Emerging data suggests that piracetam may also be beneficial for post-operative cognitive outcomes. T...

  4. Current peripheral bypass surgery: various clinical studies

    NARCIS (Netherlands)

    Slaa, Alexander te

    2011-01-01

    Substantial post-operative edema occurs in the majority of patients who undergo peripheral bypass surgery due to severe peripheral arterial disease (PAD). The pathophysiological mechanisms that underlay edema formation following peripheral bypass surgery include hyperemia, an increased capillary

  5. Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long-Term Risks of Congestive Heart Failure.

    Science.gov (United States)

    Benotti, Peter N; Wood, G Craig; Carey, David J; Mehra, Vishal C; Mirshahi, Tooraj; Lent, Michelle R; Petrick, Anthony T; Still, Christopher; Gerhard, Glenn S; Hirsch, Annemarie G

    2017-05-23

    Obesity and its association with reduced life expectancy are well established, with cardiovascular disease as one of the major causes of fatality. Metabolic surgery is a powerful intervention for severe obesity, resulting in improvement in comorbid diseases and in cardiovascular risk factors. This study investigates the relationship between metabolic surgery and long-term cardiovascular events. A cohort of Roux-en-Y gastric bypass surgery (RYGB) patients was tightly matched by age, body mass index, sex, Framingham Risk Score, smoking history, use of antihypertension medication, diabetes mellitus status, and calendar year with a concurrent cohort of nonoperated control patients. The primary study end points of major cardiovascular events (myocardial infarction, stroke, and congestive heart failure) were evaluated using Cox regression. Secondary end points of longitudinal cardiovascular risk factors were evaluated using repeated-measures regression. The RYGB and matched controls (N=1724 in each cohort) were followed for up to 12 years after surgery (overall median of 6.3 years). Kaplan-Meier analysis revealed a statistically significant reduction in incident major composite cardiovascular events ( P =0.017) and congestive heart failure (0.0077) for the RYGB cohort. Adjusted Cox regression models confirmed the reductions in severe composite cardiovascular events in the RYGB cohort (hazard ratio=0.58, 95% CI=0.42-0.82). Improvements of cardiovascular risk factors (eg, 10-year cardiovascular risk score, total cholesterol, high-density lipoprotein, systolic blood pressure, and diabetes mellitus) were observed within the RYGB cohort after surgery. Gastric bypass is associated with a reduced risk of major cardiovascular events and the development of congestive heart failure. © 2017 The Authors and Geisinger Clinic. Published on behalf of the American Heart Association, Inc., by Wiley.

  6. Gastric bypass surgery - discharge

    Science.gov (United States)

    ... on it. DO NOT soak in a bathtub, swimming pool, or hot tub until your provider says ... American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J ...

  7. Heart failure - surgeries and devices

    Science.gov (United States)

    CHF - surgery; Congestive heart failure - surgery; Cardiomyopathy - surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure

  8. Controlled reoxygenation during cardiopulmonary bypass decreases markers of organ damage, inflammation, and oxidative stress in single-ventricle patients undergoing pediatric heart surgery.

    Science.gov (United States)

    Caputo, Massimo; Mokhtari, Amir; Miceli, Antonio; Ghorbel, Mohamed T; Angelini, Gianni D; Parry, Andrew J; Suleiman, Saadeh M

    2014-09-01

    Single-ventricle patients undergoing pediatric heart surgery are a high-risk group owing to reoxygenation injury during cardiopulmonary bypass (CPB). The present study investigated the effects of controlled reoxygenation CPB on biomarkers of organ damage, inflammation, stress, and long-term functional outcomes in cyanotic patients with either a single or double ventricle during open heart surgery. Cyanotic patients with either a single (n = 32) or double (n = 47) ventricle undergoing surgical correction were randomized to receive CPB using either standard oxygen levels or controlled reoxygenation. The markers of cardiac injury, inflammation, stress, and cerebral and hepatic injury were measured preoperatively, at 10 and 30 minutes after starting CPB, and at 10 minutes and 4 and 24 hours after CPB. The data were analyzed using a mixed regression model. No difference was found in the pre- or intraoperative characteristics between the standard and controlled reoxygenation CPB groups for single- or double-ventricle patients. In the single-ventricle patients, controlled reoxygenation CPB significantly (P markers of organ damage, inflammation, stress, and oxidative stress. In contrast, the markers of inflammation and cardiac injury were not altered by controlled reoxygenation CPB in the double-ventricle patients. Controlled reoxygenation CPB decreased the markers of organ damage, stress, inflammation, and oxidative stress in single-ventricle patients undergoing cardiac surgery. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  9. Bypass materials in vascular surgery

    Directory of Open Access Journals (Sweden)

    Willich, Stephan N.

    2006-03-01

    Full Text Available Introduction: Arteriosclerotic changes can lead to circulatory disturbances in various areas of the human vascular system. In addition to pharmacological therapy and the management of risk factors (e. g. hypertension, diabetes, lipid metabolism disorders, and lifestyle, surgical interventions also play an important role in the treatment of arteriosclerosis. Long-segment arterial occlusions, in particular, can be treated successfully with bypass sur-gery. A number of different materials are available for this type of operation, such as autologous vein or pros-thetic grafts comprised of polytetrafluoroethylene (PTFE or Dacron®. Prosthetic materials are used especially in the treatment of peripheral artery disease, such as in aortoiliac or femoropopliteal bypass surgery. The present report will thus focus on this area in order to examine the effectiveness of different bypass materials. Among the efforts being made to refine the newly introduced DRG system in Germany, analysing the different bypass materials used in vascular surgery is particularly important. Indeed, in its current version the German DRG system does not distinguish between bypass materials in terms of reimbursement rates. Differences in cost structures are thus of especial interest to hospitals in their budget calculations, whereas both private and statutory health insurance funds are primarily interested in long-term results and their costs. Objectives: The goal of this HTA is to compare the different bypass materials used in vascular surgery in terms of their medical efficiency and cost-effectiveness, as well as with regard to their ethical, social and legal implications. In addition, this report aims to point out the areas in which further medical, epidemiological and health economic research is still needed. Methods: Relevant publications were identified by means of a structured search of databases accessed through the German Institute of Medical Documentation and Information

  10. Changes in adhesion molecule expression and oxidative burst activity of granulocytes and monocytes during open-heart surgery with cardiopulmonary bypass compared with abdominal surgery

    DEFF Research Database (Denmark)

    Toft, P; Nielsen, C H; Tønnesen, Else Kirstine

    1998-01-01

    surgery. The ability to respond with an oxidative burst was measured by means of flow cytometry using 123-dihydrorhodamine. The adhesion molecules CD11a/CD18, CD11c/CD18, CD44 were measured using monoclonal antibodies. Blood samples from eight patients undergoing open-heart surgery were taken before...

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

    Science.gov (United States)

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

    2015-06-01

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

  12. Pediatric heart surgery - discharge

    Science.gov (United States)

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  13. Limited-Access Heart Surgery

    Science.gov (United States)

    ... Surgery Menu Topics Topics FAQs Limited-Access Heart Surgery Article Info En español Thousands of heart surgeries ... with cardiovascular disease. What is minimally invasive heart surgery? In minimally invasive heart surgery, surgeons take steps ...

  14. 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 addit...

  15. Effects of different levels of positive airway pressure on breathing pattern and heart rate variability after coronary artery bypass grafting surgery

    Directory of Open Access Journals (Sweden)

    C.B.F. Pantoni

    2011-01-01

    Full Text Available The application of continuous positive airway pressure (CPAP produces important hemodynamic alterations, which can influence breathing pattern (BP and heart rate variability (HRV. The aim of this study was to evaluate the effects of different levels of CPAP on postoperative BP and HRV after coronary artery bypass grafting (CABG surgery and the impact of CABG surgery on these variables. Eighteen patients undergoing CABG were evaluated postoperatively during spontaneous breathing (SB and application of four levels of CPAP applied in random order: sham (3 cmH2O, 5 cmH2O, 8 cmH2O, and 12 cmH2O. HRV was analyzed in time and frequency domains and by nonlinear methods and BP was analyzed in different variables (breathing frequency, inspiratory tidal volume, inspiratory and expiratory time, total breath time, fractional inspiratory time, percent rib cage inspiratory contribution to tidal volume, phase relation during inspiration, phase relation during expiration. There was significant postoperative impairment in HRV and BP after CABG surgery compared to the preoperative period and improvement of DFAα1, DFAα2 and SD2 indexes, and ventilatory variables during postoperative CPAP application, with a greater effect when 8 and 12 cmH2O were applied. A positive correlation (P < 0.05 and r = 0.64; Spearman was found between DFAα1 and inspiratory time to the delta of 12 cmH2O and SB of HRV and respiratory values. Acute application of CPAP was able to alter cardiac autonomic nervous system control and BP of patients undergoing CABG surgery and 8 and 12 cmH2O of CPAP provided the best performance of pulmonary and cardiac autonomic functions.

  16. Heart Surgery - Multiple Languages

    Science.gov (United States)

    ... Coronary Artery Bypass Surgery - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Pacemaker - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF ...

  17. Coronary Artery Bypass Surgery - Multiple Languages

    Science.gov (United States)

    ... Coronary Artery Bypass Surgery - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Chinese, Traditional (Cantonese dialect) (繁體中文) Expand Section Coronary ...

  18. Investigation of the effects of chest physiotherapy in different positions on the heart and the respiratory system after coronary artery bypass surgery.

    Science.gov (United States)

    Guner, Sukriye Ilkay; Korkmaz, Fatma Demir

    2015-07-01

    This trial was conducted to investigate the effect of chest physiotherapy in different positions on the heart and the respiratory system after coronary artery bypass surgery. Patients are divided into two groups of 30 patients each in the study. To the patients in the first group (30 patients), percussion-vibration was performed in the 45° supine position, while slightly laterally lying and endotracheal aspiration was performed in the supine position. To the patients in the second group (30 patients), percussion-vibration was performed in the 0° supine position, while slightly laterally lying and endotracheal aspiration was performed in the supine position. The procedures are repeated two times for all patients and their means were taken. The pre- and postapplication values of patients were measured from central venous and arterial catheters and the values of patient monitors were recorded. Comparison of the two groups in terms of respiratory values did not reveal a significant difference, but chest physiotherapy with the head of the bed at 0° was determined to improve cardiac functions. Evaluation of the groups in terms of pre- and postphysiotherapy applications showed a significant increase in mixed venous oxygen saturation in both groups. Chest physiotherapy with the head of the bed elevated to 45° may be recommended in patients who carry a risk of pulmonary complications and who are candidates for chest physiotherapy at an early stage. © The Author(s) 2013.

  19. Continuous renal replacement therapy with a polymethyl methacrylate membrane hemofilter suppresses inflammation in patients after open-heart surgery with cardiopulmonary bypass.

    Science.gov (United States)

    Mukaida, Hiroshi; Matsushita, Satoshi; Inotani, Takahiro; Nakamura, Atsushi; Amano, Atsushi

    2018-02-05

    Cardiopulmonary bypass (CPB) induces a complex inflammatory response involving an increase in inflammatory cytokines, called postperfusion syndrome. Previous studies demonstrated that adsorption of the serum cytokines can reduce acute inflammation and improve clinical outcomes. In this study, patients were placed on continuous renal replacement therapy (CRRT) with a polymethyl methacrylate (PMMA) membrane hemofilter immediately after the start of an open-heart surgery with CPB and throughout the postoperative course to prevent postperfusion syndrome. The aim of this study was to assess whether continuous CRRT using a PMMA filter (PMMA-CRRT) could affect cytokine expression and improve perioperative outcomes. We designed a randomized controlled trial, which included 19 consecutive adult patients on maintenance dialysis and 7 consecutive adult patients who were not on maintenance dialysis (NHD group). Patients on maintenance dialysis were randomly divided into two groups: Ten patients who received CRRT with a polysulfone membrane hemofilter (PS group) and nine patients who received CRRT with a PMMA membrane (PMMA group). Blood samples were collected from the radial or brachial artery at five different time points. Comparisons between the PS, PMMA, and NHD groups revealed a significant main effect of time on changes in serum IL-6 and IL-8 concentrations (p < 0.01) and an interaction (p < 0.05) between time and group. Plasma IL-6 and IL-8 levels after surgery were significantly lower in the PMMA group than in the PS group, while other cytokines measured in this study were not significantly different. In addition, clinical outcomes were not significantly different between the groups. The continuous use of PMMA-CRRT throughout the perioperative period suppressed serum IL-6 and IL-8 concentrations, although there were no differences in clinical outcomes.

  20. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob

    2014-01-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines...... analgesic treatment in LRYGB surgery....

  1. Pregnancy outcomes after gastric-bypass surgery.

    Science.gov (United States)

    Dao, Tuoc; Kuhn, Joseph; Ehmer, Dale; Fisher, Tammy; McCarty, Todd

    2006-12-01

    The purpose of this study is to compare outcomes of patients who become pregnant within the first year after surgery and those who delayed pregnancy until after 1 year after surgery. A retrospective review was performed to identify patients who became pregnant after their gastric-bypass surgery from 2001 to 2004. Endpoints included pregnancy complications, fetal birth weight and outcome, delivery method, weight change during pregnancy, and nutrition. Of 2,423 patients who had undergone bariatric surgery from 2001 to 2004, 21 patients became pregnant within the first year after surgery and 13 became pregnant after 1 year. Similar outcomes were seen between the 2 groups regarding fetal weight, term pregnancy, and complications. Pregnancy outcomes within the first year after weight-loss surgery revealed no significant episodes of malnutrition, adverse fetal outcomes, or pregnancy complications. Anxiety over poor outcomes of pregnancy during the first year after bariatric surgery can be allayed.

  2. Postoperative pulmonary hypertensive crisis caused by inverted left atrial appendage after cardiopulmonary bypass surgery for congenital heart disease in a neonate.

    Science.gov (United States)

    Zhao, Qifeng; Hu, Xingti

    2013-09-01

    Postoperative pulmonary hypertensive crisis (PHC) caused by an inverted left atrial appendage (ILAA) is a rare complication following cardiac surgery. We present a case of 23 day-old male infant who developed postoperative PHC attacks after undergoing cardiopulmonary bypass (CPB) surgery for repair of the coactation of aorta. A hyperechogenic left atrial mass was detected via bedside transthoracic echocardiography (TTE), which was identified as an ILAA and corrected following repeat surgery. In this case, both the negative pressure in vent catheter and the long left atrial appendage (LAA) with a narrow base led to an irreversible ILAA. As in this neonate, ILAA had significant influence on the left atrial volume and caused PHC since the ILAA was located on the mitral valve orifice and interfered with the blood flow through the valve. Therefore, we recommend that the vent catheter should be turned off before removing to avoid this potential complication. Additionally, LAA should be carefully inspected after CPB surgery, and intra-operative and post-operative transoesophageal echocardiography (TEE) should be performed to detect ILAA intraoperatively so as to avoid the reoperation. When an ILAA is diagnosed postoperatively, whether conservative treatment or surgery will depend on the balance of benefit and risk for a particular patient. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

  3. 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

  4. Changes in Heart Rate Variability after Coronary Artery Bypass Grafting and Clinical Importance of These Findings.

    Science.gov (United States)

    Lakusic, Nenad; Mahovic, Darija; Kruzliak, Peter; Cerkez Habek, Jasna; Novak, Miroslav; Cerovec, Dusko

    2015-01-01

    Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented.

  5. Combined Coronary Artery and Abdominal Aortic Surgery without Cardiopulmonary Bypass

    Science.gov (United States)

    Ascione, Raimondo; Iannelli, Gabriele; Spampinato, Nicola

    2000-01-01

    To determine the effects of beating heart surgery on patients undergoing simultaneous coronary artery bypass grafting and abdominal aortic surgery, we performed such surgery on 20 patients (mean age, 64.55 ± 7.96 SD years). Abdominal aortic disease was defined as an abdominal aortic aneurysm larger than 5 cm in diameter or as end-stage aortic occlusive disease. Hemodynamic measurements, inotropic requirements, and incidence of perioperative myocardial infarction and arrhythmias were recorded, as were subsystem clinical outcomes, length of intensive care unit and hospital stays, blood loss, and transfusion requirements. There was no incidence of death, perioperative myocardial infarction, stroke, or acute renal failure. The mean number of grafts per patient was 1.95 ± 0.69. Only 4 minor postoperative complications were observed: three patients (15%) had evidence of supraventricular tachyarrhythmias, and 1 patient (5%) had chest infection that required a longer-than-average intubation period. Six patients (30%) required minimal-to-moderate inotropic support. The mean blood loss was 673 ± 246.8 mL and transfusion requirements were low. The mean intensive care unit and hospital lengths of stay were 2.12 ± 0.33 days and 7.08 ± 1.44 days, respectively. Clinical follow-up (mean, 10 months) showed all patients to be in New York Heart Association functional class I or II with no late cardiac or abdominal events. We conclude that simultaneous coronary artery bypass grafting and abdominal aortic surgery on the beating heart is safe and effective, and has a low perioperative clinical morbidity rate. To our knowledge, ours is the 1st report on this procedure. Larger studies with longer follow-up are needed. PMID:10830623

  6. Infant open heart surgery (image)

    Science.gov (United States)

    During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia. ... During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia.

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

    Directory of Open Access Journals (Sweden)

    Temucin Noyan Ogus

    2010-01-01

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

  8. Crohn’s disease after gastric bypass surgery

    OpenAIRE

    Janczewska, Izabella; Nekzada, Qayium; Kapraali, Marjo

    2011-01-01

    Bariatric surgery for the treatment of severe obesity has increased dramatically in recent years in the USA and parts of Western Europe. The most commonly used technique is the Roux-en Y gastric bypass (RYGBP). Several nutritional and gastrointestinal complications after bariatric surgery have been described during the last 10 years. The authors present two patients with diarrhoea and malnutrition; one after RYGBP and the other after jejunoileal bypass surgery. These patients were subsequentl...

  9. Coronary Artery-Bypass-Graft Surgery Increases the Plasma Concentration of Exosomes Carrying a Cargo of Cardiac MicroRNAs: An Example of Exosome Trafficking Out of the Human Heart with Potential for Cardiac Biomarker Discovery.

    Directory of Open Access Journals (Sweden)

    Costanza Emanueli

    Full Text Available Exosome nanoparticles carry a composite cargo, including microRNAs (miRs. Cultured cardiovascular cells release miR-containing exosomes. The exosomal trafficking of miRNAs from the heart is largely unexplored. Working on clinical samples from coronary-artery by-pass graft (CABG surgery, we investigated if: 1 exosomes containing cardiac miRs and hence putatively released by cardiac cells increase in the circulation after surgery; 2 circulating exosomes and exosomal cardiac miRs correlate with cardiac troponin (cTn, the current "gold standard" surrogate biomarker of myocardial damage.The concentration of exosome-sized nanoparticles was determined in serial plasma samples. Cardiac-expressed (miR-1, miR-24, miR-133a/b, miR-208a/b, miR-210, non-cardiovascular (miR-122 and quality control miRs were measured in whole plasma and in plasma exosomes. Linear regression analyses were employed to establish the extent to which the circulating individual miRs, exosomes and exosomal cardiac miR correlated with cTn-I. Cardiac-expressed miRs and the nanoparticle number increased in the plasma on completion of surgery for up to 48 hours. The exosomal concentration of cardiac miRs also increased after CABG. Cardiac miRs in the whole plasma did not correlate significantly with cTn-I. By contrast cTn-I was positively correlated with the plasma exosome level and the exosomal cardiac miRs.The plasma concentrations of exosomes and their cargo of cardiac miRs increased in patients undergoing CABG and were positively correlated with hs-cTnI. These data provide evidence that CABG induces the trafficking of exosomes from the heart to the peripheral circulation. Future studies are necessary to investigate the potential of circulating exosomes as clinical biomarkers in cardiac patients.

  10. Preparing Children for Heart Surgery

    Science.gov (United States)

    ... hospital or in the neighborhood. Learn more about: Feeding Tips Children's Special Needs Learn more about your child and ... Cardiac Catheterizations Heart Transplants Preparing Children for Surgery - Feeding Tips - Children's Special Needs Physical Activity Recommendations for Heart Health • ...

  11. Exercise-induced Atrioventricular Block with Coronary Artery Stenosis that Appeared Five Years after Bypass Surgery.

    Science.gov (United States)

    Yamazaki, Shinya; Kato, Taku; Ushimaru, Shunpei; Yokoi, Hirokazu; Mani, Hiroki

    2018-02-01

    A 68-year-old man with a history of coronary artery bypass surgery was referred to our hospital because of pre-syncope on effort. During a treadmill exercise electrocardiogram test, the patient developed advanced atrioventricular block associated with dizziness. Coronary angiography revealed significant stenosis of the right coronary artery, which had not existed at the time of the bypass surgery. We implanted drug-eluting stents in the stenotic lesion, and an exercise test showed resolution of the atrioventricular block. Exercise-induced atrioventricular block is rare, and it is necessary to distinguish it from ischemic heart disease, especially in patients with a history of coronary artery disease.

  12. Transfusion requirements in elective cardiopulmonary bypass surgery patients

    DEFF Research Database (Denmark)

    Sivapalan, Praleene; Bäck, Anne Caroline; Ostrowski, Sisse Rye

    2017-01-01

    Managing haemostasis in patients undergoing cardiopulmonary bypass (CPB) surgery remains a challenge. There is no established laboratory test to predict transfusion requirements in cardiac surgery. We investigated whether preoperative Thromboelastography (TEG) with Platelet Mapping Assay (PMA......) or Multiple Electrode Aggrometry (MEA) could predict transfusion requirements in patients undergoing elective coronary artery bypass grafting (CABG) or combined CABG with aortic or mitral valve replacement. We prospectively investigated 199 patients undergoing elective CABG or combined procedures. PMA and MEA...

  13. Combined coronary artery bypass surgery and abdominal aortic aneurysm repair.

    OpenAIRE

    Black, J J; Desai, J B

    1995-01-01

    The proper management of patients with asymptomatic abdominal aortic aneurysms and significant coexistent coronary artery disease is still debatable. The most common approach has been to perform the coronary artery bypass surgery some weeks before the abdominal aortic aneurysm repair in the hope of reducing the cardiac morbidity and mortality. We report our initial experience of three consecutive elective cases where the coronary artery bypass surgery and the abdominal aortic aneurysm repair ...

  14. Robotically assisted totally endoscopic coronary artery bypass surgery

    OpenAIRE

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi; Bonatti, Johannes

    2013-01-01

    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of o...

  15. Cardiopulmonary bypass: development of John Gibbon's heart-lung machine

    OpenAIRE

    Passaroni, Andréia Cristina; Silva, Marcos Augusto de Moraes; Yoshida, Winston Bonetti

    2015-01-01

    AbstractObjective:To provide a brief review of the development of cardiopulmonary bypass.Methods:A review of the literature on the development of extracorporeal circulation techniques, their essential role in cardiovascular surgery, and the complications associated with their use, including hemolysis and inflammation.Results:The advancement of extracorporeal circulation techniques has played an essential role in minimizing the complications of cardiopulmonary bypass, which can range from vari...

  16. Early extubation after congenital heart surgery

    Directory of Open Access Journals (Sweden)

    Mirza Halimić

    2014-12-01

    Full Text Available Introduction: Despite recent advances in anesthesia, cardiopulmonary bypass and surgical techniques, children undergoing congenital heart surgery require postoperativemechanical ventilation. Early extubation was definedas ventilation shorter than 12 hours. Aim of this study is to identify factors associated with successful early extubation after pediatric cardiac surgery.Methods: The study was performed during period from January 2006 to January 2011 at Pediatric Clinic and Heart Center University Clinical center Sarajevo. One hundred children up to 5 years of age, who have had congenital heart disease, with left–right shunt and obstructive heart disease were included in the study. Patients were divided into two groups: Group I - patients extubated within 12 hours after surgery and Group II - patients extubated 12 or more hours after surgery. Results: The most frequently encountered preoperative variables were age with odds ratio 4% 95%CI (1-7%, Down's syndrome 8.5 95%CI (1.6-43.15, failure to thrive 4.3 95%CI( 1-18. Statistically significant postoperative data included lung disease (reactive airways, pneumonia, atelectasis, pneumothorax and with odds ratio 35.1 95 %CI (4-286 and blood transfusion with odds ratio 4.6 95%CI (2-12. Blood transfusion (p=0.002 (Wald=9.2 95%CI (2-12, during as well as after operation procedure has statistically significant influence on prediction time of extubation. Proven markers were age with cut of 21.5 months (sensitivity 74% and specificity 70% and extracorporeal circulation (ECC with cut-of 45.5 minutes (sensitivity 71% and specificity 65%.Conclusion: Early extubation is possible in many children undergoing congenital heart surgery. Younger age and prolonged ECC time are markers associated with prolonged mechanical ventilation.

  17. Robotically assisted totally endoscopic coronary artery bypass surgery

    Science.gov (United States)

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi

    2013-01-01

    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the “best of both worlds” from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations. PMID:24251021

  18. Exercise thallium-201 scintigraphy in evaluating aortocoronary bypass surgery

    International Nuclear Information System (INIS)

    Iskandrian, A.S.; Haaz, W.; Segal, B.L.; Kane, S.A.

    1981-01-01

    Thirty patients with recurrent symptoms after aortocoronary bypass graft surgery underwent angiography as well as exercise thallium 201 imaging. Exercise imaging has been shown to be highly specific (100 percent in our study) in evaluating patients after bypass surgery. Patients with complete revascularization have normal thallium 201 images. Similarly, exercise-induced defects are seen only in the presence of incomplete revascularization. There are patients, however, with incomplete revascularization with normal exercise images, but these generally limited to the right coronary artery or the diagonal vessels or their grafts

  19. Heart valve surgery

    Science.gov (United States)

    ... techniques are used: Percutaneous surgery (through the skin) Robot-assisted surgery If your surgeon can repair your ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  20. HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

    Directory of Open Access Journals (Sweden)

    R. Sh. Saitgareev

    2016-01-01

    Full Text Available Heart Transplantation (HTx to date remains the most effective and radical method of treatment of patients with end-stage heart failure. The defi cit of donor hearts is forcing to resort increasingly to the use of different longterm mechanical circulatory support systems, including as a «bridge» to the follow-up HTx. According to the ISHLT Registry the number of recipients underwent cardiopulmonary bypass surgery increased from 40% in the period from 2004 to 2008 to 49.6% for the period from 2009 to 2015. HTx performed in repeated patients, on the one hand, involves considerable technical diffi culties and high risks; on the other hand, there is often no alternative medical intervention to HTx, and if not dictated by absolute contradictions the denial of the surgery is equivalent to 100% mortality. This review summarizes the results of a number of published studies aimed at understanding the immediate and late results of HTx in patients, previously underwent open heart surgery. The effect of resternotomy during HTx and that of the specifi c features associated with its implementation in recipients previously operated on open heart, and its effects on the immediate and long-term survival were considered in this review. Results of studies analyzing the risk factors for perioperative complications in repeated recipients were also demonstrated. Separately, HTx risks after implantation of prolonged mechanical circulatory support systems were examined. The literature does not allow to clearly defi ning the impact factor of earlier performed open heart surgery on the course of perioperative period and on the prognosis of survival in recipients who underwent HTx. On the other hand, subject to the regular fl ow of HTx and the perioperative period the risks in this clinical situation are justifi ed as a long-term prognosis of recipients previously conducted open heart surgery and are comparable to those of patients who underwent primary HTx. Studies

  1. Your diet after gastric bypass surgery

    Science.gov (United States)

    ... and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring) . 2009;17 Suppl 1:S1- ...

  2. [Rosuvastatin in Coronary Bypass Surgery: Whether Only Secondary Prevention?

    Science.gov (United States)

    Panov, A V; Gordeev, M L; Mitrofanova, L B; Kuleshov, E V; Buthashvili, M I; Abesadze, I T; Alugishvili, M Z; Lohovinina, N L; Korzhenevskaya, K V

    2016-05-01

    The increasing number of coronary artery bypass grafting (CABG) is associated with a need for active introduction of methods improving immediate and long-term results of these interventions. Results of a number of studies conducted during recent years allow to consider high dose statin therapy one of such methods. In this article we present results of rosuvastatin administration to patients with ischemic heart disease (IHD) prior to surgery. Rosuvastatin (40 mg/day) was given for 4 weeks before CABG to patients who had previously taken simvastatin (20 mg/day). This regimen was assocaed with reduction of desquamation of endothelium of the intima, reduction of the number of smooth muscle cells in the media, as well as the proliferation index according to the immunohistochemical analysis in sections of the great saphenous vein selected for the coronary anastomosis. It is assumed that the antiproliferative effects of high-dose rosuvastatin therapy may have a positive impact in relation to the viability of a remote arterio-venous grafts.

  3. Anesthetic implications of subxiphoid coronary artery bypass surgery.

    Science.gov (United States)

    Chakravarthy, Murali; Veerappa, Muralimanohar; Jawali, Vivek; Pandya, Nischal; Krishnamoorthy, Jayaprakash; Muniraju, Geetha; George, Antony; Baishya, Jitumoni

    2016-01-01

    Minimal invasive surgeries are carried out to benefit the patient with less pain, blood loss, mechanical ventilation and hospital stay; a smaller scar is not the aim. Minimal invasive cardiac surgeries are carried out via small sternotomy, small thoracotomy and via robotic arms. Subxiphoid route is a novel method and avoids sternotomy. This case series is an attempt to understand the anesthetic modifications required. Secondly, whether it is feasible to carry out subxiphoid coronary artery bypass surgery. Elective patients scheduled to undergo subxiphoid coronary artery bypass surgery were chosen. The surgeries were conducted under general anesthesia with left lung isolation via either endobronchial tube or bronchial blocker. We conducted ten (seven males and 3 females) coronary artery bypass graft surgeries via subxiphoid technique. The mean EuroSCORE was 1.7 and the mean ejection fraction was 53.6. Eight patients underwent surgery via endobronchial tube, while, in the remaining two lung isolation was obtained using bronchial blocker. Mean blood loss intraoperatively was 300 ± 42 ml and postoperatively 2000 ± 95 ml. The pain score on the postoperative day '0' was 4.3 ± 0.6 and 2.3 ± 0.7 on the day of discharge. Length of stay in the hospital was 4.8 ± 0.9 days. There were no complications, blood transfusions, conversion to cardiopulmonary bypass. The modifications in the anesthetic and surgical techniques are, use of left lung isolation using either endobronchial tube or bronchial blocker, increased duration for conduit harvesting, grafting, requirement of transesophageal echocardiography monitoring in addition to hemodynamic monitoring. Other minor requirements are transcutaneous pacing and defibrillator pads, a wedge under the chest to 'lift' up the chest, sparing right femoral artery and vein (to serve as vascular access) for an unlikely event of conversion to cardiopulmonary bypass. Any anesthesiologist wishing to start this technique must be aware of

  4. Anesthetic implications of subxiphoid coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Murali Chakravarthy

    2016-01-01

    Full Text Available Background: Minimal invasive surgeries are carried out to benefit the patient with less pain, blood loss, mechanical ventilation and hospital stay; a smaller scar is not the aim. Minimal invasive cardiac surgeries are carried out via small sternotomy, small thoracotomy and via robotic arms. Subxiphoid route is a novel method and avoids sternotomy. Aim: This case series is an attempt to understand the anesthetic modifications required. Secondly, whether it is feasible to carry out subxiphoid coronary artery bypass surgery. Methods: Elective patients scheduled to undergo subxiphoid coronary artery bypass surgery were chosen. The surgeries were conducted under general anesthesia with left lung isolation via either endobronchial tube or bronchial blocker. Results: We conducted ten (seven males and 3 females coronary artery bypass graft surgeries via subxiphoid technique. The mean EuroSCORE was 1.7 and the mean ejection fraction was 53.6. Eight patients underwent surgery via endobronchial tube, while, in the remaining two lung isolation was obtained using bronchial blocker. Mean blood loss intraoperatively was 300 ± 42 ml and postoperatively 2000 ± 95 ml. The pain score on the postoperative day ′0′ was 4.3 ± 0.6 and 2.3 ± 0.7 on the day of discharge. Length of stay in the hospital was 4.8 ± 0.9 days. There were no complications, blood transfusions, conversion to cardiopulmonary bypass. The modifications in the anesthetic and surgical techniques are, use of left lung isolation using either endobronchial tube or bronchial blocker, increased duration for conduit harvesting, grafting, requirement of transesophageal echocardiography monitoring in addition to hemodynamic monitoring. Other minor requirements are transcutaneous pacing and defibrillator pads, a wedge under the chest to ′lift′ up the chest, sparing right femoral artery and vein (to serve as vascular access for an unlikely event of conversion to cardiopulmonary bypass. Any

  5. Recovery from circulatory depression after coronary artery bypass surgery

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); R.W. Brower (Ronald); H.J. ten Katen (Harald); G.T. Meester (Geert)

    1980-01-01

    textabstractThe direct traumatic effects of coronary artery bypass surgery may counter-balance the expected improvement of myocardial function in the early postoperative period. In 55 patients, the regional shortening fraction was measured over 12 months using radiopaque epicardial markers pairs

  6. Oxidative Stress after Surgery on the Immature Heart

    Directory of Open Access Journals (Sweden)

    Daniel Fudulu

    2016-01-01

    Full Text Available Paediatric heart surgery is associated with increased inflammation and the production of reactive oxygen species. Use of the extracorporeal cardiopulmonary bypass during correction of congenital heart defects generates reactive oxygen species by various mechanisms: haemolysis, neutrophil activation, ischaemia reperfusion injury, reoxygenation injury, or depletion of the endogenous antioxidants. The immature myocardium is more vulnerable to reactive oxygen species because of developmental differences compared to the adult heart but also because of associated congenital heart diseases that can deplete its antioxidant reserve. Oxidative stress can be manipulated by various interventions: exogenous antioxidants, use of steroids, cardioplegia, blood prime strategies, or miniaturisation of the cardiopulmonary bypass circuit. However, it is unclear if modulation of the redox pathways can alter clinical outcomes. Further studies powered to look at clinical outcomes are needed to define the role of oxidative stress in paediatric patients.

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

    Directory of Open Access Journals (Sweden)

    Michael Diodato

    2014-01-01

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

  8. [Health education. Heart surgery].

    Science.gov (United States)

    Iriarte Roteta, Andrea; Wilson-Barnett, Jenifer; Narvaiza, M Jesús

    2003-06-01

    By means of a literature review of nursing articles, the authors aim to evaluate the importance of educational programmes before and after cardiac surgery, to assess the advantages and drawbacks of these programmes and to evaluate the need for following-up patients and their carers after being discharged from hospital. Health Education and cardiac surgery: Delivering information following cardiac surgery is an essential task, not only to achieve a behavioural change and the development of patients' self-care attitudes but also to reduce their anxiety. It is also essential to educate family members as they are the most importance source of physical and emotional support following surgery. Issues about in-hospital teaching programmes: Despite the numerous benefits of in-hospital teaching programmes, the actual tendency to shorten hospitalisation length in association with the high levels of anxiety, impede patients and carers' learning. Some studies suggest that these educational programmes have not completely achieved the task of preparing patients and their families to face the early recovery. Education during the early recovery: The authors highlight those studies that have focused on patients and their carers' needs for information following discharge from hospital. Results from these studies show the need for following-up patients and their carers at this period. Educational programmes can extent and reinforce the information provided at hospital.

  9. Autopsy findings following gastric bypass surgery for morbid obesity.

    Science.gov (United States)

    Melinek, Judy; Livingston, Edward; Cortina, Galen; Fishbein, Michael C

    2002-09-01

    Roux-en-Y gastric bypass, currently the most frequently performed surgical procedure for morbid obesity, has a low but significant mortality rate. There are limited data documenting the findings at necropsy in patients who have died following this procedure. To determine cause of death and pathologic processes present in obese subjects dying after gastric bypass surgery. We studied 10 patients who underwent autopsy following gastric bypass surgery for morbid obesity between the years 1994 and 2000. There were 6 men and 4 women. The mean age of the patients was 48 years (range, 28-62 years). The mean preoperative weight was 162 kg (range, 112-245 kg), and the mean body mass index was 54 kg/m(2) (range, 39-76 kg/m(2)), similar to all patients undergoing gastric bypass at our institution during the same period. Five deaths were directly attributable to technical complications. Five deaths were attributed to underlying comorbid conditions. One patient died of cirrhosis and one of pulmonary hemorrhage. Three patients died from pulmonary embolism. However, 8 of 10 patients had microscopic evidence of pulmonary emboli, despite prophylaxis for deep vein thrombosis. Most patients had some degree of steatohepatitis and hepatic fibrosis (80% and 70%, respectively). There were no deaths from primary cardiac events. In patients who die after Roux-en-Y gastric bypass, half die due to technical complications, whereas the other half die of complications of their obesity. Clinically, only 20% of patients were suspected to have pulmonary emboli, yet at autopsy, 80% of patients had pulmonary emboli. In morbidly obese patients undergoing Roux-en-Y gastric bypass, there is an unexpectedly high rate of clinically silent pulmonary emboli contributing to morbidity and mortality.

  10. Reducing family stress during and after coronary artery bypass surgery.

    Science.gov (United States)

    Gilliss, C L

    1984-03-01

    Based on the findings of this study of couples after coronary artery bypass surgery, there are numerous stresses and unmet needs that might be addressed by hospital-based nurses. The study demonstrated that, as a group, the spouses of the bypass patients report higher levels of stress than the patients did while in the hospital. Together, patients and spouses reported high levels of marital conflict, dissatisfaction, and discord during the first 6 months after the surgery. Many indicated that they were unprepared for these experiences. Further, they found it difficult to maintain continuity with a provider who could answer their questions about recovery. As a result of these findings a program of nursing care that focuses on the family during and after coronary artery bypass surgery has been proposed. The model program consists of preparation for surgery, preparation for discharge, and continuous contact with the family after discharge, at least through the first follow-up appointment with the surgeon at 6 weeks. For each phase it is necessary to consider content that is appropriate to the individual patient, but it is essential to include content aimed at reducing the stresses and risk experienced by the family as well. By doing so hospital-based nurses are treating the family as well as nursing the patient through this episode of acute illness.

  11. Antioxidant defence during cardiopulmonary bypass surgery

    NARCIS (Netherlands)

    Luyten, Chris R.; van Overveld, Frans J.; de Backer, Lieve A.; Sadowska, Anna M.; Rodrigus, Inez E.; de Hert, Stefan G.; de Backer, Wilfried A.

    2005-01-01

    OBJECTIVE: Cardiac surgery may lead to severe oxidative stress due to formation of oxidation products generated during ischemia and reperfusion. We investigated to which extent oxidative stress influences a number of endogenous antioxidants and markers of cellular activation. METHODS: At six time

  12. Protective effect of dexmedetomidine in coronary artery bypass grafting surgery

    OpenAIRE

    REN, JIANJUN; ZHANG, HUIJUN; HUANG, LINING; LIU, YUE; LIU, FENGQIN; DONG, ZHENMING

    2013-01-01

    The aim of this study was to observe the impact of dexmedetomidine on postoperative myocardial injury in patients undergoing off-pump coronary artery bypass (OPCAB) grafting. One hundred and sixty-two patients who were undergoing OPCAB surgery were randomly divided into control and dexmedetomidine groups (groups C and Dex, respectively). Following the first vascular anastomosis grafting, the patients in group Dex received a continuous intravenous infusion of 0.2?0.5 ?g/kg/h dexmedetomidine, u...

  13. [Outcome of gastric bypass surgery in Iceland 2001-2015].

    Science.gov (United States)

    Thorarinsdottir, Rosamunda; Palmason, Vilhjalmur; Leifsson, Bjorn Geir; Gislason, Hjortur

    2016-01-01

    Laparoscopic roux-en-y gastric bypass (LRYGB) has been performed at Landspitali University Hospital (LSH) since 2001. The procedure represents an important treatment option for morbidly obese patients. The aim of this study is to evaluate the long-term results of these operations in Iceland. All 772 consecutive patients undergoing LRYGB at LSH during 2001-2015 were included. Information was collected from a prospective database. Successful weight loss was defined as body mass index (BMI) less than 33 kg/m2 or excess body mass index loss (EBMIL) more than 50%. Mean age of patients was 41 years and 83% were females. Mean pre-operative weight was 127 kg (±20) and mean BMI was 44 (±6). Mean %EBMIL was 80% after 1.5 year, 70% after 5 years and 64% after 10-13 years. 85% of patients had successful weight loss with a mean follow-up time of 7.4 years. Pre-operatively patients on average had 2.8 obesity related comorbid diseases. 71% of patients with type 2 diabetes were in full remission after surgery. One third of patients with hypertension and one third of patients with hyperlipidemia achieved full remission after surgery. 37 patients (5%) had an early complication and 174 (25%) had a late complication that frequently needed surgical solution. Most patients (78%) needed repeated adjustment of vitamins and minerals often many years after surgery. Majority of patients achieved a successful weight loss and most obesity related comorbidities are still in remission 7.4 years after surgery. Early complications were rare but one fourth of patients had late complications. Life long follow-up is of utmost importance after gastric bypass surgery. Key words: gastric bypass surgery in Iceland 2001-2015. Correspondence: Hjörtur Gíslason, hjorturg@landspitali.is.

  14. Changing tastes: learning hunger and fullness after gastric bypass surgery.

    Science.gov (United States)

    Hillersdal, Line; Christensen, Bodil J; Holm, Lotte

    2017-03-01

    Gastric bypass surgery is a specific medical technology that alters the body in ways that force patients to fundamentally change their eating habits. When patients enrol for surgery, they enter a learning process, encountering new and at times contested ways of sensing their bodies, tasting, and experiencing hunger and fullness. In this paper, we explore how patients begin to eat again after gastric bypass surgery. The empirical data used here are drawn from a Danish fieldwork study of individuals undergoing obesity surgery. The material presented shows how the patients used instructions on how to eat. We explore the ways in which diverse new experiences and practices of hunger and fullness are part of the process of undergoing surgery for severe obesity. New sensory experiences lead to uncertainty; as a result, patients practice what we term mimetic eating, which reflects a 'sensory displacement' and hence a rupture in the person's sense of self and social relations. We suggest that eating should be conceptualised as a practice that extends beyond the boundaries of our bodies and into diverse realms of relations and practices, and that changing the way we eat also changes the fundamentally embodied experience of who we are. © 2016 Foundation for the Sociology of Health & Illness.

  15. SheppHeartCABG trial-comprehensive early rehabilitation after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Hojskov, Ida Elisabeth; Moons, Philip; Hansen, Niels Viggo

    2017-01-01

    outcomes are mental health and physical activity measured by the Medical Outcome Study Short Form (SF-12), anxiety and depression measured by the Hospital Anxiety and Depression Scale questionnaire, physical, emotional and global scores by the HeartQoL questionnaire, sleep measured by the Pittsburgh Sleep......INTRODUCTION: Patients undergoing coronary artery bypass graft surgery often experience a range of symptoms. Studies indicate that non-pharmacological interventions such as exercise training and psychoeducation have a positive physiological and psychological effect in early outpatient...

  16. Fatty acid uptake and turnover rate in the ischemic before and after bypass surgery

    International Nuclear Information System (INIS)

    Freundlieb, C.; Hoeck, A.; Vyska, K.; Erbel, R.; Feinendegen, L.E.

    1982-01-01

    17-123-Iodo-heptadecanoic acid (IHA) turnover in myocardium signals myocardial metabolism of free fatty acids. Thus, it appeared promising to examine the influence of cardiovascular surgery on coronary perfusion and on the metabolic state of the ischemic myocardium by use of IHA. The data show that IHA uptake and elimination are two separate parameters which may be changed in the ischemic heart. The two parameters do not necessarily change in parallel. In ischemic heart disease at rest a normal IHA accumulation pattern may be associated with altered regional IHA turnover rates. On the other hand also accumulation defects without changes in IHA turnover rate were observed. Although the relationship between IHA uptake and turnover is not yet sufficiently understood that statements about the indication and prognosis of bypass surgery can be derived

  17. In situ saphenous vein bypass surgery in diabetic patients

    DEFF Research Database (Denmark)

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

    1992-01-01

    .005). Indication for surgery was gangrene or ulceration in 57% of diabetics, as opposed to 36% in non-diabetic patients (p = 0.0002). A femoro-popliteal bypass was performed in 18% of patients, whereas 82% received an infrapopliteal procedure, of which 42% were to the distal third of the calf or foot. Diabetic......From 1986 through to 1990 a total of 483 consecutive in situ infra-inguinal vein bypass procedures were performed in 444 patients, of whom 112 (25%) were diabetics (57 insulin dependent diabetes mellitus and 55 non-insulin-dependent diabetes mellitus). Based on a prospective vascular data registry...... this material was analysed to determine the influence of diabetes on the outcome. Preoperative risk factors were equally distributed among diabetic and non-diabetic patients, except for smoking habits (diabetics: 48%; non-diabetics: 64%, p = 0.002) and cardiac disease (diabetics: 45%; non-diabetics: 29%, p = 0...

  18. Left heart bypass support with the Rotaflow Centrifugal Pump® as a bridge to decision and recovery in an adult.

    Science.gov (United States)

    Kashiwa, Koichi; Nishimura, Takashi; Saito, Aya; Kubo, Hitoshi; Fukaya, Aoi; Tamai, Hisayoshi; Yambe, Tomoyuki; Kyo, Shunei; Ono, Minoru

    2012-06-01

    Since left heart bypass or biventricular circulatory assist with an extracorporeal centrifugal pump as a bridge to decision or recovery sometimes requires long-time support, the long-term durability of extracorporeal centrifugal pumps is crucial. The Rotaflow Centrifugal Pump(®) (MAQUET Cardiopulmonary AG, Hirrlingen, Germany) is one of the centrifugal pumps available for long-term use in Japan. However, there have been few reports of left heart bypass or biventricular circulatory support over the mid-term. This is a case report of left heart bypass support with the Rotaflow Centrifugal Pump(®) as a bridge to decision and recovery for an adult patient who could not be weaned from cardiopulmonary bypass and percutaneous cardiopulmonary support after cardiac surgery. We could confirm that the patient's consciousness level was normal; however, the patient could not be weaned from the left heart bypass support lasting 1 month. Therefore, the circulatory assist device was switched to the extracorporeal Nipro ventricular assist device (VAD). This time, left heart bypass support could be maintained for 30 days using a single Rotaflow Centrifugal Pump(®). There were no signs of hemolysis during left heart bypass support. The Rotaflow Centrifugal Pump(®) itself may be used as a device for a bridge to decision or recovery before using a VAD in cardiogenic shock patients.

  19. Right ventricular function declines after cardiac surgery in adult patients with congenital heart disease

    NARCIS (Netherlands)

    Schuuring, Mark J.; Bolmers, Pauline P. M.; Mulder, Barbara J. M.; de Bruin-Bon, Rianne H. A. C. M.; Koolbergen, Dave R.; Hazekamp, Mark G.; Lagrand, Wim K.; de Hert, Stefan G.; de Beaumont, E. M. F. H.; Bouma, Berto J.

    2012-01-01

    Right ventricular function (RVF) is often selectively declined after coronary artery bypass graft surgery. In adult patients with congenital heart disease (CHD) the incidence and persistence of declined RVF after cardiac surgery is unknown. The current study aimed to describe RVF after cardiac

  20. On-pump versus off-pump coronary artery bypass surgery in elderly patients

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  1. Cerebroprotective effect of piracetam in patients undergoing open heart surgery.

    Science.gov (United States)

    Holinski, Sebastian; Claus, Benjamin; Alaaraj, Nour; Dohmen, Pascal Maria; Neumann, Konrad; Uebelhack, Ralf; Konertz, Wolfgang

    2011-01-01

    Reduction of cognitive function is a possible side effect after the use of cardiopulmonary bypass (CPB) during cardiac surgery. Since it has been proven that piracetam is cerebroprotective in patients undergoing coronary bypass surgery, we investigated the effects of piracetam on the cognitive performance of patients undergoing open heart surgery. Patients scheduled for elective open heart surgery were randomized to the piracetam or placebo group in a double-blind study. Patients received 12 g of piracetam or placebo at the beginning of the operation. Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer's Disease Assessment Scale were performed preoperatively and on day 3, postoperatively. To assess the overall cognitive function and the degree of cognitive decline across all tests after the surgery, we combined the six test-scores by principal component analysis. A total of 88 patients with a mean age of 67 years were enrolled into the study. The mean duration of CPB was 110 minutes. Preoperative clinical parameters and overall cognitive functions were not significantly different between the groups. The postoperative combined score of the neuropsychological tests showed deterioration of cognitive function in both groups (piracetam: preoperative 0.19 ± 0.97 vs. postoperative -0.97 ± 1.38, p piracetam did not perform better than those taking placebo, and both groups had the same decline of overall cognitive function (p = 0.955). Piracetam had no cerebroprotective effect in patients undergoing open heart surgery. Unlike the patients who underwent coronary surgery, piracetam did not reduce the early postoperative decline of neuropsychological abilities in heart valve patients.

  2. 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

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

    Directory of Open Access Journals (Sweden)

    Zerkowski Hans-Reinhard

    2006-05-01

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

  4. Open heart surgery in Nigeria; a work in progress.

    Science.gov (United States)

    Falase, Bode; Sanusi, Michael; Majekodunmi, Adetinuwe; Animasahun, Barakat; Ajose, Ifeoluwa; Idowu, Ariyo; Oke, Adewale

    2013-01-12

    There has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme. This is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome. 51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%), Atrial Septal Defect Repair in 14 patients (27.5%), Ventricular Septal Defect Repair in 8 patients (15.7%), Aortic Valve Replacement in 5 patients (9.8%), excision of Left Atrial Myxoma in 2 patients (3.9%), Coronary Artery Bypass Grafting in 2 patients (3.9%), Bidirectional Glenn Shunts in 2 patients (3.9%), Tetralogy of Fallot repair in 2 patients (3.9%) and Mitral Valve Repair in 1 patient (2%). There were 9 mortalities (17.6%) in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model. The Open Heart Surgery program in our institution is still being developed but the identified challenges need to be overcome if this program is to be sustained. Similar

  5. Open heart surgery in Nigeria; a work in progress

    Directory of Open Access Journals (Sweden)

    Falase Bode

    2013-01-01

    Full Text Available Abstract Background There has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme. Methods This is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome. Results 51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%, Atrial Septal Defect Repair in 14 patients (27.5%, Ventricular Septal Defect Repair in 8 patients (15.7%, Aortic Valve Replacement in 5 patients (9.8%, excision of Left Atrial Myxoma in 2 patients (3.9%, Coronary Artery Bypass Grafting in 2 patients (3.9%, Bidirectional Glenn Shunts in 2 patients (3.9%, Tetralogy of Fallot repair in 2 patients (3.9% and Mitral Valve Repair in 1 patient (2%. There were 9 mortalities (17.6% in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model. Conclusions The Open Heart Surgery program in our institution is still being developed but the identified challenges need to

  6. BLOOD MONOCYTE SUBPOPULATIONS DURING UNCOMPLICATED CORONARY ARTERY BYPASS SURGERY

    Directory of Open Access Journals (Sweden)

    A. S. Golovkin

    2012-01-01

    Full Text Available Abstract. We have observed thirty-six patients with coronary artery disease (CAD who have undergone coronary artery bypass graft (CABG surgery. In patients with uncomplicated clinical course post-CABG, total lymphocyte counts, T-, B- and NK-cell contents did not significantly differ from baseline levels. Meanwhile, the numbers of CD14HIGH and CD14LOW monocyte subpopulations showed significant differences from initial levels at day 1 and day 7 after surgery. The changes in monocyte subsets in blood of patients with and absence of post-surgical septic complications reflected severity of inflammatory response, and development of systemic inflammatory syndrome. In such a case, further studies of peripheral blood monocytes can be both a useful tool for studying the mechanisms of systemic inflammation, as well as a good diagnostic system, in order to assess the patient’s condition and to predict post-surgical clinical outcomes.

  7. Intussusception after Laparoscopic Gastric Bypass Surgery: An Underrecognized Complication

    Directory of Open Access Journals (Sweden)

    Smit Singla

    2012-01-01

    Full Text Available Introduction. Intussusception after bariatric surgery is an uncommon complication that is now being frequently reported. Most people consider dysmotility to be the causative mechanism in the absence of obvious etiology. Material and Methods. A worldwide search identified literature describing intussusception after bariatric surgery. We also included our own patients and analyzed information regarding demographic profile, risk factors, presentation, diagnosis, and post treatment course. Results. Seventy one patients were identified between 1991 and 2011. Majority of the affected patients were females (=70, 98.6%; median time to presentation after gastric bypass surgery was 36 months. Most patients presented with abdominal pain, nausea and vomiting, but without obvious peritonitis. Sixty eight patients (96% required surgery; 48 (70.6% underwent revision of anastomosis, 16 (23.5% had reduction without resection, while 4 patients (5.9% had plication only. Amongst these, most patients (=51, 75% were found to have retrograde intussusception. Post-operatively, 9 patients presented with recurrence (range, 0.5–32 months. Five patients, who had earlier been treated without resection, eventually required revision of the anastomosis. There was no mortality noted. Conclusion. Intussusception after bariatric surgery is uncommon and its diagnosis is based on a combination of physicial, radiological and operative findings. An early surgical intervention reduces morbidity and prevents recurrence.

  8. Does the Aristotle Score predict outcome in congenital heart surgery?

    Science.gov (United States)

    Kang, Nicholas; Tsang, Victor T; Elliott, Martin J; de Leval, Marc R; Cole, Timothy J

    2006-06-01

    The Aristotle Score has been proposed as a measure of 'complexity' in congenital heart surgery, and a tool for comparing performance amongst different centres. To date, however, it remains unvalidated. We examined whether the Basic Aristotle Score was a useful predictor of mortality following open-heart surgery, and compared it to the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system. We also examined the ability of the Aristotle Score to measure performance. The Basic Aristotle Score and RACHS-1 risk categories were assigned retrospectively to 1085 operations involving cardiopulmonary bypass in children less than 18 years of age. Multiple logistic regression analysis was used to determine the significance of the Aristotle Score and RACHS-1 category as independent predictors of in-hospital mortality. Operative performance was calculated using the Aristotle equation: performance = complexity x survival. Multiple logistic regression identified RACHS-1 category to be a powerful predictor of mortality (Wald 17.7, p Aristotle Score was only weakly associated with mortality (Wald 4.8, p = 0.03). Age at operation and bypass time were also highly significant predictors of postoperative death (Wald 13.7 and 33.8, respectively, p Aristotle Score was only weakly associated with postoperative mortality in this series. Operative performance appeared to be inflated by the fact that the overall complexity of cases was relatively high in this series. An alternative equation (performance = complexity/mortality) is proposed as a fairer and more logical method of risk-adjustment.

  9. Refined anaesthesia for implantation of engineered experimental aortic valves in the pulmonary artery using a right heart bypass in sheep.

    Science.gov (United States)

    Schauvliege, S; Narine, K; Bouchez, S; Desmet, D; Van Parys, V; Van Nooten, G; Gasthuys, F

    2006-10-01

    The feasibility of an anaesthetic protocol developed for surgery during right heart bypass in sheep is reported. Seven female Suffolk sheep, weighing 25-35 kg, were selected for the study. Premedication consisted of midazolam and methadone (both 0.1 mg kg(-1) intravenously). Anaesthesia was induced with propofol (2-4 mg kg(-1)) and maintained with isoflurane in oxygen and continuous rate infusions of propofol (5-7 mg kg(-1 )h(-1)) and fentanyl (5 microg kg(-1) bolus, 5 microg kg(-1) h(-1)). Cisatracurium (0.2 mg kg(-1)) provided muscle relaxation. A standard roller pump was used for the extracorporeal circulation. Drugs administered to maintain blood pressure and heart rate within acceptable levels included phenylephrine (3-4 microg kg(-1)), ephedrine (0.1-0.2 mg kg(-1)), nitroglycerine (50-150 microg kg(-1) h(-1)) and metoprolol succinate (30-80 microg kg(-1)). Electrolytes were infused as needed. Postoperative analgesia was provided by an intercostal block (15 mL 0.5% bupivacaine + epinephrine), carprofen (4 mg kg(-1)) and an opioid (methadone 0.1 mg kg(-1) or buprenorphine 0.01 mg kg(-1)). One sheep became hypoxic during the bypass (PaO(2) 47.7 mmHg). Irregularities of the electrocardiogram were observed during manipulation of the heart in all animals. During the initial phase of the bypass, blood pressure decreased in all sheep, accompanied by dilatation of the heart and large intrathoracic veins in five sheep. With appropriate treatment, blood pressure was restored and easily maintained until the end of the bypass. Weaning from the bypass, using an infusion of nitrates, was smooth. One sheep required a blood transfusion because of severe blood loss and another sheep died postoperatively from respiratory complications. Minor irregularities of the electrocardiogram observed during manipulation of the heart were not life threatening and required no treatment. Decreases in blood pressure at the beginning of the bypass can be expected and require treatment

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

    Science.gov (United States)

    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.

  11. Changes in mood states after coronary artery bypass graft surgery.

    Science.gov (United States)

    Elliott, Peter C; Murphy, Barbara M; Oster, Kerry A; Le Grande, Michael R; Higgins, Rosemary O; Worcester, Marian U C

    2010-09-01

    Few studies have investigated the change in mood states, such as anger, fatigue and confusion, after coronary artery bypass graft surgery (CABGS). The aim of this study was to describe the progression of these mood states over time and to determine the factors associated with these trajectories. The Profile of Mood States (POMS) was administered to 182 CABGS patients prior to surgery and at two and six months post-operatively. Socio-demographic and medical data were collected before surgery. Growth curve modelling was used to describe the POMS subscale trajectories. Four POMS subscales (tension-anxiety, fatigue-inertia, confusion-bewilderment, and vigour-activity) showed rapid improvement over the first two months after CABGS followed by a lesser improvement. There was no significant change over time for the depression-dejection and anger-hostility subscales. Being younger, male, having a manual occupation, and smoking were factors associated with poorer pre-operative mood states. Those at risk of persistent mood disturbance after CABGS were younger, unpartnered, female and those with diabetes. These patients can be identified prior to hospital admission. (c) 2009. Published by Elsevier B.V.

  12. Does gastric bypass surgery change body weight set point?

    Science.gov (United States)

    Hao, Z; Mumphrey, M B; Morrison, C D; Münzberg, H; Ye, J; Berthoud, H R

    2016-12-01

    The relatively stable body weight during adulthood is attributed to a homeostatic regulatory mechanism residing in the brain which uses feedback from the body to control energy intake and expenditure. This mechanism guarantees that if perturbed up or down by design, body weight will return to pre-perturbation levels, defined as the defended level or set point. The fact that weight re-gain is common after dieting suggests that obese subjects defend a higher level of body weight. Thus, the set point for body weight is flexible and likely determined by the complex interaction of genetic, epigenetic and environmental factors. Unlike dieting, bariatric surgery does a much better job in producing sustained suppression of food intake and body weight, and an intensive search for the underlying mechanisms has started. Although one explanation for this lasting effect of particularly Roux-en-Y gastric bypass surgery (RYGB) is simple physical restriction due to the invasive surgery, a more exciting explanation is that the surgery physiologically reprograms the body weight defense mechanism. In this non-systematic review, we present behavioral evidence from our own and other studies that defended body weight is lowered after RYGB and sleeve gastrectomy. After these surgeries, rodents return to their preferred lower body weight if over- or underfed for a period of time, and the ability to drastically increase food intake during the anabolic phase strongly argues against the physical restriction hypothesis. However, the underlying mechanisms remain obscure. Although the mechanism involves central leptin and melanocortin signaling pathways, other peripheral signals such as gut hormones and their neural effector pathways likely contribute. Future research using both targeted and non-targeted 'omics' techniques in both humans and rodents as well as modern, genetically targeted, neuronal manipulation techniques in rodents will be necessary.

  13. Utilising cardiopulmonary bypass for cancer surgery. Malignancy-induced protein C deficiency and thrombophilia.

    LENUS (Irish Health Repository)

    Marshall, C

    2012-02-03

    Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.

  14. Pregnancy following gastric bypass surgery (Roux-en-Y) for morbid obesity

    OpenAIRE

    Anasiudu, R; Gajjar, K; Osoba, O; Soliman, N

    2011-01-01

    Morbidly obese women are at increased risk of obstetric complications and poor neonatal outcomes. Gastric bypass surgery is being performed with increased frequency in reproductive-aged women to treat morbid obesity. Both maternal and fetal complications have been reported in women who underwent gastric bypass surgery. Current recommendations advise delaying pregnancy for at least 1 year following bariatric surgery. This guideline is meant to discourage women from becoming pregnant during the...

  15. Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children

    Directory of Open Access Journals (Sweden)

    Aymen N Naguib

    2015-01-01

    Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental

  16. Severe scurvy after gastric bypass surgery and a poor postoperative diet

    DEFF Research Database (Denmark)

    Hansen, Esben P K; Metzsche, Carsten; Henningsen, Emil

    2012-01-01

    After bariatric gastric bypass surgery patients are at risk of developing micronutrient deficiencies. If gastric bypass surgery is followed by a vitamin deficient diet the patients have a risk of developing vitamin-C deficiency. When spontaneous ecchymosis is observed in the skin, in at......-risk patients, scurvy must be considered. When treated with large doses of vitamin-C the symptoms of scurvy rapidly improve even if the patient has developed multiple organ dysfunction syndrome. KEYWORDS: Scurvy; Gastric bypass surgery; Multiorgan dysfunction....

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

    DEFF Research Database (Denmark)

    Houlind, Kim Christian

    2013-01-01

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

  18. Origins of and recognition of micronutrient deficiencies after gastric bypass surgery.

    Science.gov (United States)

    Bal, Bikram S; Finelli, Frederick C; Koch, Timothy R

    2011-04-01

    Roux-en-Y gastric bypass surgery remains the major surgical option for individuals with medically complicated obesity. The importance of preoperative evaluation to permit identification of micronutrient deficiencies is being re-evaluated. The risk of complications related to pregnancy after gastric bypass supports careful follow-up. Micronutrient deficiencies are common in postoperative gastric bypass patients, despite the suggested use of routine vitamin and mineral supplements after surgery. Copper deficiency must be considered as an origin for visual disorders after gastric bypass. Vitamin D deficiency with metabolic bone disease remains common after gastric bypass and the results suggest that the present postoperative supplements of calcium and vitamin D are inadequate. Major nutritional complications of bariatric surgery are occurring more than 20 years after surgery. There is no evidence for intestinal adaptation as there remains decreased intestinal absorption of iron up to 18 months after gastric bypass surgery. This article supports ongoing examination of nutritional complications after gastric bypass surgery and supports the notion that the daily doses of micronutrient supplements, such as vitamin D, may need to be revised.

  19. Hospital variation in readmission after coronary artery bypass surgery in California.

    Science.gov (United States)

    Li, Zhongmin; Armstrong, Ehrin J; Amstrong, Ehrin J; Parker, Joseph P; Danielsen, Beate; Romano, Patrick S

    2012-09-01

    Readmissions are common after coronary artery bypass grafting (CABG) surgery and account for a significant percentage of hospital healthcare costs. Readmission rates also vary widely between hospitals, but the reasons for this variation have not been studied previously. We linked 2009 California CABG clinical registry data to hospital discharge data for 2009 and 2010 to identify 30-day readmissions for all patients undergoing isolated CABG surgery. Both standard and hierarchical logistic models were developed to predict readmission risk and explore sources of hospital readmission variation. Among 11 823 patients discharged alive after isolated CABG in 2009, 1565 (13.2%) patients were readmitted within 30 days of surgery. Heart failure and postoperative infections were the most frequent reasons for readmission (15.3% and 12.9%, respectively). Multiple patient risk factors, including age, sex, and lower zip code-level median household income, were significant predictors of readmission (all adjusted odds ratios >1.0; P0.05, with an intraclass correlation of 0.004 for hospitals). California hospitals performing CABG surgery vary widely in 30-day readmission rates. Patient demographic and clinical risk factors, rather than measured hospital characteristics, accounted for most of the observed hospital-level variation in CABG readmissions.

  20. Myocardial metabolism during anaesthesia with propofol--low dose fentanyl for coronary artery bypass surgery

    NARCIS (Netherlands)

    Vermeyen, K. M.; de Hert, S. G.; Erpels, F. A.; Adriaensen, H. F.

    1991-01-01

    We have studied the haemodynamic and myocardial effects of propofol-fentanyl anaesthesia in 12 patients undergoing coronary artery bypass surgery during the pre-bypass period. The induction dose of propofol was 1.5 mg kg-1 and mean infusion rate during maintenance was 4.48 mg kg-1 h-1 (range

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

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

  3. Academic proficiency in children after early congenital heart disease surgery.

    Science.gov (United States)

    Mulkey, Sarah B; Swearingen, Christopher J; Melguizo, Maria S; Reeves, Rachel N; Rowell, Jacob A; Gibson, Neal; Holland, Greg; Bhutta, Adnan T; Kaiser, Jeffrey R

    2014-02-01

    Children with early surgery for congenital heart disease (CHD) are known to have impaired neurodevelopment; their performance on school-age achievement tests and their need for special education remains largely unexplored. The study aimed to determine predictors of academic achievement at school age and placement in special education services among early CHD surgery survivors. Children with CHD surgery at achieving proficiency in literacy and mathematics and the receipt of special education were determined. Two hundred fifty-six children who attended Arkansas public schools and who had surgery as infants were included; 77.7 % had either school-age achievement-test scores or special-education codes of mental retardation or multiple disabilities. Scores on achievement tests for these children were 7-13 % lower than those of Arkansas students (p increase in receipt of special education due to multiple disabilities [odds ratio (OR) 10.66, 95 % confidence interval (CI) 4.23-22.35] or mental retardation (OR 4.96, 95 % CI 2.6-8.64). Surgery after the neonatal period was associated with decreased literacy proficiency, and cardiopulmonary bypass during the first surgery was associated with decreased mathematics proficiency. Children who had early CHD surgery were less proficient on standardized school assessments, and many received special education. This is concerning because achievement-test scores at school age are "real-world" predictors of long-term outcomes.

  4. 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.

  5. Usefulness of needle holder with a function of fine forceps for bypass surgery in both hands.

    Science.gov (United States)

    Horiuchi, Tetsuyoshi; Seguchi, Tatsuya; Ito, Kiyoshi; Hongo, Kazuhiro

    2015-01-01

    In bypass surgery, a single-handed needle holder is usually used with other handed fine forceps. Recently, a needle holder with the function of fine forceps has been developed. In this technical note, usefulness of newly developed needle holders in both hands is presented in bypass surgery. With this method, surgeons can make stitches and ties by both hands without exchanging instruments. This method is effective and may result in faster anastomotic procedure comparing with the traditional one.

  6. 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....

  7. Congenital heart defect - corrective surgery

    Science.gov (United States)

    ... up and over time, cause medical problems and arrhythmias. Sometimes, an ASD can be closed without open- ... surgery. The surgery may be done in the newborn period if the infant has severe symptoms. If ...

  8. A new arena in cardiac surgery: Pediatric coronary artery bypass surgery

    Science.gov (United States)

    KITAMURA, Soichiro

    2018-01-01

    Prior to the 1970s, pediatric coronary artery bypass surgery (PCABS) was seldomly performed due to the lack of compelling surgical indications. The advent of coronary sequelae secondary to Kawasaki disease (KD) and the occurrence of coronary artery complications due to newly developed procedures, such as the arterial switch operation and early repair for intrinsic congenital coronary malformations, necessitated the development of PCABS. Because children grow rapidly and their life expectancy is very long, with increasing exercise capability requirements, the strategy for PCABS should differ from that for bypass surgery in adults. PCABS utilizing unilateral and bilateral internal thoracic arteries (ITA) has become the most reliable surgical method for children because of the distinct structure of ITAs being resistant to KD, growth potential according to the child’s somatic growth and long-term patency without wall degeneration. This operation utilizing ITA grafts is now being performed worldwide and is referred to as the “Kitamura operation” for KD coronary sequelae. Notably, the use of vein grafts should be avoided in children. Likewise, this operation can now be successfully performed in infants using a surgical microscope, for congenital coronary disorders. Currently, PCABS with ITAs has been established as a new arena in cardiac surgery, following our initial attempts. PMID:29321443

  9. [Risk factors related to nosocomial pneumonia in pediatric patients undergoing heart surgery].

    Science.gov (United States)

    Fortanelli-Rodríguez, Rocío Elvira; Gómez-Delgado, Alejandro; Vera-Canelo, José Manuel; Alvarado-Diez, Miguel Ángel; Miranda-Novales, María Guadalupe; Furuya, María Elena Yuriko; Solórzano-Santos, Fortino; Vázquez-Rosales, José Guillermo

    2015-01-01

    Procalcitonin is a diagnostic marker useful to discern infections and non-infectious complications in heart surgeries. The aim is to describe risk factors related to nosocomial pneumonia and the predictive value of serum procalcitonin in pediatric patients undergoing heart surgery. During a year a nested case-control study was carried out in a third level hospital. All patients undergoing open-heart surgery were followed and clinical data searching for pneumonia were registered every day. Blood samples for determination of procalcitonin were taken 48 hours after surgery. Those patients who developed pneumonia based on CDC clinical criteria were defined as cases; and controls were those patients who did not developed pneumonia. 188 patients underwent heart surgery (15 % developed pneumonia). Ninety-seven patients were submitted to open-heart surgery: 24 cases and 73 controls. Seventy-eight % of cases developed pneumonia between second and fifth day after surgery. The average time of surgery, extracorporial bypass, aortic cross-clamp, and mechanical ventilation were greater in control patients. The frequency of open sternotomy, reintubation, and surgical wound infections was greater in case patients. Some of the events related to heart surgery and their subsequent management are associated significantly to the development of hospital-acquired pneumonia.

  10. Preoperative weight gain might increase risk of gastric bypass surgery.

    Science.gov (United States)

    Istfan, Nawfal W; Anderson, Wendy A; Apovian, Caroline M; Hess, Donald T; Forse, R Armour

    2011-01-01

    Weight loss improves the cardiovascular and metabolic risk associated with obesity. However, insufficient data are available about the health effects of weight gain, separate from the obesity itself. We sought to determine whether the changes in body weight before open gastric bypass surgery (OGB) would have a significant effect on the immediate perioperative hospital course. A retrospective chart review of 100 consecutive patients was performed to examine the effects of co-morbidities and body weight changes in the immediate preoperative period on the hospital length of stay and the rate of admission to the surgical intensive care unit (SICU). Of our class III obese patients undergoing OGB, 95% had ≥1 co-morbid condition and an overall SICU admission rate of 18%. Compared with the patients with no perioperative SICU admission, the patients admitted to the SICU had a greater degree of insulin resistance (homeostatic model analysis-insulin resistance 10.8 ± 1.3 versus 5.9 ± 0.5, P = .001), greater serum triglyceride levels (225 ± 47 versus 143 ± 8 mg/dL, P = .003), and had gained more weight preoperatively (.52 ± .13 versus .06 ± .06 lb/wk, P = .003). The multivariate analyses showed that preoperative weight gain was a risk factor for a longer length of stay and more SICU admissions lasting ≥3 days, as were a diagnosis of sleep apnea and an elevated serum triglyceride concentration. The results of the present retrospective study suggest that weight gain increases the risk of perioperative SICU admission associated with OGB, independent of the body mass index. Sleep apnea and elevated serum triglyceride levels were also important determinants of perioperative morbidity. In view of the increasing epidemic of obesity and the popularity of bariatric surgical procedures, we propose that additional clinical and metabolic research focusing on the understanding of the complex relationship among obesity, positive energy balance, weight gain, and perioperative

  11. Outcome of Anesthesia and Open Heart Surgery in Pregnant Patients

    Directory of Open Access Journals (Sweden)

    Alireza Mahoori

    2007-03-01

    Methods: In this descriptive study, fifteen pregnant women who underwent cardiac surgery were studied. Maternal age ranged from 27 to 36 years, and gestational age varied from 4 to 22 weeks. Most of the patients were in New York Heart Association Classes II and III. Opioid- based anesthesia with fentanyl citrate (50µ/kg or sufentanil (5µ/kg plus low dose of thiopental were used for the induction of anesthesia. During non-pulsatile cardio-pulmonary bypass, core temperature was between 28-36 °C, average CBP time was 61.2±22 min, average aortic cross-clamp time was 34.13±14 min, and mean pump pressure was maintained between 65-80 mmHg. Results: Ten patients had severe mitral valve disease (66.6%, three had aortic valve disease (20%, one had subvalvular aortic stenosis (6.7%, and the remaining one had left atrial myxoma (6.7%. There were five fetal deaths (33.3% and one maternal death (6.7%. Conclusion: It seems that open heart surgery in the first trimester is very hazardous for the fetus and may lead to fetal death. If possible, surgery should be carried out in the second trimester of pregnancy. The recommendations are simply guidelines because research data and clinical experience in this area are limited. 

  12. Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Reza Arefizadeh

    2017-05-01

    CONCLUSIONS: Regarding QOL and psychological status, there were no differences in the CR outcome between those who underwent off-pump bypass surgery and those who underwent on-pump surgery; nevertheless, the off-pump technique was superior to the on-pump method on METs improvement following CR.

  13. Axillofemoral Bypass Markedly Improved Acute Decompensated Heart Failure and Kidney Injury in a Patient with Severely Calcified Stenosis of Thoracoabdominal Aorta (Atypical Aortic Coarctation).

    Science.gov (United States)

    Ishizuka, Masato; Yamada, Shintaro; Maemura, Sonoko; Yamamoto, Keisuke; Takizawa, Masataka; Uozumi, Hiroki; Minegishi, Sachito; Kobayashi, Jotaro; Ikenouchi, Hiroshi

    2017-10-21

    Atypical aortic coarctation (AAC) has been reported to occur anywhere along the aorta, except for the ascending aorta. The associated symptoms include hypotension in the lower half of the body, secondary hypertension in the upper half of the body, and heart failure. Here we present an 80-year-old Asian woman complaining of progressive exertional dyspnea. She was diagnosed with acute decompensated heart failure and kidney injury due to severely calcified stenosis of the thoracoabdominal aorta, the so called AAC. She received hemodiafiltration, and pulmonary congestion improved in part. Generally, surgical treatments are quite invasive in elderly patients. Endovascular stent graft placement is less invasive, however, fracture and rupture should be considered at severely calcified lesions like this case. Therefore, we selected extra-anatomical axillofemoral bypass. Her recovery after the surgery was remarkable. In a few days, she became free from hemodiafiltration, intravenous diuretics, and oxygen administration. We thought the contributive factors are the increase in kidney blood flow and the correction of afterload mismatch. The decrease in pulse pressure may reflect the reduction in systemic arterial compliance by axillofemoral bypass. The operative mortality of axillofemoral bypass was reported to be acceptable, although the patency of the axillofemoral bypass graft was not high enough. In conclusion, axillofemoral bypass is effective and feasible for elderly patients with acute decompensated heart failure and kidney injury due to AAC.

  14. The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients.

    Science.gov (United States)

    Gomes, Walter J; Moreira, Rita Simone; Zilli, Alexandre Cabral; Bettiati, Luiz Carlos; Figueira, Fernando Augusto Marinho Dos Santos; D' Azevedo, Stephanie Steremberg Pires; Soares, Marcelo José Ferreira; Fernandes, Marcio Pimentel; Ardito, Roberto Vito; Bogdan, Renata Andrea Barberio; Campagnucci, Valquíria Pelisser; Nakasako, Diana; Kalil, Renato Abdala Karam; Rodrigues, Clarissa Garcia; Rodrigues, Anilton Bezerra; Cascudo, Marcelo Matos; Atik, Fernando Antibas; Lima, Elson Borges; Nina, Vinicius José da Silva; Heluy, Renato Albuquerque; Azeredo, Lisandro Gonçalves; Henrique, Odilon Silva; Mendonça, José Teles de; Silva, Katharina Kelly de Oliveira Gama; Pandolfo, Marcelo; Lima, José Dantas de; Faria, Renato Max; Santos, Jonas Pereira Dos; Paez, Rodrigo Pereira; Coelho, Guilherme Henrique Biachi; Pereira, Sergio Nunes; Senger, Roberta; Buffolo, Enio; Caputi, Guido Marco; Santo, José Amalth do Espírito; Oliveira, Juliana Aparecida Borges de; Berwanger, Otavio; Cavalcanti, Alexandre Biasi; Jatene, Fabio B

    2017-01-01

    To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.

  15. Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

    Directory of Open Access Journals (Sweden)

    Krog AH

    2017-06-01

    Full Text Available Anne Helene Krog,1,2 Mehdi Sahba,3 Erik M Pettersen,4 Torbjørn Wisløff,5,6 Jon O Sundhagen,2 Syed SH Kazmi2 1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 2Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, 3Department of Vascular Surgery, Østfold Central Hospital, Kalnes, 4Department of Vascular Surgery, Sørlandet Hospital HF, Kristiansand, 5Department of Health Management and Health Economics, University of Oslo, 6Norwegian Institute of Public Health, Oslo, Norway Objectives: Laparoscopic aortobifemoral bypass has become an established treatment option for symptomatic aortoiliac obstructive disease at dedicated centers. Minimally invasive surgical techniques like laparoscopic surgery have often been shown to reduce expenses and increase patients’ health-related quality of life. The main objective of our study was to measure quality-adjusted life years (QALYs and costs after totally laparoscopic and open aortobifemoral bypass. Patients and methods: This was a within trial analysis in a larger ongoing randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial. Fifty consecutive patients suffering from symptomatic aortoiliac occlusive disease suitable for aortobifemoral bypass surgery were randomized to either totally laparoscopic (n=25 or open surgical procedure (n=25. One patient dropped out of the study before surgery. We measured health-related quality of life using the EuroQol (EQ-5D-5L questionnaire at 4 different time points, before surgery and for 6 months during follow-up. We calculated the QALYs gained by using the area under the curve for both groups. Costs were calculated based on prices for surgical equipment, vascular prosthesis and hospital stay. Results: We found a significantly higher increase in QALYs after laparoscopic vs open aortobifemoral bypass surgery, with a difference of 0.07 QALYs, (p=0

  16. Hematological disorders following gastric bypass surgery: emerging concepts of the interplay between nutritional deficiency and inflammation.

    Science.gov (United States)

    Chen, Mingyi; Krishnamurthy, Amrita; Mohamed, Ali R; Green, Ralph

    2013-01-01

    Obesity and the associated metabolic syndrome are among the most common and detrimental metabolic diseases of the modern era, affecting over 50% of the adult population in the United States. Surgeries designed to promote weight loss, known as bariatric surgery, typically involve a gastric bypass procedure and have shown high success rates for treating morbid obesity. However, following gastric bypass surgery, many patients develop chronic anemia, most commonly due to iron deficiency. Deficiencies of vitamins B1, B12, folate, A, K, D, and E and copper have also been reported after surgery. Copper deficiency can cause hematological abnormalities with or without neurological complications. Despite oral supplementation and normal serum concentrations of iron, copper, folate, and vitamin B12, some patients present with persistent anemia after surgery. The evaluation of hematologic disorders after gastric bypass surgery must take into account issues unique to the postsurgery setting that influence the development of anemia and other cytopenias. In this paper, the clinical characteristics and differential diagnosis of the hematological disorders associated with gastric bypass surgery are reviewed, and the underlying molecular mechanisms are discussed.

  17. Hematological Disorders following Gastric Bypass Surgery: Emerging Concepts of the Interplay between Nutritional Deficiency and Inflammation

    Directory of Open Access Journals (Sweden)

    Mingyi Chen

    2013-01-01

    Full Text Available Obesity and the associated metabolic syndrome are among the most common and detrimental metabolic diseases of the modern era, affecting over 50% of the adult population in the United States. Surgeries designed to promote weight loss, known as bariatric surgery, typically involve a gastric bypass procedure and have shown high success rates for treating morbid obesity. However, following gastric bypass surgery, many patients develop chronic anemia, most commonly due to iron deficiency. Deficiencies of vitamins B1, B12, folate, A, K, D, and E and copper have also been reported after surgery. Copper deficiency can cause hematological abnormalities with or without neurological complications. Despite oral supplementation and normal serum concentrations of iron, copper, folate, and vitamin B12, some patients present with persistent anemia after surgery. The evaluation of hematologic disorders after gastric bypass surgery must take into account issues unique to the postsurgery setting that influence the development of anemia and other cytopenias. In this paper, the clinical characteristics and differential diagnosis of the hematological disorders associated with gastric bypass surgery are reviewed, and the underlying molecular mechanisms are discussed.

  18. Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery

    OpenAIRE

    Alam, Shirjel R.; Stirrat, Colin; Spath, Nick; Zamvar, Vipin; Pessotto, Renzo; Dweck, Marc R.; Moore, Colin; Semple, Scott; El-Medany, Ahmed; Manoharan, Divya; Mills, Nicholas L.; Shah, Anoop; Mirsadraee, Saeed; Newby, David E.; Henriksen, Peter A.

    2017-01-01

    Background Myocardial inflammation and injury occur during coronary artery bypass graft (CABG) surgery. We aimed to characterise these processes during routine CABG surgery to inform the diagnosis of type 5 myocardial infarction. Methods We assessed 87 patients with stable coronary artery disease who underwent elective CABG surgery. Myocardial inflammation, injury and infarction were assessed using plasma inflammatory biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magne...

  19. Fetal Growth in Pregnancies Conceived after Gastric Bypass Surgery in Relation to Surgery-to-Conception Interval

    DEFF Research Database (Denmark)

    Nørgaard, Lone Nikoline; Gjerris, Anne Cathrine Roslev; Kirkegaard, Ida

    2014-01-01

    Medicine Database). Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester......OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton...... ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA). RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351) days. The mean "fetal...

  20. Cardiac Rehabilitation After Heart Valve Surgery

    DEFF Research Database (Denmark)

    Pollmann, Agathe Gerwina Elena; Frederiksen, Marianne; Prescott, Eva

    2017-01-01

    PURPOSE: Evidence of the effect of cardiac rehabilitation (CR) after heart valve surgery is scarce, but nevertheless CR is recommended for this group of patients. Therefore, this study assessed the effect of CR on exercise capacity, cardiovascular risk factors, and long-term mortality and morbidity......, as well as predictors for enrolment in or failing to complete CR. METHODS: A review of medical records identified 250 patients who underwent heart valve surgery between January 2009 and August 2013. Of these, 211 patients eligible for CR were identified. Effect of CR was assessed by peak oxygen uptake...... ((Equation is included in full-text article.)O2peak) or 6-minute walk test (6MWT). A composite endpoint of all-cause mortality and hospital admission due to myocardial infarction, stroke, heart failure, endocarditis, revascularization, or reoperation was used to assess the hazard ratio between CR attenders...

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

    Directory of Open Access Journals (Sweden)

    Mahdi Najafi

    2015-01-01

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

  2. 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

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

    DEFF Research Database (Denmark)

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

    2002-01-01

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

  4. Changes in Hematology and Calcium Metabolism After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Worm, Dorte; Madsbad, Sten; Kristiansen, Viggo B

    2015-01-01

    BACKGROUND: Concerns regarding nutritional deficiencies have recently emerged after Roux-en-Y gastric bypass (RYGB). METHODS: A total of 835 subjects underwent RYGB, age 43.3 years, body mass index (BMI) 47.2 kg/m(2). Hematological and calcium metabolic variables were measured before, 6, 12, and 24...

  5. Reemergence of pica following gastric bypass surgery for obesity: a new presentation of an old problem.

    Science.gov (United States)

    Kushner, Robert F; Gleason, Briana; Shanta-Retelny, Victoria

    2004-09-01

    Abstract Pica, the compulsive ingestion of nonnutritive substances, has been a fascinating and poorly understood phenomenon for centuries. Pagophagia, or ice eating, is one of the most common forms of pica and is closely associated with the development of iron-deficiency anemia. Although this condition has been well described among pregnant women and malnourished children, particularly in developing countries, it has not been previously reported to occur following gastric bypass surgery for treatment of severe obesity. This article presents two cases of women who experienced a recurrence of pagophagia following gastric bypass surgery, along with an updated review of the literature.

  6. A comparison of low vs conventional-dose heparin for minimal cardiopulmonary bypass in coronary artery bypass grafting surgery.

    Science.gov (United States)

    Fromes, Y; Daghildjian, K; Caumartin, L; Fischer, M; Rouquette, I; Deleuze, P; Bical, O M

    2011-06-01

    The biocompatibility of minimal extracorporeal circuits has improved; however, anticoagulation is still required. We compared standard high-dose anticoagulation with a low-dose heparin regimen in a retrospective study of patients who underwent coronary bypass surgery using minimal cardiopulmonary bypass. One hundred patients who received 300 IU.kg(-1) heparin were compared with 68 patients who received heparin according to an individually adjusted activated coagulation time target of 300 s, resulting in a mean (SD) heparin dose of 145 (30) IU.kg(-1) . There were no thromboembolic events in either group; however, patients in the low-dose group had lower 24-hour mean (SD) postoperative blood loss than the conventional group (545 (61) vs 680 (88) ml, p=0.001) and a reduced rate of transfusion of allogeneic blood (15% patients transfused vs 32%, p=0.01). An individually tailored low-dose heparin regimen for minimal cardiopulmonary bypass is safe and may be associated with reduced bleeding and lower transfusion requirements. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

  7. Experiência da doença cardíaca entre adultos submetidos à revascularização do miocárdio Experiencia de enfermedad cardiaca entre adultos sometidos a revascularización del miocárdio Heart disease experience of adults undergoing coronary artery bypass grafting surgery

    Directory of Open Access Journals (Sweden)

    Vanessa da Silva Carvalho Vila

    2008-08-01

    ón de cirugía de revascularizacion del miocárdio. Con base en antropología interpretativa, los datos fueron reunidos en informes narrativos y analizados por medio de la a elaboración de unidades de significados y núcleos temáticos. RESULTADOS:Los sentidos atribuidos a la enfermedad se relacionaron a: descubierta de la enfermedad cardiaca, sentimientos desencadenados, explicaciones formuladas, aceptación de la cirugía y vida pos-cirurgica. La experiencia fue interpretada como ruptura biográfica, situación entre la vida y la muerte, invalidez, perdida de autonomía e incapacidad de trabajar. Los significados se remitieron a una lógica que articula sentido común, religión y fragmentos del discurso médico en la comprensión de la enfermedad y de la cirugía cardiaca. CONCLUSIONES: Los resultados rebelan que las experiencias de la enfermedad y de la cirugía cardíaca marcan una ruptura en el modo de vivir, trabajar y comprender el proceso salud-enfermedad. La abordaje de la experiencia de la enfermedad cardiaca contribuye para extrapolar los límites de un modelo centrado en la enfermedad, sus síntomas y causas, característico del entendimiento biomédico del proceso salud-enfermedad, cuyo foco es el mal funcionamiento del proceso biológico y/o psicológico.OBJECTIVE:To evaluate the meanings of heart disease experience in patients undergoing rehabilitation post-coronary artery bypass grafting surgery. METHODS:Ethnographic study carried out between 2003 and 2005 in the city Goiânia, Central-West Brazil. Direct observation and in-depth interviews were conducted in 11 patients undergoing rehabilitation post- coronary artery bypass grafting surgery. Using an interpretative anthropology approach, data were gathered in narrative documents and analyzed through the identification of units of meanings and thematic groups. RESULTS:Disease-related meanings included heart disease realization, triggered feelings, formulated explanations, surgery acceptance and post-surgery

  8. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P. van den Heuvel; F. Unger (Felix); R. Beyar; W.K. Lindeboom (Wietze); V. de Valk (Vincent); S. Milo; R. Simon (Rudiger); G.F.O. Tyers (Frank); D. Regensburger; P.A. Crean (Peter); I.M. Penn (Ian); E. McGovern; C. van Cauwelaert; P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the

  9. Towards robot-assisted anchor deployment in beating-heart mitral valve surgery.

    Science.gov (United States)

    Cheng, Lingbo; Sharifi, Mojtaba; Tavakoli, Mahdi

    2018-03-24

    Beating-heart intracardiac surgery promises significant benefits for patients compared with cardiopulmonary bypass based procedures. However, the fast motions of the heart introduce serious challenges for surgeons. In this work, a new impedance-controlled master-slave telerobotic system is developed to help perform anchor deployment for mitral valve annuloplasty under the guidance of live ultrasound images of the heart. The proposed bilateral teleoperation system can both reflect the non-oscillatory portion of slave-heart tissue interaction force on the surgeon's hand as haptic feedback and implement rapid compensation for the beating heart's motion. The surgical task involves performing anchor deployment on a simulated moving heart tissue to evaluate the effectiveness of the proposed strategy for safely interacting with a moving organ. The results obtained show that the telerobotic system increases the success rate of anchor deployment by 100% and reduces the excess force application rate by 70% compared with manual attempts. Copyright © 2018 John Wiley & Sons, Ltd.

  10. The Prevalence and Risk Factors of Early Arrhythmias Following Pediatric Open Heart Surgery in Egyptian Children

    Directory of Open Access Journals (Sweden)

    Tarek Ahmed Abdel Gawad

    2017-12-01

    Full Text Available AIM: This study aimed to assess the prevalence of early postoperative arrhythmias after cardiac operation in the pediatric population, and to analyse possible risk factors. MATERIAL AND METHODS: Cross-sectional study included 30 postoperative patients, with age range four up to 144 months. They were selected from those admitted to the Cardiology Unit in the Pediatric department of Ain Shams University hospitals, after undergoing cardiopulmonary bypass (CPB surgery for correction of congenital cardiac defects. All patients had preoperative sinus rhythm and normal preoperative electrolytes levels. All patients’ records about age, weight, type of surgery, intraoperative arrhythmias, cardiopulmonary bypass time, ischemic time and use of inotropic drugs were taken before they were admitted to the specialised pediatric post-surgery intensive care unit (ICU. RESULTS: Arrhythmia was documented in 15 out of 30 patients (50%. Statistically significant difference between the arrhythmic and non-arrhythmic group were recorded in relation to the age of operation (23 vs 33 months, weight (12 vs. 17 kg, ischemic time (74.5 vs. 54 min, cardiopulmonary bypass time (125.5 vs. 93.5min, inotrope use (1.6 vs. 1.16 and postoperative ICU stay (5.8 vs. 2.7 days, P<0.05. CONCLUSION: Early postoperative arrhythmias following surgery for congenital heart disease are relatively frequent in children (50%.Younger age, lower body weight, longer ischemic time and bypass time, and more inotrope use are all risk factors for postoperative arrhythmias and lead to increase the hospital stay.

  11. Open-Heart surgery and cerebrovascular accident: retrospective study at King Khalid University Hospital

    International Nuclear Information System (INIS)

    Al-Satli, R.A.; Takrouri, Mohammad S.M.; Al-Daif, A.; Fouda, Mohamed N.; Maher, S.; Al-Khwsky, F.

    2000-01-01

    Stroke after coronary by-pass grafting (CABG) is often disabling. The incidence of ischemic stroke may approach 3% to 5%. Several risk factors have been identified including previous history of stroke, prolonged cardiopulmonary bypass time, and postoperative atrial fibrillation. Objective was to determine the incidence and risk factors of neurological deficit after open heart surgery. Retrospective study was done during the period 1992-1995 at the King Khalid University Hospital, Riyadh, Saudi Arabia. There were 350 patients who were subjected to (CABG), 10 patients (2.8%) found to suffer from cerebrovascular accidents (CVA) following open-heart surgery. In 8 patients, the complaint lasted more than 24 hours (stroke), while 2 patients developed transient ischemic attacks (TIA). Five factors were found to be associated with increased risk of post cardiac surgery CVA. These factors are postoperative atrial fibrillation, carotid bruit, past history of heart failure, past history of CVA and smoking. The authors concluded that it is necessary to start a prospective study to verify the area of improvement with regards to technique, selection of patients and mode of perfusion during cardiopulmonary bypass (CPB) Arabia. (author)

  12. Clinical significance of 201Tl reverse redistribution in patients with aorto-coronary bypass surgery

    International Nuclear Information System (INIS)

    Nishimura, Tsunehiko; Uehara, Tashiisa; Hayashida, Kohei; Kozuka, Takahira

    1987-01-01

    Detection of myocardial ischemia by the stress thallium scan has traditionally been performed using transient defect analysis on exercise, followed by redistribution studies. Worsening of the 201 Tl myocardial image from exercise to redistribution is referred to as reverse redistribution. In this study, we found reverse redistribution in 10 (21%) of 48 angina pectoris patients who had undergone aortocoronary bypass surgery. The clinical significance of this phenomenon in these patients was investigated in relation to angiographic and surgical findings. Reverse redistribution was found to occur in regions which were supplied by bypass grafts. These areas showed increased coronary blood flow and rapid thallium washout. Our results indicate that a perfusion defect in the bypass region of the redistribution image might be caused by relatively rapid washout in the bypass graft region compared to the adjacent normal myocardium. These results should be considered in the clinical interpretation of stress thallium scans. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

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

  14. Transfusion practice in coronary artery bypass surgery in Denmark

    DEFF Research Database (Denmark)

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

    2007-01-01

    Transfusion rates in coronary artery bypass grafting (CABG) continue to vary substantially, although guidelines for allogeneic transfusion have been developed. In order to evaluate ongoing transfusion practices, we performed a multicenter audit in four Danish hospitals regarding the use of alloge......Transfusion rates in coronary artery bypass grafting (CABG) continue to vary substantially, although guidelines for allogeneic transfusion have been developed. In order to evaluate ongoing transfusion practices, we performed a multicenter audit in four Danish hospitals regarding the use......-related factors. Interesting differences in transfusion rates exists in Danish hospitals and these differences may reflect true variations in transfusion practices. Audits create a basis for educational efforts among surgeons and anesthesiologists to standardize transfusion practices...

  15. Aprotinina preserva plaquetas em crianças com cardiopatia congênita acianogênica operadas com circulação extracorpórea? Does aprotinin preserve platelets in children with acyanogenic congenital heart disease undergone surgery with cardiopulmonary bypass?

    Directory of Open Access Journals (Sweden)

    Cesar Augusto Ferreira

    2009-09-01

    Full Text Available OBJETIVO: Avaliação dos efeitos hemostáticos e plaquetários em crianças submetidas a correção de cardiopatias congênitas acianogênicas com circulação extracorpórea que receberam aprotinina. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas a correção de cardiopatia congênita acianogênica, com circulação extracorpórea (CEC e divididas em dois grupos, um denominado Controle (n=9 e o outro, Aprotinina (n=10. Neste, a droga foi administrada antes e durante a CEC. A disfunção hemostática foi analisada por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: Evaluation of the hemostatic and platelets effects in children with acyanogenic congenital heart disease undergone on-pump surgery who received aprotinin. METHODS: A prospective randomized study was performed on children aged 30 days to 4 years who had undergone correction of acyanogenic congenital heart disease using cardiopulmonary bypass (CPB and were divided into two groups: Control (n=9 and Aprotinin (n=10. In the Aprotinin Group the drug was administered before and during CPB and the hemostatic dysfunction was analyzed by clinical and biochemical markers. Differences were considered to be significant when P<0.05. RESULTS: The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug presented no benefit regarding time of mechanical pulmonary ventilation, stay in the postoperative intensive care unit and hospital, or regarding the use of inotropic drugs and renal function. Platelet concentration was preserved with the use of Aprotinin, whereas thrombocytopenia occurred in the Control Group since the initiation of CPB. Blood loss was similar for both groups. There were no complications with the use of Aprotinin. CONCLUSION: Aprotinin quantitatively preserved the blood platelets in children with

  16. Augmented reality-assisted bypass surgery: embracing minimal invasiveness.

    Science.gov (United States)

    Cabrilo, Ivan; Schaller, Karl; Bijlenga, Philippe

    2015-04-01

    The overlay of virtual images on the surgical field, defined as augmented reality, has been used for image guidance during various neurosurgical procedures. Although this technology could conceivably address certain inherent problems of extracranial-to-intracranial bypass procedures, this potential has not been explored to date. We evaluate the usefulness of an augmented reality-based setup, which could help in harvesting donor vessels through their precise localization in real-time, in performing tailored craniotomies, and in identifying preoperatively selected recipient vessels for the purpose of anastomosis. Our method was applied to 3 patients with Moya-Moya disease who underwent superficial temporal artery-to-middle cerebral artery anastomoses and 1 patient who underwent an occipital artery-to-posteroinferior cerebellar artery bypass because of a dissecting aneurysm of the vertebral artery. Patients' heads, skulls, and extracranial and intracranial vessels were segmented preoperatively from 3-dimensional image data sets (3-dimensional digital subtraction angiography, angio-magnetic resonance imaging, angio-computed tomography), and injected intraoperatively into the operating microscope's eyepiece for image guidance. In each case, the described setup helped in precisely localizing donor and recipient vessels and in tailoring craniotomies to the injected images. The presented system based on augmented reality can optimize the workflow of extracranial-to-intracranial bypass procedures by providing essential anatomical information, entirely integrated to the surgical field, and help to perform minimally invasive procedures. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Determination of improved myocardial perfusion after aortocoronary bypass surgery by exercise 81Rb scintigraphy

    International Nuclear Information System (INIS)

    Lurie, A.J.; Salel, A.F.; Berman, D.S.; DeNardo, G.L.; Hurley, E.J.; Mason, D.T.

    1976-01-01

    Practical and noninvasive means are needed for evaluating efficacy of coronary bypass surgery (CBS) in improving blood flow (CBF) to ischemic myocardium in coronary patients. Revascularization was assessed in 15 patients by pre- and post-CBS rest and exercise rubidium-81 myocardial images with a scintillation camera equipped with pinhole collimator and high-energy shield. Ischemic areas were detected by decreased 81 Rb activity after exercise compared to rest. Before CBS all patients had exercise angina (EA), positive treadmill ECG (TECG), and abnormal exercise 81 Rb scans. After CBS all 15 patients had increased physical activity before angina or completion of treadmill exercise with increased heart rate-blood pressure product (HRBP) (+63 +/- 3.2 x 10(2) bpm - mm Hg) in 14 of 15 patients indicating increased CBF; four had positive TECG, and five had EA. The increased HRBP in 14 patients was associated with improved post-CBS exercise 81 Rb scans: six had normal patterns while nine were improved with less ischemic patterns. Further, lack of angina and increased exercise tolerance correlated closely with increased 81 Rb myocardial perfusion. Thus pre- and postoperative rest and exercise 81 Rb scintigraphy gives an accurate, noninvasive, objective approach for evaluation of CBF following CBS and demonstrates the usefulness of this revascularization procedure in coronary patients

  18. Patient Specific Multiscale Simulations of Blood Flow in Coronary Artery Bypass Surgery

    Science.gov (United States)

    Bangalore Ramachandra, Abhay; Sankaran, Sethuraman; Kahn, Andrew M.; Marsden, Alison L.

    2013-11-01

    Coronary artery bypass surgery is performed to revascularize blocked coronary arteries in roughly 400,000 patients per year in the US.While arterial grafts offer superior patency, vein grafts are used in more than 70% of procedures, as most patients require multiple grafts. Vein graft failure (approx. 50% within 10 years) remains a major clinical issue. Mounting evidence suggests that hemodynamics plays a key role as a mechano-biological stimulus contributing to graft failure. However, quantifying relevant hemodynamic quantities (e.g. wall shear stress) invivo is not possible directly using clinical imaging techniques. We numerically compute graft hemodynamics in a cohort of 3-D patient specific models using a stabilized finite element method. The 3D flow domain is coupled to a 0D lumped parameter circulatory model. Boundary conditions are tuned to match patient specific blood pressures, stroke volumes & heart rates. Results reproduce clinically observed coronary flow waveforms. We quantify differences in multiple hemodynamic quantities between arterial & venous grafts & discuss possible correlations between graft hemodynamics & clinically observed graft failure.Such correlations will provide further insight into mechanisms of graft failure and may lead to improved clinical outcomes.

  19. Outcome of patients undergoing open heart surgery at the Uganda ...

    African Journals Online (AJOL)

    governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally. Keywords: Open heart surgery, ... where surgery is the definitive therapy were operated. The mean age of the patients .... plasma and vitamin K. She remained ventilator depend- ent from initial surgery.

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

    DEFF Research Database (Denmark)

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

    2002-01-01

    OBJECTIVE: A major effect of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and impaired left ventricular (LV) contractile function is believed to be an improvement in LV function due to recovery of dysfunctional, but viable myocardium. However, recent studies have...... indicated a time limit for such a recovery. We therefore investigated the extent of viable myocardium in patients with impaired LV function due to ischemic heart disease after a prolonged strategy of medical treatment and its relation to changes in clinical variables after CABG. METHODS: Forty......-five consecutive patients with a mean duration of ischemic heart symptoms of 9 years and LV ejection fraction (EF) stress...

  1. Gastric bypass surgery reveals independency of obesity and diabetes melitus type 2

    DEFF Research Database (Denmark)

    Fenger, Mogens; Hansen, Dorte Lindqvist; Worm, Dorte

    2016-01-01

    BACKGROUND: Roux-en-Y gastric bypass surgery is widely applied to ameliorate morbid obesity, including diabetes in people with type 2 diabetes. The latter vanish a few days after surgery for many, but not in all patients before any weight reduction has occurred. The explanation for this change...... in metabolic status is poorly understood, but the observation may suggest that the fate obesity and diabetes is only partly linked after surgery. METHODS: The trajectories of weight reduction measured as reduced body mass index (BMI) in 741obese subjects with and without diabetes were evaluated. Evaluation...... was performed on three groups: 1) subjects that were non-diabetic before and after surgery; 2) subjects that were diabetics before surgery but non-diabetics after surgery; and 3) subjects that were diabetics before surgery and remained diabetics after surgery. The diabetic state was established at HbA1c above...

  2. Gastric bypass surgery: Improving psoriasis through a GLP-1-dependent mechanism?

    DEFF Research Database (Denmark)

    Faurschou, Annesofie; Zachariae, Claus; Skov, Lone

    2011-01-01

    surgery. This most likely contributes importantly to the acute remission of type 2 diabetes, which is often induced by gastric bypass operations. The hormone is not hypersecreted after the purely restrictive bariatric procedure gastric banding and no case reports exist on improvement in psoriasis......, both a direct anti-inflammatory effect of GLP-1 as well as an indirect effect through weight loss could contribute to improvement in psoriasis. A potential involvement of GLP-1 in the remission of psoriasis observed after bariatric surgery offers exciting possibilities for research and eventually...... bypass surgery in patients with psoriasis may result in complete remission of the disease. A substantial weight loss is achieved in the months following surgery, which is likely to reduce psoriasis symptoms and risk of comorbidities. Interestingly, however, it has been described that improvement...

  3. Virtual Surgery in Congenital Heart Disease

    DEFF Research Database (Denmark)

    Sørensen, Thomas Sangild; Mosegaard, Jesper; Kislinskiy, Stefan

    2014-01-01

     Teaching, diagnosing, and planning of therapy in patients with complex structural cardiovascular heart disease require profound understanding of the three-dimensional (3D) nature of cardiovascular structures in these patients. To obtain such understanding, modern imaging modalities provide high...... et al., Cardiol Young 13:451–460, 2003). In combination with the availability of virtual models of congenital heart disease (CHD), techniques for computer- based simulation of cardiac interventions have enabled early clinical exploration of the emerging concept of virtual surgery (Sorensen et al......., Interact Cardiovasc Thorac Surg 5:536–539, 2006; Sorensen et al., Pediatr Radiol 38:1314–1322, 2008). This chapter serves as an introduction to virtual surgery for patient-specific preoperative planning and teaching of cardiovascular anatomy and interventions for clinicians. The chapter is mainly based...

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

    Directory of Open Access Journals (Sweden)

    Worcester Marian UC

    2006-08-01

    Full Text Available Abstract Background Many studies have demonstrated that health related quality of life (HRQoL improves, on average, after coronary artery bypass graft surgery (CABGS. However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. Methods 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36, Profile of Mood States (POMS and the Everyday Functioning Questionnaire (EFQ. These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. Results For both the physical component summary scale (PCS and the mental component summary scale (MCS of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers. A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation. Conclusion It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of

  5. Efficiency and safety of leukocyte filtration during cardiopulmonary bypass for cardiac surgery

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    Background. Leukocyte filtration of systemic blood during cardiopulmonary bypass surgery to reduce post-operative morbidity has not yet been established because of the enormous leukocyte release from the third space. This study was designed to examine the efficiency and safety of leukocyte

  6. Scintigraphic assessment of focal platelet accumulations following infrainguinal bypass surgery in humans

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Hesse, B; Eiberg, J

    1997-01-01

    . In 28 patients undergoing in situ vein (n = 24), composite vein-polytetrafluoroethylene (PTFE) (n = 1) or PTFE (n = 3) bypass surgery, assumed vascular injuries were recorded intraoperatively. Autologous indium-111-labelled platelets were injected into the inflow artery immediately after restoration...

  7. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  8. Does the closure of mesenteric defects during laparoscopic gastric bypass surgery cause complications?

    DEFF Research Database (Denmark)

    Kristensen, Sara Danshøj; Floyd, Andrea Karen; Naver, Lars

    2015-01-01

    BACKGROUND: A well-known complication of laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) is bowel obstruction due to internal herniation (IH). Evidence suggests that mesenteric defects should be closed during LRYGB to reduce the risk of IH. Therefore, surgeons are now closing mesenteric...

  9. A short or a long Roux limb in gastric bypass surgery: does it matter?

    NARCIS (Netherlands)

    Dogan, K.; Homan, J.; Aarts, E.O.; Laarhoven, C.J.H.M. van; Janssen, I.M.C.; Berends, F.J.

    2017-01-01

    BACKGROUND: The Roux-en-Y gastric bypass (RYGB) still remains the gold standard in bariatric surgery. However, no consensus exists on the optimal limb lengths to induce maximum weight reduction. The aim of the present study was to assess the effect of a longer alimentary limb (AL) length on weight

  10. Venous coronary artery bypass surgery. A 15-year follow-up study

    NARCIS (Netherlands)

    van Brussel, B. L.; Plokker, H. W.; Ernst, S. M.; Ernst, N. M.; Knaepen, P. J.; Koomen, E. M.; Tijssen, J. G.; Vermeulen, F. E.; Voors, A. A.

    1993-01-01

    BACKGROUND: Although the long-term results of isolated venous coronary artery bypass surgery are well known, there are few multivariate statistical data on such patient groups. METHODS AND RESULTS: We report on 428 consecutive patients, 383 men and 45 women with a mean age of 52.6 years, who

  11. Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery

    NARCIS (Netherlands)

    Kist-van Holthe tot Echten, J. E.; Goedvolk, C. A.; Doornaar, M. B.; van der Vorst, M. M.; Bosman-Vermeeren, J. M.; Brand, R.; van der Heijden, A. J.; Schoof, P. H.; Hazekamp, M. G.

    2001-01-01

    The aim of the study was to investigate renal function and renal replacement therapy after cardiopulmonary bypass surgery in children. Patient characteristics (sex, age, diagnosis), operation type, and death were listed. The study was performed retrospectively using serum creatinine level before,

  12. Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial.

    Science.gov (United States)

    Chen, Jung-Chien; Lee, Wei-Jei; Tsou, Jun-Juin; Liu, Tsang-Pai; Tsai, Pei-Ling

    2016-01-01

    Gastric bypass surgery is the recommended treatment for severely obese patients. However, postoperative symptomatic gastrointestinal (GI) episodes are common complaints. To determine if administration of probiotics improves symptomatic GI episodes after gastric bypass surgery. Hospital-based bariatric center. This double-blind, randomized trial was conducted between March 2010 and September 2010 with 60 patients who underwent gastric bypass for severe obesity and experienced postoperative symptomatic GI episodes. Patients were randomly assigned to the probiotics group A (n = 20; 1 g Clostridium butyricum MIYAIRI twice daily); probiotics group B (n = 20; Bifidobacterium longum BB536 twice daily); or digestive enzymes group (n = 20; Aczym, containing 100 mg takadiastase N, 20 mg cellulase AP, 50 mg lipase MY, and 100 mg pancreatin, twice daily). Quality of life was measured using the modified Gastrointestinal Quality of Life Index (mGIQLI) before and after the 2-week intervention. Preintervention patient characteristics and mGIQLI scores were similar among the 3 groups. After the 2-week intervention, the mean mGIQLI score improved from 57.4 to 63.9 points in the entire sample and also within each group for 7 items specifically for 7: excessive passage of gas, foul smell of flatulence, belching, heartburn, abdominal noises, abdominal bloating, and abdominal pain. Administration of probiotics or digestive enzymes may improve symptomatic GI episodes after gastric bypass surgeries and improve quality of life, at least initially. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  13. Functional integrity and aging of the left internal thoracic artery after coronary artery bypass surgery

    NARCIS (Netherlands)

    Amoroso, G; Tio, RA; Mariani, MA; van Boven, AJ; Jessurun, GAJ; Monnink, SHJ; Grandjean, JG; Boonstra, PW; Crijns, HJGM

    Objective: To study the endothelial function in the left internal thoracic artery after coronary artery bypass surgery and to identify predictors of early dysfunction, we performed a provocative test with acetylcholine in 23 male patients who underwent routine postoperative coronary angiography.

  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. Eating in mice with gastric bypass surgery causes exaggerated activation of brainstem anorexia circuit

    OpenAIRE

    Mumphrey, Michael B.; Hao, Zheng; Townsend, R. Leigh; Patterson, Laurel M.; M?nzberg, Heike; Morrison, Christopher C.; Ye, Jianping; Berthoud, Hans-Rudolf

    2016-01-01

    Background/Objective Obesity and metabolic diseases are at an alarming level globally and increasingly affect children and adolescents. Gastric bypass and other bariatric surgeries have proven remarkably successful and are increasingly performed worldwide. Reduced desire to eat and changes in eating behavior and food choice account for most of the initial weight loss and diabetes remission after surgery, but the underlying mechanisms of altered gut-brain communication are unknown. Subjects/Me...

  16. Psychiatric Factors and Weight Loss Patterns Following Gastric Bypass Surgery in a Veteran Population

    OpenAIRE

    Rutledge, Thomas; Groesz, Lisa M.; Savu, Michelle

    2009-01-01

    Background Although pre-surgical psychological evaluations are commonly administered to patients considered for weight loss surgeries, the value of these evaluations for predicting weight loss success has been questioned. In this study, we addressed this issue by examining patient’s total number of psychiatric indicators rather than individual psychological factors as predictors of weight loss/weight regain. Methods Sixty adult veterans completed gastric bypass surgery or laparoscopic gastric...

  17. Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

    OpenAIRE

    Ehab A. Wahby; Mohamed M. Abo Elnasr; Michael I. Eissa; Sahbaa M. Mahmoud

    2016-01-01

    Background: The concept of perioperative glycemic control in cardiac surgery patients was conducted in many studies, however, it remains unclear how tight the glycemic control should be. Our aim is to study the effect of perioperative tight glycemic control versus moderate glycemic control on the outcome of diabetic patients undergoing coronary artery bypass graft (CABG) surgery. Methods: This study is a randomized prospective study conducted on 135 diabetic patients planned for CABG surge...

  18. Trends in the treatment of coronary disease today. Selective use of PTCA and bypass surgery.

    Science.gov (United States)

    Jones, E L; Craver, J M; Guyton, R A; Bone, D K; Hatcher, C R

    1983-01-01

    Selection and treatment of patients with ischemic heart disease is presently undergoing an evolutionary trend. Percutaneous transluminal coronary angioplasty (PTCA) has been recommended as the initial procedure for many patients with coronary artery disease (CAD), thus possibly redefining candidates for coronary bypass surgery (CABS). Between October 1980 and June 1982, 777 patients having PTCA and 2068 patients having CABS were analyzed for differences in clinical presentation, complications, and early outcome. Patients having CABS were significantly older, had a higher incidence of hypertension (46% vs. 32%), more multivessel disease (80% vs. 12%), and poorer left ventricular function (nl. wall motion = 88% vs. 52%). The incidence of myocardial infarction in patients after PTCA was 1.0% (8/777). Emergency CAB was required in 5.3% of patients following PTCA. There were no deaths following the angioplasty procedure and 25 deaths in 2068 patients having CABS (hospital mortality rate = 1.2%). Since 1973, there has been a progressive decline in hospital mortality rate (now, less than 1%), postoperative infarction (now, 3%), requirement for inotropic drugs (now, 5%) and frequency of IABP (less than 1%). Increasing ability to achieve complete revascularization now means improved survival and freedom from angina with CAB surgery. PTCA and CAB are both procedures that may be used effectively for selected patients, depending on clinical presentation, extent of CAD, and left ventricular function (LVF). Careful patient selection affords the opportunity for use of PTCA in patients with single-vessel disease (SVD) and good LVF and CABS in patients with multivessel disease, regardless of LVF. Symptomatic patients with SVD and total vessel occlusion are not candidates for PTCA. Our data demonstrate that both PTCA and CABS may be accomplished with very low perioperative complications and hospital mortality. PMID:6222708

  19. Reconstructive surgery after jejunoileal bypass or gastric partition operations.

    Science.gov (United States)

    Bingham, H G

    1982-05-01

    Twenty-five morbidly obese patients had plastic operations to remove redundant tissue after either jejunoileal bypass or gastric partition. The average weight loss in this group of patients was 79.9 kg (176 lb) and the average age was 32 years. Abdominoplasty was the most common operation, and, although there was no mortality, postoperative complications were common and usually related to wound healing. The average hospital stay was ten days. Most of these patients were pleased with their results and lived happier and more productive lives.

  20. Outcome of Anesthesia and Open Heart Surgery in Pregnant Patients

    Directory of Open Access Journals (Sweden)

    Golamali Mollasadeghi

    2007-06-01

    Full Text Available Background: Cardiovascular disease is an important non-obstetric cause of maternal and fetal /neonatal morbidity and mortality during pregnancy. For a pregnant woman with cardiac disease, the potential inability of the maternal cardiovascular system to contend with normal pregnancy-induced physiologic changes may produce deleterious effects on both mother and fetus. To determine the most frequent surgical indications of maternal and fetal mortality, we studied 15 cases of severe cardiac disease in pregnant women who required cardiac surgical procedures. Methods: In this descriptive study, fifteen pregnant women who underwent cardiac surgery were studied. Maternal age ranged from 27 to 36 years, and gestational age varied from 4 to 22 weeks. Most of the patients were in New York Heart Association Classes II and III. Opioid- based anesthesia with fentanyl citrate (50µ/kg or sufentanil (5µ/kg plus low dose of thiopental were used for the induction of anesthesia. During non-pulsatile cardio-pulmonary bypass, core temperature was between 28-36 °C, average CBP time was 61.2±22 min, average aortic cross-clamp time was 34.13±14 min, and mean pump pressure was maintained between 65-80 mmHg. Results: Ten patients had severe mitral valve disease (66.6%, three had aortic valve disease (20%, one had subvalvular aortic stenosis (6.7%, and the remaining one had left atrial myxoma (6.7%. There were five fetal deaths (33.3% and one maternal death (6.7%. Conclusion: It seems that open heart surgery in the first trimester is very hazardous for the fetus and may lead to fetal death. If possible, surgery should be carried out in the second trimester of pregnancy. The recommendations are simply guidelines because research data and clinical experience in this area are limited.

  1. Cardiovascular Surgery with Cardiopulmonary Bypass in Patients with Preoperative Non-dialysis Dependent Renal Insufficiency.

    Science.gov (United States)

    Bahar, Temur; Kaplan, Mehmet; Muruvvet, Yilmaz; Nehir, Selcuk Ummuhan; Tolga, Can; Adlan, Olsun; Hakkı, Aydogan

    2015-04-28

    Preoperative renal insufficiency is a predictor of acute renal injury in patients undergoing cardiovascular surgery with cardiopulmonary bypass. From January 2010 to September 2012, 121 patients undergoing coronary bypass, valve replacement, or both were included in our retrospective study, using cardiopulmonary bypass. We compared the changes in renal function and clinical outcomes of 66 patients with a baseline serum creatinine level more than 1.5 mg/dL with 55 patients with normal serum creatinine levels. We analyzed the impact of cardiopulmonary bypass in patients with non-dialysis dependent renal insufficiency. In the group of patients with preoperative renal injury, the need for dialysis was greater, time of mechanical ventilation longer, and daily diuresis lesser compared with the group of patients with normal serum creatinine levels. Other clinical outcomes such as postoperative hemodynamic problems and organ dysfunction were similar. Prolonged time of cardiopulmonary bypass and cross-clamp affected postoperative renal injury. The study also showed intraoperative dopamine infusion at renal dose and ultrafiltration are not effective with protecting renal tubular function. Serum creatinine levels and glomerular filtration rate (GFR) were found to be useful parameters for renal injury. These results demonstrate the safety and trustworthiness of cardiopulmonary bypass in patients with non-dialysis dependent renal insufficiency.

  2. 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.

  3. High readmission rate after heart valve surgery

    DEFF Research Database (Denmark)

    Sibilitz, K L; Berg, S K; Thygesen, L C

    2015-01-01

    investigated. RESULTS: After valve surgery, the self-reported health was lower (Short Form-36 (SF-36) Physical Component Scale (PCS): 44.5 vs. 50.6 and Mental Component Scale (MCS): 51.9 vs. 55.0, pClinical signs......BACKGROUND: After heart valve surgery, knowledge on long-term self-reported health status and readmission is lacking. Thus, the optimal strategy for out-patient management after surgery remains unclear. METHODS: Using a nationwide survey with linkage to Danish registers with one year follow-up, we...... of anxiety and depression were present in 13.6% and 13.8%, respectively (Hospital Anxiety and Depression Scale score≥8). Twelve months following discharge, 483 persons (56%) were readmitted. Readmission was associated with lower self-reported health (SF-36 PCS: 46.5 vs. 43.9, and MCS 52.2 vs. 50.7). Higher...

  4. Causes of hospital readmission after heart surgery

    Directory of Open Access Journals (Sweden)

    Bárbara Rodrigues Nunes Barreiros

    2016-12-01

    Full Text Available The objective was to identify readmission’s profile and causes of  heart surgery patients. A retrospective, descriptive study, through the revision of records from patients submitted to myocardial revascularization surgery or valvar prosthesis implantation with posterior readmission. Sixty-two patients composed the sample. The readmission rate was 5.9%. Surgical site infection was the main cause for readmission in 87.5% of patients submitted to myocardial revascularization surgery and in 12.5% of valvar implantation (p<0.001 and, it was associated with obesity (p=0.05 and dyslipidemia (p=0.007. To identify patients at risk of surgical site infection can minimize readmission rates and decrease care costs and, it deserves a special planning of multi-professional actions.

  5. Supervised Physical Training Improves Weight Loss After Roux-en-Y Gastric Bypass Surgery: A Randomized Controlled Trial.

    Science.gov (United States)

    Mundbjerg, Lene Hymøller; Stolberg, Charlotte Røn; Cecere, Stefano; Bladbjerg, Else-Marie; Funch-Jensen, Peter; Gram, Bibi; Juhl, Claus Bogh

    2018-03-22

    Bariatric surgery results in significant weight loss and reduces cardiovascular morbidity. However, a large variation in postsurgery weight loss is seen. Physical activity promotes weight loss in nonsurgically treated subjects with obesity. The aim of this study was to investigate the effects of 6 months of supervised physical training following Roux-en-Y gastric bypass surgery (RYGB) on body weight and cardiovascular risk markers. Sixty participants eligible for RYGB were included. Six months post surgery, the participants were randomly assigned to either twice-weekly supervised physical training sessions in a fitness center (INT) or a control group (CON) for 26 weeks. Before surgery and 6, 12, and 24 months after surgery, the participants underwent an examination program that included anthropometric measurements, blood pressure, heart rate, blood samples, and an abdominal computed tomography scan. RYGB significantly reduced body weight and improved cardiovascular risk markers (all P physical training intervention resulted in a 4.2-kg (CI: -0.2 to -8.3 kg) lower body weight in INT compared with CON at the study end (P = 0.042). The high-density lipoprotein concentration was significantly higher in INT than in CON at the termination of the intervention, but this was not maintained at the 24-months examination. Physical training following RYGB improves weight loss and cardiovascular health. © 2018 The Obesity Society.

  6. Population pharmacokinetics of pentobarbital in neonates, infants, and children after open heart surgery.

    Science.gov (United States)

    Zuppa, Athena F; Nicolson, Susan C; Barrett, Jeffrey S; Gastonguay, Marc R

    2011-09-01

    To determine the pharmacokinetics of pentobarbital in neonates, infants, and young children with congenital heart disease after open-heart surgery. Thirty-five subjects (3.0 days-4.4 years) after open-heart surgery who received pentobarbital as standard of care were enrolled. Serial pharmacokinetic blood samples were obtained. A population-based, nonlinear mixed-effects modeling approach was used to characterize pentobarbital pharmacokinetics. A two-compartment model with weight as a co-variate allometrically expressed on clearance (CL), inter-compartmental clearance, central (V1) and peripheral volume of distributions, bypass grafting time as a co-variate on CL and V1, and age and ventricular physiology as co-variates on CL best described the pharmacokinetics. A typical infant (two-ventricle physiology, 6.9 kg, 5.2 months, and bypass grafting time of 60 minutes) had a CL of 0.12 L/hr/kg, V1 of 0.45 L/kg, and peripheral volume of distributions of 0.98 L/kg. The bypass grafting effect was poorly estimated. For subjects Pentobarbital pharmacokinetics is influenced by age and weight. Subjects with single-ventricle physiology demonstrated a 15% decrease in clearance when compared with subjects with two-ventricle physiology. Copyright © 2011 Mosby, Inc. All rights reserved.

  7. Population Pharmacokinetics of Pentobarbital in Neonates, Infants and Children Following Open Heart Surgery

    Science.gov (United States)

    Zuppa, Athena F; Nicolson, Susan C.; Barrett, Jeffrey S.; Gastonguay, Marc R.

    2011-01-01

    Objectives To determine the pharmacokinetics of pentobarbital in neonates, infants and young children with congenital heart disease post-operative from open heart surgery. Study design 35 subjects, (3 days – 4.4 years), following open heart surgery who received pentobarbital as standard of care were enrolled. Serial pharmacokinetic blood samples were obtained. A population-based, nonlinear mixed–effects modeling approach was used to characterize pentobarbital pharmacokinetics. Results A two-compartment model with weight as a covariate allometrically expressed on clearance (CL), inter-compartmental clearance (Q), central (V1) and peripheral volume of distributions (V2), bypass time as a covariate on CL and V1, and age and ventricular physiology as covariates on CL best described the pharmacokinetics.. A typical infant (two-ventricle physiology, 6.9 kg, 5.2 months, and bypass time of 60 minutes) had a CL of 0.12 L/hr/kg, V1 of 0.45 L/kg and V2 of 0.98 L/kg. The bypass effect was poorly estimated. For subjects less than 12 months age, an age effect on CL remained after accounting for weight, and was precisely estimated. Conclusions Pentobarbital pharmacokinetics is influenced by age and weight. Subjects with single-ventricle physiology demonstrated a 15% decrease in clearance when compared with subjects with two-ventricle physiology. PMID:21665222

  8. Pulmonary Perfusion and Ventilation During Cardiopulmonary Bypass Are Not Associated with Improved Postoperative Outcomes After Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Yiliam F Rodriguez-Blanco

    2016-11-01

    Full Text Available ObjectivesClinical trials of either pulmonary perfusion or ventilation during cardiopulmonary bypass are equivocal. We hypothesized that to achieve significant improvement in outcomes both interventions had to be concurrent.DesignRetrospective case-control studySettingsMajor academic tertiary referral medical centerParticipants274 consecutive patients who underwent open heart surgery with cardiopulmonary bypass 2009 - 2013.InterventionsThe outcomes of 86 patients who received pulmonary perfusion and ventilation during cardiopulmonary bypass were retrospectively compared to the control group of 188 patients.Measurements and Main ResultsRespiratory complications rates were similar in both groups (33.7% vs. 33.5%, as were the rates of postoperative pneumonia (4.7% vs. 4.3%, pleural effusions (13.9% vs. 12.2% and re-intubations (9.3% vs. 9.1%. Rates of adverse postoperative cardiac events including ventricular tachycardia (9.3% vs. 8.5% and atrial fibrillation (33.7% vs. 28.2% were equivalent in both groups. Incidence of sepsis (8.1% vs. 5.3%, postoperative stroke (2.3% vs. 2.1%, acute kidney injury (2.3% vs. 3.7% and renal failure (5.8% vs. 3.7% were likewise comparable. Despite similar transfusion requirements, coagulopathy (12.8% vs. 5.3%, p=0.031 and the need for mediastinal re-exploration (17.4% vs. 9.6%, p=0.0633 were observed more frequently in the pulmonary perfusion and ventilation group, but the difference did not reach the statistical significance. ICU and hospital stays, and the ICU readmission rates (7.0% vs. 8.0% were similar in both groups.ConclusionsSimultaneous pulmonary perfusion and ventilation during cardiopulmonary bypass were not associated with improved clinical outcomes.

  9. Effects of Peripheral Neurotensin on Appetite Regulation and Its Role in Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Ratner, Cecilia; Skov, Louise J; Raida, Zindy

    2016-01-01

    increased proopiomelanocortin mRNA in the arcuate nucleus. We also investigated the importance of NT for the decreased food intake after gastric bypass surgery in a rat model of Roux-en-Y gastric bypass (RYGB). NT was increased in plasma and in the gastrointestinal tract in RYGB rats, and pharmacological......Neurotensin (NT) is a peptide expressed in the brain and in the gastrointestinal tract. Brain NT inhibits food intake, but the effects of peripheral NT are less investigated. In this study, peripheral NT decreased food intake in both mice and rats, which was abolished by a NT antagonist. Using c...

  10. Scintigraphic assessment of focal platelet accumulations following infrainguinal bypass surgery in humans

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Hesse, B; Eiberg, J

    1997-01-01

    . In 28 patients undergoing in situ vein (n = 24), composite vein-polytetrafluoroethylene (PTFE) (n = 1) or PTFE (n = 3) bypass surgery, assumed vascular injuries were recorded intraoperatively. Autologous indium-111-labelled platelets were injected into the inflow artery immediately after restoration...... antiplatelet therapy or vein graft diameter. Only 2 of the 20 intragraft platelet depositions occurred in areas where intra-operative vascular injury was suspected. In the composite graft and the PTFE grafts, diffuse activity was observed throughout the entire bypass. In conclusion, focal activity...

  11. Association between serum lactate and postoperative outcomes following coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Fatemeh Hasanshiri

    2017-02-01

    Full Text Available Background: Increased serum lactate during cardio-pulmonary bypass is associated with high mortality and cardiac complications up to 10-20 percent. The aim of this study was to evaluate the effect of serum lactate increase on postoperative outcomes after coronary artery bypass graft (CABG Surgery. Materials and Methods: This descriptive-analytical study was performed on cases (no=116 undergoing CABG at Beheshti hospital in Kashan between 2013-2014. Demographic data, variables related to surgery, serum lactate level and the time of tracheal extubation, length of stay in intensive care unit (ICU and hospital post-surgery left ventricular ejection fraction were collected. These data was compared in two groups: Normal serum lactate ( 2 m mol\\liter group. Results: The postoperative hyperlactatemia was observed in 62.1 % of patients. There were no significant differences between two groups in time of tracheal extubation, length of stay in ICU and hospital. There was a relationship between the mean postoperative serum lactate and blood sugar, bicarbonate, pH, length of cardiopulmonary bypass and the aortic cross clamping time. There was a significant relationship between the serum lactate increment and the left ventricular ejection fraction decrement. Conclusion: Hyperlactatemia is probably associated with such important factors as high blood sugar, longer duration of aortic cross clamp and cardio-pulmonary bypass time. So controlling such factors can reduce the rate of hyperlactatemia and help postoperative recovery.

  12. [Flap repair for vascular prosthesis exposure after artificial blood vessel bypass surgery for critical limb ischemia].

    Science.gov (United States)

    Wu, Wei-wei; Wu, Hao; Zeng, Ang; Bai, Ming; Zeng, Rong; Chen, Yu; Liu, Chang-wei

    2013-08-01

    To investigate the effectiveness of flap repair for vascular prosthesis exposure after the artificial blood vessel bypass surgery for critical limb ischemia. From August 2007 to December 2011, bypass surgery with vascular prosthetic grafts were performed in 192 patients with critical limb ischemia.Five patients among them (2.6%) suffered from vascular prosthesis exposure 6 to 13 days after the previous surgery, including 4 males and 1 female, with a median age of 68 years(arranged from 52 to 81 years). The surgical managements included surgical debridement and local flap or transferred muscle-cutaneous flap repair to preserve the prosthetic vascular grafts. Three patients underwent Z-plasty with local flap repair, while 2 patients underwent transferred rectus abdominis or rectus femoris muscle flap repair of the wounds. After the surgery, prosthetic vascular graft was successfully preserved in 4 of the 5 cases with first intention healing. At a median follow-up of 38 months (arranged from 5 to 57 months), all the 4 limbs were salvaged with patent of the prosthetic grafts.One flap failed to heal and the prosthetic graft had to be removed due to infection and hemorrhage. An above-knee-amputation was performed due to severe limb ischemia. The vascular prosthesis exposure is often a disaster after artificial blood vessel bypass surgery for critical limb ischemia.Local flap or transferred muscle-cutaneous flap repair is an effective surgical management to salvage the exposed graft and the affected limb.

  13. Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT

    DEFF Research Database (Denmark)

    Frederiksen, Katrine Diemer; Hanson, Stine; Hansen, Stinus

    2016-01-01

    Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral densit...... increased risk of fracture in bariatric patients after surgery. We only observed bone structural changes in the weight-bearing bone, which indicates that mechanical un-loading is the primary mediator.......Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral density...

  14. Transient hyperperfusion after extracranial-intracranial bypass surgery on brain perfusion SPECT

    International Nuclear Information System (INIS)

    Kim, Yu Kyeong; Oh, Chang Wan; Cho, Sang Soo; Lee, Eun Ju; Eo, Jae Seon; Lee, Won Woo; Kim, Sang Eun

    2005-01-01

    We designed this study to investigate the transient relative hyperperfusion and its clinical implication after STA (superficial temporal artery) to MCA (middle cerebral artery) bypass surgery in patients with ischemic cerebral stroke. In 25 patients, comprising of 11 moyamoya disease (MMD) and 14 atherosclerotic disease (ASD), STA-MCA anastomosis was performed to distal cortical branches of middle cerebral artery for revascularization. 99mTc-ECD brain perfusion SPECT was performed before, 3 days and then 10 days after bypass surgery. Each image was spatially normalized into the standard space and changes of brain perfusion in the entire internal carotid artery (ICA) territory were evaluated using standardized ROIs. In the overall analysis including all patients, the surgery effectively increased ICA territory perfusion on the 3rd and 10th day after bypass surgery in comparison with the preoperative one (p<0.01 and p=0.03). The 3rd day perfusion was significantly higher than the 10th day one (p<0.01), demonstrating transient relative hyperperfusion on the 3rd day compared with the 10th day. In MMD group, such transient increase of perfusion was most severe in the vicinity of the anastomosis site, and more definite than the ASD group. Three patients, 2 ASD and one MMD, showed temporary neurological deterioration (dysphasia or dysarthria) beginning within 3 days after surgery and resolving completely within 2 weeks after onset, without hemorrhage, infarction or other serious defects on CT scan. Their neurological changes correlated well with the focal perfusion changes confirmed by SPECT images on the 3rd and 10th postoperative day. Transient relative hyperperfusion was observed on postoperative 3rd day compared with the 10th day following STA-MCA bypass surgery. In some patients, such transient increase of focal perfusion seems to provoke temporary neurological deterioration

  15. Transient hyperperfusion after extracranial-intracranial bypass surgery on brain perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yu Kyeong; Oh, Chang Wan; Cho, Sang Soo; Lee, Eun Ju; Eo, Jae Seon; Lee, Won Woo; Kim, Sang Eun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2005-07-01

    We designed this study to investigate the transient relative hyperperfusion and its clinical implication after STA (superficial temporal artery) to MCA (middle cerebral artery) bypass surgery in patients with ischemic cerebral stroke. In 25 patients, comprising of 11 moyamoya disease (MMD) and 14 atherosclerotic disease (ASD), STA-MCA anastomosis was performed to distal cortical branches of middle cerebral artery for revascularization. 99mTc-ECD brain perfusion SPECT was performed before, 3 days and then 10 days after bypass surgery. Each image was spatially normalized into the standard space and changes of brain perfusion in the entire internal carotid artery (ICA) territory were evaluated using standardized ROIs. In the overall analysis including all patients, the surgery effectively increased ICA territory perfusion on the 3rd and 10th day after bypass surgery in comparison with the preoperative one (p<0.01 and p=0.03). The 3rd day perfusion was significantly higher than the 10th day one (p<0.01), demonstrating transient relative hyperperfusion on the 3rd day compared with the 10th day. In MMD group, such transient increase of perfusion was most severe in the vicinity of the anastomosis site, and more definite than the ASD group. Three patients, 2 ASD and one MMD, showed temporary neurological deterioration (dysphasia or dysarthria) beginning within 3 days after surgery and resolving completely within 2 weeks after onset, without hemorrhage, infarction or other serious defects on CT scan. Their neurological changes correlated well with the focal perfusion changes confirmed by SPECT images on the 3rd and 10th postoperative day. Transient relative hyperperfusion was observed on postoperative 3rd day compared with the 10th day following STA-MCA bypass surgery. In some patients, such transient increase of focal perfusion seems to provoke temporary neurological deterioration.

  16. Brain volumes predict neurodevelopment in adolescents after surgery for congenital heart disease.

    Science.gov (United States)

    von Rhein, Michael; Buchmann, Andreas; Hagmann, Cornelia; Huber, Reto; Klaver, Peter; Knirsch, Walter; Latal, Beatrice

    2014-01-01

    Patients with complex congenital heart disease are at risk for neurodevelopmental impairments. Evidence suggests that brain maturation can be delayed and pre- and postoperative brain injury may occur, and there is limited information on the long-term effect of congenital heart disease on brain development and function in adolescent patients. At a mean age of 13.8 years, 39 adolescent survivors of childhood cardiopulmonary bypass surgery with no structural brain lesions evident through conventional cerebral magnetic resonance imaging and 32 healthy control subjects underwent extensive neurodevelopmental assessment and cerebral magnetic resonance imaging. Cerebral scans were analysed quantitatively using surface-based and voxel-based morphometry. Compared with control subjects, patients had lower total brain (P = 0.003), white matter (P = 0.004) and cortical grey matter (P = 0.005) volumes, whereas cerebrospinal fluid volumes were not different. Regional brain volume reduction ranged from 5.3% (cortical grey matter) to 11% (corpus callosum). Adolescents with cyanotic heart disease showed more brain volume loss than those with acyanotic heart disease, particularly in the white matter, thalami, hippocampi and corpus callosum (all P-values Brain volume reduction correlated significantly with cognitive, motor and executive functions (grey matter: P < 0.05, white matter: P < 0.01). Our findings suggest that there are long-lasting cerebral changes in adolescent survivors of cardiopulmonary bypass surgery for congenital heart disease and that these changes are associated with functional outcome.

  17. Outcome and quality of life after aorto-bifemoral bypass surgery.

    Science.gov (United States)

    Abelha, Fernando J; Botelho, Miguela; Fernandes, Vera; Barros, Henrique

    2010-03-18

    Aorto-bifemoral bypass (AFB) is commonly performed to treat aorto-iliac disease and a durable long-term outcome is achieved. Most studies documenting beneficial outcomes after AFB have been limited to mortality and morbidity rates, costs and length of hospital stay (LOS). Few studies have examined the dependency of patients and how their perception of their own health changes after surgery. The aim of the present study was to evaluate outcome after AFB and to study its determinants. This retrospective study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. Out of 1597 intensive care patients admitted to the PACU, 75 were submitted to infrarenal AFB and admitted to these intensive care unit (ICU) beds over 2 years. Preoperative characteristics and outcome were evaluated by comparing occlusive disease with aneurysmatic disease patients. Six months after discharge, the patients were contacted to complete a Short Form-36 questionnaire (SF-36) and to have their dependency in Activities of Daily Living (ADL) evaluated. Patient's characteristics and postoperative follow-up data were compared using Mann-Whitney U test, t test for independent groups, chi-square or Fisher's exact test. Patient preoperative characteristics were evaluated for associations with mortality using a multiple logistic regression analysis. The mortality rate was 12% at six months. Multivariate analysis identified congestive heart disease and APACHE II as independent determinants for mortality. Patients submitted to AFB for occlusive disease had worse SF-36 scores in role physical and general health perception. Patients submitted to AFB had worse SF-36 scores for all domains than a comparable urban population and had similar scores to other PACU patients. Sixty-six percent and 23% of patients were dependent in at least one activity in instrumental and personal ADL, respectively, but 64% reported having better general health. This study shows that

  18. Metabolite profiling identifies candidate markers reflecting the clinical adaptations associated with Roux-en-Y gastric bypass surgery.

    Directory of Open Access Journals (Sweden)

    David M Mutch

    Full Text Available BACKGROUND: Roux-en-Y gastric bypass (RYGB surgery is associated with weight loss, improved insulin sensitivity and glucose homeostasis, and a reduction in co-morbidities such as diabetes and coronary heart disease. To generate further insight into the numerous metabolic adaptations associated with RYGB surgery, we profiled serum metabolites before and after gastric bypass surgery and integrated metabolite changes with clinical data. METHODOLOGY AND PRINCIPAL FINDINGS: Serum metabolites were detected by gas and liquid chromatography-coupled mass spectrometry before, and 3 and 6 months after RYGB in morbidly obese female subjects (n = 14; BMI = 46.2+/-1.7. Subjects showed decreases in weight-related parameters and improvements in insulin sensitivity post surgery. The abundance of 48% (83 of 172 of the measured metabolites changed significantly within the first 3 months post RYGB (p<0.05, including sphingosines, unsaturated fatty acids, and branched chain amino acids. Dividing subjects into obese (n = 9 and obese/diabetic (n = 5 groups identified 8 metabolites that differed consistently at all time points and whose serum levels changed following RYGB: asparagine, lysophosphatidylcholine (C18:2, nervonic (C24:1 acid, p-Cresol sulfate, lactate, lycopene, glucose, and mannose. Changes in the aforementioned metabolites were integrated with clinical data for body mass index (BMI and estimates for insulin resistance (HOMA-IR. Of these, nervonic acid was significantly and negatively correlated with HOMA-IR (p = 0.001, R = -0.55. CONCLUSIONS: Global metabolite profiling in morbidly obese subjects after RYGB has provided new information regarding the considerable metabolic alterations associated with this surgical procedure. Integrating clinical measurements with metabolomics data is capable of identifying markers that reflect the metabolic adaptations following RYGB.

  19. Early experience with open heart surgery in a pioneer private ...

    African Journals Online (AJOL)

    Introduction: More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review ...

  20. Effects of intestinal bypass surgery on appetite, food intake, and body weight in obese and lean rats.

    Science.gov (United States)

    Sclafani, A; Koopmans, H S; Vasselli, J R; Reichman, M

    1978-04-01

    Jejunoileal bypass surgery or sham surgery was performed in female rats made obese with ventromedial hypothalamic (VMH) knife cuts, and in lean control rats. After bypass surgery, the VMH rats underate and lost weight until they reached the body weight of the control sham rats, and they then maintained their weight at control levels. Bypass surgery in lean rats produced much smaller reductions in food intake and body weight. Both bypass groups initially consumed less of a sucrose solution and milk diet during 1 h/day tests, but their intakes returned to near normal levels during the second postoperative month. Reconnection of the intestinal tract in the VMH-bypass rats led to renewed hyperphagia and return to obese body weights. A second experiment revealed that bypass surgery reduces food intake and body weight in genetically obese (fatty) rats, but this effect is not as pronounced as that displayed by VMH rats. These results confirm recent clinical observations that reduced appetite and caloric intake are the major causes of the weight loss produced by intestinal bypass surgery.

  1. Effectiveness of massage therapy on the mood of patients after open-heart surgery.

    Science.gov (United States)

    Babaee, Sima; Shafiei, Zahra; Sadeghi, Mohsen Mir Mohammad; Nik, Ahmadreza Yazdan; Valiani, Mahboobeh

    2012-02-01

    Cardiovascular diseases have the highest death rates in human society. Coronary artery disease is among the most important of these diseases. No treatment of cardiovascular disease has as much impact on the quality of life of the patients as the heart surgery. The recovery from heart surgery is associated with symptoms of pain and psychological distress. In the early recovery period, the patients will face moderate symptoms of anxiety and depression. In this regard, various measures of nursing, as complementary therapy practices have been performed to help the patients for overcoming the physical and psychological needs. One of these methods, in recent years has been the use of complementary and alternative therapies, particularly massage therapy, after heart surgery. Thus, the aim of this study was to determine the effectiveness of massage therapy on the mood of patients after open-heart surgery in Isfahan Chamran Hospital during 2010-11. In this study 72 patients, who underwent coronary artery bypass surgery, were selected. They were randomly assigned to the two case and control groups. The patients of the case group (n = 36) received Swedish massage for 20 minutes in 4 sessions in 4 consecutive days, 3 to 6 days after the open-heart surgery. The patients in the control group received only the routine care. The mood questionnaire (POMS) which was used in this study has been completed the day before the start of the study and intervention and again after the last day of the intervention. SPSS software version 12 and descriptive and inferential statistical methods were used for data analysis. The comparison of study results showed that massage decreased the overall rating of the patients' mood after the surgery. The use of massage therapy as an effective nursing intervention can improve the patients' mood after open-heart surgery. Due to the low cost and simplicity of this method, it can perhaps be used as a complement to drug therapy and postoperative

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

    DEFF Research Database (Denmark)

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

    2002-01-01

    OBJECTIVE: A major effect of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and impaired left ventricular (LV) contractile function is believed to be an improvement in LV function due to recovery of dysfunctional, but viable myocardium. However, recent studies have...... was correlated to the LV extent of myocardial metabolism--blood flow reverse mismatch. Most of the patients experienced an improvement in their angina pectoris, heart failure symptoms and exercise capacity after CABG; the overall 3-year survival was 77%. CONCLUSIONS: Patients with chronic ischemic heart disease...... indicated a time limit for such a recovery. We therefore investigated the extent of viable myocardium in patients with impaired LV function due to ischemic heart disease after a prolonged strategy of medical treatment and its relation to changes in clinical variables after CABG. METHODS: Forty...

  3. Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery.

    Science.gov (United States)

    Arefizadeh, Reza; Hariri, Seyed Yaser; Moghadam, Adel Johari

    2017-06-15

    A few studies have compared the cardiac rehabilitation (CR) outcome between those who undergo conventional on-pump bypass surgery and off-pump surgery. We compared this outcome among the patients differentiated by the On-pump and off-pump surgical procedures about cardiovascular variables and psychological status. This longitudinal study recruited 318 and 102 consecutive patients who had undergone CABG (on-pump surgery, n = 318 and off-pump surgery, n = 102) and been referred to the CR clinic. The off-pump surgery patients had more improvement in their metabolic equivalents (METs) value. The physical and mental components of health-related quality of life (QOL) (based on SF-36 questionnaire) as well as depression-anxiety (based on Costello-Comrey Depression and Anxiety Scale) were notably improved in the two study groups after the CR program, while changes in the QOL components scores and also depression-anxiety score were not different between the off-pump and on-pump techniques. Regarding QOL and psychological status, there were no differences in the CR outcome between those who underwent off-pump bypass surgery and those who underwent on-pump surgery; nevertheless, the off-pump technique was superior to the on-pump method on METs improvement following CR.

  4. Proposing a validated clinical app predicting hospitalization cost for extracranial-intracranial bypass surgery.

    Directory of Open Access Journals (Sweden)

    Hai Sun

    Full Text Available United States healthcare reforms are focused on curtailing rising expenditures. In neurosurgical domain, limited or no data exists identifying potential modifiable targets associated with high-hospitalization cost for cerebrovascular procedures such as extracranial-intracranial (ECIC bypass. Our study objective was to develop a predictive model of initial cost for patients undergoing bypass surgery.In an observational cohort study, we analyzed patients registered in the Nationwide Inpatient Sample (2002-2011 that underwent ECIC bypass. Split-sample 1:1 randomization of the study cohort was performed. Hospital cost data was modelled using ordinary least square to identity potential drivers impacting initial hospitalization cost. Subsequently, a validated clinical app for estimated hospitalization cost is proposed (https://www.neurosurgerycost.com/calc/ec-ic-by-pass.Overall, 1533 patients [mean age: 45.18 ± 19.51 years; 58% female] underwent ECIC bypass for moyamoya disease [45.1%], cerebro-occlusive disease (COD [23% without infarction; 12% with infarction], unruptured [12%] and ruptured [4%] aneurysms. Median hospitalization cost was $37,525 (IQR: $16,225-$58,825. Common drivers impacting cost include Asian race, private payer, elective admission, hyponatremia, neurological and respiratory complications, acute renal failure, bypass for moyamoya disease, COD without infarction, medium and high volume centers, hospitals located in Midwest, Northeast, and West region, total number of diagnosis and procedures, days to bypass and post-procedural LOS. Our model was validated in an independent cohort and using 1000-bootstrapped replacement samples.Identified drivers of hospital cost after ECIC bypass could potentially be used as an adjunct for creation of data driven policies, impact reimbursement criteria, aid in-hospital auditing, and in the cost containment debate.

  5. Pomegranate Supplementation Protects against Memory Dysfunction after Heart Surgery: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Susan A. Ropacki

    2013-01-01

    Full Text Available Memory dysfunction is a common complaint following heart surgery and may be related to a diffuse ischemic state induced by microemboli dislodged during the procedure. Ischemia can induce damage by a number of mechanisms, including oxidative stress. Because pomegranates contain a variety of polyphenols with antioxidant and other potentially beneficial effects, we tested whether supplementation with a pomegranate extract before and after heart surgery could protect against postoperative cognitive dysfunction. Patients undergoing elective coronary artery bypass graft and/or valve surgery were given either 2 g of pomegranate extract (in 2 POMx pills or placebo (pills containing no pomegranate ingredients per day from one week before surgery to 6 weeks after surgery. The patients were also administered a battery of neuropsychological tests to assess memory function at 1 week before surgery (baseline, 2 weeks after surgery, and 6 weeks after surgery. The placebo group had significant deficits in postsurgery memory retention, and the pomegranate treatment not only protected against this effect, but also actually improved memory retention performance for up to 6 weeks after surgery as compared to presurgery baseline performance.

  6. Postoperative nonlethal complications following open heart surgery

    Directory of Open Access Journals (Sweden)

    Golubović Miodrag

    2012-01-01

    Full Text Available Background/Aim. Postoperative nonlethal complications after open heart surgery are a serious clinical problem causing a considerable engagement of health workers, an augmented use of drugs, and prolonged operation incapacity leading to prolonged hospital stay and increased expenses. The aim of the study was to establish whether there is any correlation between the level of expected operative risk and postoperative nonlethal complications. Methods. A consecutive series of 853 patients subjected to the open heart surgery were investigated, 622 (73% males and 231 (27% females. The average age of the patients was 57.2 ± 9.9 (16-81 years. The patients were divided into 3 groups according to the additive EuroSCORE model: groups I, II and III with the expected operative risk of 0%-2%, 2%- 5% and over 5%, respectively. The data were collected prospectively and analyzed retrospectively. Statistical methods of correlation and t-test were used. Results. A high degree of correlation between the operative risk level and frequency of postoperative nonlethal complications (R = 0.98 was found. The average rate of complications was 24% for the whole group of 853 patients. It accounted for 21%, 29% and 47% in the groups I, II and III, respectively. According to the expected operative risk level there was a statistically significant difference in respect of heart arrhythmias (p = 0.02, neurologic complications (p = 0.002, and pulmonary complications (p = 0.009. Conclusion. Our results show a high degree of correlation between the expected level of operative risk according to the EuroSCORE model and the frequency of postoperative nonlethal complications. There is a statistically significant difference in respect to frequency of heart rhythm disturbances, pulmonary and neurological complications and expected operative mortality.

  7. Robotic Gastric Bypass Surgery in the Swiss Health Care System: Analysis of Hospital Costs and Reimbursement.

    Science.gov (United States)

    Hagen, Monika E; Rohner, Peter; Jung, Minoa K; Amirghasemi, Nicolas; Buchs, Nicolas C; Fakhro, Jassim; Buehler, Leo; Morel, Philippe

    2017-08-01

    Robotic technology shows some promising early outcomes indicating potentially improved outcomes particularly for challenging bariatric procedures. Still, health care providers face significant clinical and economic challenges when introducing innovations. Prospectively derived administrative cost data of patients who were coded with a primary diagnosis of obesity (ICD-10 code E.66.X), a procedure of gastric bypass surgery (CHOP code 44.3), and a robotic identifier (CHOP codes 00.90.50 or 00.39) during the years 2012 to 2015 was analyzed and compared to the triggered reimbursement for this patient cohort. A total of 348 patients were identified. The mean number of diagnoses was 2.7 and the mean length of stay was 5.9 days. The overall mean cost per patients was Swiss Francs (CHF) from 2012 to 2014 that was 21,527, with a mean reimbursement of CHF 24,917. Cost of the surgery in 2015 was comparable to the previous years with CHF 22,550.0 (p = 0.6618), but reimbursement decreased significantly to CHF 20,499.0 (0.0001). The average cost for robotic gastric bypass surgery fell well below the average reimbursement within the Swiss DRG system between 2012 and 2014, and this robotic procedure was a DRG winner for that period. However, the Swiss DRG system has matured over the years with a significant decrease resulting in a deficit for robotic gastric bypass surgery in 2015. This stipulates a discussion as to how health care providers should continue offering robotic gastric bypass surgery, particularly in the light of developing clinical evidence.

  8. Malaria complicating open-heart surgery.

    OpenAIRE

    Mok, C K; Cheung, K L; Wai, K H; Ong, G B

    1980-01-01

    Two cases of malaria developing immediately after open-heart surgery are reported to illustrate that malaria is one of the rarer causes of postoperative pyrexia. The diagnosis can easily be missed, resulting in unnecessary morbidity and even mortality. It is important for cardiac surgeons to be aware of this possibility in malaria-free as well as malaria-endemic areas as patients or blood donors who come from or have recently visited an endemic area are potential victims or sources of the inf...

  9. Popliteo-pedal bypass surgery for critical limb ischemia.

    LENUS (Irish Health Repository)

    Good, D W

    2011-12-01

    Critical limb ischaemia due to distal arterial disease represents a significant challenge. Randomised controlled evidence suggests that open surgery may be superior to endovascular intervention but there is limited data on the specific clinical cohort with exclusively infra-popliteal disease.

  10. Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery.

    Science.gov (United States)

    Ogami, Takuya; Matsue, Yuya; Kawasumi, Ryo; Tanabe, Hiroaki

    2017-02-01

    Chronic kidney disease (CKD) and anemia are independent preoperative risk factors for coronary artery bypass graft (CABG) surgery. We evaluated the implications of the coexistence of these two factors and their associated prognosis for CABG surgery. We analyzed, retrospectively, consecutive patients who underwent elective CABG surgery between 2004 and 2014. The patients were classified into four groups depending on the presence or absence of preoperative CKD and anemia. We assessed the major adverse cardiac and cerebrovascular event (MACCE), defined as composite outcomes of cardio- and cerebrovascular death, revascularization through surgery or percutaneous intervention, hospitalization for congestive heart failure, and cerebral infarction. The study population consisted of 510 patients (73 % male; median age 71 years old), followed up for a median period of 2.8 years. Multivariate analysis indicated that neither the CKD/no-anemia group [hazard ratio (HR) 0.98, 95 % confidence interval (CI) 0.39-2.51, P = 0.973] nor the no-CKD/anemia group (HR 1.20, 95 % CI 0.69-2.09, P = 0.512) had significantly poorer prognoses than the no-CKD/no-anemia group. However, the CKD/anemia group had a significantly higher risk of a MACCE (HR 2.01, 95 % CI 1.01-3.98, P = 0.046). The presence of both CKD and anemia in patients undergoing CABG for coronary artery disease is synergistically associated with a worse outcome.

  11. Coronary artery bypass surgery in the diabetic patient.

    LENUS (Irish Health Repository)

    Maher, M

    2012-02-03

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

  12. The Effect of Aromatherapy with Lavender Essential Oil on Anxiety and Stress in Patients Undergoing Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    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.

  13. Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity

    OpenAIRE

    Elbanna, Abduh; Eldin, Mohammed Tag; Fathy, Mohammad; Osman, Osama; Abdelfattah, Mohammed; Safwat, Abdelrahman; Elkader, Mohammed Sedki Abd; Bilasy, Shymaa E.; salama, Khaled; Elnour, Asim A.; Shehab, Abdullah; Baghdady, Shazly; Amer, Mohamed; Alboraie, Mohamed; ragb, Aly

    2015-01-01

    Abstract Children obesity has become one of the most important public health problems in many countries worldwide. Although the awareness of childhood obesity as a modifiable health risk is high, but many societies do not prioritize this issue as a health care problem, which may lead to comorbidities and even premature death. Despite the rising interest in bariatric surgery for children, only laparoscopic sleeve gastrectomy (LSG) is being considered in resolving childhood obesity who failed o...

  14. Effects of coronary artery bypass surgery on regions showing persistent defects in thallium myocardial images

    International Nuclear Information System (INIS)

    Konishi, Yutaka; Ban, Toshihiko; Okamoto, Yoshifumi

    1989-01-01

    The indications for revascularization surgery and its effects on myocardial regions showing persistent defects in thallium myocardial images are controversial. The effects of aortocoronary bypass surgery on myocardial perfusion and wall motion in the regions with persistent defects were evaluated in 47 patients with thallium-201 single photon emission computed tomography and left ventriculography. In areas showing persistent thallium defects preoperatively the rate of improvement of perfusion was only 24% by postoperative thallium imaging, and 57% by wall motion analysis. These results were significantly inferior to those of regions with transient defects, which were 84% and 82%, respectively. A persistent defect may not be a definitive marker of a non-viable scar, but the results of surgery on such regions were unsatisfactory. It is concluded, therefore, that revascuralization surgery in regions with persistent defects is not always recommended and that the indications for surgery should be individually determined with operative risk balanced against benefits. (author)

  15. Thallium-201 exercise myocardial imaging to evaluate myocardial perfusion after coronary artery bypass surgery

    International Nuclear Information System (INIS)

    Hirzel, H.O.; Nuesch, K.; Sialer, G.; Horst, W.; Krayenbuehl, H.P.

    1980-01-01

    To assess the usefulness of thallium-201 exercise scintigraphy in evaluating myocardial perfusion after coronary artery bypass surgery, imaging was performed after submaximal bicycle ergometry and at rest in 54 patients before and within 24 +- 10 (SD) weeks after operation. Scintigraphy identified 8 out of 20 patients who were symptom free after operation and showed normal exercise electrocardiograms as still having exercise-induced ischaemia and thus as having not truly benefited from the surgical intervention. In contrast, improvement in perfusion was documented in 17 out of 31 patients despite further complaints of chest pain and persistence of a pathological exercise electrocardiogram in 6 of them. Bypass graft patency rate paralleled the scintigraphic findings in the 35 patients who were restudied arteriographically. It was concluded that thallium-201 exercise scintigraphy is a useful technique to document changes in regional perfusion after surgery and is definitely superior to the clinical evaluation of patients including the exercise electrocardiogram. (author)

  16. Long-term quality of life and mobility after prosthetic above-the-knee bypass surgery.

    Science.gov (United States)

    Bosma, Jan; Turkçan, Kagan; Assink, Joeri; Wisselink, Willem; Vahl, Anco C

    2012-02-01

    Multiple studies have addressed above-the-knee femoral artery bypass grafting; however, information on late quality of life (QoL) and mobility is scarce. We studied long-term QoL and mobility after above-the-knee bypass surgery. Consecutive patients presenting with claudication, ischemic rest pain, or gangrene who received above-the-knee prosthetic bypass grafting between December 1997 and January 2003 were included in this observational study. Data used were recorded in a prospectively collected database of patients receiving Dacron and polytetrafluoroethylene (PTFE) supragenicular bypasses for lower limb ischemia. Primary outcomes were QoL and mobility, and secondary outcomes were patency and patient survival. QoL was measured with the EuroQol questionnaire (EQ-5D/EQ-VAS). Mobility was assessed with the Walking Impairment Questionnaire (WIQ) and analyzed in univariate and multivariate models. Patency and survival were computed with Cox regression. One hundred forty patients were treated during the study period. Sixty-nine patients (50%) died during follow-up, leaving 71 survivors who were asked (63 [89%] complied) to complete the EQ-5D/EQ-VAS and WIQ questionnaires. None of the primary outcome parameters (WIQ, EQ-5D, EQ-VAS) were affected by primary bypass occlusion (p = 0.34, p = 0.44, and p = 0.27, respectively) or long-term patency (p = 0.07, p = 0.54, and p = 0.36, respectively). Male sex was significantly associated with a better outcome on all primary outcome parameters. Patients with Dacron versus PTFE grafts had WIQ scores of 0.49 and 0.26, respectively (p = 0.01). EQ-5D scores of patients with Dacron and PTFE were 0.576 and 0.409 (p = 0.08) and EQ-VAS scores were 61 and 54, respectively (p = 0.24). Graft type was not independently associated with occlusion, but runoff was. The 5-year and 10-year patient survival rates were 58% and 51%, respectively. In this study, long-term QoL and mobility did not seem to be associated with bypass patency, as assessed

  17. Filtration of activated granulocytes during cardiopulmonary bypass surgery : A morphologic and immunologic study to characterize the trapped leukocytes

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    Cardiopulmonary bypass surgery induces an inflammatory reaction among others by activation of granulocytes. Leukocyte filtration has been shown to reduce the postoperative morbidity mediated by activated granulocytes. However, little is known about the mechanism of filter-leukocyte interaction, This

  18. Relationship Between Successful Extracranial-Intracranial Bypass Surgeries and Ischemic White Matter Hyperintensities.

    Science.gov (United States)

    Nagm, Alhusain; Horiuchi, Tetsuyoshi; Ito, Kiyoshi; Hongo, Kazuhiro

    2016-07-01

    Few studies have described regression of white matter hyperintensities (WMHs); however, no studies have described their recurrence or fluctuation. Thus, we aimed to study the course of WMHs on fluid-attenuated inversion recovery (FLAIR) magnetic resonance image (MRI) after extracranial-intracranial (EC-IC) bypass surgery and its correlation with the clinical outcome. We enrolled perioperative FLAIR MRIs of 12 patients with WMHs who underwent EC-IC bypass surgeries because of ischemic-vascular stenosis with postoperative improvement of the cerebral blood flow confirmed by (123)I-iodoamphetamine single-photon emission computed tomography. Correlation between WMHs and cerebral blood flow was confirmed by perioperative single-photon emission computed tomography and diffusion-weighted imaging MRI. The WMHs were assessed visually with meticulous volumetric grading. Depending on postoperative changes among different grades, the WMHs course was determined to be improved, fluctuating, worsened, or unchanged. A statistical analysis was performed on the course of WMHs over time. Imaging analysis was done with FLAIR MRI in 12 patients. The course of WMHs over time was 41.7% improvement, 33.3% fluctuation, 16.7% unchanged, and 8.3% worsening of the deep WMHs. After unilateral bypass surgery, 80% of the improved WMHs occurred bilaterally. Among patients with improved clinical outcomes, 16.7% showed improvement and 33.3% showed fluctuation, whereas in patients with unchanged clinical outcomes, 25% showed improvement of their WMHs on follow-up FLAIR MRIs. This study might be considered the first step to find a relationship between successful EC-IC bypass surgeries and the course of ischemic WMHs. It could also open the door for further studies to make more solid conclusions. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Single Anastomosis Sleeve Ileal Bypass: New Step in the Evolution of Bariatric Surgeries.

    Science.gov (United States)

    Salama, Tamer M S; Sabry, Karim; Ghamrini, Yaser El

    2017-10-01

    Single anastomosis sleeve ileal bypass (SASI) procedure appears as a new metabolic and bariatric surgery based on Santoro's operation, in which a sleeve gastrectomy is followed by a side-to-side gastroileal anastomosis. The study is aimed to evaluate the short-term outcomes of laparoscopic single anastomosis sleeve ileal bypass with respect to postoperative weight loss and metabolic and nutritional effects on patients. Forty-five morbidly obese patients with a mean age of 31.2 years and a mean body mass index (BMI) of 43.2 kg/m 2 underwent SASI bypass. Postoperatively, all patients were followed up at 1, 3, 6, and 12 months, and during each visit data about their BMI, obesity-related comorbidities, and nutritional status were collected. One year after the surgery, mean BMI decreased to 29.1 kg/m 2 and there was significant decrease in plasma level of fasting blood glucose, insulin, and low-density lipoprotein. On the other hand, there was significant increase in high-density lipoprotein plasma level, whereas hemoglobin and albumin plasma level remained normal. Six months after the surgery, calcium plasma level showed mild decrease in two cases, which was improved with multivitamin tablets. In 93% of our patients, multivitamin supplements were stopped after six months of surgery. Laparoscopic SASI bypass has been shown to be an effective, safe, and simple procedure for the treatment of morbid obesity and its associated metabolic consequences. Moreover, it results in minimal postoperative nutritional complications in comparison to other bariatric procedures.

  20. Gastric Bypass Surgery but Not Caloric Restriction Improves Reproductive Function in Obese Mice

    OpenAIRE

    Frank, Aaron P.; Zechner, Juliet F.; Clegg, Deborah J

    2016-01-01

    In women, obesity is associated with decrements in reproductive health that are improved with weight loss. Due to the difficulty of maintaining weight loss through lifestyle interventions, surgical interventions have become popular treatments for obesity. We examined how weight loss induced by Roux-en Y gastric bypass surgery (RYGB) or calorie restriction impacted expression of hypothalamic genes related to energy intake and reproduction. RYGB and calorie restriction induced equivalent weight...

  1. Bariatric Surgery Is Gaining Ground as Treatment of Obesity After Heart Transplantation: Report of Two Cases.

    Science.gov (United States)

    Tsamalaidze, Levan; Elli, Enrique F

    2017-11-01

    Experience with bariatric surgery in patients after orthotopic heart transplantation (OHT) is still limited. We performed a retrospective review of patients who underwent bariatric surgery after OHT from January 1, 2010 to December 31, 2016. Two post-OHT patients with BMI of 37.5 and 36.2 kg/m² underwent laparoscopic robotic-assisted Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, respectively. Quality of life substantially improved for both patients. Bariatric surgery is safe and feasible in OHT patients, despite numerous risk factors. Careful selection of patients is required with proper preoperative management and overall care. Due to the complexity of treatment and perioperative care in this specific population, these operations should be done in high-volume centers with multidisciplinary teams composed of bariatric, cardiac transplant surgeons and critical care physicians. Bariatric surgery can be highly effective for treatment of obesity after OHT.

  2. Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery.

    Science.gov (United States)

    Lopes, Célia Regina; Brandão, Carlos Manuel de Almeida; Nozawa, Emília; Auler, José Otávio Costa

    2008-01-01

    to show the benefits of the use of non-invasive positive pressure ventilation (NPPV) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery. A prospective, randomized and controlled study was performed involving 100 consecutive patients submitted to coronary artery bypass grafting or valve surgery. The subjects were admitted into the Intensive Care Unit (ICU) under mechanical ventilation and randomized in a study group (n=50), which used NPPV with bilevel pressure for 30 minutes after extubation, and a control group (n=50) which only used a nasal O2 catheter. Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia, surgery and cardiopulmonary bypass, as well as the time required for weaning from invasive mechanical ventilation were analysed. The arterial blood gases and hemodynamic variables were also assessed before and after extubation. The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO2. On comparing the groups, the PaO2 improved significantly (p = 0.0009) with the use of NPPV for 30 minutes after extubation, but there was no statistically significant difference in the PaCO2 (p = 0.557). The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery.

  3. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2016-01-01

    Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

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

    OpenAIRE

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

    2016-01-01

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

  5. Gastric bypass surgery: Improving psoriasis through a GLP-1-dependent mechanism?

    DEFF Research Database (Denmark)

    Faurschou, Annesofie; Zachariae, Claus; Skov, Lone

    2011-01-01

    Psoriasis is a common inflammatory skin disease and obesity constitutes a risk factor for the disease. Obese patients with psoriasis are often more difficult to treat and are at increased risk for dyslipidemia, diabetes, hypertension and cardiovascular disease. Case reports suggest that gastric...... bypass surgery in patients with psoriasis may result in complete remission of the disease. A substantial weight loss is achieved in the months following surgery, which is likely to reduce psoriasis symptoms and risk of comorbidities. Interestingly, however, it has been described that improvement...

  6. Increased Atrial β-Adrenergic Receptors and GRK-2 Gene Expression Can Play a Fundamental Role in Heart Failure After Repair of Congenital Heart Disease with Cardiopulmonary Bypass.

    Science.gov (United States)

    Oliveira, Marcela Silva; Carmona, Fabio; Vicente, Walter V A; Manso, Paulo H; Mata, Karina M; Celes, Mara Rúbia; Campos, Erica C; Ramos, Simone G

    2017-04-01

    Surgeries to correct congenital heart diseases are increasing in Brazil and worldwide. However, even with the advances in surgical techniques and perfusion, some cases, especially the more complex ones, can develop heart failure and death. A retrospective study of patients who underwent surgery for correction of congenital heart diseases with cardiopulmonary bypass (CPB) in a university tertiary-care hospital that died, showed infarction in different stages of evolution and scattered microcalcifications in the myocardium, even without coronary obstruction. CPB is a process routinely used during cardiac surgery for congenital heart disease. However, CPB has been related to increased endogenous catecholamines that can lead to major injuries in cardiomyocytes. The mechanisms involved are not completely understood. The aim of this study was to evaluate the alterations induced in the β-adrenergic receptors and GRK-2 present in atrial cardiomyocytes of infants with congenital heart disease undergoing surgical repair with CPB and correlate the alterations with functional and biochemical markers of ischemia/myocardial injury. The study consisted of right atrial biopsies of infants undergoing surgical correction in HC-FMRPUSP. Thirty-three cases were selected. Atrial biopsies were obtained at the beginning of CPB (group G1) and at the end of CPB (group G2). Real-time PCR, Western blotting, and immunofluorescence analysis were conducted to evaluate the expression of β 1 , β 2 -adrenergic receptors, and GRK-2 in atrial myocardium. Cardiac function was evaluated by echocardiography and biochemical analysis (N-terminal pro-brain natriuretic peptide (NT-ProBNP), lactate, and cardiac troponin I). We observed an increase in serum lactate, NT-proBNP, and troponin I at the end of CPB indicating tissue hypoxia/ischemia. Even without major clinical consequences in cardiac function, these alterations were followed by a significant increase in gene expression of β 1 and β 2

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

    Directory of Open Access Journals (Sweden)

    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. Impaired alcohol metabolism after gastric bypass surgery: a case-crossover trial.

    Science.gov (United States)

    Woodard, Gavitt A; Downey, John; Hernandez-Boussard, Tina; Morton, John M

    2011-02-01

    Severe obesity remains the leading public health crisis of the industrialized world, with bariatric surgery the only effective and enduring treatment. Poor psychological adjustment has been occasionally reported postoperatively. In addition, evidence suggests that patients can metabolize alcohol differently after gastric bypass. Preoperatively and at 3 and 6 months postoperatively, 19 Roux-en-Y gastric bypass (RYGB) patients' breath alcohol content (BAC) was measured every 5 minutes after drinking 5 oz red wine to determine peak BAC and time until sober in a case-crossover design preoperatively and at 6 months postoperatively. Patients reported symptoms experienced when intoxicated and answered a questionnaire of drinking habits. The peak BAC in patients after RYGB was considerably higher at 3 months (0.059%) and 6 months (0.088%) postoperatively than matched preoperative levels (0.024%). Patients also took considerably more time to return to sober at 3 months (61 minutes) and 6 months (88 minutes) than preoperatively (49 minutes). Postoperative intoxication was associated with lower levels of diaphoresis, flushing, and hyperactivity and higher levels of dizziness, warmth, and double vision. Postoperative patients reported drinking considerably less alcohol, fewer preferred beer, and more preferred wine than before surgery. This is the first study to match preoperative and postoperative alcohol metabolism in gastric bypass patients. Post-RYGB patients have much higher peak BAC after ingesting alcohol and require more time to become sober. Patients who drink alcohol after gastric bypass surgery should exercise caution. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Comparison of ketamine-pentobarbital anesthesia and fentanyl-pentobarbital anesthesia for open-heart surgery in minipigs.

    Science.gov (United States)

    Liu, Debin; Shao, Yanbin; Luan, Xiushu; Zhang, Mingkui; Shui, Chaoxiang; Wu, Qingyu

    2009-07-01

    The authors analyzed and compared the cardiovascular effects of two anesthetic combinations in minipigs undergoing open-heart surgery and cardiopulmonary bypass. Pigs in group K (n = 15) were anesthetized with low-dose ketamine combined with pentobarbital (5 mg per kg and 20 mg per kg, respectively, for induction; continuous intravenous infusion of 5 mg per kg per h and 10 mg per kg per h, respectively, for maintenance). Pigs in group F (n = 15) were treated with fentanyl and pentobarbital (20 microg per kg and 20 mg per kg, respectively, for induction; continuous intravenous infusion of 20 microg per kg per h and 10 mg per kg per h, respectively, for maintenance). Most pigs remained stable during the surgical procedures and survived for at least one day after surgery; two pigs in group F died during or soon after surgery. Heart rate and mean arterial pressure after bypass were significantly lower in group F than in group K, and pigs in group F required higher doses of inotropic agents to maintain cardiac function. Results suggest that for open-heart surgery and bypass in minipigs, ketamine-pentobarbital anesthesia is associated with more stable cardiovascular conditions than is fentanyl-pentobarbital anesthesia.

  10. Revision of Immediate Post-Open Heart Surgery Education for Critical Care RNs.

    Science.gov (United States)

    Mowry, Marianne J; Gabel, Mollie A

    2015-11-01

    Responding to the complex nature of critical care is imperative, as extensive clinical judgment is required during those vital moments when patients are experiencing complications related to open heart surgery, post-vessel bypass, or valve replacement. Critical care registered nurses must rely on evidence-based foundational knowledge and skills particular to cardiovascular pathophysiology, hemodynamic monitoring, and medications. This article reports on the critical care educator's revision of the immediate post-open heart surgery curriculum. Mixed educational methods within the plan were foundational to develop clinicians for competent care of these complex patients (within the first 8 hours). The revision included experiential learning and learner centeredness to bolster the learner's confidence, reduce the time to competence, and, most important, ensure positive patient outcomes. Kirkpatrick's classic four-level model provided the framework for evaluation. Lessons learned were discussed following the program initiation. Copyright 2015, SLACK Incorporated.

  11. Chance of surgery in adult congenital heart disease.

    Science.gov (United States)

    Verheugt, Carianne L; Uiterwaal, Cuno Spm; Vaartjes, Ilonca; van der Velde, Enno T; Zomer, A C; Meijboom, Folkert J; Pieper, Petronella G; Post, Marco C; Vliegen, Hubert W; Hazekamp, Mark G; Grobbee, Diederick E; Mulder, Barbara Jm

    2017-08-01

    Background Young patients with congenital heart disease reaching adulthood face mandatory transition to adult cardiology. Their new cardiologist needs to assess the chances of major future events such as surgery. Using a large national registry, we assessed if patient characteristics at the age of 18 years could predict the chance of congenital heart surgery in adulthood. Design and methods Of 10,300 patients from the CONCOR national registry, we used general patient characteristics at age 18 years, underlying congenital heart defect, history of complications, and interventions in childhood as potential predictors of congenital heart surgery occurring from age 18 years up to age 40 and 60 years. Cox regression was used to calculate hazard ratios with 95% confidence intervals. Analyses were performed separately for all congenital heart surgery and for valvular surgery alone. Results Altogether 2427 patients underwent congenital heart surgery after age 18 years, 1389 of whom underwent valvular surgery. Underlying heart defect, male sex, multiple defects, childhood endocarditis, supraventricular arrhythmia, aortic complications and paediatric cardiovascular surgery, independently predicted adult congenital heart surgery. The mean chance of congenital heart surgery was 22% up to age 40 and 43% up to age 60 years; individual chances spanned from 9-68% up to age 40 and from 19-93% up to age 60 years. Conclusion At the time of transition from paediatric to adult cardiology, an easily obtainable set of characteristics of patients with congenital heart disease can meaningfully inform cardiologists about the patient's individual chance of surgery in adulthood. Our findings warrant validation in other cohorts.

  12. Open heart surgery: management of nonsurgical bleeding in the peri ...

    African Journals Online (AJOL)

    The data analyzed were patients' demographics, the total number of open heart surgery cases, the number that had perioperative nonsurgical bleeding,clinical detection strategies,treatment and preventive modalities as well as the outcome. RESULTS: During the period,a total number of 78 cases of open heart surgery ...

  13. Extra-Thoracic Supra-aortic Bypass Surgery Is Safe in Thoracic Endovascular Aortic Repair and Arterial Occlusive Disease Treatment.

    Science.gov (United States)

    Gombert, Alexander; van Issum, Lea; Barbati, Mohammad E; Grommes, Jochen; Keszei, Andras; Kotelis, Drosos; Jalaie, Houman; Greiner, Andreas; Jacobs, Michael J; Kalder, Johannes

    2018-04-20

    The safety and feasibility of supra-aortic debranching as part of endovascular aortic surgery or as a treatment option for arterial occlusive disease (AOD) remains controversial. The aim of this study was to assess the clinical outcome of this surgery. This single centre, retrospective study included 107 patients (mean age 69.2 years, 38.4% women) who underwent supra-aortic bypass surgery (carotid-subclavian bypass, carotid-carotid bypass, and carotid-carotid-subclavian bypass) because of thoracic or thoraco-abdominal endovascular aortic repair (57%; 61/107) or as AOD treatment (42.9%; 46/107) between January 2006 and January 2015. Mortality, morbidity with a focus on neurological complications, and patency rate were assessed. Twenty-six of 107 (14.2%) of the debranching patients were treated under emergency conditions because of acute type B dissection or symptomatic aneurysm. Follow up, conducted by imaging interpretation and telephone interviews, continued till March 2017 (mean 42.1, 0-125, months). The in hospital mortality rate was 10.2% (11/107), all of these cases from the debranching group and related to emergency procedures (p supra-aortic bypass surgery involves low complication rates and high mid-term bypass patency rates. It is a safe and feasible treatment option in the form of debranching in combination with endovascular aortic aneurysm repair and in AOD. Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

  14. Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience.

    Science.gov (United States)

    Onakpoya, Uvie Ufuoma; Adenle, Adebisi David; Adenekan, Anthony Taiwo

    2017-01-01

    More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review our initial experience with open heart surgery in this private hospital. All patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data was analysed using SPSS version 16. Eighteen patients comprising of 12 males and 6 females with ages ranging between 8 months and 52 years (mean= of 15.7 +/- 15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 7 patients (38.9%) while total correction of isolated tetralogy of Fallot was carried out in 5 patients (27.8%). Two patients had mitral valve repair for rheumatic mitral regurgitation. Sixty day mortality was 0%. Safe conduct of open heart surgery in the private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.

  15. The History of Surgery at the Montreal Heart Institute.

    Science.gov (United States)

    Grondin, Claude M; Cartier, Raymond; Roy, Denis; Perrault, Louis P

    2016-01-01

    The Montreal Heart Institute (MHI) is a specialty hospital dedicated to cardiology and heart surgery. Founded in 1954 by Paul David, it is currently affiliated with the Université de Montréal. The Montreal Heart Institute is a center that has rested on the shoulders of multiple pioneers over the past 63 years. Renowned for its sustained excellence and commitment to patient care, the MHI also focuses on research and innovation. It has become one of the leading heart institutions in modern cardiac surgery and also one of the busiest cardiac surgery centers in the country. Our leaders have impacted the treatment of patients with heart diseases through clinical care and education. Staff surgeons have been trained at top centers across the world for the benefit of Canadian patients. The MHI was a pioneer in heart transplantation and CABG surgery and focuses on evaluative research of new technology. Copyright © 2016. Published by Elsevier Inc.

  16. Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

    Directory of Open Access Journals (Sweden)

    Malheiros Suzana M. F.

    2001-01-01

    Full Text Available Coronary artery bypass surgery (CABG without cardiopulmonary bypass (CPB may potentially reduce the number of microembolic signals (MES associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue.

  17. Exercise-based cardiac rehabilitation after heart valve surgery

    DEFF Research Database (Denmark)

    Hansen, T B; Zwisler, A D; Berg, S K

    2015-01-01

    BACKGROUND: Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR...... expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis....

  18. Coping strategies and adaptation to coronary artery bypass surgery as experienced by three couples.

    Science.gov (United States)

    Whitsitt, David R

    2012-01-01

    Coping strategies affect the psychosocial adaptation of couples in which one of the partners has undergone coronary artery bypass grafting. Research has focused on coping strategies of patients and spouses as individuals, but little is known about how couples cope with this procedure. The purpose of this study was to understand couples' coping strategies and their influence on adaptation to bypass surgery. Three couples were recruited from the Cardiac Wellness Institute of Calgary, Alberta, Canada. The descriptive phenomenological psychological method was used to analyze data from 2 interviews with each couple. The analysis revealed a single structure that described the couples' lived experiences. The structure and interview data revealed coping strategies and key factors influencing adaptation postsurgery. Coping strategies, such as redefining the illness, seeking spiritual support, and partnering, enhanced psychosocial adaptation for couples. In addition, marital quality, coping congruence, and shared meaning contributed to effective coping and better adaptation. Copyright © 2012 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    O5 Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: A nationwide cohort study Kristinn Thorsteinsson, Jan Jesper Andreasen, Christian Torp Pedersen, Kirsten Fonager, Rikke Nørmark Mortensen, Kristian Kragholm, Gunnar Gislason, Lars Køber....... Aalborg, Denmark Background: Data on nursing home admission in patients >80 years of age after isolated coronary artery bypass grafting (CABG) are scarce. Aim: The purpose of this study was to evaluate longevity and subsequent admission to nursing home stratified by age in a nationwide CABG cohort....... Methods: All patients who underwent isolated CABG in 1996-2012 in Denmark were identified through nationwide administrative registers and included. The cumulative incidence of admission to a nursing home after CABG was estimated. A cause specific Cox-regression model was constructed to identify predictors...

  20. Differences in perioperative femoral and radial arterial blood pressure in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Hwa Jin Cho

    Full Text Available Abstract Objective: Several reports claim that blood pressure (BP in the radial artery may underestimate the accurate BP in critically ill patients. Here, the authors evaluated differences in mean blood pressure (MBP between the radial and femoral artery during pediatric cardiac surgery to determine the effectiveness of femoral arterial BP monitoring. Method: The medical records of children under 1 year of age who underwent open-heart surgery between 2007 and 2013 were retrospectively reviewed. Radial and femoral BP were measured simultaneously, and the differences between these values were analyzed at various times: after catheter insertion, after the initiation of cardiopulmonary bypass (CPB-on, after aortic cross clamping (ACC, after the release of ACC, after weaning from CPB, at arrival in the intensive care unit (ICU, and every 6 h during the first day in the ICU. Results: A total of 121 patients who underwent open-heart surgery met the inclusion criteria. During the intraoperative period, from the beginning to the end of CPB, radial MBPs were significantly lower than femoral MBPs at each time-point measured (p 60 min, odds ratio: 7.47 was a risk factor for lower radial pressure. However, discrepancies between these two values disappeared after arrival in the ICU. There was no incidence of ischemic complications associated with the catheterization of both arteries. Conclusion: The authors suggest that femoral arterial pressure monitoring can be safely performed, even in neonates, and provides more accurate BP values during CPB-on periods, and immediately after weaning from CPB, especially when CPB time was greater than 60 min.

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

    Science.gov (United States)

    Højskov, Ida E; Moons, Philip; Hansen, Niels V; Greve, Helle; Olsen, Dorte Bæk; Cour, Søren La; Glud, Christian; Winkel, Per; Lindschou, Jane; Egerod, Ingrid; Christensen, Anne Vinggaard; Berg, Selina Kikkenborg

    2016-10-01

    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, no randomized clinical trials have tested a comprehensive rehabilitation programme consisting of both physical exercise and psycho-education in the early rehabilitation phase. The aims of the present SheppHeart pilot randomized clinical trial were to evaluate the feasibility of patient recruitment, patient acceptance of the intervention, safety and tolerability of the intervention. 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 and psycho-educational plus usual care, or 4) usual care alone during a four week period after surgery. The acceptability of trial participation was 67% during the three month recruitment period. In the physical exercise groups, patients complied with 59% of the total expected training sessions during hospitalization. Nine patients (30%) complied with >75% and nine patients (30%) complied with 50% of the planned exercise sessions. Eleven patients (42%) participated in ⩾75% of the four consultations and six patients (23%) participated in 50% of the psycho-educational programme. Comprehensive phase one rehabilitation combining physical exercise and psycho-education in coronary artery bypass graft patients shows reasonably high inclusion, feasibility and safety. © The European Society of Cardiology 2015.

  2. Emergency coronary artery bypass surgery for failed percutaneous coronary angioplasty. A 10-year experience.

    Science.gov (United States)

    Craver, J M; Weintraub, W S; Jones, E L; Guyton, R A; Hatcher, C R

    1992-01-01

    Six hundred ninety-nine patients have required emergency coronary artery bypass after failed elective percutaneous coronary angioplasty during the decade September 1980 through December 1990. This represents 4% of 9860 patients having 12,146 elective percutaneous coronary angioplasty procedures during this interval. Emergency coronary artery bypass was required for acute refractory myocardial ischemia in 82%. Hospital mortality rate for all patients was 3.1%; 3.7% in patients with refractory myocardial ischemia but 0.8% in patients without refractory myocardial ischemia, p = 0.08. Postprocedural Q-wave myocardial infarctions were observed in 21% versus 2.4%, p less than 0.0001, and intra-aortic balloon pumping was required in 19% with versus 0.8% without refractory myocardial ischemia, p less than 0.0001. Multivessel disease, p = 0.004, age older than 65 years, p = 0.005, and refractory myocardial ischemia, p = 0.08, interacted to produce the highest risk of in-hospital death. Follow-up shows that there have been 28 additional late deaths, including 23 of cardiac causes for a 91% survival at 5 years. Freedom from both late death and Q-wave myocardial infarction at 5 years was 61%. In the group going to emergency coronary artery bypass with refractory myocardial ischemia, the late cardiac survival was 90%, and in those without ischemia, 92% at 5 years, p = not significant. The MI--free survival in the group with refractory ischemia, however, was 56% versus 83% in the group without ischemia, p less than 0.0001. Multivariate analysis showed the highest late event rates for patients with Q-wave myocardial infarction at the initial emergency coronary artery bypass, age older than 65 years, angina class III or IV, and prior coronary bypass surgery. In spite of a continuing high incidence of early acute myocardial infarction and an increasing operative mortality rate (7%) in the latest 3 years cohort of patients, excellent late survival and low subsequent cardiac event

  3. Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery.

    Science.gov (United States)

    Cazelli, José Guilherme; Camargo, Gabriel Cordeiro; Kruczan, Dany David; Weksler, Clara; Felipe, Alexandre Rouge; Gottlieb, Ilan

    2017-10-01

    The prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement. To evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score. Cross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877; 95%CI: 0.830 - 0.923) in different valve populations. Obstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease.

  4. Braun gastrointestinal bypass surgery exerts similar hypoglycemic effects, with minimal operation time and earlier functional recovery, than Roux-en-Y bypass in type 2 diabetic rats.

    Science.gov (United States)

    Sun, Wen; Dai, Xingrong; Li, Jun; Li, Shoumin

    2014-02-01

    Despite the beneficial hypoglycemic and potentially curative effects in type 2 diabetes, large stomach volume deficits caused by Roux-en-Y gastrointestinal bypass (RYGB) surgery increase complications. Hypoglycemic effects of Braun surgery and RYGB surgery, both modified to maximally preserve stomach volume, were compared in rat type 2 diabetes models. Three-month-old, male Goto-Kakizaki (GK) rats (n = 40) were randomly divided into equal groups and not treated (control) or treated with sham surgery (sham group), modified stomach-preserving Braun gastrointestinal bypass (Braun group), or modified RYGB (RYGB group). Pre- and postoperative body weight and water intake were recorded, along with operative and defecation times. Fasting blood glucose at 12 h, and blood glucose 180 min after intragastric glucose administration, were measured at weeks 1, 2, 3, 4, 10, and 11 along with glycosylated hemoglobin (preoperatively, week 11). Statistically similar (P > 0.05) increased body weight and decreased water intake, fasting blood glucose, blood glucose after intragastric glucose administration, and glycosylated hemoglobin were observed in Braun and RYGB groups compared with control and sham groups (P fasting blood glucose from 13.0 ± 4.1 to 6.9 ± 1.4 mmol/L and 12.4 ± 4.4 to 7.3 ± 0.9 mmol/L, respectively (P gastrointestinal bypass surgery was faster and produced hypoglycemic effects similar to RYGB bypass surgery, potentially minimizing metabolic disruption.

  5. Predictors and Frequency of Conduction Disturbances After Open-Heart Surgery

    Directory of Open Access Journals (Sweden)

    Zahra Emkanjoo

    2008-02-01

    Full Text Available Introduction The risk of developing conduction disturbances after coronary bypass grafting (CABG or valvular surgery has been well established in previous studies, leading to permanent pacemaker implantation in about 2% to 3% of patients, and in 10% of patients undergoing repeat cardiac surgery.We sought to determine the incidence, features and predictors of conduction disorders in the immediate post-operative period of patients subjected to open-heart surgery, and the need for permanent pacemaker implantation.Material and Method We prospectively studied 374 consecutive patients who underwent open-heart surgery in our institution: coronary artery bypass (CABG (n=128, Mitral valve replacement(MVR(n=18, aortic valve replacement(AVR (n=21, MVR and AVR(n=56, repair of ventricular septal defect (VSD (n=51, repair of tetralogy of Fallot (TOF (n=57,CABG and valvular surgery (n=6, others (n=37.Results Among 374 patients included in our study (mean age 34.46±25.68; 146 males, 192 developed new conduction disorders: symptomatic sinus bradycardia in 8%, atrial fibrillation with slow ventricular response (AF in 4.5%, first-degree atrioventricular block (AVBin 6.4%, second-degree AVB in 0.3%, third-degree AVB in 7%, new right bundle branch block (RBBB in 33%, and new left bundle branch block (LBBB in 2.1%. In 5.6% patients, a permanent pacemaker was implanted, 47.6% of them underwent valvular surgery. In 44.1% of patients the conduction defects occurred in the first 48 hr. after surgery. In CABG group, 29.7% of patients developed new conduction disturbances; the most common of them was symptomatic sinus bradycardia. After valvular surgery 44.2% of patients developed conduction disturbances, of those the most common was atrial fibrillation with slow ventricular response . After VSD and TOF repair, the most common conduction disturbance was new RBBB. Perioperative myocardial infarction (MI occurred in 1.9% of patients. The occurrence conduction disturbance

  6. Splanchnic organ injury during coronary surgery with or without cardiopulmonary bypass: a randomized, controlled trial.

    Science.gov (United States)

    Ascione, Raimondo; Talpahewa, Sudath; Rajakaruna, Chanaka; Reeves, Barnaby C; Lovell, A Timothy; Cohen, Alan; Angelini, Gianni D

    2006-01-01

    We investigated the efficacy of coronary surgery with or without cardiopulmonary bypass in protecting the function of the small intestine, liver, and pancreas. Patients were randomized to off-pump coronary artery bypass grafting (OPCAB) or coronary artery bypass grafting with cardiopulmonary bypass (CABG-CPB). Small intestine function was assessed by differential four sugars (O = methyl-D-glucose, D-xylose, L-rhamnose, and lactulose) permeability and absorption tests. Liver function was assessed by monoethylglycinexylidide/lidocaine ratios and by serial measurements of transaminases (aspartate transaminase and alanine-amino transferase), bilirubin, and alkaline phosphatase. Pancreatic function was assessed by serial measurements of insulin/glucagon ratio, amylase, and glucose. Forty patients were recruited (20 per group). Permeability and absorption were more impaired in the OPCAB group immediately after surgery, but returned to baseline levels in both groups by postoperative day 5 (interaction of surgery type and time; p = 0.05 and p = 0.02, respectively). Monoethylglycinexylidide/lidocaine ratios were not different in the two groups. Aspartate transaminase and alanine-amino transferase levels were higher in the CABG-CPB group for the first postoperative day, but levels converged by day 3 (interaction of surgery type and time; p < 0.0001 and p = 0.04, respectively). The bilirubin level for the OPCAB group overshot the CABG-CPB group at 36 hours before returning to a similar level 60 hours postoperatively. Amylase levels were higher in the CABG-CPB group than in the OPCAB group (1.17 times; p = 0.03); other markers of pancreatic function showed no differences between the groups. Early small intestine function is worse with OPCAB; all functions recover to similar levels in both groups by day 5. Conversely, pancreatic function is worse with the CABG-CPB group than with the OPCAB group. Hepatic metabolic function does not differ by type of surgery to the end of the

  7. 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.

  8. Wernicke’s encephalopathy following Roux en Y gastric bypass surgery

    Directory of Open Access Journals (Sweden)

    Azra Zafar

    2015-12-01

    Full Text Available Wernicke’s encephalopathy (WE is a serious neurological disorder characterized by a classical triad of acute mental confusion, ataxia, and opthalmoplegia due to thiamine deficiency. It was initially described in chronic alcoholics; however, any condition resulting in poor nutritional status places the patient at risk of WE. Bariatric surgery is now considered as an emergent cause of WE. The number of bariatric surgery is increasing for morbid obesity. We present a case of a 40-year-old male who presented with confusion and difficulty in maintaining the balance while walking 3 months after Roux en Y gastric bypass surgery. Diagnosis of WE was made on clinical ground and confirmed by magnetic resonance imaging of the brain, which showed bilateral hyperintense signals in paramedian thalami. Parenteral thiamine replacemen

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

    Directory of Open Access Journals (Sweden)

    Manouchehr Hekmat

    2016-01-01

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

  10. Psychological characteristics and associations with weight outcomes two years after gastric bypass surgery

    DEFF Research Database (Denmark)

    Beck, Nina Nonboe; Mehlsen, Mimi Yung; Støving, René Klinkby

    2012-01-01

    (EDI-2), Harvard Anxiety and Depression Scale (HADS), and questions related specifically to binge eating. Forty-five patients (8 men, 37 women) out of 65 (67%) responded. Scores were significant higher on impulse regulation, interoceptive awareness, ineffectiveness, maturity fears and interpersonal......This study investigated symptoms of eating disorder, depression, and anxiety among Roux-en-Y gastric bypass patients two years after surgery, and the relationship between these characteristics and weight loss. Respondents completed assessment questionnaires including Eating Disorder Inventory-2...... distrust in comparison with a Danish norm group (p≤0.05). The weight losses obtained after surgery varied from 12 to 60% of the starting weights. Binge eating and ineffectiveness were found to significantly correlate with weight loss variations after surgery (p≤0.05). The results of this study indicate...

  11. Accuracy of CT for Selecting Candidates for Coronary Artery Bypass Graft Surgery: Combination with the SYNTAX Score.

    Science.gov (United States)

    Suh, Young Joo; Hong, Yoo Jin; Lee, Hye-Jeong; Hur, Jin; Kim, Young Jin; Hong, Sae Rom; Kim, Tae Hoon; Seo, Jae Seung; Yoo, Kyung-Jong; Chang, Hyuk-Jae; Choi, Byoung Wook

    2015-08-01

    To investigate the diagnostic performance of coronary computed tomographic (CT) angiography for selecting candidates for coronary artery bypass graft (CABG) surgery according to the 2011 American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) guidelines for CABG surgery and determine the added value of SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) scoring for selecting CABG surgery candidates. Approval was obtained from the Institutional Review Board, and informed consent was waived for this retrospective study. A total of 399 patients (mean age, 63.8 years; 244 men and 155 women) who underwent both coronary CT angiography and invasive coronary angiography were included. Eligible criteria for CABG surgery were established on the basis of the 2011 ACCF/AHA guidelines. from coronary CT angiography and invasive coronary angiography were retrospectively reviewed, and SYNTAX scores were determined. The diagnostic performance of coronary CT angiography for selecting CABG surgery candidates was calculated with invasive coronary angiography as the reference method. The diagnostic performance of coronary CT angiography alone, the CT-based SYNTAX score, and the combined coronary CT angiography with CT-based SYNTAX score were assessed by using a combination of invasive coronary angiography and invasive coronary angiography-based SYNTAX scores as a reference method. Statistical analyses were performed by using the generalized estimating equation, independent t test, Mann-Whitney U test, Wilcoxon signed rank test, Fisher exact test, and χ(2) statistics. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value of coronary CT angiography for selecting CABG surgery candidates were 96.5%, 96.5%, 88.3%, and 99.0%, respectively. When a combination of invasive coronary angiography with an invasive coronary angiography-based SYNTAX score was used as a standard reference, combined coronary CT

  12. Extracranial-Intracranial Bypass Surgery for Stroke Prevention in Hemodynamic Cerebral Ischemia: The Carotid Occlusion Surgery Study: A Randomized Trial

    Science.gov (United States)

    Powers, William J.; Clarke, William R.; Grubb, Robert L.; Videen, Tom O; Adams, Harold P.; Derdeyn, Colin P.

    2013-01-01

    Context Patients with symptomatic atherosclerotic internal carotid artery occlusion (AICAO) and hemodynamic cerebral ischemia are at high risk for subsequent stroke when treated medically. Objective Test the hypothesis that extracranial-intracranial (EC-IC) bypass surgery, added to best medical therapy, reduces subsequent ipsilateral ischemic stroke in patients with recently symptomatic AICAO and hemodynamic cerebral ischemia. Design Parallel group, randomized, open-label, blinded-adjudication clinical treatment trial conducted from 2002–2010. Setting 49 clinical centers and 18 positron emission tomography (PET) centers in the United States and Canada. The majority were academic medical centers. Participants Arteriographically-confirmed AICAO causing hemispheric symptoms within 120 days and hemodynamic cerebral ischemia identified by ipsilateral increased oxygen extraction fraction measured by PET. 195 were randomized: 97 to surgery and 98 to no surgery. Follow-up for the primary endpoint until occurrence, 2 years, or end of trial was 99% complete. No participant withdrew because of adverse events. Interventions Anastomosis of superficial temporal artery branch to a middle cerebral artery cortical branch for the surgical group. Anti-thrombotic therapy and risk factor intervention were recommended for all. Main Outcome Measure For all participants who were assigned to surgery and received surgery, the combination of (1) all stroke and death from surgery through 30 days post surgery and (2) ipsilateral ischemic stroke within 2 years of randomization. For the nonsurgical group and participants assigned to surgery who did not receive surgery was the combination of (1) all stroke and death from randomization to randomization plus 30 days and (2) ipsilateral ischemic stroke within two years of randomization. Results The trial was terminated early for futility. Two-year rates for the primary endpoint were 21.0% (95% CI, 12.8% to 29.2%; 20 events) for the surgical group

  13. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial.

    Science.gov (United States)

    Powers, William J; Clarke, William R; Grubb, Robert L; Videen, Tom O; Adams, Harold P; Derdeyn, Colin P

    2011-11-09

    Patients with symptomatic atherosclerotic internal carotid artery occlusion (AICAO) and hemodynamic cerebral ischemia are at high risk for subsequent stroke when treated medically. To test the hypothesis that extracranial-intracranial (EC-IC) bypass surgery, added to best medical therapy, reduces subsequent ipsilateral ischemic stroke in patients with recently symptomatic AICAO and hemodynamic cerebral ischemia. Parallel-group, randomized, open-label, blinded-adjudication clinical treatment trial conducted from 2002 to 2010. Forty-nine clinical centers and 18 positron emission tomography (PET) centers in the United States and Canada. The majority were academic medical centers. Patients with arteriographically confirmed AICAO causing hemispheric symptoms within 120 days and hemodynamic cerebral ischemia identified by ipsilateral increased oxygen extraction fraction measured by PET. Of 195 patients who were randomized, 97 were randomized to receive surgery and 98 to no surgery. Follow-up for the primary end point until occurrence, 2 years, or termination of trial was 99% complete. No participant withdrew because of adverse events. Anastomosis of superficial temporal artery branch to a middle cerebral artery cortical branch for the surgical group. Antithrombotic therapy and risk factor intervention were recommended for all participants. For all participants who were assigned to surgery and received surgery, the combination of (1) all stroke and death from surgery through 30 days after surgery and (2) ipsilateral ischemic stroke within 2 years of randomization. For the nonsurgical group and participants assigned to surgery who did not receive surgery, the combination of (1) all stroke and death from randomization to randomization plus 30 days and (2) ipsilateral ischemic stroke within 2 years of randomization. The trial was terminated early for futility. Two-year rates for the primary end point were 21.0% (95% CI, 12.8% to 29.2%; 20 events) for the surgical group and

  14. Roux-en-Y gastric bypass surgery is effective in fibroblast growth factor-21 deficient mice.

    Science.gov (United States)

    Morrison, Christopher D; Hao, Zheng; Mumphrey, Michael B; Townsend, R Leigh; Münzberg, Heike; Ye, Jianping; Berthoud, Hans-Rudolf

    2016-10-01

    The mechanisms by which bariatric surgeries so effectively and lastingly reduce body weight and normalize metabolic dysfunction are not well understood. Fibroblast growth fator-21 (FGF21) is a key regulator of metabolism and is currently considered for treatment of obesity. Although elevated by acute food deprivation, it is downregulated after weight loss induced by chronic calorie restriction but not after Roux-en-Y gastric bypass surgery. Therefore, the goal of the present study was to assess the role of FGF21-signaling in the beneficial effects of Roux-en-Y gastric bypass surgery (RYGB). High-fat diet-induced obese FGF21-deficient (FGF21(-/-)) and wildtype (WT) mice were subjected to RYGB, sham surgery, or caloric restriction to match body weight of RYGB mice. Body weight, body composition, food intake, energy expenditure, glucose tolerance, and insulin sensitivity, as well as plasma levels and hepatic mRNA expression of FGF21 were measured. Hepatic expression and plasma levels of FGF21 are higher after RYGB compared with similar weight loss induced by caloric restriction, suggesting that elevated FGF21 might play a role in preventing increased hunger and weight regain after RYGB. However, although the body weight differential between RYGB and sham surgery was significantly reduced in FGF21(-/-) mice, RYGB induced similarly sustained body weight and fat mass loss, initial reduction of food intake, increased energy expenditure, and improvements in glycemic control in FGF21(-/-) and WT mice. FGF21 signaling is not a critical single factor for the beneficial metabolic effects of RYGB. This may open up the possibility to use FGF21 as adjuvant therapy in patients with ineffective bariatric surgeries.

  15. Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Darzi Ara

    2007-06-01

    Full Text Available Abstract The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique.

  16. Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery.

    Science.gov (United States)

    Massey, Rachel M; Warren, Oliver J; Szczeklik, Michal; Wallace, Sophie; Leff, Daniel R; Kokotsakis, John; Darzi, Ara; Athanasiou, Thanos

    2007-06-05

    The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique.

  17. Matrix Metalloproteinase-9 Production following Cardiopulmonary Bypass Was Not Associated with Pulmonary Dysfunction after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Tso-Chou Lin

    2015-01-01

    Full Text Available Background. Cardiopulmonary bypass (CPB causes release of matrix metalloproteinase- (MMP- 9, contributing to pulmonary infiltration and dysfunction. The aims were to investigate MMP-9 production and associated perioperative variables and oxygenation following CPB. Methods. Thirty patients undergoing elective cardiac surgery were included. Arterial blood was sampled at 6 sequential points (before anesthesia induction, before CPB and at 2, 4, 6, and 24 h after beginning CPB for plasma MMP-9 concentrations by ELISA. The perioperative laboratory data and variables, including bypass time, PaO2/FiO2, and extubation time, were also recorded. Results. The plasma MMP-9 concentrations significantly elevated at 2–6 h after beginning CPB (P<0.001 and returned to the preanesthesia level at 24 h (P=0.23, with predominant neutrophil counts after surgery (P<0.001. The plasma MMP-9 levels at 4 and 6 h were not correlated with prolonged CPB time and displayed no association with postoperative PaO2/FiO2, regardless of reduced ratio from preoperative 342.9±81.2 to postoperative 207.3±121.3 mmHg (P<0.001. Conclusion. Elective cardiac surgery with CPB induced short-term elevation of plasma MMP-9 concentrations within 24 hours, however, without significant correlation with CPB time and postoperative pulmonary dysfunction, despite predominantly increased neutrophils and reduced oxygenation.

  18. Open-heart surgery using a centrifugal pump: a case of hereditary spherocytosis.

    Science.gov (United States)

    Matsuzaki, Yuichi; Tomioka, Hideyuki; Saso, Masaki; Azuma, Takashi; Saito, Satoshi; Aomi, Shigeyuki; Yamazaki, Kenji

    2016-08-26

    Hereditary spherocytosis is a genetic, frequently familial hemolytic blood disease characterized by varying degrees of hemolytic anemia, splenomegaly, and jaundice. There are few reports on adult open-heart surgery for patients with hereditary spherocytosis. We report a rare case of an adult open-heart surgery associated with hereditary spherocytosis. A 63-year-old man was admitted for congestive heart failure due to bicuspid aortic valve, aortic valve regurgitation, and sinus of subaortic aneurysm. The family history, the microscopic findings of the blood smear, and the characteristic osmotic fragility confirmed the diagnosis of hereditary spherocytosis. Furthermore, splenectomy had not been undertaken preoperatively. The patient underwent a successful operation by means of a centrifugal pump. Haptoglobin was used during the cardiopulmonary bypass, and a biological valve was selected to prevent hemolysis. No significant hemolysis occurred intraoperatively or postoperatively. There are no previous reports of patients with hereditary spherocytosis, and bicuspid aortic valve. We have successfully performed an adult open-heart surgery using a centrifugal pump in an adult patient suffering from hereditary spherocytosis and bicuspid aortic valve.

  19. Prognosis and Complications of Diabetic Patients Undergoing Isolated Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Karen Alcantara Queiroz Santos

    2016-02-01

    Full Text Available Abstract Objective: Compare the prognosis and complications of diabetic and non-diabetic patients undergoing isolated coronary artery bypass surgery at a hospital with a high surgical volume. Methods: Data of patients who underwent coronary artery bypass surgery from June 2009 to July 2010 were analyzed. We selected diabetic and non-diabetic patients and evaluated their postoperative and long-term prognosis based on clinical complications. To reduce the disparity within the sample, statistical analyses were performed using propensity scores. Results: We included 2,688 patients who underwent coronary artery bypass surgery; 36% of them had diabetes, their mean age was 62.1±9.49 years and 70% (1,884 of them were men. Patients with diabetes were older (63±9 years vs. 61±10 years; P25 kg/m2: 70.7% vs.64.5%; P<0.001, dyslipidemic (50.4%vs. 41.1%; P<0.001, hypertensive (89.2% vs. 78.7%; P<0.001, and presented chronic renal failure (8.3% vs. 3.8%;P<0.001. They also presented higher rates of acute renal failure (5.6% vs. 2.7%, P<0.001, infection (11.4% vs. 7.2%, P<0.001 and mortality after one year (9.1% vs. 5.6%,P<0.001. Pneumonia was more common among patients with diabetes (7.7% vs. 4.0%, P<0.001. According to propensity scoring, 430 patients (215 diabetics and 215 non-diabetics had a mean age of 61.3±8.97 years, and 21.2% (91 of 430 were women. However, diabetes was not an independent factor for poor prognosis. Conclusion: Patients with diabetes were at higher risk for postoperative complications and mortality after undergoing coronary artery bypass surgery. However, diabetes did not explain the poor prognosis of these patients after pairing this factor with the propensity score.

  20. Radiologic evaluation following Roux-en-Y gastric bypass surgery for morbid obesity

    International Nuclear Information System (INIS)

    Carucci, Laura R.; Turner, Mary Ann

    2005-01-01

    Morbid obesity is an increasing health problem, and bariatric surgery is becoming a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical postoperative findings of the Roux-en-Y gastric bypass (RYGBP) procedure for morbid obesity on upper gastrointestinal (UGI) series are presented. An overview of the potential complications that may be diagnosed with contrast studies and computed tomography (CT) is provided in addition to a description of potential pitfalls in interpreting these studies

  1. Radiologic evaluation following Roux-en-Y gastric bypass surgery for morbid obesity

    Energy Technology Data Exchange (ETDEWEB)

    Carucci, Laura R. [Department of Radiology, Virginia Commonwealth University Medical Center, P.O. Box 980615, Richmond, VA 23298-0615 (United States)]. E-mail: lcarucci@vcu.edu; Turner, Mary Ann [Department of Radiology, Virginia Commonwealth University Medical Center, P.O. Box 980615, Richmond, VA 23298-0615 (United States)

    2005-03-01

    Morbid obesity is an increasing health problem, and bariatric surgery is becoming a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical postoperative findings of the Roux-en-Y gastric bypass (RYGBP) procedure for morbid obesity on upper gastrointestinal (UGI) series are presented. An overview of the potential complications that may be diagnosed with contrast studies and computed tomography (CT) is provided in addition to a description of potential pitfalls in interpreting these studies.

  2. Thrombelastographic hypercoagulability and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial)

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Johansson, Pär I; Kofoed, Klaus F

    2017-01-01

    , and death compared to aspirin monotherapy in hypercoagulable patients undergoing coronary artery bypass surgery. A total of 1683 patients were screened for eligibility, among which 165 patients were randomized and 133 patients underwent multislice computed tomography scan to evaluate their grafts...... trial to test the hypothesis of intensified antiplatelet therapy in hypercoagulable patients. Due to the low enrollment and high loss to follow up, our results can only be viewed as hypothesis generating. We found a high rate of graft occlusions in this patient population. Our results were...

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

    Directory of Open Access Journals (Sweden)

    Bougioukas Ioannis

    2010-08-01

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

  4. Effect of inhalation aromatherapy with lavender essential oil on stress and vital signs in patients undergoing coronary artery bypass surgery: A single-blinded randomized clinical trial.

    Science.gov (United States)

    Bikmoradi, Ali; Seifi, Zahra; Poorolajal, Jalal; Araghchian, Malihe; Safiaryan, Reza; Oshvandi, Khodayar

    2015-06-01

    At present, aromatherapy is used widely in medical research. This study aimed to investigate the effects of inhalation aromatherapy using lavender essential oil to reduce mental stress and improve the vital signs of patients after coronary artery bypass surgery (CABG). A single-blinded randomized controlled trial was conducted with 60 patients who had undergone CABG in a 2-day intervention that targeted stress reduction. Sixty subjects following coronary artery bypass surgery in two aromatherapy and control groups. The study was conducted in Ekbatan Therapeutic and Educational Center, Hamadan, Iran, in 2013. On the second and third days after surgery, the aromatherapy group patients received two drops of 2% lavender essential oil for 20min and the control group received two drops of distilled water as a placebo. The primary outcome was mental stress, which was measured before and after the intervention using the DASS-21 questionnaire. The secondary outcomes were vital signs, including the heart rate, respiratory rate, and systolic and diastolic blood pressure, which were measured before and after the intervention. The individual characteristics of the aromatherapy and control groups were the same. There were no significant difference in the mean mental stress scores and vital signs of the aromatherapy and control groups on the second or third days after surgery. Inhalation aromatherapy with lavender essential oil had no significant effects on mental stress and vital signs in patients following CABG, except the systolic blood pressure. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Effect of Roux-en-Y gastric bypass surgery on ventricular function and cardiac risk factors in obese patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Alireza Abdollahi Moghaddam

    2016-03-01

    Full Text Available Introduction: Weight gain and obesity are two important public health problems, which are associated with many diseases such as cardiovascular disorders. Various policies such as bariatric surgery have been proposed for the treatment of morbid obesity. Methods: PubMed and Scopus were searched thoroughly with the following search terms (roux-en-y gastric bypass surgery AND (ventricular function, OR cardiac risk factors OR heart AND (BMI OR body mass index to find the articles in which the effect of roux-en-Y gastric bypass (RYGB surgery had been evaluated in severely obese patients.Result: Out of 120 articles which were found in PubMed, and 28 records which were found in Scopus, only 18 articles fully met the inclusion criteria. Out of 2740 participants in the included studied, 1706 were patients with body mass index (BMI over 40 kg/m2 who had undergone RYGB surgery, and 1034 were control participants. Results of the studies showed that RYGB surgery could reduce BMI, and cardiac risk factors, and improve diastolic function, systolic and diastolic blood pressures, and aortic function, postoperatively.Discussion: Obesity is associated with increased risk of cardiovascular diseases, impaired cardiac function, and hypertension. It is shown that RYGB surgery reduces the serum level of biochemical markers of cardiac diseases. Cardiac structure, parasympathetic indices of autonomic function, coronary circulatory function, hypertension, epicardial fat thickness, and ventricular performance improve after bariatric surgery.Conclusions: It is concluded that RYGB surgery is an effective strategy to improve ventricular function and cardiac risk factors in morbid obese patients.

  6. Eating in mice with gastric bypass surgery causes exaggerated activation of brainstem anorexia circuit.

    Science.gov (United States)

    Mumphrey, M B; Hao, Z; Townsend, R L; Patterson, L M; Münzberg, H; Morrison, C D; Ye, J; Berthoud, H-R

    2016-06-01

    Obesity and metabolic diseases are at an alarming level globally and increasingly affect children and adolescents. Gastric bypass and other bariatric surgeries have proven remarkably successful and are increasingly performed worldwide. Reduced desire to eat and changes in eating behavior and food choice account for most of the initial weight loss and diabetes remission after surgery, but the underlying mechanisms of altered gut-brain communication are unknown. To explore the potential involvement of a powerful brainstem anorexia pathway centered around the lateral parabrachial nucleus (lPBN), we measured meal-induced neuronal activation by means of c-Fos immunohistochemistry in a new high-fat diet-induced obese mouse model of Roux-en-Y gastric bypass (RYGB) at 10 and 40 days after RYGB or sham surgery. Voluntary ingestion of a meal 10 days after RYGB, but not after sham surgery, strongly and selectively activates calcitonin gene-related peptide neurons in the external lPBN as well as neurons in the nucleus tractus solitarius, area postrema and medial amygdala. At 40 days after surgery, meal-induced activation in all these areas was greatly diminished and did not reach statistical significance. The neural activation pattern and dynamics suggest a role of the brainstem anorexia pathway in the early effects of RYGB on meal size and food intake that may lead to adaptive neural and behavioral changes involved in the control of food intake and body weight at a lower level. However, selective inhibition of this pathway will be required for a more causal implication.

  7. Eating in mice with gastric bypass surgery causes exaggerated activation of brainstem anorexia circuit

    Science.gov (United States)

    Mumphrey, Michael B.; Hao, Zheng; Townsend, R. Leigh; Patterson, Laurel M.; Münzberg, Heike; Morrison, Christopher C.; Ye, Jianping; Berthoud, Hans-Rudolf

    2016-01-01

    Background/Objective Obesity and metabolic diseases are at an alarming level globally and increasingly affect children and adolescents. Gastric bypass and other bariatric surgeries have proven remarkably successful and are increasingly performed worldwide. Reduced desire to eat and changes in eating behavior and food choice account for most of the initial weight loss and diabetes remission after surgery, but the underlying mechanisms of altered gut-brain communication are unknown. Subjects/Methods To explore the potential involvement of a powerful brainstem anorexia pathway centered around the lateral parabrachial nucleus (lPBN) we measured meal-induced neuronal activation by means of c-Fos immunohistochemistry in a new high-fat diet-induced obese mouse model of Roux-en-Y gastric bypass (RYGB) at 10 and 40 days after RYGB or sham surgery. Results Voluntary ingestion of a meal 10 days after RYGB, but not after sham surgery, strongly and selectively activates calcitonin gene-related peptide neurons in the external lPBN as well as neurons in the nucleus tractus solitaries, area postrema, and medial amygdala. At 40 days after surgery, meal-induced activation in all these areas was greatly diminished and did not reach statistical significance. Conclusions The neural activation pattern and dynamics suggest a role of the brainstem anorexia pathway in the early effects of RYGB on meal size and food intake that may lead to adaptive neural and behavioral changes involved in the control of food intake and body weight at a lower level. However, selective inhibition of this pathway will be required for a more causal implication. PMID:26984418

  8. SURGICAL CORRECTION OF HEART VALVE DISEASE WITH CARDIOPULMONARY BYPASS IN PATIENTS AFTER RENAL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    D. A. Belokurov

    2013-01-01

    Full Text Available Aim. Evaluation of the possibility heart valve replacement in renal transplant recipients from a position of safe- ty for graft function. Materials and methods. 5 patients, heart valve replacement was performed with a func- tioning kidney transplant at a satisfactory its function. The average age of patients at the time of cardiac surgery was 38,8 ± 12,6 years, among whom were two (40% men and 3 (60% women. The interval between renal transplantation and heart surgery was 40,3 ± 44,1 (2 to 120 months. Prior to kidney transplantation, all patients were on renal replacement therapy with hemodialysis program for 50,2 ± 48,6 months. In 4 of the 5 patients of heart disease was the cause of infective endocarditis. Results. Average time IR was 81,2 ± 21,7 minutes , the average time of aortic clamping 63,6 ± 20,9 minutes and hypothermia during CPB 29,2 ± 3,2 °C. All patients were implanted with double-leaf mechanical prostheses "MedEng-2" and "SarboMedics". All 5 patients in sa- tisfactory condition were discharged from the hospital. The average duration of the postoperative period was 14,2 ± 3,4 days. All patients had relatively smooth flow after surgery, no infectious complications, a satisfactory renal transplant function and prosthetic heart valves. In the late period in four patients and transplant graft func- tion is satisfactory in terms of the observation of 5 years, 3 years and 6 months after surgery. Conclusion. Our experience shows the possibility of successful correction of heart defects in IR in renal transplant recipients. 

  9. Gastric bypass surgery reveals independency of obesity and diabetes melitus type 2.

    Science.gov (United States)

    Fenger, Mogens; Hansen, Dorte Lindqvist; Worm, Dorte; Hvolris, Lisbeth; Kristiansen, Viggo B; Carlsson, Elin Rebecka; Madsbad, Sten

    2016-11-09

    Roux-en-Y gastric bypass surgery is widely applied to ameliorate morbid obesity, including diabetes in people with type 2 diabetes. The latter vanish a few days after surgery for many, but not in all patients before any weight reduction has occurred. The explanation for this change in metabolic status is poorly understood, but the observation may suggest that the fate obesity and diabetes is only partly linked after surgery. The trajectories of weight reduction measured as reduced body mass index (BMI) in 741obese subjects with and without diabetes were evaluated. Evaluation was performed on three groups: 1) subjects that were non-diabetic before and after surgery; 2) subjects that were diabetics before surgery but non-diabetics after surgery; and 3) subjects that were diabetics before surgery and remained diabetics after surgery. The diabetic state was established at HbA1c above 48 mmol/mol. The trajectories differ significantly between groups and any sub-populations of groups, the latter identified by the distance between individual trajectories using a k-means procedure. The results suggest that different domains in the enormous genetic network governing basic metabolism are perturbed in obesity and diabetes, and in fact some of the patients are affected by two distinct diseases: obesity and diabetes mellitus type 2. Although RYGB "normalized" many glycaemic parameters in some of the diabetic subjects apparently converting to a non-diabetics state, other diabetic subjects stay diabetic in the context of the new gut anatomy after surgery. Thus, the obesity part of the glycaemic derangement may have been ameliorated, but some defects of the diabetic state had not.

  10. Predictors of psychological symptoms in morbidly obese patients after gastric bypass surgery.

    Science.gov (United States)

    Ortega, Joaquin; Fernandez-Canet, Regina; Alvarez-Valdeita, Sagrario; Cassinello, Norberto; Baguena-Puigcerver, Maria Jose

    2012-01-01

    Morbid obesity is associated with debilitating psychosocial consequences, such as depression, anxiety, and low self-esteem. One of the main goals of bariatric surgery should not only be reducing weight and counteracting co-morbid conditions, but also improving postoperative psychosocial functioning. The objective of our study was to determine the preoperative variables that could predict the psychological symptoms 6 and 12 months after surgery to improve the clinical outcome of morbidly obese patients undergoing bariatric surgery. The setting was a university hospital in Spain. The study group consisted of 60 morbidly obese patients (46 women and 14 men) who had undergone gastric bypass surgery for weight reduction and had ≥ 1 year of follow-up. The patients were evaluated using different questionnaires (Symptom Checklist-90-Revised, Body Shape Questionnaire, Rosenberg Self-Esteem Questionnaire, COPE, Medical Outcomes Study Social Support Survey) at 3 points: before surgery, at 6 months postoperatively, and at 1 year postoperatively. To determine the influence of preoperative variables on long-term psychological status, a step-by-step multivariate linear regression analysis was performed, taking P self-esteem, instrumental support, and coping focused in the emotions were the main preoperative predictors for psychological symptoms 6 months after surgery. Preoperative drug abuse as a strategy of problem solving and mainly body image significantly predicted most of the psychological disorders 1 year after surgery. The study of different psychosocial variables in patients before bariatric surgery is an important aid to predict postoperative psychological functioning. Self-esteem and body image were the most influential factors in the postoperative psychological outcome of morbidly obese patients in our study. Copyright © 2012 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  11. 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.

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

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    João Manoel Rossi Neto

    2013-12-01

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

  13. The role of dumping syndrome in weight loss after gastric bypass surgery.

    Science.gov (United States)

    Banerjee, Ambar; Ding, Yi; Mikami, Dean J; Needleman, Bradley J

    2013-05-01

    Roux-en-Y gastric bypass is the most commonly performed operation for the treatment of morbid obesity in the US. Dumping syndrome is an expected and desired part of the behavior modification caused by gastric bypass surgery; it can deter patients from consuming energy-dense food. In this study we assessed the role dumping has in weight loss and its relationship with the patient's eating behavior. Fifty patients who underwent gastric bypass between January 2008 and June 2008 were enrolled. Two questionnaires, the dumping syndrome questionnaire and the Three-Factor Eating Questionnaire (TFEQ), were used to record the patients' responses. The diagnosis of dumping syndrome was based on the Sigstad scoring system, where a score of 7 and above was considered positive. TFEQ evaluated the patients' eating behavior under three scales: cognitive restraint, uncontrolled eating, and emotional eating. The results were analyzed with descriptive and parametric statistics where applicable. The prevalence of dumping syndrome was 42 %, with 66.7 % of the subjects being women. The nondumpers were observed to have a greater mean decrease in body mass index than the dumpers at 1 and 2 years (18.5 and 17.8 vs. 14.4 and 13.7 respectively). There was no definite relationship between the presence of dumping syndrome and the eating behavior of the patient. However, the cognitive restraint scores, greater than 80 %, were associated with an average decrease in BMI of 19 and 20.8 at 1 and 2 years compared with 14.6 and 12.4 in those with scores less than 80 % (p = 0.01 and p = 0.03, respectively). The presence of dumping syndrome after gastric bypass does not influence weight loss, though eating behaviors may directly influence it.

  14. Survival of cardiorespiratory arrest after coronary artery bypass grafting or aortic valve surgery.

    Science.gov (United States)

    Ngaage, Dumbor L; Cowen, Michael E

    2009-07-01

    Study objectives were to (1) report the clinical profile of and outcome for patients who experience a cardiorespiratory arrest after coronary artery bypass grafting or aortic valve replacement, and (2) identify factors associated with improved probability of survival. We identified 108 consecutive patients who had cardiorespiratory arrest after coronary artery bypass grafting or aortic valve replacement between April 1999 and June 2008. We studied the characteristics of arrests and survivors, and performed a multivariate logistic analysis to determine features associated with survival to hospital discharge. Cardiac arrest (n = 86) was more common than respiratory arrest (n = 13; unknown cause, n = 9). Cardiorespiratory arrest occurred with decreasing frequency from the day of surgery. Ventricular fibrillation or tachycardia was the dominant mechanism of cardiac arrest (70% versus 17% for asystole versus 13% for pulseless electrical activity), and the principal causes were postoperative myocardial infarction (n = 46; 53%) and tamponade or bleeding (n = 21; 24%). Resternotomy was performed in 45 patients (52%), cardiopulmonary bypass reinstituted in 14 (16%), and additional grafts constructed in 5 (6%). The causes of respiratory arrest were mainly pulmonary (n = 8) and neurologic (n = 5). Survival to hospital discharge was better for respiratory arrest (69%) than for cardiac arrest (50%). Older age, ejection fraction less than 0.30, and postoperative myocardial infarction decreased the probability of survival. Ventricular fibrillation or tachycardia was the most common mechanism, and myocardial infarction, the predominant precipitating cause of cardiac arrest after coronary artery bypass grafting or aortic valve replacement. Despite aggressive resuscitation, outcome is poor. Young patients with good left ventricular function had a better probability of survival if they did not suffer a postoperative myocardial infarction.

  15. Normothermic Versus Hypothermic Heart Surgery: Evaluation of Post-Operative Complications

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    H Akhlagh

    2012-04-01

    Full Text Available Introduction: The recently introduced technique of warm heart surgery may be a very effective method of myocardial protection. Although the systemic effects of hypothermic cardiopulmonary bypass are well known, the effects of warm heart surgery are not. Methods: In a prospective trial, 60 patients undergoing an elective coronary artery bypass grafting were randomly allocated to normothermic(30 patients and hypothermic(30 patients group and assessments regarding renal, respiratory and neurologic complications and bleeding volume was done. Resulst: Eighty percent of hypothermic group and 86% of normothermic group were males (p=0/36. Mean age was 56.4 and 56.1 years in hypothermic and normothermic groups, respectively. Groups had similar central temperature, shivering, nipride usage, intake and output, bleeding volume, neurologic complications and ICU staying(p>0/05 but inotrop usage and incidence of phrenic nerve palsy were higher in hypothermic group(p<0/05. Conclusion: Hypothermic procedure leads to a lower rate of respiratory complications, therefore we recommend replacing hypothermic procedure by normothermic one.

  16. The impact of gastric bypass surgery on sex hormones and menstrual cycles in premenopausal women

    DEFF Research Database (Denmark)

    Kjær, Mette Mandrup; Madsbad, Sten; Hougaard, David M.

    2017-01-01

    postoperative months. SHBG increased progressively and was doubled after 12 months. In contrast, total and free androgens and DHEA declined about 50% during the first three postoperative months and remained fairly constant hereafter. One year after surgery, 85% (11/13) of the women with oligo-/amenorrhea gained...... regular menstrual cycles. Our results indicate that some of the endocrine changes related to regulation of ovarian function occur very early after bariatric surgery.......Obesity has adverse effects on ovulation, menstrual cyclicity and oocyte development leading to clinical symptoms such as infertility and menstrual disorders. The Roux-en-Y gastric bypass (RYGB) leads to weight loss, improved insulin sensitivity and may improve ovarian function. In 31 premenopausal...

  17. Bilateral tension pneumothoraces leading to cardiac arrest after coronary artery bypass surgery.

    Science.gov (United States)

    Alozie, Anthony; Westphal, Bernd; Yerebakan, Can; Steinhoff, Gustav

    2012-12-01

    Bilateral pneumothoraces are a very rare event. In clinical settings, inadvertent incursion into the pleural space resulting from diagnostic or therapeutic medical interventions such as bilateral venipunctures or damage to the lung parenchyma due to high pressure ventilation may be causative. Bilateral pneumothoraces postcardiac surgery are rarely reported. We present the case of bilateral tension pneumothoraces leading up to cardiorespiratory arrest in a 57-year-old male, weighing 130 kg, who underwent without any complications a coronary artery bypass surgery. Thoracic chest tubes (retrosternal and intrapericardial) and a left pleural tube were removed 24 hours prior to the incident. Diffuse sternal pain sensation accompanied by slow progressive respiratory distress and confusion shortly before the incident were all developed over a period of 12 hours. A prompt cardiopulmonary resuscitation and bilateral chest tube insertion had prevented a fatality in the patient. Georg Thieme Verlag KG Stuttgart · New York.

  18. Supervised Physical Training Improves Weight Loss After Roux-en-Y Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Mundbjerg, Lene Hymøller; Stolberg, Charlotte Røn; Cecere, Stefano

    2018-01-01

    the effects of 6 months of supervised physical training following Roux-en-Y gastric bypass surgery (RYGB) on body weight and cardiovascular risk markers. Methods: Sixty participants eligible for RYGB were included. Six months post surgery, the participants were randomly assigned to either twice......, and an abdominal computed tomography scan. Results: RYGB significantly reduced body weight and improved cardiovascular risk markers (all Ptraining intervention resulted in a 4.2-kg (CI: -0.2 to -8.3 kg) lower body weight in INT compared with CON at the study end (P=0.042). The high......-density lipoprotein concentration was significantly higher in INT than in CON at the termination of the intervention, but this was not maintained at the 24-months examination. Conclusions: Physical training following RYGB improves weight loss and cardiovascular health....

  19. The IGF-Axis and Diabetic Retinopathy Before and After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Brynskov, Troels; Laugesen, Caroline Schmidt; Floyd, Andrea Karen

    2017-01-01

    BACKGROUND: Laparoscopic gastric bypass (LGB) abruptly causes remission of type 2 diabetes (T2D). Such dramatic metabolic changes have previously been found to cause worsening of diabetic retinopathy (DR) and circulating insulin-like growth factor I (IGF-I) has been suggested as a causal mediator...... 3 months after bariatric surgery. IGFBP-1 increased while IGFBP-3 and total IGF-II decreased postoperatively, but these changes were unassociated with the development of DR. Markers of the metabolic syndrome improved....... at the two postoperative visits (p ≤ 0.001). Total IGF-I showed no significant changes. HbA1c, glucose, HOMA-IR and lipids improved after surgery. Two patients did not complete the 12-month visit. CONCLUSIONS: In obese T2D patients, bioactive IGF is a potential biomarker for DR and levels tended to increase...

  20. Development of significant disordered eating in an adolescent following gastric bypass surgery.

    Science.gov (United States)

    Sondike, Stephen B; Pisetsky, Emily M; Luzier, Jessica L

    2016-03-01

    The development of eating pathology is a concern following bariatric surgery, even in the absence of any pre-surgical psychopathology. No consistent risk factors have emerged in the literature to identify those at greatest risk. However, post-surgical guidelines encourage eating behaviors that would be considered disordered in other contexts. We present a case of an adolescent developing bulimia nervosa following gastric bypass surgery and the escalation of her symptoms from diligently following recommended food behaviors to a full-syndrome clinical eating disorder. We discuss the differences between appropriate post-surgical eating behaviors and disordered eating behaviors. We provide recommendations for clinicians to screen for eating pathology and referrals to an interprofessional treatment team to address eating disordered behaviors and cognitions.

  1. Enhanced insulin signaling in human skeletal muscle and adipose tissue following gastric bypass surgery

    DEFF Research Database (Denmark)

    Albers, Peter Hjorth; Bojsen-Moller, Kirstine N; Dirksen, Carsten

    2015-01-01

    Roux-en-Y gastric bypass (RYGB) leads to increased peripheral insulin sensitivity. The aim of this study was to investigate the effect of RYGB on expression and regulation of proteins involved in regulation of peripheral glucose metabolism. Skeletal muscle and adipose tissue biopsies from glucose......-surgery when major weight loss was evident and occurred concomitantly with alterations in plasma adiponectin and in protein expression/signaling in peripheral tissues. In skeletal muscle, protein expression of GLUT4, phosphorylated levels of TBC1D4 as well as insulin-induced changes in phosphorylation of Akt...... and glycogen synthase activity were enhanced 12 months post-surgery. In adipose tissue, protein expression of GLUT4, Akt2, TBC1D4 and acetyl-CoA carboxylase (ACC), phosphorylated levels of AMP-activated protein kinase and ACC as well as insulin-induced changes in phosphorylation of Akt and TBC1D4 were enhanced...

  2. Patient profiling for success after weight loss surgery (GO Bypass study)

    DEFF Research Database (Denmark)

    Christensen, Bodil Just; Schmidt, Julie Berg; Nielsen, Mette Søndergaard

    2018-01-01

    -load, depression, eating disorders, ADHD, personality disorder, impulsivity, emotion regulation, attachment pattern, general self-efficacy, alexithymia, internalization of weight bias, addiction, quality of life and trauma; and sociological and anthropological measures: sociodemographic measures, eating behavior......Despite substantial research efforts, the mechanisms proposed to explain weight loss after gastric bypass (RYGB) and sleeve gastrectomy (SL) do not explain the large individual variation seen after these treatments. A complex set of factors are involved in the onset and development of obesity...... women and 8 men, aged 25–56 years old, with a BMI of 45.8 ± 7.1 kg/m2 from the waiting list for RYGB and SL at Køge hospital, Denmark. Pre-surgery and 1.5, 6 and 18 months after surgery we assessed various endpoints spanning multiple domains. Endpoints were selected on basis of previous studies...

  3. 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

  4. 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....

  5. Esophagus-duodenum Gastric Bypass Surgery Improves Glucose and Lipid Metabolism in Mice.

    Science.gov (United States)

    He, Rui; Yin, Yue; Li, Yin; Li, Ziru; Zhao, Jing; Zhang, Weizhen

    2018-02-01

    Despite of its significant therapeutic effects on obesity and metabolic diseases, Roux-en-Y gastric bypass (RYGB) has limited clinical application because of considerable impacts on the gastrointestinal structure and postoperative complications. This study aims to develop a simplified surgical approach with less damage and complication but efficient metabolic benefit. The effects of Esophagus-Duodenum gastric bypass (EDGB) on body weight, food intake, glucose and lipid metabolism were compared to RYGB in mice. EDGB is simple, has higher survival rate and less complication. Relative to RYGB, EDGB demonstrated modest body weight control, identical improvement of glucose and lipid metabolism in obese mice. Blood glucose increased significantly 15 and 30min after oral glucose administration, then markedly decreased in both EDGB and RYGB groups relative to the sham surgery, indicating a quicker absorption of oral glucose and improvement in glucose uptake by insulin targeted tissues. Insulin sensitivity was identically improved. EDGB significantly decreased plasma and hepatic triglyceride levels, while increased browning in visceral and subcutaneous white adipose tissue to the extent identical to RYGB. Levels of ghrelin and nesfatin-1 increased significantly after EDGB and RYGB. EDGB is a valuable model to study the metabolic benefit of bariatric surgery in mice. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  6. Effect of opium use on short-term outcome in patients undergoing coronary artery bypass surgery.

    Science.gov (United States)

    Safaii, Nasser; Kazemi, Babak

    2010-02-01

    Data regarding the effect of opium use on short-term outcome in patients undergoing coronary artery bypass surgery are limited. We sought to assess the morbidity and in-hospital mortality of current and past users compared the data with those from nonusers of opium after coronary artery bypass grafting (CABG). This is a descriptive analytical review of prospectively collected data on 782 consecutive male patients who underwent isolated CABG between January 2005 and December 2007. Of these, 708 (90.5%) were nonusers, 56 (7.1%) were current users, and 18 (2.3%) were former opium users of more than 4 weeks. The effect of opium usage on clinical, admission, and outcome variables were analyzed. Current opium users were younger (P = 0.004) and more likely to be cigarette smokers (P = 0.0004). Other demographic characteristics, major coronary risk factors, rates of postoperative complications, intensive care unit readmission, postoperative length of stay, and in-hospital mortality did not differ among the three groups. Current opium users needed less analgesic postoperatively (P = 0.0001), were significantly less compliant with medical and dietary recommendations after discharge (P opium (P opium is a significant predictor of rehospitalization with a cardiac cause within 6 months of CABG surgery. This may be partly due to the low compliance of these patients with treatment recommendations.

  7. A patient with profound weight loss after gastric bypass surgery: A case report

    Directory of Open Access Journals (Sweden)

    Michael T Flannery

    2013-09-01

    Full Text Available Introduction: A case of profound weight loss after gastric bypass surgery with multiple negative evaluations. Case presentation: A 41-year-old African-American female presented with greater-than-expected weight loss after gastric bypass and increasing abdominal pain over a 2-year period. An extensive workup was pursued for the patient with blood analysis, tumor markers, imaging studies both computed tomography and magnetic resonance imaging, arterial studies, and endoscopy from above and below, all of which demonstrated normal results. The patient was followed up without improvement, and repeated studies were also normal. The patient was labeled with a nonorganic etiology for her symptoms, which led to a psychiatry referral which was refused. Conclusion: The patient’s surgeon, who already had removed a normal appendix and gallbladder, repeated a laparoscopic exam. The exam was normal except for a small focus of pancreatic cancer in the celiac plexus. The patient died from perioperative sepsis from peritonitis 2 days after surgery. The case is discussed and findings reviewed.

  8. Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, R.R.; Sawada, A.Y.; Fukuda, M.J.; Neves, F.H.; Carmona, M.J.; Auler, J.O.; Malbouisson, L.M.S., E-mail: malbouisson@hcnet.usp.b [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Hospital das Clinicas; Pelosi, P. [Universita' degli Studi dell' Insubria, Varese (Italy). Dipt. Ambiente, Salute e Sicurezza; Rouby, J.-J. [University Pierre and Marie Curie, Paris (France). La Pitie Salpetriere Hospital. Dept. of Anesthesiology and Critical Care and Medicine

    2011-06-15

    Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated postoperative pulmonary alterations and their impact on blood oxygenation. Eighteen non-hypoxemic patients (15 men and 3 women) with normal cardiac function scheduled for CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at admission to the intensive care unit, and 12, 24, and 48 h after surgery. Pre- and postoperative volumetric thoracic CT scans were acquired under apnea conditions after a spontaneous expiration. Data were analyzed by the paired Student t-test and one-way repeated measures analysis of variance. Mean age was 63 {+-} 9 years. The PaO{sub 2}/FiO{sub 2} ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially improving 12 h after surgery. Compared to preoperative CT, there was a 31% postoperative reduction in pulmonary gas volume (P < 0.001) while tissue volume increased by 19% (P < 0.001). Non-aerated lung increased by 253 {+-} 97 g (P < 0.001), from 3 to 27%, after surgery and poorly aerated lung by 72 {+-} 68 g (P < 0.001), from 24 to 27%, while normally aerated lung was reduced by 147 {+-} 119 g (P < 0.001), from 72 to 46%. No correlations (Pearson) were observed between PaO{sub 2}/FiO{sub 2} ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. The data show that lung structure is profoundly modified after CABG with CPB. Taken together, multiple changes occurring in the lungs contribute to postoperative hypoxemia rather than atelectasis alone. (author)

  9. Tier 3 multidisciplinary medical weight management improves outcome of Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Patel, P; Hartland, A; Hollis, A; Ali, R; Elshaw, A; Jain, S; Khan, A; Mirza, S

    2015-04-01

    In 2013 the Department of Health specified eligibility for bariatric surgery funded by the National Health Service. This included a mandatory specification that patients first complete a Tier 3 medical weight management programme. The clinical effectiveness of this recommendation has not been evaluated previously. Our bariatric centre has provided a Tier 3 programme six months prior to bariatric surgery since 2009. The aim of our retrospective study was to compare weight loss in two cohorts: Roux-en-Y gastric bypass only (RYGB only cohort) versus Tier 3 weight management followed by RYGB (Tier 3 cohort). A total of 110 patients were selected for the study: 66 in the RYGB only cohort and 44 in the Tier 3 cohort. Patients in both cohorts were matched for age, sex, preoperative body mass index and pre-existing co-morbidities. The principal variable was therefore whether they undertook the weight management programme prior to RYGB. Patients from both cohorts were followed up at 6 and 12 months to assess weight loss. The mean weight loss at 6 months for the Tier 3 cohort was 31% (range: 18-69%, standard deviation [SD]: 0.10 percentage points) compared with 23% (range: 4-93%, SD: 0.12 percentage points) for the RYGB only cohort (p=0.0002). The mean weight loss at 12 months for the Tier 3 cohort was 34% (range: 17-51%, SD: 0.09 percentage points) compared with 27% (range: 14-48%, SD: 0.87 percentage points) in the RYGB only cohort (p=0.0037). Our study revealed that in our matched cohorts, patients receiving Tier 3 specialist medical weight management input prior to RYGB lost significantly more weight at 6 and 12 months than RYGB only patients. This confirms the clinical efficacy of such a weight management programme prior to gastric bypass surgery and supports its inclusion in eligibility criteria for bariatric surgery.

  10. Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Raquel Pei Chen Chan

    2009-01-01

    Full Text Available BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days. A p-value of 0.05. CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.

  11. Impact of Experiencing Acute Coronary Syndrome Prior to Open Heart Surgery on Psychiatric Status

    Directory of Open Access Journals (Sweden)

    Volkan Yüksel

    Full Text Available Abstract Objective: The incidence of depression and anxiety is higher in patients with acute coronary syndrome. The aim of this study is to determine whether experiencing acute coronary syndrome prior to open heart surgery affects patients in terms of depression, hopelessness, anxiety, fear of death and quality of life. Methods: The study included 63 patients who underwent coronary bypass surgery between January 2015 and January 2016. The patients were divided into two groups: those diagnosed after acute coronary syndrome (Group 1 and those diagnosed without acute coronary syndrome (Group 2. Beck depression scale, Beck hopelessness scale, Templer death anxiety scale and death depression scale, State-Trait anxiety inventory and WHOQOL-Bref quality of life scale were applied. Results: There was no significant difference between the two groups in terms of the total score obtained from Beck depression scale, Beck hopelessness scale - future-related emotions, loss of motivation, future-related expectations subgroups, death anxiety scale, the death depression scale, State-Trait Anxiety Inventory - social and environmental subgroups. The mental quality of life sub-scores of group 2 were significantly higher. The patients in both groups were found to be depressed and hopeless about the future. Anxiety levels were found to be significantly higher in all of the patients in both groups. Conclusion: Acute coronary syndrome before coronary artery bypass surgery impairs more the quality of life in mental terms. But unexpectedly there are no differences in terms of depression, hopelessness, anxiety and fear of death.

  12. Incidental intracranial hemorrhage after uncomplicated birth: MRI before and after neonatal heart surgery

    International Nuclear Information System (INIS)

    Tavani, F.; Zimmerman, R.A.; Clancy, R.R.; Licht, D.J.; Mahle, W.T.

    2003-01-01

    We investigated the prevalence of intracranial hemorrhage (ICH) before and after neonatal heart surgery. We carried out pre- and postoperative MRI looking for brain lesions in 24 full-term new-borns with known congenital heart disease. They underwent heart surgery with cardiopulmonary bypass (CPB), usually with deep hypothermic circulatory arrest (DHCA). The first MRI was 1-22 days after birth. There were 21 children born after uncomplicated vaginal delivery and three delivered by cesarean section (CS). ICH was seen in 13 (62%) of the vaginal delivery group but in none of the CS group. We saw subdural bleeding along the inferior surface of the tentorium in 11 (52%) and supratentorially in six (29%) of the 21 children with ICH. Small hemorrhages were present in the choroid plexus in seven (33%), in the parenchyma in one (5%) and in the occipital horn in one (5%). There were 26 foci of bleeding in these 21 patients (1.2 per patient). None was judged by formal neurologic examination to be symptomatic from the hemorrhage. Follow-up MRI after cardiac surgery was obtained in 23 children, showing 37 foci of ICH (1.6 per patient), but all appeared asymptomatic. Postoperatively, ICH had increased in 10 children (43%), was unchanged in seven (30%) and was less extensive in six (26%). (orig.)

  13. Incidental intracranial hemorrhage after uncomplicated birth: MRI before and after neonatal heart surgery

    Energy Technology Data Exchange (ETDEWEB)

    Tavani, F.; Zimmerman, R.A. [Neuroradiology Dept., The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Clancy, R.R.; Licht, D.J. [Dept. of Neurology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Mahle, W.T. [Children' s Heart Hospital, Atlanta, GA (United States)

    2003-04-01

    We investigated the prevalence of intracranial hemorrhage (ICH) before and after neonatal heart surgery. We carried out pre- and postoperative MRI looking for brain lesions in 24 full-term new-borns with known congenital heart disease. They underwent heart surgery with cardiopulmonary bypass (CPB), usually with deep hypothermic circulatory arrest (DHCA). The first MRI was 1-22 days after birth. There were 21 children born after uncomplicated vaginal delivery and three delivered by cesarean section (CS). ICH was seen in 13 (62%) of the vaginal delivery group but in none of the CS group. We saw subdural bleeding along the inferior surface of the tentorium in 11 (52%) and supratentorially in six (29%) of the 21 children with ICH. Small hemorrhages were present in the choroid plexus in seven (33%), in the parenchyma in one (5%) and in the occipital horn in one (5%). There were 26 foci of bleeding in these 21 patients (1.2 per patient). None was judged by formal neurologic examination to be symptomatic from the hemorrhage. Follow-up MRI after cardiac surgery was obtained in 23 children, showing 37 foci of ICH (1.6 per patient), but all appeared asymptomatic. Postoperatively, ICH had increased in 10 children (43%), was unchanged in seven (30%) and was less extensive in six (26%). (orig.)

  14. Ultrasound-guided bilateral combined inguinal femoral and subgluteal sciatic nerve blocks for simultaneous bilateral below-knee amputations due to bilateral diabetic foot gangrene unresponsive to peripheral arterial angioplasty and bypass surgery in a coagulopathic patient on antiplatelet therapy with a history of percutaneous coronary intervention for ischemic heart disease: A case report.

    Science.gov (United States)

    Byun, Sung Hye; Lee, Jonghoon; Kim, Jong Hae

    2016-07-01

    Patients on antiplatelet therapy following percutaneous coronary intervention can become coagulopathic due to infection. Performing regional anesthesia for bilateral surgery in such cases is challenging. We report a case of successful combined inguinal femoral and subgluteal sciatic nerve blocks (CFSNBs) for simultaneous bilateral below-knee amputations in a coagulopathic patient on antiplatelet therapy. A 70-year-old male patient presented with pain in both feet due to diabetic foot syndrome. The condition could not be managed by open amputations of the toes at the metatarsal bones and subsequent antibiotic therapy. Computed tomographic angiography showed significant stenosis in the arteries supplying the lower limbs, indicating atherosclerotic gangrene in both feet. Balloon angioplasty and bypass surgery with subsequent debridements with application of negative-pressure wound therapy and additional open amputations did not improve the patient's clinical condition: his leukocyte counts and C-reactive protein levels were above the normal range, and his prothrombin and activated partial thromboplastin times were increased. Simultaneous bilateral below-knee amputations were performed under ultrasound-guided CFSNBs. Following left CFSNBs using 45 mL of a local anesthetic mixture (1:1 ratio of 1.0% mepivacaine and 0.75% ropivacaine), the left below-knee amputation was performed for 76 minutes. Subsequently, under right CFSNBs using 47 mL of the local anesthetic mixture, the right below-knee amputation proceeded for 85 minutes. Throughout each surgery, dexmedetomidine was continuously administered, and a sensory blockade was well maintained in both limbs. The patient did not complain of pain due to regression of the first CFSNBs during the second surgery. The CFSNBs successfully prevented tourniquet pain. Local anesthetic systemic toxicity (LAST) and hemodynamic instability due to tourniquet deflation and administration of dexmedetomidine did not occur. No

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

    Directory of Open Access Journals (Sweden)

    Suzanne Marnocha

    2013-01-01

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

  16. Incidence and prevalence of copper deficiency following roux-en-y gastric bypass surgery.

    Science.gov (United States)

    Gletsu-Miller, N; Broderius, M; Frediani, J K; Zhao, V M; Griffith, D P; Davis, S S; Sweeney, J F; Lin, E; Prohaska, J R; Ziegler, T R

    2012-03-01

    The frequency of copper deficiency and clinical manifestations following roux-en-y gastric bypass (RYGB) surgery is not yet clear. Objectives were to determine the prevalence and incidence of copper deficiency in patients who have undergone RYGB. We sought to determine the number of RYGB patients undergoing medical and nutritional follow-up visits at the Emory Bariatric Center who experienced copper deficiency and associated hematological and neurological complaints (n=136). Separately, in patients followed longitudinally before and during 6 and 24 months following RYGB surgery, we obtained measures of copper status (n=16). Systemic blood cell counts and measures of copper, zinc and ceruloplasmin were determined using standardized assays in reference laboratories including atomic absorption spectrometry and immunoassays. Thirteen patients were identified to have copper deficiency suggesting a prevalence of copper deficiency of 9.6%, and the majority of these had concomitant complications including anemia, leukopenia and various neuro-muscular abnormalities. In the longitudinal study, plasma copper concentrations and ceruloplasmin activity decreased over 6 and 24 months following surgery, respectively (Pdeficiency in these subjects was determined to be 18.8%. The prevalence and incidence of copper deficiency following RYGB surgery was determined to be 9.6% and 18.8%, respectively, with many patients experiencing mild-to-moderate symptoms. Given that copper deficiency can lead to serious and irreversible complications if untreated, frequent monitoring of the copper status of RYGB patients is warranted.

  17. Presurgical Weight Is Associated with Pain, Functional Impairment, and Anxiety among Gastric Bypass Surgery Patients

    Directory of Open Access Journals (Sweden)

    Sharlene Wedin

    2012-01-01

    Full Text Available Chronic pain and obesity are significant public health concerns in the United States associated with significant levels of health-care expenses and lost productivity. Previous research suggests that obesity is a risk factor for chronic pain, mainly due to excessive weight placed on the joints. However, the obesity-pain relationship appears to be complex and reciprocal. Little work to date has focused on the relationship between weight and pain among patients undergoing gastric bypass surgery for weight loss. Patients scheduled to undergo bariatric surgery for weight loss at a large southeastern academic medical center ( completed the Brief Pain Inventory (BPI, the Center for Epidemiological Studies 10-item Depression scale (CESD-10, and the Beck Anxiety Inventory (BAI. Higher presurgical weight was associated with higher pain-on-average ratings, higher functional impairment due to pain across the domains of physical activity, mood, walking ability, relationships, and enjoyment of life. Higher presurgical weight was associated with higher BAI scores, but weight was not related to depression. Findings suggest that bariatric surgery candidates report a moderate amount of pain prior to surgery and that presurgical weight is associated with higher pain, increased functional impairment due to pain, and increased anxiety. Anxiety was found to mediate the relationship between increased weight and pain.

  18. How older female spouses cope with partners' coronary artery bypass graft surgery.

    Science.gov (United States)

    Marnocha, Suzanne; Marnocha, Mark

    2013-01-01

    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.

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

    Science.gov (United States)

    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%.

  20. Effects of opium addiction on bleeding after coronary artery bypass graft surgery: report from Iran.

    Science.gov (United States)

    Nemati, Mohammad Hassan; Astaneh, Behrooz; Ardekani, Gholamreza Safaee

    2010-09-01

    Opium abuse is a major type of drug abuse in Iran. This study was designed to find the possible relation between opium addiction and excessive bleeding after coronary artery bypass graft (CABG) surgery. In a historical cohort study during a 1.5-year period, consecutive patients scheduled for elective CABG surgery were assigned to two group on the basis of having or not having the criteria for inhalational opium addiction. Before and after operations, the complete blood count, bleeding time, prothrombin time, partial thromboplastin time, and platelet count were checked for all patients. The volumes of infused red blood cells during and after the operation were recorded. After operations, the volumes of bleeding through the patients' chest tubes were recorded. The recorded data were analyzed using SPSS software version 11.5. Independent t, chi-square and repeated measure tests were used; and P Opium-addicted patients received more packed red blood cells during and after the operations. Inhalational opium addiction might lead to more hemorrhage after CABG surgery. It is recommended that cardiac surgeons consider these patients at high risk for major complications after surgery.

  1. Radical Gastrectomy Combined with Modified Gastric Bypass Surgery for Gastric Cancer Patients with Type 2 Diabetes.

    Science.gov (United States)

    Liu, Tao; Xie, Guang-Wei; Tian, Qing-Zhong; Li, Jin

    2015-07-01

    The aim of the study is to explore the effectiveness of radical gastrectomy with modified gastric bypass surgery in treating gastric cancer patients with type 2 diabetes mellitus (T2DM). A total of 93 patients with gastric cancer and T2DM were treated in our hospital and enrolled in this study. Patients in group A (n = 30) had a body mass index (BMI) of >28 kg/m(2). Radical total gastrectomy and modified esophagojejunal Roux-en-y anastomosis were performed on 13 patients, and radical distal subtotal gastrectomy and gastric remnant jejunal Roux-en-y anastomosis were performed on 17 patients. The data from groups B, C, and D were derived from 63 patients with gastric cancer and diabetes who were admitted to our hospital from January 2005 to July 2012. All patients underwent radical gastrectomy (including 21 cases of gastric cancer surgery with Billroth I anastomosis, 25 cases of radical gastrectomy with Roux-en-Y anastomosis and BMI >28 kg/m(2), and 17 cases with BMI PBG), C-peptide (C-P), and glycosylated hemoglobin (HbAIC) data were collected before and 6 and 12 months after surgery. In groups A and D, BMI, FBG, 2 h PBG, C-P, and HbAIC at the 6th and 12th post-operative months were significantly lower than those before the surgery. In group B, BMI, FBG, 2 h PBG, C-P, and HbAIC at the 6th and 12th post-operative months did not decrease significantly, when compared with the pre-operative levels. In group C, BMI, FBG, 2 h PBG, C-P, and HbAIC at the 6th and 12th post-operative months decreased but showed no statistical significance. However, in comparison, groups A C showed significant differences after the surgeries. Radical gastrectomy combined with modified gastric bypass surgery is effective in treating patients with gastric cancer with type 2 diabetes, although this requires further investigation.

  2. Comparing cardiovascular factors in opium abusers and non-users candidate for coronary artery bypass graft surgery.

    Science.gov (United States)

    Aghadavoudi, Omid; Eizadi-Mood, Nastaran; Najarzadegan, Mohammad Reza

    2015-01-01

    In some opinions, opium consumption has traditionally been considered to be a means to lower blood lipids and to put off heart diseases. In this study, the relationship between opium consumption and risk factors of coronary artery diseases, hemodynamic factors and cardiac related functions before and after surgery was evaluated. In a cross-sectional study 325 patient's candidate for elective coronary artery bypass grafting were enrolled in a period of 6 months. Opium addicted patients were recognized based on taking history from the patients by an anaesthesiologist. Serum lipid profile was determined at the beginning of the study. Frequency and distribution of coronary artery diseases were assessed according to the pre-operative coronary angiography. From 325 patients, 117 patients were opium abusers and 208 patients were not. Mean duration of opium abuse was 12.6 ± 7.7 years. Mean total serum cholesterol levels were not significantly different in abusers and non-users patients (185 ± 47 vs. 190 ± 49, P > 0.05). Mean level of low-density lipoprotein cholesterol was significantly higher in addicted group (121 ± 27 vs. 81 ± 22, P opium addicted cases. Mean body mass index was also lower in addicted patients significantly (25.3 ± 3.7 vs. 27.5 ± 4.1, P opium abuse and aggravating lipid profile and hypercholesterolemia and coronary artery disease.

  3. Insulin resistance and inflammation are a cause of hyperglycemia after pediatric cardiopulmonary bypass surgery.

    Science.gov (United States)

    Floh, Alejandro A; Manlhiot, Cedric; Redington, Andrew N; McCrindle, Brian W; Clarizia, Nadia A; Caldarone, Christopher A; Schwartz, Steven M

    2015-09-01

    Hyperglycemia is common after pediatric cardiopulmonary bypass (CPB) surgery and is attributed to a state of insulin resistance. We examined the role of CPB-induced inflammation on postoperative plasma glucose, insulin, and the glucose-to-insulin ratio, which was used as a marker of insulin resistance; a decrease in the ratio reflects increased resistance. We conducted an ancillary study on a previously published randomized trial of children undergoing CPB surgery. Serial blood glucose, insulin, and cytokines were drawn after CPB and at selected intervals for up to 48 hours after surgery. The primary outcome was plasma insulin levels and glucose-to-insulin ratio. Glucose delivery and feeding status were monitored for potential modifying effects. The 299 children studied were predominantly male (55%) with a median age of 2.7 (interquartile range [IQR]: 0.5-6.5) years, and weight of 12.6 (IQR: 6.4-10.8) kg. Operations had a median Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery complexity score of 1 (IQR: 1-2) and CPB time of 82 (IQR: 58-122) minutes. Hyperglycemia occurred in 85% of subjects; odds of hyperglycemia peaked at 6 hours after CPB. Plasma glucose was associated with increased insulin and a lower glucose-to-insulin ratio. Increased interleukin (IL)-6 concentrations were associated with increased glucose (estimate [EST]: 0.55 (±0.13) mmol/L; P insulin (EST: 1.14 (±0.12) μmol/L; P insulin ratio (EST: 0.21 (±0.03) mmol/μmol; P insulin resistance in some patients. Inflammation induced by CPB may play a causative role in insulin resistance. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  4. Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass - a case series.

    Science.gov (United States)

    Träger, Karl; Skrabal, Christian; Fischer, Guenther; Datzmann, Thomas; Schroeder, Janpeter; Fritzler, Daniel; Hartmann, Jan; Liebold, Andreas; Reinelt, Helmut

    2017-05-29

    Infective endocarditis is a serious disease condition. Depending on the causative microorganism and clinical symptoms, cardiac surgery and valve replacement may be needed, posing additional risks to patients who may simultaneously suffer from septic shock. The combination of surgery bacterial spreadout and artificial cardiopulmonary bypass (CPB) surfaces results in a release of key inflammatory mediators leading to an overshooting systemic hyperinflammatory state frequently associated with compromised hemodynamic and organ function. Hemoadsorption might represent a potential approach to control the hyperinflammatory systemic reaction associated with the procedure itself and subsequent clinical conditions by reducing a broad range of immuno-regulatory mediators. We describe 39 cardiac surgery patients with proven acute infective endocarditis obtaining valve replacement during CPB surgery in combination with intraoperative CytoSorb hemoadsorption. In comparison, we evaluated a historical group of 28 patients with infective endocarditis undergoing CPB surgery without intraoperative hemoadsorption. CytoSorb treatment was associated with a mitigated postoperative response of key cytokines and clinical metabolic parameters. Moreover, patients showed hemodynamic stability during and after the operation while the need for vasopressors was less pronounced within hours after completion of the procedure, which possibly could be attributed to the additional CytoSorb treatment. Intraoperative hemoperfusion treatment was well tolerated and safe without the occurrence of any CytoSorb device-related adverse event. Thus, this interventional approach may open up potentially promising therapeutic options for critically-ill patients with acute infective endocarditis during and after cardiac surgery, with cytokine reduction, improved hemodynamic stability and organ function as seen in our patients.

  5. Fracture Risk After Bariatric Surgery: Roux-en-Y Gastric Bypass Versus Adjustable Gastric Banding.

    Science.gov (United States)

    Yu, Elaine W; Lee, Moa P; Landon, Joan E; Lindeman, Katherine G; Kim, Seoyoung C

    2017-06-01

    The long-term consequences of bariatric surgery on fracture risk are unclear but are likely to vary by procedure type. In physiologic studies, Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) have differential effects on rates of bone loss. Therefore, our objective was to compare fracture risk in obese adults after RYGB and AGB procedures. Using claims data from a US commercial health plan, we analyzed rates of nonvertebral fractures within a propensity score-matched cohort (n = 15,032) of morbidly obese adults who received either RYGB or AGB surgery between 2005 and 2013. A total of 281 nonvertebral fractures occurred during a mean follow-up time of 2.3 ± 1.9 years. RYGB patients had an increased risk of nonvertebral fracture (hazard ratio [HR] = 1.43, 95% confidence interval [CI] 1.13-1.81) compared with AGB patients. In fracture site-specific analyses, RYGB patients had increased risk of fracture at the hip (HR = 1.54, 95% CI 1.03-2.30) and wrist (HR = 1.45, 95% CI 1.01-2.07). Nonvertebral fracture risk associated with RYGB manifested >2 years after surgery and increased in subsequent years, with the highest risk in the fifth year after surgery (HR = 3.91, 95% CI 1.58-9.64). In summary, RYGB is associated with a 43% increased risk of nonvertebral fracture compared with AGB, with risk increasing >2 years after surgery. Fracture risk should be considered in risk/benefit discussions of bariatric surgery, particularly among patients with high baseline risk of osteoporosis who are deciding between RYGB and AGB procedures. © 2017 American Society for Bone and Mineral Research. © 2017 American Society for Bone and Mineral Research.

  6. 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.

  7. The OTSC®-clip in revisional endoscopy against weight gain after bariatric gastric bypass surgery.

    Science.gov (United States)

    Heylen, Alex Marie Florent; Jacobs, Anja; Lybeer, Monika; Prosst, Ruediger L

    2011-10-01

    The maintenance of the restrictive component of the Fobi pouch gastric bypass is essential for permanent weight control. Dilatation of the pouch-outlet and of the pouch itself is responsible for substantial weight gain by an increased volume per meal and binge-eating due to the rapid emptying. An endoscopic over-the-scope clip (OTSC®; Ovesco AG, Tübingen, Germany) was applied in 94 patients following gastric bypass and unintended weight gain by dilated gastro-jejunostomy to narrow the pouch-outlet. The OTSC®-clip application was safe and efficient to reduce the pouch-outlet in all cases. Best clinical results were obtained by narrowing the gastro-jejunostomy by placing two clips at opposite sites, hence reducing the outlet of more than 80%. Preferably, the clip approximated the whole thickness of the wall to avoid further dilatation of the anastomosis. Between surgery and OTSC®-clip application the mean BMI dropped from 45.8 (±3.6) to 32.8 (±1.9). At the first follow-up about 3 months (mean 118 days, ±46 days) after OTSC®-clip application the mean BMI was 29.7 (±1.8). At the second follow-up about 1 year (mean 352 days, ±66 days) after OTSC®-clip application the mean BMI was 27.4 (±3.8). The OTSC®-clip for revisional endoscopy after gastric bypass is reliable and effective in treating weight gain due to a dilated pouch-outlet with favorable short- and midterm results.

  8. Protective effect of dexmedetomidine combined with ulinastatin on cardiopulmonary function injury caused by cardiopulmonary bypass surgery

    Directory of Open Access Journals (Sweden)

    Zhu Zhu

    2016-11-01

    Full Text Available Objective: To analyze the protective effect of dexmedetomidine combined with ulinastatin on cardiopulmonary function impairment caused by cardiopulmonary bypass surgery. Methods: A total of 78 patients who received valve replacement under cardiopulmonary bypass were divided into observation group and control group (n=39 according to random number table. Control group received intraoperative ulinastatin intervention and observation group received intraoperative dexmedetomidine combined with ulinastatin intervention. Differences in the levels of cardiac function indexes, myocardial injury markers, pulmonary function parameters, inflammatory indexes and so on were compared between two groups of patients 24 hours after operation. Results: Cardiac function parameters LSV, RSV and RVEF values of observation group 24 hours after operation were higher than those of control group while PAP value was lower than that of control group; serum myocardial injury markers H-FABP, cTn-T, CKMB, cTnⅠ and NT-proBNP levels were lower than those of control group; lung function parameters Cs and Cd values were higher than those of control group while RI, R5-R20, X5 and Fres values were lower than those of control group; serum pro-inflammatory factors IL-6 and TNF-α levels were lower than those of control group while anti-inflammatory factors sTNF-RI, IL-4 and IL-10 levels were higher than those of control group. Conclusions: Dexmedetomidine combined with ulinastatin can protect the cardiopulmonary function in patients with cardiopulmonary bypass, and help to reduce the occurrence of postoperative cardiopulmonary dysfunction and other severe complications.

  9. Bariatric Surgery-Induced Cardiac and Lipidomic Changes in Obesity-Related Heart Failure with Preserved Ejection Fraction.

    Science.gov (United States)

    Mikhalkova, Deana; Holman, Sujata R; Jiang, Hui; Saghir, Mohammed; Novak, Eric; Coggan, Andrew R; O'Connor, Robert; Bashir, Adil; Jamal, Ali; Ory, Daniel S; Schaffer, Jean E; Eagon, J Christopher; Peterson, Linda R

    2018-02-01

    To determine the effects of gastric bypass on myocardial lipid deposition and function and the plasma lipidome in women with obesity and heart failure with preserved ejection fraction (HFpEF). A primary cohort (N = 12) with HFpEF and obesity underwent echocardiography and magnetic resonance spectroscopy both before and 3 months and 6 months after bariatric surgery. Plasma lipidomic analysis was performed before surgery and 3 months after surgery in the primary cohort and were confirmed in a validation cohort (N = 22). After surgery-induced weight loss, Minnesota Living with Heart Failure questionnaire scores, cardiac mass, and liver fat decreased (P < 0.02, P < 0.001, and P = 0.007, respectively); echo-derived e' increased (P = 0.03), but cardiac fat was unchanged. Although weight loss was associated with decreases in many plasma ceramide and sphingolipid species, plasma lipid and cardiac function changes did not correlate. Surgery-induced weight loss in women with HFpEF and obesity was associated with improved symptoms, reverse cardiac remodeling, and improved relaxation. Although weight loss was associated with plasma sphingolipidome changes, cardiac function improvement was not associated with lipidomic or myocardial triglyceride changes. The results of this study suggest that gastric bypass ameliorates obesity-related HFpEF and that cardiac fat deposition and lipidomic changes may not be critical to its pathogenesis. © 2017 The Obesity Society.

  10. Effect of methylprednisolone on the oxidative burst activity, adhesion molecules and clinical outcome following open heart surgery

    DEFF Research Database (Denmark)

    Toft, P; Christiansen, K; Tønnesen, Else Kirstine

    1997-01-01

    Following cardiac surgery with cardiopulmonary bypass (CPB), activated granulocytes may be involved with ischaemia/ reperfusion injury. The purpose of this study was to investigate whether steroids could reduce the oxidative burst activity of granulocytes, the expression of adhesion molecules...... on granulocytes and improve clinical outcome. Sixteen patients undergoing open heart surgery participated in the study. Eight were randomized to receive methylprednisolone (30 mg/kg intravenously) at the start of anaesthesia while eight patients served as a control group. The oxidative burst was measured flow...... not improve the weaning from the ventilator or reduce the stay in the intensive-care unit. In conclusion, treatment with steroids prevented hyperthermia following open heart surgery with CPB and reduced capillary leak during ECC. Methylprednisolone, however, did not reduce the oxidative burst activity...

  11. Aortic perforation caused by friction of a chest tube after coronary artery bypass surgery.

    Science.gov (United States)

    Yen, Chih-Chien; Yang, Ya-Sung; Liu, Kuang-Yi

    2010-06-01

    Aortic perforation caused by the friction of a chest tube is a rare but life-threatening complication of coronary artery bypass grafting (CABG). We report a case involving CABG for triple-vessel disease and unstable angina. Reexploration was necessary 24 hours after the operation because of the sudden onset of pronounced bleeding. Perforation of the ascending aorta caused by friction of the chest tube was found. Bleeding was controlled by means of a purse string suture with 4-0 Prolene. Use of pericardium membrane between the heart and the chest tube and the choice of smaller and more flexible Silastic chest tubes in high-risk patients can probably reduce the incidence of this complication.

  12. Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex.

    Science.gov (United States)

    Aliku, Twalib O; Lubega, Sulaiman; Lwabi, Peter; Oketcho, Michael; Omagino, John O; Mwambu, Tom

    2014-12-01

    Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI). We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative outcomes and challenges faced in conducting open heart surgery in a developing country. Medical records of patients undergoing open heart surgery at the UHI from October 2007 to June 2012 were reviewed. A total of 124 patients underwent open heart surgery during the study period. The commonest conditions were: venticular septal defects (VSDs) 34.7% (43/124), Atrial septal defects (ASDs) 34.7% (43/124) and tetralogy of fallot (TOF) in 10.5% (13/124). Non governmental organizations (NGOs) funded 96.8% (120/124) of the operations, and in only 4 patients (3.2%) families paid for the surgeries. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and TAPVR. The local team independently operated 19 patients (15.3%). Postoperative morbidity was low with arrhythmias, left ventricular dysfunction and re-operations being the commonest seen. Post operative sepsis occurred in only 2 cases (1.6%). The overall mortality rate was 3.2. Open heart surgery though expensive is feasible in a developing country. With increased direct funding from governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally.

  13. Aortic Graft at Coronary Artery Bypass Surgery as a Source of Human Aortic Smooth Muscle Cells.

    Science.gov (United States)

    Kostina, Daria; Zverev, Dmitry; Grebennik, Vadim; Gordeev, Mikhail; Ignatieva, Elena; Voronkina, Irina; Kostareva, Anna; Malashicheva, Anna

    2017-10-01

    One of the serious obstacles of the aortopathies research is a considerable shortage of human aortic smooth muscle cells (SMCs), which can be used to model the disease. SMC in most cases come from the whole aorta of transplant donors, which are rather difficult to access. In the course of coronary artery bypass graft (CABG) surgery, a fragment of aortic tissue is excised to make a bypass root. In this study, we show a possibility to use CABG leftover fragments of thoracic aorta as a source of human SMC for in vitro research. We isolated SMC from the fragments of aortic tissues obtained during CABG procedure and compared these cells to the cells that were isolated from aortic tissue of transplant donors. The content of key SMC contractile markers (SMA, SM22α, and vimentin) as well as proliferation and migration rates, metalloproteases MMP-2 and MMP-9 activities were similar in CABG-derived SMC and in transplant donor-derived SMC. In conclusion, leftovers of ascending thoracic aorta obtained during CABG can be used as a source of human aortic SMCs for in vitro research.

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

    Science.gov (United States)

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

    2015-09-01

    To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inlay clamp and marked with an hemoclip. The number of pre-existing atherosclerotic segments, clamp force, and clamp time were recorded and the occurrence of a stenosis at the clamp site was determined. After a mean follow-up of 83 months, a significant stenosis was confirmed at 23 of the 178 clamp sites (12.9%; 95% confidence interval 8.4 to 18.8). The mean number of pre-existing atherosclerotic segments (P = .28) and the mean clamp force (P = .55) was similar between the groups with and without a stenosis. There was a significant difference regarding clamp time between the group with and without a stenosis (38 minutes and 26 minutes, P = .001). Arterial clamping, even with the Fogarty-Soft-Inlay clamp, can lead to clamp stenosis and seems to be related to the duration of clamping, but not to pre-existent atherosclerotic burden. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

    Directory of Open Access Journals (Sweden)

    Kambiz Alizadeh

    2014-02-01

    Full Text Available Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB. Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used.

  16. Systems Signatures Reveal Unique Remission-path of Type 2 Diabetes Following Roux-en-Y Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Li, Qing-Run; Wang, Zi-Ming; Wewer Albrechtsen, Nicolai J

    2018-01-01

    Roux-en-Y Gastric bypass surgery (RYGB) is emerging as a powerful tool for treatment of obesity and may also cause remission of type 2 diabetes. However, the molecular mechanism of RYGB leading to diabetes remission independent of weight loss remains elusive. In this study, we profiled plasma...

  17. 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.

  18. Neuroprotective Anesthesia Regimen and Intensive Management for Pediatric Cardiac Surgery with Cardiopulmonary Bypass: a Review and Initial Experience

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    Full Text Available Abstract This article describes our proposal for routine anesthesia, intraoperative medical management, cerebral and physiological monitoring during pediatric cardiac surgery with cardiopulmonary bypass that intend to provide appropriate anesthesia (analgesia, hypnosis, neuroprotection, adequate cerebral and systemic oxygen supply, and preventing against drugs neurotoxicity. A concise retrospective data is presented.

  19. A randomized blind study comparing standard heparin and a new low molecular weight heparinoid in cardiopulmonary bypass surgery in dogs

    NARCIS (Netherlands)

    Henny, C. P.; ten Cate, H.; ten Cate, J. W.; Moulijn, A. C.; Sie, T. H.; Warren, P.; Büller, H. R.

    1985-01-01

    Postoperative hemorrhage remains a serious complication in cardiopulmonary bypass (CPB) surgery. In our study, alternative anticoagulation with a new low molecular weight (LMW) heparinoid (Org 10172) was compared with a standardized heparin regimen. A preliminary dose-finding study indicated the

  20. Pregnancy and perinatal outcomes according to surgery to conception interval and gestational weight gain in women with previous gastric bypass

    DEFF Research Database (Denmark)

    Laage Stentebjerg, Louise; Andersen, Lise Lotte Torvin; Renault, Kristina

    2017-01-01

    's recommendations for GWG. Secondary outcomes were birthweight, preterm delivery, cesarean section (CS), iron deficiency and post partum hemorrhage (PPH). RESULTS: Forty-three (61%) women conceived less than 18 months after gastric bypass surgery. Women in the late group had a significantly higher risk of requiring...

  1. Preservation for future use of the autologous saphenous vein during femoro-popliteal bypass surgery is inexpedient.

    NARCIS (Netherlands)

    Dirven, M.; Scharn, D.M.; Blankensteijn, J.D.; Vliet, J.A. van der

    2008-01-01

    PURPOSE: To investigate the usefulness of greater saphenous vein preservation for future vascular reconstructions during femoro-popliteal bypass surgery. DESIGN: Post-hoc analysis of data acquired in a randomized multi-centre clinical trial comparing two different vascular prostheses

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

    Directory of Open Access Journals (Sweden)

    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.

  3. [Robot-assisted vs laparoscopic gastric bypass : First experiences with the DaVinci system in bariatric surgery].

    Science.gov (United States)

    Beckmann, J H; Aselmann, H; Egberts, J H; Bernsmeier, A; Laudes, M; Becker, T; Schafmayer, C; Ahrens, M

    2018-03-27

    Conventional laparoscopy is the gold standard in bariatric surgery. Internationally, robot-assisted surgery is gaining in importance. Up to now there are only few reports from Germany on the use of the system in bariatric surgery. Since January 2017 we have been performing robot-assisted gastric bypass surgery. It remains unclear whether the use of the robotic system has advantages over the well-established laparoscopic technique. Within a period from January to early August 2017 a total of 53 gastric bypass operations were performed. Of these 16 proximal redo Roux-en-Y gastric bypass operations were performed with the DaVinci Si system versus 29 laparoscopic procedures. A retrospective analysis of the perioperative course was carried out. Body weight, body mass index (BMI), Edmonton obesity staging system (EOSS) and American Society of Anesthesiologists (ASA) classification did not show significant differences. There were also no significant differences in terms of estimated blood loss, intraoperative complications, duration of surgery, postoperative inflammatory parameters and weight loss. There was no mortality and no need for revisional surgery in either group. After laparoscopic surgery there was a delayed occurrence of a leak of the gastrojejunostomy followed by readmission and endoscopic negative pressure wound therapy. The results show that the proximal Roux-en-Y gastric bypass can be performed safely and efficiently using the DaVinci surgical system. Significant differences to the conventional laparoscopic procedure were not found. Larger randomized controlled trials are needed to define the role of the DaVinci system in bariatric surgery.

  4. Effects of Roux-en-Y gastric bypass surgery on energy expenditure and bone metabolism in rats

    OpenAIRE

    Abegg, Kathrin

    2014-01-01

    Bariatric surgery, including the Roux-en-Y gastric bypass (RYGB), is currently the only effective long-term treatment for morbid obesity. Contrary to the traditional classification of RYGB as a restrictive and malabsorptive procedure, these factors seem to play a minor role. Increasing evidence suggests that changes in gut hormone levels, such as glucagon-like peptide-1 (GLP-1), may account for the majority of the effects. One major side effect of RYGB surgery is a decrease in bone density...

  5. Clinical characteristics and usage of statins in patients with stable ischemic heart disease referred for angiography or coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    I.V. Shklianka

    2017-12-01

    Full Text Available The aim – to compare the clinical characteristics and frequency of statins usage in real clinical practice in patients referred to a specialized clinic for angiography or coronary artery bypass grafting. Materials and methods. In a retrospective slice single-center study data from a primary examination of 155 patients with stable ischemic heart disease, consecutively selected for coronary artery bypass grafting surgery, were analyzed. Depending on the inclusion of statins in the list of medicinal prescriptions, patients were retrospectively divided into two groups: those who had been prescribed statins while they were initially referred to a specialized cardiac surgery center for angiography or revascularization (n = 84 and those who were not prescribed statins (n ​​= 71. Results. The studied patients’ cohort was characterized by earlier coronary events, signs of the peripheral artery atherosclerosis and other absolute indications for treatment with statins in vast majority of cases. At the same time, groups of patients who had been and had not been prescribed statins, did not differ by vast majority of demographic, clinical and instrumental characteristics, concomitant diseases and risk factors. No statin therapy was associated with higher levels of total cholesterol and interleukin-6 compared with the group of patients taking statins (total cholesterol, respectively, 4.8 versus 4.2 mmol/l (p = 0.016 and interleukin-6, respectively, 4.4 versus. 3.1 p/ml (p = 0.022. In general, statins were prescribed in 54,2 % of patients, among them high doses – in 17 patients (20.2 %, moderate – 46 patients (54.8 %, low – 21 patients (25 %. Conclusions. The obtained data show the insufficient level of ambulatory statins usage in patients with ischemic heart disease referred for myocardial revascularization and significant discrepancy between clinical characteristics and real statins usage. Therefore, there is a great need to determine the

  6. 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...

  7. Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery

    International Nuclear Information System (INIS)

    Sandrasegaran, Kumaresan; Rajesh, Arumugam; Lall, Chandana; Maglinte, Dean D.; Gomez, Gerardo A.; Lappas, John C.

    2005-01-01

    Obesity is rapidly becoming the most important public health issue in USA and Europe. Roux-en-Y gastric bypass is now established as the gold standard for treating intractable morbid or super obesity. We reviewed the imaging findings following this surgery in 234 patients. In this pictorial essay we present the CT and upper gastrointestinal contrast study appearances of the expected postoperative anatomy as well as a range of abdominal complications. The complications are classified into leaks, fistula and obstruction. Postoperative gastric outlet and small bowel obstruction can be caused by anastomotic stenosis, mesocolic tunnel stenosis, adhesions, stomal ulcer, obturation, intussusception and internal or external hernia. Small bowel obstruction may be of a simple, closed loop and/or strangulating type. The radiologist should be able to diagnose the type and possible cause of obstruction. (orig.)

  8. Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sandrasegaran, Kumaresan; Rajesh, Arumugam; Lall, Chandana; Maglinte, Dean D. [Indiana University Medical Center, UH 0279, Department of Radiology, Indianapolis, IN (United States); Gomez, Gerardo A. [Wishard Memorial Hospital, Department of Surgery, Indianapolis (United States); Lappas, John C. [Wishard Memorial Hospital, Department of Radiology, Indianapolis (United States)

    2005-02-01

    Obesity is rapidly becoming the most important public health issue in USA and Europe. Roux-en-Y gastric bypass is now established as the gold standard for treating intractable morbid or super obesity. We reviewed the imaging findings following this surgery in 234 patients. In this pictorial essay we present the CT and upper gastrointestinal contrast study appearances of the expected postoperative anatomy as well as a range of abdominal complications. The complications are classified into leaks, fistula and obstruction. Postoperative gastric outlet and small bowel obstruction can be caused by anastomotic stenosis, mesocolic tunnel stenosis, adhesions, stomal ulcer, obturation, intussusception and internal or external hernia. Small bowel obstruction may be of a simple, closed loop and/or strangulating type. The radiologist should be able to diagnose the type and possible cause of obstruction. (orig.)

  9. 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.

  10. 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.

  11. Great saphenous vein stump thrombosis after harvesting for coronary artery bypass graft surgery.

    Science.gov (United States)

    Labropoulos, N; Bishawi, M; Gasparis, A; Tassiopoulos, A; Gupta, S

    2014-05-01

    To determine the rate of superficial venous thrombosis in patients undergoing great saphenous vein (GSV) harvesting for coronary artery bypass surgery (CABG). Post-CABG patients with suspected lower-extremity thrombosis underwent duplex scanning. Thrombus in the saphenofemoral junction stump was noted, and thrombus extension and associated complications collected. Out of 2335 patients who underwent CABG in five years, 98 patients presented with signs and symptoms of lower-extremity thrombosis. Thrombosis was present in 19 (19.4%) of these patients, 15 of which had a thrombus in the GSV. Five patients had significant signs and symptoms of pulmonary embolism (PE). On objective diagnostic imaging, three of them had a PE. Patients undergoing great saphenous vein harvesting for CABG are at an increased risk of developing superficial vein thrombosis especially at the saphenous stump. Given the increased risk of deep vein thrombosis and PE, further studies investigating this topic are warranted.

  12. Central 5-HT Neurotransmission Modulates Weight Loss following Gastric Bypass Surgery in Obese Individuals

    DEFF Research Database (Denmark)

    Haahr, M. E.; Hansen, D. L.; Fisher, P. M.

    2015-01-01

    The cerebral serotonin (5-HT) system shows distinct differences in obesity compared with the lean state. Here, it was investigated whether serotonergic neurotransmission in obesity is a stable trait or changes in association with weight loss induced by Roux-in-Y gastric bypass (RYGB) surgery......, it was confirmed that obese individuals have higher cerebral 5-HT2A receptor binding than lean individuals. Importantly, we found that higher presurgical 5-HT2A receptor binding predicted greater weight loss after RYGB and that the change in 5-HT2A receptor and 5-HT transporter binding correlated with weight loss...... after RYGB. The changes in the 5-HT neurotransmission before and after RYGB are in accordance with a model wherein the cerebral extracellular 5-HT level modulates the regulation of body weight. Our findings support that the cerebral 5-HT system contributes both to establish the obese condition...

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

    Directory of Open Access Journals (Sweden)

    Arun Garg

    2015-01-01

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

  14. Dietary education among patients following coronary artery bypass surgery - a necessity or an unnecessary luxury?

    Science.gov (United States)

    Szczepańska, Elżbieta; Brodzikowska, Malwina; Całyniuk, Beata

    2014-03-01

    Despite rapid progress in cardiology and cardiac surgery, cardiovascular disease still present a serious epidemiological problem in industrialized countries, including Poland. Great interest in risk factors of these diseases is associated with an improper lifestyle, including diet. We aimed to assess the dietary intake among patients with a history of coronary artery bypass (CABG) surgery and to determine whether a regular dietary education among this population of patients is necessary. 212 patients with a history of CABG surgery were enrolled in the study. A questionnaire concerning the diet within 24 hours prior to the visit was used to obtain the necessary data. 43% of patients ate 4 to 5 servings per day. Milk was consumed most often several times per week or once every day. Meat consumption several times per week was reported by 41% of patients. 54% of patients reported eating fish several times per month. Half of the patients ate several servings of vegetables per day. 84% of patients used salt and other spices to season their meals. The energy value and the intake of protein, fats, carbohydrates and fiber was lower, while sodium intake was higher, than recommended for this group of patients. Patients with a history of CABG have an unhealthy diet, and do not follow the dietary guidelines. It is necessary to carry out systematic nutrition education among this group.

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

    Science.gov (United States)

    Albert, A; Sergeant, P; Ennker, J

    2009-10-01

    The strength of coronary bypass operations depends on the preservation of their benefits regarding freedom of symptoms, quality of life and survival, over decades. Significant variability of the results of an operative intervention according to the hospital or the operating surgeon is considered a weakness in the procedure. The external quality insurance tries to reach a transparent service providing market through hospital ranking comparability. Widely available information and competition will promote the improvement of the whole quality. The structured dialog acts as a control instrument for the BQS (Federal Quality Insurance). It is launched in case of deviations from the standard references or statistically significant differences between the results of the operations in any hospital and the average notational results. In comparison to the external control the hospital internal control has greater ability to reach a medically useful statement regarding the results of the treatment and to correct the mistakes in time. An online information portal based on a departmental databank (DataWarehouse, DataMart) is an attractive solution for the physician in order to get transparently and timely informed about the variability in the performance.The individual surgeon significantly influences the short- and long-term treatment results. Accordingly, selection, targeted training and performance measurements are necessary.Strict risk management and failure analysis of individual cases are included in the methods of internal quality control aiming to identify and correct the inadequacies in the system and the course of treatment. According to the international as well as our own experience, at least 30% of the mortalities after bypass operations are avoidable. A functioning quality control is especially important in minimally invasive interventions because they are often technically more demanding in comparison to the conventional procedures. In the field of OPCAB surgery

  16. Impairment of neuropsychological function in patients with hemodynamic cerebral ischemia and efficacy of bypass surgery

    International Nuclear Information System (INIS)

    Sasoh, Masayuki

    1999-01-01

    In order to evaluate the relation between neuropsychological functions and hemodynamic cerebral ischemia, the author analyzed neuropsychological examination and the cerebral blood flow and metabolism of patients before and after bypass surgery. Twenty-five patients were defined by clinical and laboratory criteria as suffering from hemodynamic cerebral ischemia. All patients had one or more episodes of focal cerebral ischemia due to unilateral internal carotid or middle cerebral artery occlusion. Computerized tomography scans either were normal or showed evidence of watershed infarction. Based on these criteria, superficial temporal artery-proximal middle cerebral artery anastomosis was performed. The baseline cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO 2 ) and cerebrovascular reserve capacity (CVRC) were studied using positron emission computerized tomography (PET) and the acetazolamide test. Neuropsychological evaluations including Hasegawa Dementia Scale-Revised, Mini-Mental State and Wechsler Adult Intelligence Scale-Revised (WAIS-R), and PET study were completed one month after the last ischemic event and 3-6 months after the operation. A significant negative correlation was observed between OEF and neuropsychological functions. Postoperative neuropsychological functions showed significant improvement. Significant correlations were observed for ΔWAIS-R (preoperative WAIS-R postoperative WAIS-R) versus preoperative CMRO 2 (r=0.52), for ΔWAIS-R versus preoperative OEF (r=0.47). In view of these findings, the author concludes that elevation of OEF impairs neuropsychological functions and bypass surgery improves neuropsychological functions in patients with normal CMRO 2 and elevated OEF. (author)

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Determinants of Length of Stay in Surgical Ward after Coronary Bypass Surgery: Glycosylated Hemoglobin as a Predictor in All Patients, Diabetic or Non-Diabetic

    Directory of Open Access Journals (Sweden)

    Mahdi Najafi

    2015-10-01

    Full Text Available Background: Reports on the determinants of morbidity in coronary artery bypass graft surgery (CABG have focused on outcome measures such as length of postoperative stay in the Intensive Care Unit (ICU. We proposed that major comorbidities in the ICU hampered the prognostic effect of other weaker but important preventable risk factors with effect on patients’ length of hospitalization. So we aimed at evaluating postoperative length of stay in the ICU and surgical ward separately.Methods: We studied isolated CABG candidates who were not dialysis dependent. Preoperative, operative, and postoperative variables as well as all classic risk factors of coronary artery disease were recorded. Using multivariate analysis, we determined the independent predictors of length of stay in the ICU and in the surgical ward.Results: Independent predictors of extended length of stay in the surgical ward ( > 3 days were a history of peripheral vascular disease, total administered insulin during a 24-hour period after surgery, glycosylated hemoglobin (HbA1c, last fasting blood sugar of the patients before surgery, and inotropic usage after cardiopulmonary bypass. The area under the Receiver Operating Characteristic Curve (AUC was found to be 0.71 and Hosmer-Lemeshow (HL goodness of fit statistic p value was 0.88. Independent predictors of extended length of stay in the ICU ( > 48 hours were surgeon category, New York Heart Association functional class, intra-aortic balloon pump, postoperative arrhythmias, total administered insulin during a 24-hour period after surgery, and mean base excess of the first 6 postoperative hours (AUC = 0.70, HL p value = 0.94 .Conclusion: This study revealed that the indices of glycemic control were the most important predictors of length of stay in the ward after cardiac surgery in all patients, diabetic or non-diabetic. However, because HbA1c level did not change under the influence of perioperative events, it could be deemed a

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

    Directory of Open Access Journals (Sweden)

    Gaurab Maitra

    2009-01-01

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

  20. Oxygen-derived free radicals and hemolysis during open heart surgery.

    Science.gov (United States)

    Das, D K; Engelman, R M; Liu, X; Maity, S; Rousou, J A; Flack, J; Laksmipati, J; Jones, R M; Prasad, M R; Deaton, D W

    1992-04-01

    Reperfusion injury occurs during open-heart surgery after prolonged cardioplegic arrest. Cardiopulmonary bypass also is known to cause hemolysis. Since reperfusion of ischemic myocardium is associated with the generation of oxygen free radicals, and since free radicals can attack a protein molecule, it seems reasonable to assume that hemolysis might be the consequence of free radical attack on hemoglobin protein. The results of this study demonstrated that reperfusion following ischemic arrest caused an increase in free hemoglobin and free heme concentrations, simultaneously releasing free iron and generating hydroxyl radicals. In vitro studies using pure hemoglobin indicated that superoxide anion generated by the action of xanthine oxidase on xanthine could release iron from the heme ring and cause deoxygenation of oxyhemoglobin into ferrihemoglobin. This study further demonstrated that before the release of iron from the heme nucleus, oxyhemoglobin underwent deoxygenation to ferrihemoglobin. The released iron can catalyze the Fenton reaction, leading to the formation of cytotoxic hydroxyl radical (OH.). In fact, the formation of OH. in conjunction with hemolysis occurs during cardiac surgery, and when viewed in the light of the in vitro results, it seems likely that oxygen-derived free radicals may cause hemolysis during cardiopulmonary bypass and simultaneously release iron from the heme ring, which can catalyze the formation of OH..

  1. Differential pre-mRNA splicing regulates Nnat isoforms in the hypothalamus after gastric bypass surgery in mice.

    Directory of Open Access Journals (Sweden)

    William R Scott

    Full Text Available Neuronatin (NNAT is an endoplasmic reticulum proteolipid implicated in intracellular signalling. Nnat is highly-expressed in the hypothalamus, where it is acutely regulated by nutrients and leptin. Nnat pre-mRNA is differentially spliced to create Nnat-α and -β isoforms. Genetic variation of NNAT is associated with severe obesity. Currently, little is known about the long-term regulation of Nnat.Expression of Nnat isoforms were examined in the hypothalamus of mice in response to acute fast/feed, chronic caloric restriction, diet-induced obesity and modified gastric bypass surgery. Nnat expression was assessed in the central nervous system and gastrointestinal tissues. RTqPCR was used to determine isoform-specific expression of Nnat mRNA.Hypothalamic expression of both Nnat isoforms was comparably decreased by overnight and 24-h fasting. Nnat expression was unaltered in diet-induced obesity, or subsequent switch to a calorie restricted diet. Nnat isoforms showed differential expression in the hypothalamus but not brainstem after bypass surgery. Hypothalamic Nnat-β expression was significantly reduced after bypass compared with sham surgery (P = 0.003, and was positively correlated with post-operative weight-loss (R(2 = 0.38, P = 0.01. In contrast, Nnat-α expression was not suppressed after bypass surgery (P = 0.19, and expression did not correlate with reduction in weight after surgery (R(2 = 0.06, P = 0.34. Hypothalamic expression of Nnat-β correlated weakly with circulating leptin, but neither isoform correlated with fasting gut hormone levels post- surgery. Nnat expression was detected in brainstem, brown-adipose tissue, stomach and small intestine.Nnat expression in hypothalamus is regulated by short-term nutrient availability, but unaltered by diet-induced obesity or calorie restriction. While Nnat isoforms in the hypothalamus are co-ordinately regulated by acute nutrient supply, after modified gastric bypass

  2. Investigation of the effect of Acute Normovolemic Hemodilution and Tranexamic Acid on the amount of bleeding during off-pump coronary artery bypass graft surgery: a systematic review

    Directory of Open Access Journals (Sweden)

    Reza Jalaeian Taghadoomi

    2017-01-01

    Full Text Available Introduction: Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations . To evaluate the effect of ANH method and tranexamic acid on blood transfusion requirements and blood loss after off pump coronary artery bypass surgery (OPCAB. Materials and Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from inception to December 2014; reference lists of published guidelines, reviews, and associated articles, as well as conference proceedings.We included articles with available abstract in English language. Manual searching was done within the reference list of articles. Three reviewers independently reviewed and assessed eligibility criteria, assessed quality, and extracted data. Results: Bleeding and hemorrhagic complications and the consequent need for allogeneic transfusion are still major problems after off-pump coronary artery bypass surgery that can reduced in combination of ANH method and tranexamic acid. Conclusion: Tranexamic acid and ANH appear to be effective in reducing postoperative bleeding and the need for allogeneic blood products.

  3. Open Heart Surgery in a Newly Established Cardiovascular Department: The first 300 cases

    Directory of Open Access Journals (Sweden)

    Kemal Korkmaz

    2016-01-01

    Full Text Available Aim: Evaluation of the results of open heart surgery in a newly established cardiovascular clinic: Ankara Numune Education and Research Hospital. Material and Method: Between June 2012 and January 2014, 300 open heart surgeries were performed. Urgent operation was performed in 22 patients (7.3% because of ST-elevation myocardial infarction and in 1 patient because of left ventricular aneurysm rupture. Coronary artery bypass grafting was performed in 211 (70.3% patients. The other patients underwent various complex operations such as valve repair, Tirone-David procedure and repair of atrioventricular canal defect. Results: In 3 patients (1% hospital mortality was seen. Reoperation was performed in 8 patients (2.6% because of pericardial tamponade and in 9 patients (3% because of bleeding. Atrial fibrillation was developed in 28 patients (9.3% in the postoperative period and normal sinus rhythm was established with medical cardioversion. Intra-aortic balloon pump(IABP was used in 4 patients preoperatively and in 11 patients postoperatively, including 15 patients(%5. Discussion: In the current era, the patients who are consulted to cardiovascular surgery clinics become more chronic, high risk and patients with additional co-morbid diseases because of the developments in interventional cardiology. Our newly established center aims to be a nationally and internationally successful clinic which was proved by low mortality and morbidity rates with a team who follows the developments and constantly educate and trained.

  4. [Treatment of aorto-coronary saphenous vein bypass lesions: pros and cons of angioplasty].

    Science.gov (United States)

    Jacq, L; Deleuze, P; Bical, O; Lardoux, H

    2000-08-01

    Heart patients who have undergone a coronary bypass may present with renewed myocardial ischemia, often connected with bypass dysfunction. The saphenous bypass is the most frequently implicated, and palliative revascularization may be envisaged, either by further bypass surgery, or by angioplasty. The latter approach has been developed since the beginning of the 1980s, and since that time there has been considerable technical and pharmacological progress in performing this type of graft. However the indications for angioplasty and its comparison with reoperation remain controversial. In the present study, it therefore seemed pertinent to include the respective opinions of two experts in the field of angioplasty and coronary bypass surgery.

  5. Predictors of healthcare associated infections in heart surgery

    Directory of Open Access Journals (Sweden)

    Érica Vieira de Andrade

    2013-12-01

    Full Text Available The objective of this study was to determine the incidence of patients with healthcare associated infections, the topographic location of those infections in the heart surgery postoperative period, and identify the risk factors associated with the occurrence of those infections. This retrospective study was performed with 460 heart surgery patients of a teaching hospital in Minas Gerais state. The data were collected from the hospital infection report forms and patients’ records. The incidence of patients with healthcare associated infections was 24.3% and respiratory tract infection had the highest rates (20.6%. Intubation time, permanence time of central venous catheter and indwelling urinary catheter were independent predictors. The findings point at the need to implement protocols for the care and maintenance of these invasive devices with the purpose of preventing and controlling healthcare associated infection in heart surgery. Descriptors: Cross Infection; Cardiac Surgical Procedures; Perioperative Nursing.

  6. Physical activity increases survival after heart valve surgery

    DEFF Research Database (Denmark)

    Lund, K.; Sibilitz, Kirstine Lærum; Kikkenborg Berg, Selina

    2016-01-01

    physical activity levels 6-12 months after heart valve surgery and (1) survival, (2) hospital readmission 18-24 months after surgery and (3) participation in exercise-based cardiac rehabilitation. METHODS: Prospective cohort study with registry data from The CopenHeart survey, The Danish National Patient...... readmission. Patients who participated in exercise-based cardiac rehabilitation (n=297) were more likely than the non-participants (n=200) to have a moderate or high physical activity level than a low physical activity level (fully adjusted OR: 1.52, 95% CI 1.03 to 2.24). CONCLUSIONS: Moderate to high levels...... of physical activity after heart valve surgery are positively associated with higher survival rates and participation in cardiac rehabilitation....

  7. An Adjusted Calculation Model of Reduced Heparin Doses in Cardiopulmonary Bypass Surgery in a Chinese Population.

    Science.gov (United States)

    Zhang, Yufeng; Liu, Kai; Li, Wei; Xue, Qian; Hong, Jiang; Xu, Jibin; Wu, Lihui; Ji, Guangyu; Sheng, Jihong; Wang, Zhinong

    2016-10-01

    To investigate the safety and efficacy of an adjusted regimen of heparin infusion in cardiopulmonary bypass (CPB) surgery in a Chinese population. Prospective, single-center, observational study. University teaching hospital. Patients having cardiac surgery with CPB were selected for this study using the following criteria: 18 to 75 years of age, undergoing first-time cardiac surgery with conventional median sternotomy, aortic clamping time between 40 and 120 minutes, and preoperative routine blood tests showing normal liver, renal, and coagulation functions. The exclusion criteria include salvage cases, a history of coagulopathy in the family, and long-term use of anticoagulation or antiplatelet drugs. Sixty patients were divided randomly into a control group (n = 30) receiving a traditional heparin regimen and an experimental group (n = 30) receiving an adjusted regimen. Activated coagulation time (ACT) was monitored at different time points, ACT>480 seconds was set as the safety threshold of CPB. Heparin doses (initial dose, added dose, and total dose), protamine doses (initial dose, added dose, and total dose), CPB time, aortic clamping time, assisted circulation time, sternal closure time, blood transfusion volume, and drainage volume 24 hours after surgery were recorded. There was no significant difference in achieving target ACT after the initial dose of heparin between the 2 groups; CPB time, aortic clamping time, assisted circulation time, postoperative complication rate, and drainage volume between the 2 groups were not significantly different (p>0.05). However, initial and total dosage of heparin, initial and total dosage of protamine, sternal closure time, and intraoperative blood transfusion volume in the experimental group were significantly lower (pChinese CPB patients, which might reduce the initial and total dosage of heparin and protamine as well as sternal closure time and intraoperative blood transfusion volume. Copyright © 2016 Elsevier Inc

  8. Aprotinin vs. tranexamic acid in isolated coronary artery bypass surgery: A multicentre observational study.

    Science.gov (United States)

    Deloge, Elsa; Amour, Julien; Provenchère, Sophie; Rozec, Bertrand; Scherrer, Bruno; Ouattara, Alexandre

    2017-05-01

    Aprotinin appears to be more efficacious than lysine analogues to reduce bleeding and transfusion of blood products in high-transfusion-risk cardiac surgical patients. However, in isolated coronary artery bypass graft (CABG) surgery, the results from head-to-head trials remain less conclusive. Our objective was to compare the efficacies and safety of aprotinin and tranexamic acid (TXA) in patients undergoing isolated on-pump CABG. A multicentre before-and-after study pooling individual data from published trials and unpublished data from three other databases. Four tertiary care teaching hospitals (Haut-Lévêque Hospital in Bordeaux, Pitié-Salpêtrière Hospital and Bichat-Claude Bernard Hospital in Paris, and Laennec Hospital in Nantes). We included data of 2496 isolated on-pump CABG surgery patients who received either aprotinin between November 2003 and May 2008 (n = 1267) or TXA between November 2007 and November 2013 (n = 1229). The primary outcome was total blood loss within 24 h after operation. Secondary outcomes were transfusion of blood products, reoperation for bleeding, renal replacement therapy, ICU length of stay and in-hospital mortality. Adjusted mean (SEM) 24-h blood loss after surgery [483 (11) vs. 634 (11) ml, P < 0.0001] and the proportion of patients requiring intraoperative blood product transfusion (32.7 vs. 46.5%, P = 0.01) were lower in aprotinin-treated patients. No difference was observed with regard to reoperations for bleeding, renal replacement therapy and in-hospital mortality. However, patients receiving aprotinin had a significantly shorter adjusted ICU length of stay. In patients undergoing isolated CABG, aprotinin was more effective than TXA in reducing postoperative blood loss, and no safety concerns were identified. The benefits of aprotinin should be considered when evaluating the risk of major blood loss and transfusion in patients scheduled for isolated CABG surgery.

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

    International Nuclear Information System (INIS)

    Habib, S.; Khan, A. R.; Afridi, M. I.; Saeed, A.; Jan, A. F.; Amjad, N.

    2014-01-01

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

  10. Link Between Increased Satiety Gut Hormones and Reduced Food Reward After Gastric Bypass Surgery for Obesity

    Science.gov (United States)

    Miras, Alexander D.; Scholtz, Samantha; Jackson, Sabrina; Neff, Karl J.; Pénicaud, Luc; Geoghegan, Justin; Chhina, Navpreet; Durighel, Giuliana; Bell, Jimmy D.; Meillon, Sophie; le Roux, Carel W.

    2016-01-01

    Context: Roux-en-Y gastric bypass (RYGB) surgery is an effective long-term intervention for weight loss maintenance, reducing appetite, and also food reward, via unclear mechanisms. Objective: To investigate the role of elevated satiety gut hormones after RYGB, we examined food hedonic-reward responses after their acute post-prandial suppression. Design: These were randomized, placebo-controlled, double-blind, crossover experimental medicine studies. Patients: Two groups, more than 5 months after RYGB for obesity (n = 7–11), compared with nonobese controls (n = 10), or patients after gastric banding (BAND) surgery (n = 9) participated in the studies. Intervention: Studies were performed after acute administration of the somatostatin analog octreotide or saline. In one study, patients after RYGB, and nonobese controls, performed a behavioral progressive ratio task for chocolate sweets. In another study, patients after RYGB, and controls after BAND surgery, performed a functional magnetic resonance imaging food picture evaluation task. Main Outcome Measures: Octreotide increased both appetitive food reward (breakpoint) in the progressive ratio task (n = 9), and food appeal (n = 9) and reward system blood oxygen level-dependent signal (n = 7) in the functional magnetic resonance imaging task, in the RYGB group, but not in the control groups. Results: Octreotide suppressed postprandial plasma peptide YY, glucagon-like peptide-1, and fibroblast growth factor-19 after RYGB. The reduction in plasma peptide YY with octreotide positively correlated with the increase in brain reward system blood oxygen level-dependent signal in RYGB/BAND subjects, with a similar trend for glucagon-like peptide-1. Conclusions: Enhanced satiety gut hormone responses after RYGB may be a causative mechanism by which anatomical alterations of the gut in obesity surgery modify behavioral and brain reward responses to food. PMID:26580235

  11. Link Between Increased Satiety Gut Hormones and Reduced Food Reward After Gastric Bypass Surgery for Obesity.

    Science.gov (United States)

    Goldstone, Anthony P; Miras, Alexander D; Scholtz, Samantha; Jackson, Sabrina; Neff, Karl J; Pénicaud, Luc; Geoghegan, Justin; Chhina, Navpreet; Durighel, Giuliana; Bell, Jimmy D; Meillon, Sophie; le Roux, Carel W

    2016-02-01

    Roux-en-Y gastric bypass (RYGB) surgery is an effective long-term intervention for weight loss maintenance, reducing appetite, and also food reward, via unclear mechanisms. To investigate the role of elevated satiety gut hormones after RYGB, we examined food hedonic-reward responses after their acute post-prandial suppression. These were randomized, placebo-controlled, double-blind, crossover experimental medicine studies. Two groups, more than 5 months after RYGB for obesity (n = 7-11), compared with nonobese controls (n = 10), or patients after gastric banding (BAND) surgery (n = 9) participated in the studies. Studies were performed after acute administration of the somatostatin analog octreotide or saline. In one study, patients after RYGB, and nonobese controls, performed a behavioral progressive ratio task for chocolate sweets. In another study, patients after RYGB, and controls after BAND surgery, performed a functional magnetic resonance imaging food picture evaluation task. Octreotide increased both appetitive food reward (breakpoint) in the progressive ratio task (n = 9), and food appeal (n = 9) and reward system blood oxygen level-dependent signal (n = 7) in the functional magnetic resonance imaging task, in the RYGB group, but not in the control groups. Octreotide suppressed postprandial plasma peptide YY, glucagon-like peptide-1, and fibroblast growth factor-19 after RYGB. The reduction in plasma peptide YY with octreotide positively correlated with the increase in brain reward system blood oxygen level-dependent signal in RYGB/BAND subjects, with a similar trend for glucagon-like peptide-1. Enhanced satiety gut hormone responses after RYGB may be a causative mechanism by which anatomical alterations of the gut in obesity surgery modify behavioral and brain reward responses to food.

  12. Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy.

    Science.gov (United States)

    Morales, Mario P; Wheeler, Andrew A; Ramaswamy, Archana; Scott, J Stephen; de la Torre, Roger A

    2010-01-01

    Failure of primary bariatric surgery is frequently due to weight recidivism, intractable gastric reflux, gastrojejunal strictures, fistulas, and malnutrition. Of these patients, 10-60% will undergo reoperative bariatric surgery, depending on the primary procedure performed. Open reoperative approaches for revision to Roux-en-Y gastric bypass (RYGB) have traditionally been advocated secondary to the perceived difficulty and safety with laparoscopic techniques. Few studies have addressed revisions after RYGB. The aim of the present study was to provide our experience regarding the safety, efficacy, and weight loss results of laparoscopic revisional surgery after previous RYGB and sleeve gastrectomy procedures. A retrospective analysis of patients who underwent laparoscopic revisional bariatric surgery for complications after previous RYGB and sleeve gastrectomy from November 2005 to May 2007 was performed. Technical revisions included isolation and transection of gastrogastric fistulas with partial gastrectomy, sleeve gastrectomy conversion to RYGB, and revision of RYGB. The data collected included the pre- and postoperative body mass index, operative time, blood loss, length of hospital stay, and intraoperative and postoperative complications. A total of 26 patients underwent laparoscopic revisional surgery. The primary operations had consisted of RYGB and sleeve gastrectomy. The complications from primary operations included gastrogastric fistulas, refractory gastroesophageal reflux disease, weight recidivism, and gastric outlet obstruction. The mean prerevision body mass index was 42 ± 10 kg/m(2). The average follow-up was 240 days (range 11-476). The average body mass index during follow-up was 37 ± 8 kg/m(2). Laparoscopic revision was successful in all but 1 patient, who required conversion to laparotomy for staple line leak. The average operating room time and estimated blood loss was 131 ± 66 minutes and 70 mL, respectively. The average hospital stay was 6

  13. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report.

    Science.gov (United States)

    Patel, Pranav H; Slesser, Alistair Ap; Khalil, Aoff; Bassett, Oliver; Natarajan, Kt; Livingstone, Jeremy I

    2012-03-07

    Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  14. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

    Directory of Open Access Journals (Sweden)

    Patel Pranav H

    2012-03-01

    Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  15. The utility of lung epithelium specific biomarkers in cardiac surgery: a comparison of biomarker profiles in on- and off-pump coronary bypass surgery

    Directory of Open Access Journals (Sweden)

    Engels Gerwin E

    2013-01-01

    Full Text Available Abstract Background Despite continuous improvements in materials and perfusion techniques, cardiac surgery still causes lung injury and a delay of pulmonary recovery. Currently, there is no gold standard for quantifying cardiac surgery induced lung injury and dysfunction. Adding objective measures, such as plasma biomarkers, could be of great use here. In this study the utility of lung epithelium specific proteins as biomarkers for lung dysfunction was evaluated. Methods Serial measurements of plasma concentrations of Clara cell 16 kD (CC16 protein, Surfactant protein D (SP-D, Elastase and Myeloperoxidase were performed on blood samples from 40 patients who underwent coronary artery bypass grafting with cardiopulmonary bypass (CABG, n = 20 or without cardiopulmonary bypass (OPCAB, n = 20. Results The increase of SP-D and CC16 between pre-operative concentrations and concentrations at the end of cardiopulmonary bypass, correlated with the Aa-O2 gradient at 1 hour on the ICU (Rs = 0.409, p = .016 and Rs = 0.343, p = .043, respectively. Furthermore, SP-D and CC16 were higher in CABG than in OPCAB at the end of surgery [8.96 vs. 4.91 ng/mL, p = .042 and 92 vs. 113%, p = .007, respectively]. After 24 h both biomarkers returned to their baseline values. Conclusions Our results show that increases in plasma of SP-D and CC16 correlate with clinical lung injury after coronary artery bypass surgery. Therefore, lung epithelium specific proteins seem to be a useful biomarker for measuring lung injury in the setting of cardiac surgery.

  16. A Systematic Review and Meta-analysis of the Effect of Gastric Bypass Surgery on Plasma Lipid Levels.

    Science.gov (United States)

    Carswell, Kirstin A; Belgaumkar, Ajay P; Amiel, Stephanie A; Patel, Ameet G

    2016-04-01

    Obesity-related dyslipidaemia comprises hypercholesterolaemia, hypertriglyceridaemia, low HDL-cholesterol and normal to raised LDL-cholesterol levels. 40% of morbidly obese surgical patients have dyslipidaemia. Roux-en-Y gastric bypass (RYGB) surgery has many beneficial metabolic effects, but the full impact on plasma lipids has not been clearly defined. A systematic review of electronic databases (Ovid; Medline; PubMed; Embase) between 1960 and March 2012 was performed using search terms including the following: obesity surgery, bariatric surgery, gastric bypass, cholesterol, lipids, triglycerides and non-esterified fatty acids. A total of 2442 manuscripts were screened. Papers with paired plasma lipid levels around RYGB surgery were included. Exclusions included the following: editorials, dual publications, n effect of RYGB surgery upon plasma lipids at different time points up to 4 years following surgery, using a random effects model. Paired data were available for 7815 subjects around RYGB surgery for morbid obesity with a baseline BMI 48 kg/m(2) (n = 2331). There was a reduction in plasma total cholesterol and LDL-C from 1 month up to 4 years post-RYGB (p RYGB, HDL-C increased from 1 year onwards (p RYGB surgery reverses the dyslipidaemia of obesity. These findings support the use of RYGB in the management of high cardiovascular risk lipid profiles in morbid obesity.

  17. Prevalence of Self-reported Symptoms After Gastric Bypass Surgery for Obesity.

    Science.gov (United States)

    Gribsholt, Sigrid Bjerge; Pedersen, Ane Mathilde; Svensson, Elisabeth; Thomsen, Reimar Wernich; Richelsen, Bjørn

    2016-06-01

    Population-based studies on the prevalence of symptoms after Roux-en-Y gastric bypass (RYGB) surgery are sparse. Knowledge about possible predictors of these symptoms is important for prevention. To examine patients' overall well-being and the prevalence and predictors of medical, nutritional, and surgical symptoms after RYGB surgery, and their association with quality of life. A survey was conducted from March 3 to July 31, 2014, among 2238 patients who underwent RYGB surgery between January 1, 2006, and December 31, 2011, in the Central Denmark Region. A comparison cohort of 89 individuals who were matched with patients according to sex and body mass index but who did not undergo RYGB surgery were surveyed as a point of reference. Data analysis was conducted from September 1, 2014, to June 25, 2015. Prevalence and severity (based on contacts with health care system, ranging from no contact to hospitalization) of self-reported symptoms following RYGB surgery. Prevalence ratios (PRs) of symptoms associated with different predictors were computed. The association between number of symptoms and quality of life was investigated using the Spearman rank correlation coefficient. Of 2238 patients undergoing RYGB surgery, 1429 (63.7%) responded to the survey. Among these patients, 1266 (88.6%) reported 1 or more symptoms a median of 4.7 years after RYGB surgery. Mean age at the time of the survey was 47.1 years (range, 26.9-68.0 years), and 286 were men (20.0%). A total of 1219 of 1394 patients (87.4%) reported that their well-being was improved after vs before RYGB surgery, while 113 (8.1%) reported reduced well-being. Symptoms after RYGB surgery were reported by 1266 patients (88.6%); 966 patients (67.6%) had been in contact with the health care system about their symptoms vs 31 [34.8%] of those in the comparison group, and 416 (29.1%) had been hospitalized vs 6 [6.7%] of those in the comparison group. The symptoms most commonly leading to health care contact after RYGB

  18. Children's weight status, body esteem, and self-concept after maternal gastric bypass surgery.

    Science.gov (United States)

    Willmer, Mikaela; Berglind, Daniel; Tynelius, Per; Ghaderi, Ata; Näslund, Erik; Rasmussen, Finn

    2015-01-01

    There is little research on the effects of Roux-en-Y gastric bypass (RYGB) surgery on the patients' offspring's weight and psychosocial well-being. The present study investigates how children are affected in terms of weight status, body esteem, and self-concept after maternal RYGB. Sixty-nine women and their families were recruited from RYGB waiting lists at 5 Swedish hospitals. Data was collected during home visits 3 months before and 12 months after RYGB. Anthropometrical measures were taken, and the children completed the Body Esteem Scale (BES) and the Beck Self-Concept Inventory (BYI-S). Prevalence or relative risk in weight status between the time points were explored using Poisson regression models (General Estimating Equations). We found stronger statistical evidence for a decreased risk of overweight (RR = .85, 57.0% versus 48.6%, P = .048), than for obesity (RR = .87, 18.2% versus 15.9%, P = .447). The boys' body esteem increased slightly, whilst the girls' did not. There were no significant differences in mean BYI-S scores. The reasons behind the statistically significant decrease in overweight but not obesity risk in children after maternal RYGB may be caused by insufficient statistical power to detect changes in obesity risk alone. Body esteem seems to be slightly positively affected in boys 9 months after maternal RYGB. Longer follow-up times and larger samples would be useful in future research. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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.

  20. Deep sternal wound infection after coronary artery bypass surgery: management and risk factor analysis for mortality.

    Science.gov (United States)

    Yumun, Gunduz; Erdolu, Burak; Toktas, Faruk; Eris, Cuneyt; Ay, Derih; Turk, Tamer; As, Ahmet Kagan

    2014-08-01

    Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery. Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated. In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE. Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.

  1. Pre-operative high sensitive C-reactive protein predicts cardiovascular events after coronary artery bypass grafting surgery: A prospective observational study

    Directory of Open Access Journals (Sweden)

    Balciunas Mindaugas

    2009-01-01

    Full Text Available C-reactive protein is a powerful independent predictor of cardiovascular events in patients with coronary artery disease. The relation between C-reactive protein (CRP concentration and in-hospital outcome, after coronary artery bypass grafting (CABG, has not yet been established. The study aims to evaluate the predictive value of pre-operative CRP for in-hospital cardiovascular events after CABG surgery. High-sensitivity CRP (hs-CRP levels were measured pre-operatively on the day of surgery in 66 patients scheduled for elective on pump CABG surgery. Post-operative cardiovascular events such as death from cardiovascular causes, ischemic stroke, myocardial damage, myocardial infarction and low output heart failure were recorded. During the first 30 days after surgery, 54 patients were free from observed events and 14 developed the following cardiovascular events: 10 (15% had myocardial damage, four (6% had low output heart failure and two (3% suffered stroke. No patients died during the follow-up period. Serum concentration of hs-CRP ≥ 3.3 mg/l (cut-off point obtained by ROC analysis was related to higher risk of post-operative cardiovascular events (36% vs 6%, P = 0.01, myocardial damage (24% vs 6%, P = 0.04 and low output heart failure (12% vs 0%, P = 0.04. Multivariate logistic regression analysis showed that hs-CRP ≥ 3.3 mg/l ( P = 0.002, O.R.: 19.3 (95% confidence interval (CI 2.9-128.0, intra-operative transfusion of red blood cells ( P = 0.04, O.R.: 9.9 (95% C.I. 1.1-85.5 and absence of diuretics in daily antihypertensive treatment ( P = 0.02, O.R.: 15.1 (95% C.I. 1.4-160.6 were independent predictors of combined cardiovascular event. Patients having hs-CRP value greater or equal to 3.3 mg/l pre-operatively have an increased risk of post-operative cardiovascular events after on pump coronary artery bypass grafting surgery.

  2. Emergency use of cardiopulmonary bypass in complicated transcatheter aortic valve replacement: importance of a heart team approach.

    Science.gov (United States)

    Roselli, Eric E; Idrees, Jay; Mick, Stephanie; Kapadia, Samir; Tuzcu, Murat; Svensson, Lars G; Lytle, Bruce W

    2014-10-01

    Transcatheter aortic valve replacement (TAVR) expands options for high-risk patients with aortic stenosis but is complex with life-threatening complications. We describe indications for use of salvage cardiopulmonary bypass (CPB) and assess outcomes. From 2006 to 2011, 303 patients underwent TAVR, and 12 (4%) required emergency CPB. Approach was transapical (9) and transfemoral (3). Mean age was 82±9 years, median Society of Thoracic Surgeons score was 11 and mean gradient was 46±9 mm Hg. Access for CPB was femoral under fluoroscopy. Principal indication for CPB was hemodynamic instability with or without ischemic changes. These resulted from aortic insufficiency (n=5), valve embolization (n=3), coronary malperfusion (n=2), bleeding requiring pericardiocentesis (n=1), and bleeding from ventricular apex (n=1). Additional procedures included valve-in-valve TAVR (n=5), surgical valve replacement (n=3), and coronary intervention (n=2). Additional circulatory support was used in 7 cases: intra-aortic balloon pump (5) and extracorporeal membrane oxygenation (3). There were 2 hospital deaths. Mean postoperative gradient was 12±9 mm Hg, and median stay was 16 days. There were no myocardial infarctions or renal failure. One patient had stroke with arm weakness, 2 required tracheostomy, and 2 underwent reoperations for bleeding. Median follow-up was 19 months, and there were 5 late deaths. Complications during TAVR can be life threatening and may necessitate additional procedures. Expeditious use of CPB support provided by a multidisciplinary heart team optimizes rescue after myocardial collapse. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  3. Heart Valve Surgery Recovery and Follow Up

    Science.gov (United States)

    ... health are a good diet and a regular exercise routine. If your doctor has recommended a particular diet, it's important that you follow it. If a special diet has not been recommended, balanced, heart-healthy nutrition can speed healing and lessen fatigue. Weight ...

  4. Roux-en-Y Gastric Bypass Surgery Induces Early Plasma Metabolomic and Lipidomic Alterations in Humans Associated with Diabetes Remission

    DEFF Research Database (Denmark)

    Arora, Tulika; Velagapudi, Vidya; Pournaras, Dimitri J

    2015-01-01

    -surgery levels. At 4 days after surgery, insulin levels correlated positively with metabolites of branched chain and aromatic amino acid metabolism and negatively with triglycerides with long-chain fatty acids. Of the 14 subjects with diabetes prior to surgery, 7 were in remission 2 years after surgery......Roux-en-Y gastric bypass (RYGB) is an effective method to attain sustained weight loss and diabetes remission. We aimed to elucidate early changes in the plasma metabolome and lipidome after RYGB. Plasma samples from 16 insulin-resistant morbidly obese subjects, of whom 14 had diabetes, were...... subjected to global metabolomics and lipidomics analysis at pre-surgery and 4 and 42 days after RYGB. Metabolites and lipid species were compared between time points and between subjects who were in remission and not in remission from diabetes 2 years after surgery. We found that the variables that were...

  5. Comparing the Effect of Continuous and Intermittent Irrigation Techniques on Complications of Arterial Catheter and Partial Thromboplastin Time in Patients Following Coronary Artery Bypass Grafting Surgery

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    Sedigheh Arta

    2017-04-01

    Full Text Available Background: Different approaches are available to irrigate the arterial catheter, such as continuous and intermittent techniques. However, there is a disagreement regarding the most appropriate method. Aim: this study aimed to compare the effect of two continuous and intermittent irrigation methods on complications of arterial catheter and partial thromboplastin time (PTT in patients with coronary artery bypass (CABG surgery. Method: This randomized clinical trial was conducted on 60 participants undergoing coronary artery bypass grafting surgery in open-heart surgery ICU at Imam Reza hospital in Mashhad, Iran, in 2016. In continuous group, the arterial catheter was continuously irrigated with heparin solution at the rate of 2cc/h, and in the intermittent group with a syringe containing 5cc heparin solution every 3 hours. In both groups, catheter was monitored and recorded every 3 hours (until 48 hours and 3 times from enrollment in terms of complications of partial thromboplastin time. Data were analyzed using SPSS version 16. Results: The findingsof independent t-test showed that the two groups are homogeneous in age (P =0.48. The result of Fisher's exact test revealed no significant difference between the two groups in terms of average incidence of complications during the first 24 hours (P=0.55 and second 24 hours (P=0.55 after catheterization. Also during the 48 hours after surgery, independent t-test results showed no statistically significant difference in partial thromboplastin time (P=0.53 between the two groups. Implications for Practice: According to the results of the research based on the lack of difference between continuous and intermittent irrigation methods up to 48 hours after catheter replacement in terms of arterial catheter complications, further long-term follow-up researches are recommended.

  6. [Subarachnoid clonidine and trauma response in cardiac surgery with cardiopulmonary bypass].

    Science.gov (United States)

    Ferreira, Claudia Gissi da Rocha; Tenório, Sérgio Bernardo

    2014-01-01

    The intense trauma response triggered by cardiopulmonary bypass can lead to increased morbidity and mortality. The present study evaluated whether clonidine, a drug of the class of α-2 agonists, administered by spinal route, without association with local anesthetics or opioids, reduces this response in cardiac surgery with cardiopulmonary bypass. A total of 27 patients between 18 and 75 years old, divided by non-blinded fashion into a control group (15) and a clonidine group (12), were studied. All patients underwent identical technique of general anesthesia. Then, only the clonidine group received 1μgkg(-1) clonidine by spinal route. Levels of blood glucose, lactate and cortisol were measured at three consecutive times: T1, at the time of installation of invasive arterial pressure; T2, 10min after the first dose for cardioplegia; and T3, at the time of skin suture; and troponin I values at T1 and T3. The variation of results between T2-T1, T3-T2, and T3-T1 was also evaluated. There was a statistically significant difference only with respect to the variation in blood glucose in the clonidine group: T3-T2, p=0.027 and T3-T1, p=0.047. Spinal clonidine at a dose of 1μgkg(-1) did not decrease blood measurements of troponin, cortisol, or lactate. Blood glucose suffered a more moderate variation during the procedure in the clonidine group. This fact, already reported in the literature, requires further investigation to be clarified. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. Subarachnoid clonidine and trauma response in cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Claudia Gissi da Rocha Ferreira

    2014-12-01

    Full Text Available Background and objectives: The intense trauma response triggered by cardiopulmonary bypass can lead to increased morbidity and mortality. The present study evaluated whether clonidine, a drug of the class of α-2 agonists, administered by spinal route, without association with local anesthetics or opioids, reduces this response in cardiac surgery with cardiopulmonary bypass. Method: A total of 27 patients between 18 and 75 years old, divided by non-blinded fashion into a control group (15 and a clonidine group (12, were studied. All patients underwent identical technique of general anesthesia. Then, only the clonidine group received 1 μg kg−1 clonidine by spinal route. Levels of blood glucose, lactate and cortisol were measured at three consecutive times: T1, at the time of installation of invasive arterial pressure; T2, 10 min after the first dose for cardioplegia; and T3, at the time of skin suture; and troponin I values at T1 and T3. The variation of results between T2-T1, T3-T2, and T3-T1 was also evaluated. Results: There was a statistically significant difference only with respect to the variation in blood glucose in the clonidine group: T3-T2, p = 0.027 and T3-T1, p = 0.047. Conclusions: Spinal clonidine at a dose of 1 μg kg−1 did not decrease blood measurements of troponin, cortisol, or lactate. Blood glucose suffered a more moderate variation during the procedure in the clonidine group. This fact, already reported in the literature, requires further investigation to be clarified.

  8. Retinal and cerebral microembolization during coronary artery bypass surgery: a randomized, controlled trial.

    Science.gov (United States)

    Ascione, Raimondo; Ghosh, Arup; Reeves, Barnaby C; Arnold, John; Potts, Mike; Shah, Atul; Angelini, Gianni D

    2005-12-20

    We sought to compare the effects on ophthalmic function of coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and off-pump (OPCAB) grafting and to investigate whether retinal microvascular damage is associated with markers of cerebral injury. Retinal microvascular damage was assessed by fluorescein angiography and color fundus photography. Ophthalmic function was tested by the logarithm of the minimum angle of resolution visual acuity (VA), and cerebral injury, by transcranial Doppler ultrasound-detected emboli and S100 protein values. Twenty patients were randomized. Fluorescein angiography and postoperative VA could not be obtained for 1 CABG-CPB patient. Retinal microvascular damage was detected in 5 of 9 CABG-CPB but in none of 10 OPCAB patients (risk difference, 55%; 95% confidence interval [CI], 23% to 88%; P=0.01). Color fundus photography detected microvascular damage in 1 CABG-CPB patient but in no OPCAB patients; this lesion was associated with a field defect, which remained after 3 months of follow-up. There was no difference in postoperative VA. Doppler high-intensity transient signals (HITS) were 20.3 times more frequent in the CABG-CPB than in the OPCAB group (95% CI, 9.1 to 45; P<0.0001). Protein S100 levels were higher in the CABG-CPB than in the OPCAB group 1 hour after surgery (P<0.001). HITS were 14.7 times more frequent (95% CI, 3.5 to 62; P=0.001) and S100 level 2.1 times higher (95% CI, 1.3 to 3.5; P=0.005) when retinal microvascular damage was present. The relative frequency of retinal microvascular damage between groups shows the extent to which the risk of cerebral injury is reduced with OPCAB. Imaging of part of the cerebral circulation provides evidence to validate markers of cerebral injury.

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

    Directory of Open Access Journals (Sweden)

    Sambhunath Das

    2015-01-01

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

  10. Anesthetic-Induced Myocardial Preconditioning and Some Biochemical Markers for Cardiac and Coronary Failures after Aortocoronary Bypass Surgery

    Directory of Open Access Journals (Sweden)

    V. V. Moroz

    2013-01-01

    Full Text Available Objective: to provide a rationale for the efficiency of sevoflurane-induced cardiac preconditioning (CPC, by assessing the pattern of recovery of heart rate and by estimating troponin I levels and changes in NT-proBNP concentrations in patients undergoing aortocoronary bypass surgery (ACBS under extracorporeal circulation (EC. Subjects and methods. Sixty patients aged 60.6±8 years (M±& were examined after elective ACBS using EC and divided into two groups of 30 patients each: 1 inhalation induction and maintenance of anesthesia (IIMA with sevoflurane and fentanyl, with CPC being simulated; 2 total intravenous anesthesia (TIA with propofol and fentanyl. Inhalation induction of sevoflurane anesthesia was performed in the IIMA group. Ten minutes before aortic ligation, the dose of the anesthetic was increased up to 2 MAC for CPC. Inhaled anesthetics were not used in the TIA group. The authors assessed the pattern of cardiac performance recovery and estimated the level of NT-proBNP 24 and 48 hours after tracheal intubation and that of troponin I following 24 hours of the intubation. Results. Defibrillation was required in one patient from the TIA group who developed ventricular fibrillation. The baseline levels of NT-proBNP were comparable in both groups. Following 24 hours, its level was more than thrice higher in the TIA group than that in the IIMA one (p<0.05. By the end of 2 days, the concentration of NT-proBNP continued to rise (up to 480% of the baseline level in the TIA group and returned to the preoperative values in the IIMA group (p=0.05. Twenty-four hours after tracheal intubation the level of troponin I was insignificantly higher in the TIA group than that in the IIMA group (p=0.1. Conclusion. Sevoflurane has cardioprotective properties in preventing and/or reducing the degree of heart failure after ACBS using EC. There is a need to continue the study in increased cohort to provide evidence that sevoflurane-induced CPC can lower

  11. 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.

  12. Roux-en-Y Gastric Bypass Surgery Increases Respiratory Quotient and Energy Expenditure during Food Intake.

    Directory of Open Access Journals (Sweden)

    Malin Werling

    Full Text Available The mechanisms determining long-term weight maintenance after Roux-en-Y gastric bypass (RYGB remain unclear. Cross sectional studies have suggested that enhanced energy expenditure (EE may play a significant role and the aim of this study was to reveal the impact of RYGB on each major component constituting total EE.Six obese female subjects, without other co-morbidities, were assessed before and at 10 days, 3 and 20 months after RYGB. Indirect calorimetry in a metabolic chamber was used to assess 24 h EE at each study visit. Other measurements included body composition by DEXA, gut hormone profiles and physical activity (PA using high sensitivity accelerometers.Median Body Mass Index decreased from 41.1 (range 39.1-44.8 at baseline to 28 kg/m2 (range 22.3-30.3 after 20 months (p<0.05. Lean tissue decreased from 55.9 (range 47.5-59.3 to 49.5 (range 41.1-54.9 kg and adipose tissue from 61 (range 56-64.6 to 27 (range 12-34.3 kg (both p<0.05. PA over 24 h did not change after surgery whereas 24 h EE and basal metabolic rate (BMR decreased. EE after a standard meal increased after surgery when adjusted for total tissue (p<0.05. After an initial drop, RQ (respiratory quotient had increased at 20 months, both as measured during 24 h and after food intake (p<0.05.RYGB surgery up-regulates RQ and EE after food intake resulting in an increased contribution to total EE over 24 h when corrected for total tissue.

  13. Perinatal Outcomes and the Influence of Maternal Characteristics After Roux-en-Y Gastric Bypass Surgery.

    Science.gov (United States)

    Chagas, Cristiane; Saunders, Cláudia; Pereira, Silvia; Silva, Jacqueline; Saboya, Carlos; Ramalho, Andréa

    2017-01-01

    Assess the perinatal outcomes and identify what maternal characteristics can influence them in women who had undergone Roux-en-Y gastric bypass (RYGB). Analytical, prospective, and longitudinal study with pregnant adult women. chronological age >20 years; singleton pregnancy; RYGB surgery before pregnancy. prior malabsorptive or restrictive surgeries; malabsorption syndrome. Data analysis was performed using SPSS statistics software, version 17. Thirty pregnant women with 30.22 ± 4.38 years, the interval between surgery and the date of last menstrual period was 17.7 ± 9.07 months. The average prepregnancy body mass index was characterized as overweight (27.36 ± 3.26 kg/m 2 ), total gestational weight gain was 7.68 ± 3.73 kg. The most common pregnancy complications were anemia (73.3%), urinary tract infection (33.4%), and dumping syndrome (33.4%). As for newborns, 58% were male, with a mean of 39.28 ± 0.84 weeks, 90% were classified as appropriate for gestational age, and 93.4% were born at term with adequate weight (39.28 ± 0.84 weeks and 3128.79 ± 271.49 g). Positive and significant correlation was observed between gestational weekly gain in the first trimester and birth weight (r = 0.42, p = 0.024) and between gestational weekly gain in the second trimester and birth weight (r = 0.48, p = 0.008). Despite the completion of RYGB, in general, there was no apparent fetal compromise when considering the analysis of the variables proposed by this study.

  14. 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.

  15. Is chronic obstructive pulmonary disease a risk factor for epistaxis after coronary artery bypass graft surgery?

    Science.gov (United States)

    Cingoz, Faruk; Oz, Bilgehan Savas; Arslan, Gokhan; Guler, Adem; Sahin, Mehmet Ali; Gunay, Celalettin; Arslan, Mehmet

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) has customarily been associated with increased surgical morbidity and mortality rates after coronary artery bypass graft surgery (CABG). The aim of this study was to determine whether there is a relationship between epistaxis and COPD after CABG surgery. There were 3 443 patients who consecutively underwent isolated CABG from January 2002 to March 2012. We retrospectively analysed the data of 27 patients (0.8%) with newly developed and serious spontaneous epistaxis, which required consultation with the Ear Nose and Throat (ENT) Department. The patients were divided into three groups according to severity of nasal bleeding. Twenty-one (77.7%) patients in the three groups had COPD. There were 19 males (70%) and eight females (30%). Their ages ranged between 52 and 72 years (mean 61 ± 5). Fifty-five per cent of the patients had hypertension and 78% had COPD. The overall duration of hospital stay was six to 11 days (mean 7.9 ± 1.1). Epistaxis was seen particularly on the fourth and seventh days postoperatively and 17 patients (63%) were treated with anterior, posterior, or anterior and posterior nasal packing (group 1). Nasal bleeding was controlled with electrocautery in six patients (22%) (group 2), and four (15%) were treated with surgical excision and blood transfusions (group 3). All patients (100%) had a good recovery with no mortality. The high coincidence between epistaxis and COPD made us wonder whether COPD may be a risk factor for epistaxis after CABG surgery. However, we could not find any direct causative link between COPD and epistaxis in patients who had undergone CABG. Epistaxis was more common in patients with COPD and it was more serious clinically in patients who had both COPD and hypertension.

  16. Multimedia Exercise Training Program Improves Distance Walked, Heart Rate Recovery, and Self-efficacy in Cardiac Surgery Patients.

    Science.gov (United States)

    Wang, Li-Wei; Ou, Shu-Hua; Tsai, Chien-Sung; Chang, Yue-Cune; Kao, Chi-Wen

    2016-01-01

    Patient education has been shown to be more effective when delivered using multimedia than written materials. However, the effects of using multimedia to assist patients in cardiac rehabilitation have not been investigated. The purpose of this study is to examine the effect of an inpatient multimedia exercise training program on distance walked in the 6-minute walking test (6MWT), heart rate recovery, and walking self-efficacy of patients who had undergone heart surgery. For this longitudinal quasi-experimental study, 60 consecutive patients were assigned to an experimental (n = 20; inpatient multimedia exercise training program) or control (n = 40; routine care) group. Data were collected at 3 times (before surgery, 1 to 2 days before hospital discharge, and 1 month after hospital discharge) and analyzed with the generalized estimating equation approach. Most subjects were men (66.7%), had a mean age of 61.32 ± 13.4 years and left ventricular ejection fraction of 56.96% ± 13.28%, and underwent coronary artery bypass graft surgery (n = 34, 56.7%). Subjects receiving the exercise training program showed significantly greater improvement than those in the control group in the 6MWT walking distance (P multimedia exercise training program safely improved distance walked in the 6MWT, heart rate recovery, and self-efficacy at hospital discharge in patients after heart surgery and maintained their improvement in 6MWT and self-efficacy 1 month later.

  17. High-Target Versus Low-Target Blood Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral Injury in Cardiac Surgery Patients: A Randomized Controlled Trial.

    Science.gov (United States)

    Vedel, Anne G; Holmgaard, Frederik; Rasmussen, Lars S; Langkilde, Annika; Paulson, Olaf B; Lange, Theis; Thomsen, Carsten; Olsen, Peter Skov; Ravn, Hanne Berg; Nilsson, Jens C

    2018-04-24

    .71). No significant difference was observed in frequency of severe adverse events. Among patients undergoing on-pump cardiac surgery, targeting a higher versus a lower mean arterial pressure during cardiopulmonary bypass did not seem to affect the volume or number of new cerebral infarcts. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02185885. © 2018 American Heart Association, Inc.

  18. Evaluation of a decision aid for patients considering autologous blood donation before open-heart surgery

    Science.gov (United States)

    Grant, F. Curry; Laupacis, Andreas; O'Connor, Annette M.; Rubens, Fraser; Robblee, James

    2001-01-01

    Background Patients undergoing open-heart surgery frequently require one or more blood transfusions. Because of the risks of receiving blood from volunteer donors, some patients choose to donate their own blood before surgery. This reduces their risk of exposure to volunteer-donated blood, but it increases their chance of receiving any transfusion, either of self-donated or volunteer-donated blood. Also, preoperative hemoglobin levels tend to be lower in patients who donate their own blood, and surgeons may be more likely to give transfusions to patients with self-donated blood. To help patients decide whether to donate their blood before surgery, we designed a decision aid comprising a booklet and audiotape and assessed its effectiveness. Methods The 59 study subjects were a sample of consecutive patients referred to the Ottawa Heart Institute between Oct. 1, 1998, and Jan. 5, 1999, for future coronary artery bypass grafting, valve surgery or combined surgery. All were eligible to donate blood. Initial questionnaires were administered in the clinic by a physician or study nurse, and follow-up questionnaires were completed at home and mailed in after use of the decision aid. Outcome measures included patients' knowledge, values (importance ratings), preferences for transfusion methods, decisional conflict (the amount of uncertainty about the course of action to take), risk perception and acceptability of the decision aid. Results Mean knowledge scores on a 15-item test increased from 67% correct responses before the decision aid to 85% correct responses after use of the aid (p decision aid was acceptable to the majority of patients, and 95% indicated that they would recommend it to others. Interpretation The decision aid improved knowledge and risk perceptions of blood donation and transfusion, and it helped uncertain patients to make choices. PMID:11338799

  19. PSYCHOLOGICAL FEATURES IN PATIENTS WITH CORONARY HEART DISEASE (MEN AND WOMEN PRIOR TO CORONARY ARTERY BYPASS GRAFTING DEPENDING ON THEIR INVOLVEMENT IN THE INDIVIDUAL PSYCHO-CORRECTION PROGRAM

    Directory of Open Access Journals (Sweden)

    D. A. Starunskaya

    2017-01-01

    Full Text Available Importance. The study of psychological characteristics of patients is important for the creation and planning of psychological correction and improve the efficiency of the treatment of coronary heart disease.Тhe purpose. This research is devoted to the study of the psychological features in patients with coronary artery disease (CHD in the preoperative period, depending on their involvement in psycho-correction program.Material and methods. We observed 30 patients with coronary heart disease before coronary bypass surgery. Clinical-psychological method (observation, conversation and psychological testing were used.Results  and conclusions. We found that patients who participated in psycho-correction program had lower values of «anxiety», «phobic anxiety» and «obsessive-compulsive» symptoms. In both groups of patients, on average, we identified the prevalence  of the coping-strategies «self-control» and «planning solution». Furthermore, on average, the «self-awareness» and «extraversion» were more manifested features in the structure of the personality traits of the surveyed patients. The revealed features should be taken into account in planning the programs of psycho-correction for patients with CHD prior to CABG surgery.

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

    NARCIS (Netherlands)

    Atasever, Bektaş; Boer, Christa; Goedhart, Peter; Biervliet, Jules; Seyffert, Jan; Speekenbrink, Ron; Schwarte, Lothar; de Mol, Bas; Ince, Can

    2011-01-01

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

  1. Advances in coronary heart disease surgery in Latin America.

    Science.gov (United States)

    Gurfinkel, Enrique P; Lernoud, Veronica S; Laguens, Ruben P; Favaloro, Roberto R

    2007-03-06

    The beginnings of coronary artery bypass graft in Latin America could be set in the year 1971. Since then, improvements in technique and greater experience have resulted in a rapid increase in the rate of interventions performed in the region. Searches through PubMed and Literatura Latinoamericana y del Caribe en Ciencias de la Salud, as well as personal communications from specialists from Latin America, have been the source of information. Articles were selected by their content related to the theme, and the authors' nationality and information is mainly from Latin America. Demographic information of the population of Latin America denotes higher age averages, and this implies an increase in the severity of comorbidities in patients who undergo surgery. Longer life expectancy and improvements in medical therapy have implied that patients survive a first intervention beyond the expected time a bypass persists patent. Wall vessel properties of arterial conduits, plus a better anastomotic technique, seem to be the current solution to worsening in the coronary health of patients who undergo revascularization surgery in Latin America. Despite scarce economic investment in medical sciences, many academic groups contribute to the exploration of therapeutic pharmacological combinations and inclusively apply genetic strategies.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-11-15

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

  3. Congenital heart surgery: what we do to our patients

    African Journals Online (AJOL)

    knowledge of potential late complications. This article adresses these issues without dwelling on the technicalities of the surgery per se. The common operations we do can be grouped into 5 categories by their longer-term outlook: • temporary palliation for defects that cannot initially be repaired. • operations for heart defects ...

  4. 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.

  5. 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.

  6. Change in Use of Sleep Medications After Gastric Bypass Surgery or Intensive Lifestyle Treatment in Adults with Obesity.

    Science.gov (United States)

    Ng, Winda L; Peeters, Anna; Näslund, Ingmar; Ottosson, Johan; Johansson, Kari; Marcus, Claude; Shaw, Jonathan E; Bruze, Gustaf; Sundström, Johan; Neovius, Martin

    2017-08-01

    To examine the change in use of hypnotics and/or sedatives after gastric bypass surgery or intensive lifestyle modification in adults with obesity. Adults with obesity who underwent gastric bypass surgery or initiated intensive lifestyle modification between 2007 and 2012 were identified through the Scandinavian Obesity Surgery Registry and a Swedish commercial weight loss database. The two cohorts were matched on BMI, age, sex, education, history of hypnotics and/or sedatives use, and treatment year (surgery n = 20,626; lifestyle n = 11,973; 77% women, mean age 41 years, mean BMI 41 kg/m 2 ). The proportion of participants with filled hypnotics and/or sedatives prescriptions was compared yearly for 3 years. In the matched treatment cohorts, 4% had filled prescriptions for hypnotics and/or sedatives during the year before treatment. At 1 year follow-up, following an average weight loss of 37 kg and 18 kg in the surgery and intensive lifestyle cohorts, respectively, this proportion had increased to 7% in the surgery cohort but remained at 4% in the intensive lifestyle cohort (risk ratio 1.7; 95% CI: 1.4-2.1); at 2 years, the proportion had increased to 11% versus 5% (risk ratio 2.0; 95% CI: 1.7-2.4); and at 3 years, it had increased to 14% versus 6% (risk ratio 2.2; 95% CI: 1.9-2.6). Gastric bypass surgery was associated with increased use of hypnotics and/or sedatives compared with intensive lifestyle modification. © 2017 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).

  7. Clinical implications of hypothermic ventricular fibrillation versus beating-heart technique during cardiopulmonary bypass for pulmonary valve replacement in patients with repaired tetralogy of Fallot.

    Science.gov (United States)

    Lee, Ji-Hyun; Lee, Ji-Eun; Shin, Jungho; Song, In-Kyung; Kim, Hee-Soo; Kim, Chong-Sung; Kim, Woong-Han; Kim, Jin-Tae

    2017-09-01

    This study aimed to compare the effects of hypothermic ventricular fibrillation and beating-heart techniques during cardiopulmonary bypass (CPB) on postoperative outcomes after simple pulmonary valve replacement in patients with repaired tetralogy of Fallot (TOF). We retrospectively reviewed the data of 47 patients with repaired tetralogy of Fallot at a single institution, who received pulmonary valve replacement under the ventricular fibrillation or beating-heart technique without cardioplegic cardiac arrest during CPB between January 2005 and April 2015. The patients were divided into fibrillation (n = 32) and beating-heart (n = 15) groups. On comparing these groups, the fibrillation group had a larger sinotubular junction (27.1 ± 4.6 vs 22.1 ± 2.4 mm), had a longer operation duration (396 ± 108 vs 345 ± 57 min), required more postoperative transfusions (2.1 ± 2.6 vs 5.0 ± 6.3 units) and had a higher vasoactive-inotropic score at intensive care unit admission (8.0 vs 10, all P tetralogy of Fallot. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study.

    Directory of Open Access Journals (Sweden)

    Lone Nikoline Nørgaard

    Full Text Available OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton pregnancy in which first trimester screening was performed between January 2008 and June 2011. Data were derived from national registers (Danish National Registry of Patients and Danish National Birth Registry, Pregnancy Complications and Abortion-clinical quality database (PreCAb and the Danish Fetal Medicine Database. Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA. RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351 days. The mean "fetal growth index" was 0.99 (SD, 0.02 days/day and thus significantly lower than in the background population (mean, 1.04 (SD, 0.09 days/day, p<0.0001. The proportion of infants being small for gestational age was 18.8% and the proportion of large for gestational age infants was 6.7%. The correlation coefficients between surgery-to-conception time and "fetal growth index" and birthweight according to GA were 0.01 (p = 0.8 and 0.04 (p = 0.4, respectively. CONCLUSION: Fetal growth index was lower than reported in the background population. No correlation was found between the surgery-to-conception interval and early or late fetal growth in pregnancies conceived after gastric bypass surgery.

  9. Planning of vessel grafts for reconstructive surgery in congenital heart diseases

    Science.gov (United States)

    Rietdorf, U.; Riesenkampff, E.; Schwarz, T.; Kuehne, T.; Meinzer, H.-P.; Wolf, I.

    2010-02-01

    The Fontan operation is a surgical treatment for patients with severe congenital heart diseases, where a biventricular correction of the heart can't be achieved. In these cases, a uni-ventricular system is established. During the last step of surgery a tunnel segment is placed to connect the inferior caval vein directly with the pulmonary artery, bypassing the right atrium and ventricle. Thus, the existing ventricle works for the body circulation, while the venous blood is passively directed to the pulmonary arteries. Fontan tunnels can be placed intra- and extracardially. The location, length and shape of the tunnel must be planned accurately. Furthermore, if the tunnel is placed extracardially, it must be positioned between other anatomical structures without constraining them. We developed a software system to support planning of the tunnel location, shape, and size, making pre-operative preparation of the tunnel material possible. The system allows for interactive placement and adjustment of the tunnel, affords a three-dimensional visualization of the virtual Fontan tunnel inside the thorax, and provides a quantification of the length, circumferences and diameters of the tunnel segments. The visualization and quantification can be used to plan and prepare the tunnel material for surgery in order to reduce the intra-operative time and to improve the fit of the tunnel patch.

  10. Nosocomial infections in heart surgery patients: active surveillance in two Italian hospitals.

    Science.gov (United States)

    Sodano, L; Agodi, A; Barchitta, M; Musumeci, F; Menichetti, A; Bellocchi, P; Cunsolo, R; Coco, G

    2004-01-01

    In Italy no nosocomial infection surveillance database has been established despite the fact that a decrease of nosocomial infection rates was one of the priorities of the Italian National Health Plan 1998--2000. Heart surgery operations are the most frequent high risk procedures in western countries. Active surveillance was performed at the heart surgery wards of two Italian hospitals (Rome and Catania, Southern Italy) in accordance with the methods described for the National Nosocomial Infections Surveillance (NNIS) System of the USA. In both hospitals surgical site infections (SSIs) were the most frequently encountered type of nosocomial infections, accounting for 57.2% in Rome and 50% in Catania, and SSI rates in coronary artery bypass grafts with both chest and donor site incisions, calculated by risk index equal to 1, were above the 90th percentile for the NNIS System. The urinary catheter-associated urinary tract infection (UTI) rate (5.8%) in Catania exceeded the 90th percentile for the NNIS System, while the device-associated UTI (1.6%), bloodstream (4.1%) and pneumonia (8.0%) rates, from the hospital in Rome, did not. All device utilization ratios were lower than the 10th percentile for the NNIS System. Our study demonstrated that the NNIS methodology is applicable to Italian hospitals, although with some limitations mainly regarding the minimal surveillance duration required for significant interhospital comparison, and highlighted the need of a national comparison of surveillance data as benchmark.

  11. Low Cost Simulator for Heart Surgery Training

    Directory of Open Access Journals (Sweden)

    Roberto Rocha e Silva

    Full Text Available Abstract Objective: Introduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets. Methods: A transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses. Simulators for the training of valve replacement and valvoplasty, atrial septal defect repair and aortic diseases were added. These simulators are based on sewage pipes obtained in construction material stores and the silicone trays and ethyl vinyl acetate tissue were obtained in utility stores, all of them at a very low cost. Results: The models were manufactured using inert materials easily found in regular stores and do not present contamination risk. They may be used in any environment and maybe stored without any difficulties. This training enabled young surgeons to familiarize and train different surgical techniques, including procedures for aortic diseases. In a subjective assessment, these surgeons reported that the training period led to improved surgical techniques in the surgical field. Conclusion: The model described in this protocol is effective and low-cost when compared to existing simulators, enabling a large array of cardiovascular surgery training.

  12. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

    OpenAIRE

    Patel Pranav H; Slesser Alistair AP; Khalil Aoff; Bassett Oliver; Natarajan KT; Livingstone Jeremy I

    2012-01-01

    Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British C...

  13. Dose response of exercise training following roux-en-Y gastric bypass surgery: A randomized trial.

    Science.gov (United States)

    Woodlief, Tracey L; Carnero, Elvis A; Standley, Robert A; Distefano, Giovanna; Anthony, Steve J; Dubis, Gabe S; Jakicic, John M; Houmard, Joseph A; Coen, Paul M; Goodpaster, Bret H

    2015-12-01

    Roux-en-Y gastric bypass (RYGB) surgery can cause profound weight loss and improve overall cardiometabolic risk factors. Exercise (EX) training following RYGB can provide additional improvements in insulin sensitivity (SI ) and cardiorespiratory fitness. However, it remains unknown whether a specific amount of EX post-RYGB is required to achieve additional benefits. We performed a post hoc analysis of participants who were randomized into either a 6-month structured EX program or a health education control (CON). The EX group (n = 56) was divided into tertiles according to the amount of weekly exercise performed, compared with CON (n = 42): low-EX = 54 ± 8; middle-EX = 129 ± 4; and high-EX = 286 ± 40 min per week. The high-EX lost a significantly greater amount of body weight, total fat mass, and abdominal deep subcutaneous abdominal fat compared with CON (P weight loss, changes in body composition, and improvements in cardiorespiratory fitness and skeletal muscle mitochondrial capacity. © 2015 The Obesity Society.

  14. Mortality risk prediction models for coronary artery bypass graft surgery: current scenario and future direction.

    Science.gov (United States)

    Karim, Mohammed N; Reid, Christopher M; Cochrane, Andrew; Tran, Lavinia; Alramadan, Mohammed; Hossain, Mohammed N; Billah, Baki

    2017-12-01

    Many risk prediction models are currently in use for predicting short-term mortality following coronary artery bypass graft (CABG) surgery. This review critically appraised the methods that were used for developing these models to assess their applicability in current practice setting as well as for the necessity of up-gradation. Medline via Ovid was searched for articles published between 1946 and 2016 and EMBASE via Ovid between 1974 and 2016 to identify risk prediction models for CABG. Article selection and data extraction was conducted using the CHARMS checklist for review of prediction model studies. Association between model development methods and model's discrimination was assessed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U-test. A total of 53 risk prediction models for short-term mortality following CABG were identified. The review found a wide variation in development methodology of risk prediction models in the field. Ambiguous predictor and outcome definition, sub-optimum sample size, inappropriate handling of missing data and inefficient predictor selection technique are major issues identified in the review. Quantitative synthesis in the review showed "missing value imputation" and "adopting machine learning algorithms" may result in better discrimination power of the models. There are aspects in current risk modeling, where there is room for improvement to reflect current clinical practice. Future risk modelling needs to adopt a standardized approach to defining both outcome and predictor variables, rational treatment of missing data and robust statistical techniques to enhance performance of the mortality risk prediction.

  15. Reconstruction of leaking gastric pouch after redo Rouxen-Y gastric bypass – revisionary surgery strategy

    Directory of Open Access Journals (Sweden)

    Wojciech K. Karcz

    2016-01-01

    Full Text Available With the rapid development of the knowledge and techniques in bariatric surgery, as well as extensive expansion of indications for metabolic operations, surgeons have started to realize that the procedures they choose are not always suited to the needs and behavior of patients. Second and very frequently third revisional procedures are thus necessary in order to achieve desired outcomes and fulfill patients’ expectations. Restoration of restriction is commonly the first procedure, but not all may benefit from it. We hence want to illustrate the decision-making process by presenting a patient with the background of initial Rouxen-Y gastric bypass (RYGB and redo-RYGB, who then underwent a further revision by a 2-stage approach due to weight regain. The first stage involved shortening of the common channel and the second one reconstruction of his gastric pouch with duodenal switch (DS. Consequently we wish to focus here on a discussion about operative techniques and strategies to improve outcomes in such patients.

  16. Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Marc Licker

    2012-01-01

    Full Text Available A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.

  17. Effects of roux-en-Y gastric bypass surgery on postprandial fructose metabolism.

    Science.gov (United States)

    Surowska, Anna; De Giorgi, Sara; Theytaz, Fanny; Campos, Vanessa; Hodson, Leanne; Stefanoni, Nathalie; Rey, Valentine; Schneiter, Philippe; Laville, Martine; Giusti, Vittorio; Gabert, Laure; Tappy, Luc

    2016-03-01

    Fructose is partly metabolized in small bowel enterocytes, where it can be converted into glucose or fatty acids. It was therefore hypothesized that Roux-en-Y gastric bypass (RYGB) may significantly alter fructose metabolism. We performed a randomized clinical study in eight patients 12-17 months after RYGB and eight control (Ctrl) subjects. Each participant was studied after ingestion of a protein and lipid meal (PL) and after ingestion of a protein+lipid+fructose+glucose meal labeled with (13) C-fructose (PLFG). Postprandial blood glucose, fructose, lactate, apolipoprotein B48 (apoB48), and triglyceride (TG) concentrations, (13) C-palmitate concentrations in chylomicron-TG and VLDL-TG, fructose oxidation ((13) CO2 production), and gluconeogenesis from fructose (GNGf) were measured over 6 hours. After ingestion of PLFG, postprandial plasma fructose, glucose, insulin, and lactate concentrations increased earlier and reached higher peak values in RYGB than in Ctrl. GNGf was 33% lower in RYGB than Ctrl (P = 0.041), while fructose oxidation was unchanged. Postprandial incremental areas under the curves for total TG and chylomicrons-TG were 72% and 91% lower in RYGB than Ctrl (P = 0.064 and P = 0.024, respectively). ApoB48 and (13) C-palmitate concentrations were not significantly different. Postprandial fructose metabolism was not grossly altered, but postprandial lipid concentrations were markedly decreased in subjects having had RYGB surgery. © 2015 The Obesity Society.

  18. Radionuclide methods of identifying patients who may require coronary artery bypass surgery

    International Nuclear Information System (INIS)

    Beller, G.A.; Gibson, R.S.; Watson, D.D.

    1985-01-01

    Myocardial thallium-201 ( 201 Tl) scintigraphy or radionuclide angiography performed in conjunction with exercise stress testing can provide clinically useful information regarding the functional significance of underlying coronary artery stenoses in patients with known or suspected coronary artery disease. Knowledge of type, location, and extent of myocardial 201 Tl perfusion abnormalities or the severity of exercise-induced global and regional dysfunction has prognostic value. Risk stratification can be undertaken with either radionuclide technique by consideration of the magnitude of the ischemic response and may assist in the selection of patients for coronary artery bypass graft surgery (CABG). In patients with coronary artery disease, delayed 201 Tl redistribution observed on exercise or dipyridamole 201 Tl scintigraphy, particularly when present in multiple vascular regions and associated with increased lung 201 Tl uptake, has been shown to be predictive of an adverse outcome, whereas patients with chest pain and a normal exercise 201 Tl scintigram have a good prognosis with medical treatment. Similarly, a marked fall in the radionuclide ejection fraction from rest to exercise has been found to correlate with high-risk anatomic disease. Another important application of radionuclide imaging in patients being considered for CABG (particularly those with a depressed resting left ventricular ejection fraction) is the determination of myocardial viability and potential for improved blood flow and enhanced regional function after revascularization. 69 references

  19. The risk of arrhythmias following coronary artery bypass surgery: do smokers have a paradox effect?

    LENUS (Irish Health Repository)

    Al-Sarraf, Nael

    2010-11-01

    Smoking is reported to increase the risk of arrhythmias. However, there are limited data on its effects on arrhythmias following coronary artery bypass graft (CABG). This is a retrospective review of a prospective database of all CABG patients over an eight-year period. Our cohort (n=2813) was subdivided into: current (n=1169), former (n=837), and non-smokers (n=807). Predictors of arrhythmias following CABG in relation to smoking status were analysed. Atrial arrhythmias occurred in 942 patients (33%). Ventricular arrhythmias occurred in 48 patients (2%) and high-grade atrioventricular block occurred in five patients (0.2%). Arrhythmias were lower in current smokers than former and non-smokers (29% vs. 40% vs. 39%, respectively P<0.001). Logistic regression analysis showed 30% arrhythmia risk reduction in smokers compared to non-smokers [odds ratio (OR) 0.7, 95% confidence intervals (CI) 0.5-0.8] and this effect persisted after accounting for potential confounders while former smokers had the same risk as non-smokers (OR 1.04, CI 0.9-1.3). There were no significant differences in mortality. Smokers are less prone to develop arrhythmias following CABG. This paradox effect is lost in former smokers. This effect is possibly due to a lower state of hyper adrenergic stimulation observed in smokers than non-smokers following the stress of surgery.

  20. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Shantavasinkul, Prapimporn Chattranukulchai; Omotosho, Philip; Corsino, Leonor; Portenier, Dana; Torquati, Alfonso

    2016-11-01

    Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. An academic medical center in the United States. A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (Pweight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (Pweight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  1. Trends in Weight Regain Following Roux-en-Y Gastric Bypass (RYGB) Bariatric Surgery.

    Science.gov (United States)

    Cooper, Timothy C; Simmons, Elizabeth B; Webb, Kirsten; Burns, James L; Kushner, Robert F

    2015-08-01

    The primary purpose of this study was to assess weight loss and occurrence of weight regain among patients who underwent Roux-en-Y gastric bypass (RYGB) using categorical analysis. Study participants were selected from patients who underwent RYGB from a single institution. Participants (n = 300, mean procedure age = 45.6 ± 9.9) completed surveys for self-reported preoperative weight, current weight, and subsequent weights over postoperative years. Measured weights and confirmed procedure dates were acquired from patient medical records. Mean preoperative weight and BMI were 140.8 kg ± 32.1 and 49.7 ± 9.9, respectively, and mean years since surgery was 6.9 ± 4.9. Study subjects were mostly Caucasian (56.7 %) and female (80.3 %). Participants were stratified a priori into four cohorts based on percent of weight loss at 1 year, 35 % (n = 113). General linear model analyses were conducted to assess the effect of year one weight loss on percent weight regain. The mean weight regain for all patients was 23.4 % of maximum weight loss. Using categorical analysis, mean weight regain in the 35 % weight loss cohorts was 29.1, 21.9, 20.9, and 23.8 %, respectively. Excessive weight regain, defined as ≥25 % of total lost weight, occurred in 37 % of patients. Weight gain is a common complication following RYGB surgery. Despite the percentage of weight loss over the first year, all cohort patient groups regained on average between 21 and 29 % of lost weight. Excessive weight gain was experienced by over one third of patients. Greater initial absolute weight loss leads to more successful long-term weight outcomes.

  2. Anesthetic management of patients undergoing extra-anatomic renal bypass surgery for renovascular hypertension

    Directory of Open Access Journals (Sweden)

    Kumar Bhupesh

    2011-01-01

    Full Text Available Renal artery disease is the most common cause for surgically curable form of hypertension. In a small subset of patients with severe aortic disease where the aorta is not suitable for endovascular technique and to provide an arterial inflow, an extra-anatomic renal bypass surgery (EARBS is an option. Anesthetic management of such procedures has not been described so far in the literature. We retrospectively analyzed the anesthetic techniques used in all patients who underwent EARBS between February 1998 and June 2008 at this institute. We also further analyzed data concerning blood pressure (BP control and renal function response following surgery as outcome variable measures. A total of 11 patients underwent EARBS during this period. Five received oral clonidine with premedication. During laryngoscopy, esmolol was used in 4 patients, while lignocaine was used in remaining 7 patients. Of 11 patients, 7 showed significant hemodynamic response to laryngoscopy and intubation; among these, one had oral clonidine with premedicant, and 6 received lignocaine just before laryngoscopy. Intravenous vasodilators were used to maintain target BP within 20% of baseline during perioperative period. All patients received renal protective measures. During follow-up, 10% were considered cured, 70% had improved BP response, while 20% failed to show improvement in BP response. Renal functions improved in 54.5%, remain unchanged in 36.5%, and worsened in 9% of patients. Use of clonidine during premedication and esmolol before laryngoscopy were beneficial in attenuating hemodynamic response to laryngoscopy, while use of vasodilators to maintain target BP within 20% of baseline, and routine use of renal protective measures appear to be promising in patients undergoing EARBS.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Validation of a definition of excessive postoperative bleeding in infants undergoing cardiac surgery with cardiopulmonary bypass.

    Science.gov (United States)

    Bercovitz, Rachel S; Shewmake, Allison C; Newman, Debra K; Niebler, Robert A; Scott, John P; Stuth, Eckehard; Simpson, Pippa M; Yan, Ke; Woods, Ronald K

    2018-05-01

    To derive and validate an objective definition of postoperative bleeding in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass. Using a retrospective cohort of 124 infants and neonates, we included published bleeding definitions and cumulative chest tube output over different postoperative periods (eg, 2, 12, or 24 hours after intensive care unit admission) in a classification and regression tree model to determine chest tube output volumes that were associated with red blood cell transfusions and surgical re-exploration for bleeding in the first 24 hours after intensive care unit admission. After the definition of excessive bleeding was determined, it was validated via a prospective cohort of 77 infants and neonates. Excessive bleeding was defined as ≥7 mL/kg/h for ≥2 consecutive hours in the first 12 postoperative hours and/or ≥84 mL/kg total for the first 24 postoperative hours and/or surgical re-exploration for bleeding or cardiac tamponade physiology in the first 24 postoperative hours. Excessive bleeding was associated with longer length of hospital stay, increased 30-day readmission rate, and increased transfusions in the postoperative period. The proposed standard definition of excessive bleeding is based on readily obtained objective data and relates to important early clinical outcomes. Application and validation by other institutions will help determine the extent to which our specialty should consider this definition for both clinical investigation and quality improvement initiatives. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  5. The influence of coronary bypass graft surgery on the marital relationship and family functioning of the patient.

    Science.gov (United States)

    van der Poel, Alette; Greeff, Abraham P

    2003-01-01

    The primary aim of this study was to assess the effect of coronary bypass graft surgery on certain aspects of the marital relationship and on family functioning of patients. The secondary aim was to determine which coping strategies families used postoperatively. An experimental pre- and posttest research design was used. We collected data using the Enriching and Nurturing Relationship Issues, Communication and Happiness Scale, the Family Adaptability and Cohesion Evaluation Scale II, and the Family Crisis Oriented Personal Evaluation Scales. The results indicated that bypass surgery had a negative effect on the patients' marital satisfaction, communication, and attitudes toward the division of roles in the marriage and family. Bypass surgery had a further negative influence on the emotional bonding of the patients and their spouses with other members of the family. The patients' adaptability regarding new challenges facing the family was also affected negatively. The patients who were still working also showed a greater decline in some of the measured variables than the retired patients. The coping strategies used most often by the families were the seeking of spiritual support and the reframing of the problem. The results also indicated that if passive appraisal was used as a coping strategy, the patients' marital satisfaction would decrease, and if reframing of the problem was used, the patients' adaptability regarding new challenges facing the family would increase.

  6. Effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery: A meta-analysis

    Science.gov (United States)

    FANG, YU; QIU, ZHANDONG; HU, WENTAO; YANG, JIA; YI, XIYAN; HUANG, LIANGJIANG; ZHANG, SUMING

    2014-01-01

    Cognitive impairments are observed in numerous patients following coronary bypass surgery, and piracetam are nootropic compounds that modulate cerebral functions by directly enhancing cognitive processes. The present meta-analysis was conducted to evaluate the protective effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery. The relevant studies were identified by searching Medline, EMBASE, PubMed and the Cochrane Library up to June 2013 and the pertinent bibliographies from the retrieved studies were reviewed. Data were selected from the studies according to predefined criteria. The meta-analysis included two randomized control trials involving 184 patients and including the Syndrom-Kurz test (SKT). Findings of the meta-analysis showed that following treatment the change from baseline observed in five SKT subtest scores, conducted with piracetam patients, indicated a significant advantage over those patients that were in the placebo group. The subtests included immediate pictured object recall, weighted mean difference (WMD)=0.91, 95% confidence interval (CI) 0.51–1.31, Ppiracetam may have been effective in improving the short-term cognitive performance of patients undergoing coronary bypass surgery. High quality, well-controlled and longer randomized trials are required to corroborate this result. PMID:24396419

  7. Development of a high fidelity pressurized porcine beating heart simulator for cardiac surgery training.

    Science.gov (United States)

    Ribeiro, Igo B; Ngu, Janet M C; Gill, Gurinder; Rubens, Fraser D

    2017-10-01

    Development of a high-fidelity cardiac surgery simulator (CSS) requires integration of a heart model with a mock cardiopulmonary bypass (CPB) circuit that can provide feedback to mimic the pathophysiology of cardiac surgery. However, the cost of commercially available simulators precludes regular use. We describe steps in the construction of a high-fidelity CSS that integrates a pulsatile paracorporeal ventricular-assist device (Pulse-VAD) and a commercially available CPB simulator. Eight porcine hearts were initially prepared. The configuration consisted of cannulation of the distal descending aorta and the inferior vena cava to enable pressurization of the heart after connection to the Califia ® simulator, as well as Pulse-VAD cannulation (fitted with inflatable balloons) of both ventricles. After each simulation run, the team addressed key issues to derive successive model changes through consensus. Key modifications included: a) pressure maintenance of the cardiac chambers (removal of lungs, Pulse-VAD cannulation sites at the left pulmonary artery and vein, double ligation of arch vessels); b) high-fidelity beating of both ventricles (full Pulse-VAD bladder filling and ensuring balloon neck placement at the valvular plane) and c) reproducible management of porcine anatomy (management of porcine aorta, ligation of left azygous vein and shortened ascending thoracic aortic segment). A CSS can be prepared at low cost, with integration into a high-fidelity CPB simulator with a novel beating heart component. This setup can be used in teaching the basics of CPB techniques and complex surgical procedures. Future work is needed to validate this model as a simulation instrument.

  8. Effect of oxygen treatment on heart rate after abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg-Adamsen, S; Lie, C; Bernhard, A

    1999-01-01

    BACKGROUND: Cardiac complications are common during the postoperative period and may be associated with hypoxemia and tachycardia. Preliminary studies in high-risk patients after operation have shown a possible beneficial effect of oxygen therapy on arterial oxygen saturation and heart rate....... METHODS: The authors studied the effect of oxygen therapy on arterial oxygen saturation and heart rate in 100 consecutive unselected patients randomly and double blindly allocated to receive air or oxygen therapy between the first and fourth day after major abdominal surgery. RESULTS: The median arterial...... oxygen saturation rate increased significantly from 96% to 99% (P heart rate decreased significantly from 85 beats/min to 81 beats/min (P heart rate occurred...

  9. Combined Cerebral and Renal Near-Infrared Spectroscopy After Congenital Heart Surgery.

    Science.gov (United States)

    Gil-Anton, Javier; Redondo, Silvia; Garcia Urabayen, Diego; Nieto Faza, Manuel; Sanz, Irene; Pilar, Javier

    2015-08-01

    The maintenance of an adequate oxygen supply to tissues after congenital heart surgery is essential for good outcomes. The objective of this study was to assess the usefulness of near-infrared spectroscopy (NIRS) for estimating central venous oxygen saturation (ScvO2) using both cerebral and renal measurements, explore its relation with cardiac output measurements and check its ability to detect low cardiac output. A prospective observational pilot study was conducted in patients weighing <10 kg undergoing cardiopulmonary bypass surgery. Spectroscopy probes were placed on the forehead and renal area, and serial cardiac output measurements were obtained by femoral transpulmonary thermodilution over the first 24 h after surgery. In the 15 patients studied, ScvO2 was correlated with cerebral (r = 0.58), renal (r = 0.60) and combined (r = 0.71) measurements. Likewise, the systolic index was correlated with the NIRS signals: cerebral (r = 0.60), renal (r = 0.50) and combined (r = 0.66). Statistically significant differences were found in the NIRS measures registered in the 29 low cardiac output events detected by thermodilution: cerebral: 62 % (59-65) versus 69 % (63-76); renal: 83 % (70-89) versus 89 % (83-95); and combined 64 % (60-69) versus 72 % (67-76). In our series, combined cerebral and renal monitoring was correlated with central venous oxygen saturation and cardiac output; low cardiac output detection associated a different spectroscopy pattern.

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

    Directory of Open Access Journals (Sweden)

    Suryaprakash Sharadaprasad

    2011-01-01

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

  11. Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist's panacea or the surgeon's headache?

    Science.gov (United States)

    Kapetanakis, Emmanouil I; Medlam, Diego A; Boyce, Steven W; Haile, Elizabeth; Hill, Peter C; Dullum, Mercedes K C; Bafi, Ammar S; Petro, Kathleen R; Corso, Paul J

    2005-03-01

    Thrombotic complications after percutaneous coronary intervention procedures have decreased in past years mainly due to the use of clopidogrel antiplatelet therapy. However, the risk of bleeding due to enhanced and irreversible platelet inhibition in patients who will require surgical coronary revascularization instead has not been adequately addressed in the literature. The purpose of this study was to evaluate the effect of pre-operative clopidrogel exposure in haemorrhage-related re-exploration rates, peri-operative transfusion requirements, morbidity, and mortality in patients undergoing coronary artery bypass grafting (CABG) surgery. A study population of 2359 patients undergoing isolated CABG between January 2000 and June 2002 was reviewed. Of these, 415 (17.6%) received clopidogrel prior to CABG surgery, and 1944 (82.4%) did not. A risk-adjusted logistic regression analysis was used to assess the association between clopidogrel pre-medication (vs. no) and haemostatic re-operation, intraoperative and post-operative blood transfusion rates, and multiple transfusions received. Haemorrhage-related pre-operative risk factors identified from the literature and those found significant in a univariate model were used. Furthermore, a sub-cohort, matched-pair by propensity scores analysis, was also conducted. The clopidogrel group had a higher likelihood of haemostatic re-operation [OR = 4.9, (95% CI, 2.63-8.97), P < 0.01], an increase in total packed red blood cell transfusions [OR = 2.2, (95% CI, 1.70-2.84), P < 0.01], multiple unit blood transfusions [OR = 1.9, (95% CI, 1.33-2.75), P < 0.01] and platelet transfusions [OR = 2.6, (95% CI, 1.95-3.56), P < 0.01]. Surgical outcomes and operative mortality [OR = 1.5, (95% CI, 0.36-6.51), P = 0.56] were not significantly different. Pre-operative clopidogrel exposure increases the risk of haemostatic re-operation and the requirements for blood and blood product transfusion during, and after, CABG surgery.

  12. Changes in heart rate during third molar surgery.

    Science.gov (United States)

    Hollander, M H J; Schortinghuis, J; Vissink, A

    2016-12-01

    Anxiety is an undesirable psychological phenomenon. Patients are usually anxious when subjected to third molar surgery, but the pattern of anxiety is unknown. The aim of this study was to assess the intensity and course of anxiety during third molar surgery. This study included 48 consecutive patients (mean age 25±6 years) who had a third molar removed surgically under local anaesthesia. The heart rate was monitored continuously during treatment as a measure of anxiety. Preoperative anxiety was scored with the Modified Dental Anxiety Scale. Each patient's anxiety level was assessed when in the waiting room, sitting down in the dental chair, during the application of local anaesthesia, application of surgical drapes, time-out procedure, incision, alveolotomy, removal of the third molar, and suturing, and at the end of the procedure. The lowest heart rates were recorded in the waiting room, in the dental chair, during anaesthesia, when applying surgical drapes, during suturing, and at the end of the procedure. The highest values were obtained during the time-out procedure, incision, and alveolotomy (Pthird molar surgery, with the lowest levels of anxiety prior to surgery and directly postoperative and the highest during the time-out procedure and the actual surgery. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Simultaneous open-heart surgery and pectus deformity correction.

    Science.gov (United States)

    Okay, Tamer; Ketenci, Bulend; Imamoglu, Oya Uncu; Aydemir, Bulent; Tuygun, Abdullah Kemal; Ozay, Batuhan; Yapici, Fikri; Coruh, Turkan Kutsioglu; Demirtas, Mahmut Murat

    2008-01-01

    Pectus deformities and cardiac problems sometimes require simultaneous surgery. We report our experience of performing this surgery and review the relevant literature. We performed simultaneous pectus deformity correction and open-heart surgery in six patients between 1999 and 2006. The pectus deformities were pectus carinatum in one patient and pectus excavatum in five patients. The cardiac problems were coronary artery disease in one patient, an atrioseptal defect (ASD) with a ventricular septal defect (VSD) in one, a VSD in one, mitral valve insufficiency with left atrial dilatation in one, and an ascending aortic aneurysm with aortic valve insufficiency caused by Marfan's syndrome in two. We corrected the pectus deformities using the modified Ravitch's sternoplasty in all patients. First, while the patient was supine, we resected the costal cartilage; then, after completing the cardiac surgery, the sternum was closed and the additional time required for the pectus operation was calculated for each patient. Patients were examined 1, 4, and 6 months postoperatively. The average operation time was 102 min, and there were no major complications. The pectus bars were removed 4-6 months postoperatively. Good cardiac and cosmetic results were achieved in all patients, who were followed up for 5 years. Concomitant pectus deformity correction and open-heart surgery can be performed safely, eliminating the risks of a second operation in a staged procedure.

  14. ProSeal laryngeal mask airway as an alternative to standard endotracheal tube in securing upper airway in the patients undergoing beating-heart coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Kalpana Shah

    2017-01-01

    Full Text Available Background: ProSeal laryngeal mask airways (PLMAs are routinely used after failed tracheal intubation as airway rescue, facilitating tracheal intubation by acting as a conduit and to secure airway during emergencies. In long duration surgeries, use of endotracheal tube (ETT is associated with various hemodynamic complications, which are minimally affected during PLMA use. However, except for few studies, there are no significant data available that promote the use of laryngeal mask during cardiac surgery. This prospective study was conducted with the objective of demonstrating the advantages of PLMA over ETT in the patients undergoing beating-heart coronary artery bypass graft (CABG. Methodology: This prospective, interventional study was carried out in 200 patients who underwent beating-heart CABG. Patients were randomized in equal numbers to either ETT group or PLMA group, and various hemodynamic and respiratory parameters were observed at different time points. Results: Patients in PLMA group had mean systolic blood pressure 126.10 ± 5.31 mmHg compared to the patients of ETT group 143.75 ± 6.02 mmHg. Pulse rate in the PLMA group was less (74.52 ± 10.79 per min (P < 0.05 compared to ETT group (81.72 ± 9.8. Thus, hemodynamic changes were significantly lower (P < 0.05 in PLMA than in ETT group. Respiratory parameters such as oxygen saturation, pressure CO 2 (pCO 2 , peak airway pressure, and lung compliance were similar to ETT group at all evaluation times. The incidence of adverse events was also lower in PLMA group. Conclusion: In experience hand, PLMA offers advantages over the ETT in airway management in the patients undergoing beating-heart CABG.

  15. Tissue-engineered heart valve: future of cardiac surgery.

    Science.gov (United States)

    Rippel, Radoslaw A; Ghanbari, Hossein; Seifalian, Alexander M

    2012-07-01

    Heart valve disease is currently a growing problem, and demand for heart valve replacement is predicted to increase significantly in the future. Existing "gold standard" mechanical and biological prosthesis offers survival at a cost of significantly increased risks of complications. Mechanical valves may cause hemorrhage and thromboembolism, whereas biologic valves are prone to fibrosis, calcification, degeneration, and immunogenic complications. A literature search was performed to identify all relevant studies relating to tissue-engineered heart valve in life sciences using the PubMed and ISI Web of Knowledge databases. Tissue engineering is a new, emerging alternative, which is reviewed in this paper. To produce a fully functional heart valve using tissue engineering, an appropriate scaffold needs to be seeded using carefully selected cells and proliferated under conditions that resemble the environment of a natural human heart valve. Bioscaffold, synthetic materials, and preseeded composites are three common approaches of scaffold formation. All available evidence suggests that synthetic scaffolds are the most suitable material for valve scaffold formation. Different cell sources of stem cells were used with variable results. Mesenchymal stem cells, fibroblasts, myofibroblasts, and umbilical blood stem cells are used in vitro tissue engineering of heart valve. Alternatively scaffold may be implanted and then autoseeded in vivo by circulating endothelial progenitor cells or primitive circulating cells from patient's blood. For that purpose, synthetic heart valves were developed. Tissue engineering is currently the only technology in the field with the potential for the creation of tissues analogous to a native human heart valve, with longer sustainability, and fever side effects. Although there is still a long way to go, tissue-engineered heart valves have the capability to revolutionize cardiac surgery of the future.

  16. [Survival of Overweight Patients After Coronary Artery Bypass Surgery. Does the Obesity Paradox Play a Role?

    Science.gov (United States)

    Efros, L A; Samorodskaya, I V

    2015-07-01

    Although excessive body mass and obesity are considered risk factors of a number of diseases and conditions numerous results of studies evidence for the existence of the "obesity paradox" - higher long-term survival of overweight and obese patients. Aim of this study was to elucidate impact of body mass index (BMI) on postoperative mortality and long-term survival of patients after coronary artery bypass grafting (CABG). The study was conducted on the basis of register of patients with ischemic heart disease who had undergone CABG with or without correction of valvular defects and/or resection of left ventricular (LV) aneurism during the period from 2000 to 2009 in the Chelyabinsk Interregional Cardiosurgical Center. Duration of follow-up was 1 to 10 years (mean - 2.3+/-2.4 years). The patients were divided into groups in dependence on BMI. Multifactorial logistic regression analysis of association of BMI and hospital mortality was carried out with adjustment for age, sex, arterial pressure, presence of diabetes mellitus (DM), chronic obstructive pulmonary disease, LV aneurism, LV ejection fraction, and character of involvement of vessels. Long term survival was studied using Coxs regression model. Compared with group of patients with normal BMI DM and arterial hypertension were more often registered among patients with excessive body mass and obesity. Elevated body mass was not an independent factor of risk of postoperative and lower long-term survival. There was a tendency to lower survival among patients with BMI >35 rg/m2. Results of this study evidence for the absence of proof of negative impact of excessive BMI on hospital mortality and long term survival.

  17. [Survival of Overweight Patients After Coronary Artery Bypass Surgery. Does the "Obesity Paradox" Play a Role?].

    Science.gov (United States)

    Efros, L A; Samorodskaya, I V

    2015-01-01

    Although excessive body mass and obesity are considered risk factors of a number of diseases and conditions numerous results of studies evidence for the existence of the "obesity paradox"--higher long-term survival of overweight and obese patients. Aim of this study was to elucidate impact of body mass index (BMI) on postoperative mortality and long-term survival of patients after coronary artery bypass grafting (CABG). The study was conducted on the basis of register of patients with ischemic heart disease who had undergone CABG with or without correction of valvular defects and/or resection of left ventricular (LV) aneurism during the period from 2000 to 2009 in the Chelyabinsk Interregional Cardiosurgical Center. Duration of follow-up was 1 to 10 years (mean--2.3 ± 2.4 years). The patients were divided into groups in dependence on BMI. Multifactorial logistic regression analysis of association of BMI and hospital mortality was carried out with adjustment for age, sex, arterial pressure, presence of diabetes mellitus (DM), chronic obstructive pulmonary disease, LV aneurism, LV ejection fraction, and character of involvement of vessels. Long term survival was studied using Cox's regression model. Compared with group of patients with normal BMI DM and arterial hypertension were more often registered among patients with excessive body mass and obesity. Elevated body mass was not an independent factor of risk of postoperative and lower long-term survival. There was a tendency to lower survival among patients with BMI > 35 rg/m2. Results of this study evidence for the absence of proof of negative impact of excessive BMI on hospital mortality and long term survival.

  18. Minimally invasive heart valve surgery: how and why in 2012.

    Science.gov (United States)

    Suri, Rakesh M; Thalji, Nassir M

    2012-04-01

    Cardiac surgical procedures via traditional sternotomy are safe and effective operations performed by cardiothoracic surgeons worldwide. However, postoperative limitations in upper extremity activity during bone healing are seen as undesirable by some. Percutaneous catheter-based attempts to emulate the outcomes of traditional cardiac surgical procedures have largely fallen short of established standards of efficacy and durability. The field of minimally invasive heart valve surgery thus developed out of a need to offer smaller, better-tolerated incisions to patients while maintaining high-quality clinical outcomes. These operations are safe and effective when performed by proficient surgical teams, allowing patients to resume normal activities more rapidly. We explore current evidence supporting the practice of minimally invasive heart valve surgery in 2012 and analyze the clinical impact of these nascent surgical platforms.

  19. Prognostic value of paraoxonase 1 in patients undergoing coronary artery bypass grafting surgery

    Science.gov (United States)

    Wysocka, Anna; Cybulski, Marek; Berbeć, Henryk; Wysokiński, Andrzej; Stążka, Janusz; Zapolski, Tomasz

    2014-01-01

    Background The aim of this study was to evaluate whether –108C/T polymorphism of the paraoxonase 1 (PON1) gene and the plasma enzyme activity are risk factors for adverse cardiac events after coronary artery bypass grafting (CABG). Material/Methods Seventy-one patients with coronary heart disease (CHD) undergoing CABG were enrolled in the study. Genomic DNA was extracted from the venous blood using the Gen Elute™ Blood Genomic DNA kit (Sigma) according to the manufacturer’s instructions. PON1 activity was measured in 50 mM glycine/NaOH buffer (pH 10.5) containing 1.0 mM paraoxon, and 1.0mM CaCl2. Results The mean PON1 activity toward paraoxon and toward phenyl acetate was equal (166.5±86.9 U/ml and 96.0±47.2 U/ml, respectively) in patients with CHD. The –108C/T polymorphism of PON1 gene was tested. In CABG patients, PON1 activities in dependence on genotypes were significantly different and equalled 266.2±117.9 U/ml for CC, 178.8±64.7 U/ml for CT, and 98.9±59.2 U/ml for TT genotype. Patients with PON1 activity lower than 193.5 U/ml exhibited significantly increased risk of a serious cardiac event in comparison with patients with PON1 activity higher or equal to this value (p=0.03). Additionally, TT genotype was significantly associated with shorter time of event-free survival in comparison with CT and CC genotypes (p=0.009). Conclusions The PON1 polymorphism and enzyme plasma activity are associated with CHD occurrence. High PON1 activity connected with the presence of CC and CT genotypes decreases the recurrence of symptoms of coronary heart disease and improve prognosis after CABG. PMID:24721823

  20. Coronary-artery bypass surgery in patients with left ventricular dysfunction.

    Science.gov (United States)

    Velazquez, Eric J; Lee, Kerry L; Deja, Marek A; Jain, Anil; Sopko, George; Marchenko, Andrey; Ali, Imtiaz S; Pohost, Gerald; Gradinac, Sinisa; Abraham, William T; Yii, Michael; Prabhakaran, Dorairaj; Szwed, Hanna; Ferrazzi, Paolo; Petrie, Mark C; O'Connor, Christopher M; Panchavinnin, Pradit; She, Lilin; Bonow, Robert O; Rankin, Gena Roush; Jones, Robert H; Rouleau, Jean-Lucien

    2011-04-28

    The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established. Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P=0.12). A total of 201 patients (33%) in the medical-therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P=0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the follow-up period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG. In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. (Funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories; STICH ClinicalTrials.gov number, NCT00023595.).

  1. Changes in Global Transcriptional Profiling of Women Following Obesity Surgery Bypass.

    Science.gov (United States)

    Pinhel, Marcela Augusta de Souza; Noronha, Natalia Yumi; Nicoletti, Carolina Ferreira; de Oliveira, Bruno Affonso Parente; Cortes-Oliveira, Cristiana; Pinhanelli, Vitor Caressato; Salgado Junior, Wilson; Machry, Ana Julia; da Silva Junior, Wilson Araújo; Souza, Dorotéia Rossi Silva; Marchini, Júlio Sérgio; Nonino, Carla Barbosa

    2018-01-01

    Differential gene expression in peripheral blood mononuclear cells (PBMCs) after Roux-en-Y gastric bypass (RYGB) is poorly characterized. Markers of these processes may provide a deeper understanding of the mechanisms that underlie these events. The main goal of this study was to identify changes in PBMC gene expression in women with obesity before and 6 months after RYGB-induced weight loss. The ribonucleic acid (RNA) of PBMCs from 13 obese women was analyzed before and 6 months after RYGB; the RNA of PBMCs from nine healthy women served as control. The gene expression levels were determined by microarray analysis. Significant differences in gene expression were validated by real-time quantitative polymerase chain reaction (RT-qPCR). Microarray analysis for comparison of the pre- and postoperative periods showed that 1366 genes were differentially expressed genes (DEGs). The main pathways were related to gene transcription; lipid, energy, and glycide metabolism; inflammatory and immunological response; cell differentiation; oxidative stress regulation; response to endogenous and exogenous stimuli; substrate oxidation; mTOR signaling pathway; interferon signaling; mitogen-activated protein kinases (MAPK), cAMP response element binding protein (CREB1), heat shock factor 1 (HSF1), and sterol regulatory element binding protein 1c (SREBP-1c) gene expression; adipocyte differentiation; and methylation. Six months after bariatric surgery and significant weight loss, many molecular pathways involved in obesity and metabolic diseases change. These findings are an important tool to identify potential targets for therapeutic intervention and clinical practice of nutritional genomics in obesity.

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

    Directory of Open Access Journals (Sweden)

    Elmar W. Kuhn

    2015-01-01

    Full Text Available The aim of this investigation was to analyze the impact of intermittent cold blood cardioplegia (ICC and intermittent warm blood cardioplegia (IWC on endothelial injury in patients referred to elective on-pump coronary artery bypass graft (CABG surgery. Patients undergoing CABG procedures were randomized to either ICC or IWC. Myocardial injury was assessed by CK-MB and cardiac troponin T (cTnT. Endothelial injury was quantified by circulating endothelial cells (CECs, von Willebrand factor (vWF, and soluble thrombomodulin (sTM. Perioperative myocardial injury (PMI and major adverse cardiac events (MACE were recorded. Demographic data and preoperative risk profile of included patients (ICC: n=32, IWC: n=36 were comparable. No deaths, PMI, or MACE were observed. Levels of CK-MB and cTnT did not show intergroup differences. Concentrations of CECs peaked at 6 h postoperatively with significantly higher values for IWC-patients at 1 h (ICC: 10.1 ± 3.9/mL; IWC: 18.4 ± 4.1/mL; P=0.012 and 6 h (ICC: 19.3 ± 6.2/mL; IWC: 29.2 ± 6.7/mL; P<0.001. Concentrations of vWF (ICC: 178.4 ± 73.2 U/dL; IWC: 258.2 ± 89.7 U/dL; P<0.001 and sTM (ICC: 3.2 ± 2.1 ng/mL; IWC: 5.2 ± 2.4 ng/mL; P=0.011 were significantly elevated in IWC-group at 1 h postoperatively. This study shows that the use of IWC is associated with a higher extent of endothelial injury compared to ICC without differences in clinical endpoints.

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

    Science.gov (United States)

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

    2016-01-01

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

  4. Results of bypass graft surgery after prior angioplasty in critical limb ischaemia treatment.

    Science.gov (United States)

    Cury, Marcus Vinícius Martins; Brochado-Neto, Francisco Cardoso; Matielo, Marcelo Fernando; de Athayde Soares, Rafael; Sarpe, Anna Karina Paiva; Sacilotto, Roberto

    2016-01-01

    The aim of this study was to determine the outcomes of primary bypass graft surgery (BGS) compared to BGS after failed angioplasty (PTA). Between January 2007 and January 2014, we performed 136 BGSs exclusively for the treatment of critical limb ischaemia. Two cohorts were identified: 1) primary BGS (n = 102; group I), and 2) BGS after prior PTA (n = 34; group II). Data were analysed retrospectively and the primary endpoints were the rates of secondary patency, amputation-free survival, freedom from major adverse outcomes (graft occlusion, amputation, or death), and overall survival, which were assessed with the Kaplan-Meier method. Both groups were comparable with a predominance of Rutherford's category 5 ischaemic lesions (73.3 %). Most patients had extensive TASC D athe-rosclerotic disease (83.6 %), and the main conduit was the greater saphenous vein (58.1 %). The mean follow-up time was 36.2 months. The 3-year secondary patency rates were better for group I (64.3 % vs 49.6 %; P = 0.04). During the same period, the amputation-free survival rates were similar between the groups (77.4 % vs 74.5 %; P = 0.59). For multivariate Cox regression analysis, BGS after prior PTA was the only factor associated with re-intervention for limb salvage (hazard ratio = 2.39; CI 95 % = 1.19 - 4.80; P = 0.02). At the 3-year point, there were no differences in the overall survival rates (72.6 % vs 70 %; P = 0.97), but the proportion of patients without adverse outcomes was higher in group I (37.3 % vs 13.4 %; P = 0.007). Although secondary patency was better after primary BGS, the amputation-free and overall survival rates support the use of BGS after prior PTA.

  5. Striatal Dopamine Homeostasis is Altered in Mice Following Roux-en-Y Gastric Bypass Surgery

    Science.gov (United States)

    2015-01-01

    Roux-en-Y gastric bypass (RYGB) is an effective treatment for obesity. Importantly, weight loss following RYGB is thought to result in part from changes in brain-mediated regulation of appetite and food intake. Dopamine (DA) within the dorsal striatum plays an important role in feeding behavior; we therefore hypothesized that RYGB alters DA homeostasis in this subcortical region. In the current study, obese RYGB-operated mice consumed significantly less of a high-fat diet, weighed less by the end of the study, and exhibited lower adiposity than obese sham-operated mice. Interestingly, both RYGB and caloric restriction (pair feeding) resulted in elevated DA and reduced norepinephrine (NE) tissue levels compared with ad libitum fed sham animals. Consequently, the ratio of NE to DA, a measure of DA turnover, was significantly reduced in both of these groups. The RYGB mice additionally exhibited a significant increase in phosphorylation of tyrosine hydroxylase at position Ser31, a key regulatory site of DA synthesis. This increase was associated with augmented expression of extracellular-signal-regulated kinases ERK1/2, the kinase targeting Ser31. Additionally, RYGB has been shown in animal models and humans to improve insulin sensitivity and glycemic control. Curiously, we noted a significant increase in the expression of insulin receptor-β in RYGB animals in striatum (a glucosensing brain region) compared to sham ad libitum fed mice. These data demonstrate that RYGB surgery is associated with altered monoamine homeostasis at the level of the dorsal striatum, thus providing a critical foundation for future studies exploring central mechanisms of weight loss in RYGB. PMID:25068716

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

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    Scheinin Harry

    2011-05-01

    Full Text Available Abstract Background Dexmedetomidine, an alpha2-adrenoceptor agonist, has been evaluated as an adjunct to anesthesia and for the delivery of sedation and perioperative hemodynamic stability. It provokes dose-dependent and centrally-mediated sympatholysis. Coronary artery bypass grafting (CABG with extracorporeal circulation is a stressful procedure increasing sympathetic nervous system activity which could attenuate renal function due the interrelation of sympathetic nervous system, hemodynamics and renal function. We tested the hypothesis that dexmetomidine would improve kidney function in patients undergoing elective CABG during the first two postoperative days. Methods This was a double-blind, randomized, parallel-group study. Patients with normal renal function and scheduled for elective CABG were randomized to placebo or to infusion of dexmedetomidine to achieve a pseudo steady-state plasma concentration of 0.60 ng/ml. The infusion was started after anesthesia induction and continued until 4 h after surgery. The primary endpoint was creatinine clearance. Other variables included urinary creatinine and output, fractional sodium and potassium excretion, urinary potassium, sodium and glucose, serum and urinary osmolality and plasma catecholamine concentrations. The data were analyzed with repeated-measures ANOVA or Cochran-Mantel-Haenszel test. Results Sixty-six of 87 randomized patients were evaluable for analysis. No significant between-group differences were recorded for any indices of renal function except for a mean 74% increase in urinary output with dexmedetomidine in the first 4 h after insertion of a urinary catheter (p Conclusions Use of intravenous dexmedetomidine did not alter renal function in this cohort of relatively low-risk elective CABG patients but was associated with an increase in urinary output. This study was carried out in 1994-1997 and was thus not registered.

  7. Anatomic study of the lacrimal fossa and lacrimal pathway for bypass surgery with autogenous tissue grafting

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    Hai Tao

    2014-01-01

    Full Text Available Purpose: To study the microsurgical anatomy of the lacrimal drainage system and to provide anatomical evidence for transnasal endoscopic lacrimal drainage system bypass surgery by autogenous tissue grafting. Materials and Methods: A total of 20 Chinese adult cadaveric heads in 10% formaldehyde, comprising 40 lacrimal ducts were used. The middle third section of the specimens were examined for the following features: the thickness of the lacrimal fossa at the anterior lacrimal crest, vertical middle line, and posterior lacrimal crest; the cross section of the upper opening, middle part, and lower opening of the nasolacrimal canal; the horizontal, 30° oblique, and 45° oblique distances from the lacrimal caruncle to the nasal cavity; the distance from the lacrimal caruncle to the upper opening of the nasolacrimal duct; and the included angle between the lacrimal caruncle-nasolacrimal duct upper opening junction and Aeby′s plane. Results: The middle third of the anterior lacrimal crest was significantly thicker than the vertical middle line and the posterior lacrimal crest (P > 0.05. The horizontal distance, 30° oblique distance, and 45° oblique distance from the lacrimal caruncle to the nasal cavity exhibited no significant differences (P > 0.05. The included angle between the lacrimal caruncle and the lateral wall middle point of the superior opening line of the nasolacrimal duct and Aeby′s plane was average (49.9° ± 1.8°. Conclusion: The creation of the bony tunnel should start from the middle or posterior middle part of the lacrimal fossa, extending toward the anterior inferior region with an optimal downward oblique angle of 45°.

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

    International Nuclear Information System (INIS)

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

    1991-01-01

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

  9. Effect of Preoperative Inspiratory Muscle Training on Alveolar-Arterial Oxygen Gradients After Coronary Artery Bypass Surgery.

    Science.gov (United States)

    Turky, Khalid; Afify, Amera M Abdelaziz

    2017-07-01

    Gas exchange abnormalities and inspiratory muscle dysfunction are common postoperative pulmonary complications after cardiac surgery. The aim of this study was to investigate the changes in the alveolar arterial oxygen gradients and inspiratory muscle power after preoperative inspiratory muscle training (IMT) followed by postoperative IMT and early mobilization after coronary artery bypass graft surgery. Patients were randomly assigned to the intervention group (n = 20) or the usual care group (n = 20). The intervention group received preoperative IMT by a threshold load inspiratory muscle trainer and education followed by postoperative IMT and early mobilization. The usual care group received preoperative education and postoperative routine physical therapy care. Alveolar-arterial oxygen gradients and oxygen saturation were measured before induction of anesthesia and postoperatively immediately after extubation, at 24 hours, 48 hours, and on day 8 postsurgery. Inspiratory muscle power was measured before surgery, after 48 hours, and on day 8. Forty male patients underwent coronary artery bypass graft surgery. The intervention group showed significant (P inspiratory muscle power at all measurement points. The mean of inspiratory muscle power at discharge was significantly higher than at baseline but not statistically significantly different from the preoperative measurement. Pre- and postoperative IMT by the threshold load inspiratory muscle trainer resulted in improvement of inspiratory muscle power, alveolar-arterial gradient, and oxygen saturation.

  10. Genome-wide assessment for genetic variants associated with ventricular dysfunction after primary coronary artery bypass graft surgery.

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    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.

  11. Roux-en-Y Gastric Bypass Surgery Induces Early Plasma Metabolomic and Lipidomic Alterations in Humans Associated with Diabetes Remission.

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    Tulika Arora

    Full Text Available Roux-en-Y gastric bypass (RYGB is an effective method to attain sustained weight loss and diabetes remission. We aimed to elucidate early changes in the plasma metabolome and lipidome after RYGB. Plasma samples from 16 insulin-resistant morbidly obese subjects, of whom 14 had diabetes, were subjected to global metabolomics and lipidomics analysis at pre-surgery and 4 and 42 days after RYGB. Metabolites and lipid species were compared between time points and between subjects who were in remission and not in remission from diabetes 2 years after surgery. We found that the variables that were most discriminatory between time points were decanoic acid and octanoic acid, which were elevated 42 days after surgery, and sphingomyelins (18:1/21:0 and 18:1/23:3, which were at their lowest level 42 days after surgery. Insulin levels were lower at 4 and 42 days after surgery compared with pre-surgery levels. At 4 days after surgery, insulin levels correlated positively with metabolites of branched chain and aromatic amino acid metabolism and negatively with triglycerides with long-chain fatty acids. Of the 14 subjects with diabetes prior to surgery, 7 were in remission 2 years after surgery. The subjects in remission displayed higher pre-surgery levels of tricarboxylic acid cycle intermediates and triglycerides with long-chain fatty acids compared with subjects not in remission. Thus, metabolic alterations are induced soon after surgery and subjects with diabetes remission differ in the metabolic profiles at pre- and early post-surgery time points compared to patients not in remission.

  12. Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study

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    Pértega-Díaz Sonia

    2009-07-01

    Full Text Available Abstract Background Heart surgery is associated with an occurrence of pulmonary complications. The aim of this study was to determine whether pre-surgery respiratory physiotherapy reduces the incidence of post-surgery pulmonary complications. Methods Observational study of 263 patients submitted to off-pump coronary artery bypass grafting (CABG surgery at the A Coruña University Hospital (Spain. 159 (60.5% patients received preoperative physiotherapy. The fact that patients received preoperative physiotherapy or not was related to whether they were admitted to the cardiac surgery unit or to an alternative unit due to a lack of beds. A physiotherapist provided a daily session involving incentive spirometry, deep breathing exercises, coughing and early ambulation. A logistic regression analysis was carried out in order to identify variables associated with pulmonary complications. Results Both groups of patients (those that received physiotherapy and those that did not were similar in age, sex, body mass index, creatinine, ejection fraction, number of affected vessels, O2 basal saturation, prevalence of diabetes, dyslipidemia, exposure to tobacco, age at smoking initiation, number of cigarettes/day and number of years as a smoker. The most frequent postoperative complications were hypoventilation (90.7%, pleural effusion (47.5% and atelectasis (24.7%. In the univariate analysis, prophylactic physiotherapy was associated with a lower incidence of atelectasis (17% compared to 36%, p = 0.01. After taking into account age, sex, ejection fraction and whether the patients received physiotherapy or not, we observed that receiving physiotherapy is the variable with an independent effect on predicting atelectasis. Conclusion Preoperative respiratory physiotherapy is related to a lower incidence of atelectasis.

  13. Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study.

    Science.gov (United States)

    Yánez-Brage, Isabel; Pita-Fernández, Salvador; Juffé-Stein, Alberto; Martínez-González, Ursicino; Pértega-Díaz, Sonia; Mauleón-García, Angeles

    2009-07-28

    Heart surgery is associated with an occurrence of pulmonary complications. The aim of this study was to determine whether pre-surgery respiratory physiotherapy reduces the incidence of post-surgery pulmonary complications. Observational study of 263 patients submitted to off-pump coronary artery bypass grafting (CABG) surgery at the A Coruña University Hospital (Spain). 159 (60.5%) patients received preoperative physiotherapy. The fact that patients received preoperative physiotherapy or not was related to whether they were admitted to the cardiac surgery unit or to an alternative unit due to a lack of beds. A physiotherapist provided a daily session involving incentive spirometry, deep breathing exercises, coughing and early ambulation. A logistic regression analysis was carried out in order to identify variables associated with pulmonary complications. Both groups of patients (those that received physiotherapy and those that did not) were similar in age, sex, body mass index, creatinine, ejection fraction, number of affected vessels, O2 basal saturation, prevalence of diabetes, dyslipidemia, exposure to tobacco, age at smoking initiation, number of cigarettes/day and number of years as a smoker. The most frequent postoperative complications were hypoventilation (90.7%), pleural effusion (47.5%) and atelectasis (24.7%). In the univariate analysis, prophylactic physiotherapy was associated with a lower incidence of atelectasis (17% compared to 36%, p = 0.01). After taking into account age, sex, ejection fraction and whether the patients received physiotherapy or not, we observed that receiving physiotherapy is the variable with an independent effect on predicting atelectasis. Preoperative respiratory physiotherapy is related to a lower incidence of atelectasis.

  14. Multicenter preoperative stroke risk index for patients undergoing coronary artery bypass graft surgery. Multicenter Study of Perioperative Ischemia (McSPI) Research Group.

    Science.gov (United States)

    Newman, M F; Wolman, R; Kanchuger, M; Marschall, K; Mora-Mangano, C; Roach, G; Smith, L R; Aggarwal, A; Nussmeier, N; Herskowitz, A; Mangano, D T

    1996-11-01

    The paradox of present cardiac surgery is that the more elderly and debilitated patients benefit most from cardiac surgery compared with medical therapy, yet they sustain greater overall risk for morbidity and mortality after cardiac surgery. The goal of the present study was to develop a preoperative index predicting major perioperative neurological events in patients undergoing coronary artery bypass graft surgery. As part of a prospective, multicenter, observational study (McSPI Research Group), we enrolled 2417 patients at 24 academic medical centers in the United States. Patients who died intraoperatively or had concomitant open-heart procedures were excluded from analysis, resulting in a total of 2107 for analysis. Sixty-eight patients (3.2%) developed adverse neurological events, defined as cerebrovascular accident, transient ischemic attack (TIA), or persistent coma. Bivariate analysis was applied to determine associations between preoperative variables and neurological events. Significant bivariate predictors were identified then logically grouped, and for each cluster, a score was calculated based on principal components. Key predictor variables were age, history of previous neurological disease, diabetes, history of vascular disease, previous coronary artery surgery, unstable angina, and history of pulmonary disease, the coefficients for which were used to develop a preoperative stroke risk index that was validated by bootstrap (c-index = 0.778). Stroke risk could then be determined for each patient, calculating a patient's risk for stroke within 95% confidence intervals. With the McSPI stroke risk index developed in this study, neurological risk can be estimated, and the most appropriate group for perioperative therapy can be identified. Further refinement and validation of this index, however, are necessary and are under way in current studies.

  15. Validity and Clinical Utility of Subtyping by the Beck Depression Inventory in Women Seeking Gastric Bypass Surgery.

    Science.gov (United States)

    Ivezaj, Valentina; Barnes, Rachel D; Grilo, Carlos M

    2016-09-01

    The Beck Depression Inventory (BDI) is commonly used in the screening and evaluation process with bariatric surgery candidates despite relatively limited psychometric evidence in this patient group. We examined the validity of the BDI and its clinical utility for subtyping women seeking gastric bypass surgery. One hundred twenty-four women evaluated for gastric bypass surgery were administered the Structured Clinical Interview for DSM-IV (SCID-I/P) and completed a self-report battery of psychosocial measures including the BDI. Based on the SCID-I/P, 12.9 % (n = 16) met criteria for current mood disorder. Receiver operating characteristic (ROC) curve analysis revealed the BDI had a good area under the curve (0.788) for predicting SCID-I/P mood disorder diagnosis; BDI score of >15 optimized both sensitivity and specificity. Patients diagnosed with SCID-I/P mood disorders had significantly higher levels of eating disorder psychopathology, self-esteem, and shame, than those without mood disorders. Based on a BDI cut-off score of >15, 41.9 % (n = 52) were categorized as high-BDI and 58.1 % (n = 72) as low-BDI. Patients characterized as high-BDI also had significantly higher levels of all associated measures than those with low-BDI; effect sizes for the differences by BDI subtyping were generally 2-3 times greater than those observed when comparing SCID-I/P-based mood versus no mood disorder subgroups. In women seeking gastric bypass surgery, the BDI demonstrated limited acceptability efficiency for identifying mood disorders with a cut-point score of >15. When identifying clinical severity, however, subtyping women by BDI scores of >15 may identify a significantly more disturbed subgroup than relying on a SCID-I/P-generated mood disorder diagnosis.

  16. Dacron vs. PTFE as bypass materials in peripheral vascular surgery--systematic review and meta-analysis.

    Science.gov (United States)

    Roll, Stephanie; Müller-Nordhorn, Jacqueline; Keil, Thomas; Scholz, Hans; Eidt, Daniela; Greiner, Wolfgang; Willich, Stefan N

    2008-12-19

    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(R)) 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). 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. 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. 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.

  17. 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.

  18. Dacron® vs. PTFE as bypass materials in peripheral vascular surgery – systematic review and meta-analysis

    Science.gov (United States)

    Roll, Stephanie; Müller-Nordhorn, Jacqueline; Keil, Thomas; Scholz, Hans; Eidt, Daniela; Greiner, Wolfgang; Willich, Stefan N

    2008-01-01

    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. PMID:19099583

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

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    Raissi Kamal

    2009-12-01

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

  20. The current trends of mortality following congenital heart surgery: the Japan Congenital Cardiovascular Surgery Database.

    Science.gov (United States)

    Hoashi, Takaya; Miyata, Hiroaki; Murakami, Arata; Hirata, Yasutaka; Hirose, Keiichi; Matsumura, Goki; Ichikawa, Hajime; Sawa, Yoshiki; Takamoto, Shinichi

    2015-08-01

    Whereas surgical outcomes of congenital heart surgery have improved during the past two decades, there are still measurable postoperative mortalities in this field. This study is aimed at evaluating the current situation of mortality following congenital heart surgery. Data on all registered 28 810 patients in The Japan Congenital Cardiovascular Surgery Database (JCCVSD) between 2008 and 2012 were analysed, except for patients with degenerative cardiomyopathy including dilated, restrictive and hypertrophic cardiomyopathy, and pathologically or histologically malignant cardiac tumours. The number of registered cases increased every year, and reached ∼9000 cases in 2012. The median age at surgery was 0.8 years (range, 0-82). More than half of the patients (54%) who underwent surgery were <1 year old, and 6.0% of all patients were over 18 years old (adults). In this study, all mortalities within 90 days after the operation and mortality at discharge beyond 90 days of hospitalization were defined as '90-day and in-hospital mortality'. The 30-, 90-day and in-hospital mortality rates were 2.3, 3.5 and 4.5%, respectively. The mean and median durations from surgery to death were 61 ± 89 and 28 days (range, 0-717), respectively. Whereas 658 mortalities (51%) occurred within 30 days of surgery, 265 (21%) occurred later than 90 days after surgery. A total of 3630 patients (13%) were hospitalized for more than 90 days after the operation; of those, 3365 patients survived at discharge (93%). Cardiac problems were the most frequent causes of death after the surgery at any point in time, and 7.1 per 1000 patients died at over 30 days after the operation due to solely cardiac. The investigation of JCCVSD revealed that about a half of mortalities occurred later than 30 days; hence 90-day and in-hospital mortality would be a good discriminator that accurately represented the current situation of mortality after congenital heart surgery. Mortalities long after the operation due to

  1. Contemporary cardiac surgery for adults with congenital heart disease.

    Science.gov (United States)

    Beurtheret, Sylvain; Tutarel, Oktay; Diller, Gerhard Paul; West, Cathy; Ntalarizou, Evangelia; Resseguier, Noémie; Papaioannou, Vasileios; Jabbour, Richard; Simpkin, Victoria; Bastin, Anthony J; Babu-Narayan, Sonya V; Bonello, Beatrice; Li, Wei; Sethia, Babulal; Uemura, Hideki; Gatzoulis, Michael A; Shore, Darryl

    2017-08-01

    Advances in early management of congenital heart disease (CHD) have led to an exponential growth in adults with CHD (ACHD). Many of these patients require cardiac surgery. This study sought to examine outcome and its predictors for ACHD cardiac surgery. This is an observational cohort study of prospectively collected data on 1090 consecutive adult patients with CHD, undergoing 1130 cardiac operations for CHD at the Royal Brompton Hospital between 2002 and 2011. Early mortality was the primary outcome measure. Midterm to longer-term survival, cumulative incidence of reoperation, other interventions and/or new-onset arrhythmia were secondary outcome measures. Predictors of early/total mortality were identified. Age at surgery was 35±15 years, 53% male, 52.3% were in New York Heart Association (NYHA) class I, 37.2% in class II and 10.4% in class III/IV. Early mortality was 1.77% with independent predictors NYHA class ≥ III, tricuspid annular plane systolic excursion (TAPSE) <15 mm and female gender. Over a mean follow-up of 2.8±2.6 years, 46 patients died. Baseline predictors of total mortality were NYHA class ≥ III, TAPSE <15 mm and non-elective surgery. The number of sternotomies was not independently associated with neither early nor total mortality. At 10 years, probability of survival was 94%. NYHA class among survivors was significantly improved, compared with baseline. Contemporary cardiac surgery for ACHD performed at a single, tertiary reference centre with a multidisciplinary approach is associated with low mortality and improved functional status. Also, our findings emphasise the point that surgery should not be delayed because of reluctance to reoperate only. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. The cardioprotective effects of thoracal epidural anestesia are induced by the expression of vascular endothelial growth factor and inducible nitric oxide synthase in cardiopulmonary bypass surgery.

    Science.gov (United States)

    Gonca, S; Kiliçkan, L; Dalçik, C; Dalçik, H; Bayindir, O

    2007-02-01

    The cardioprotective effects of thoracal epidural anesthesia (TEA) are induced by the expression of vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (i-NOS) in cardiopulmonary bypass (CPB) surgery. When general anaesthesia (GA) is combined with TEA during coronary artery bypass graft, we investigated whether TEA together with GA play a role on VEGF and i-NOS expression in human heart tissue in cardiac ischemia. Right atrial biopsy samples were taken before CPB, before aortic cross clamp (ACC) and at 15 min after ACC release (after ischemia and reperfusion). Human heart tissues were obtained from the TEA+GA and GA groups. Immunocytochemistry was performed using antibodies for VEGF and i-NOS. Both VEGF and i-NOS immunoreactivity was observed in cardiomyocytes and arteriol walls. Although VEGF and i-NOS immunoreactivity was apparent in both groups,, immunostaining intensity was greater in the TEA+GA group than the GA group. Between groups, at 4 h and at 24 h after the end of CPB, the cardiac index (CI) was significantly higher in the TEA+GA group than GA group (3.4+/-0.8 L/min/m(2) vs 2.5+/-0.8 L/min/m(2); P0.05), (2.6+/-0.8 L/min/m(2) vs 3.1+/-1.1 L/min/m(2); P>0.05) respectively. After ACC release, 11/40 (27.5%) patients in the TEA+GA group showed ventricular fibrillation (VF), atrial fibrillation or heart block versus 25/40 (62.5%) of those in the GA group. VF after ACC release in the TEA+GA group (9/20 patients, 22.5%) was significantly lower than in the GA group (21/40 patients, 52.5%); (P<0.006). Sinus rhythm after ACC release in the TEA+GA group (29/40 patients, 72.5%) was significantly higher than in the GA group (15/40 patients, 37.5%); (P<0.002). The results of the present study indicate that TEA plus GA in coronary surgery preserve cardiac function via increased expression of VEGF and i-NOS, improved hemodynamic function and reduced arrhythmias after ACC release.

  3. Esophagus-duodenum Gastric Bypass Surgery Improves Glucose and Lipid Metabolism in Mice

    OpenAIRE

    Rui He; Yue Yin; Yin Li; Ziru Li; Jing Zhao; Weizhen Zhang

    2018-01-01

    Background: Despite of its significant therapeutic effects on obesity and metabolic diseases, Roux-en-Y gastric bypass (RYGB) has limited clinical application because of considerable impacts on the gastrointestinal structure and postoperative complications. This study aims to develop a simplified surgical approach with less damage and complication but efficient metabolic benefit. Methods: The effects of Esophagus-Duodenum gastric bypass (EDGB) on body weight, food intake, glucose and lipid...

  4. Decreased Cardiovascular Risk after Roux-en-Y Gastric Bypass Surgery in Chinese Diabetic Patients with Obesity.

    Science.gov (United States)

    Zhao, Xue; Duan, Wenyan; Sun, Chenglin; Li, Zhuo; Liu, Yujia; Xiao, Xianchao; Wang, Gang; Gang, Xiaokun; Wang, Guixia

    2017-01-01

    The influence of bariatric surgery on cardiovascular risks in Chinese diabetic patients remains unclear. Here, we aimed to explore the impact of Roux-en-Y gastric bypass surgery (RYGB) on cardiovascular risks in Chinese diabetic patients with obesity. Twenty Chinese patients with T2DM and obesity undergoing RYGB surgery were included in this study. Cardiovascular risk factors were measured before and 18 months after surgery. A 10-year cardiovascular risk was calculated by the UKPDS risk engine. Linear regression analysis was performed on CHD risk, stroke risk, and baseline metabolic parameters. The complete remission rate of diabetes was 90% after RYGB surgery, with significant improvements in blood pressure, BMI, glucose, and lipid metabolism ( P women,  5 years, using noninsulin therapy presented more obvious improvements in the 10-year cardiovascular risk after RYGB surgery. WHR, age, LDL-C, and HbA1c were the most important factors influencing CHD or stroke risk after RYGB surgery ( P treatment to reduce cardiovascular risk in Chinese diabetic patients with obesity.

  5. Heart Surgery Experience in Hitit University Faculty of Medicine Corum Research and Training Hospital: First Year Results

    Directory of Open Access Journals (Sweden)

    Adem Diken

    2014-03-01

    Full Text Available Aim: We aimed to assess the clinical outcomes of our department of cardiac surgery which was newly introduced in Hitit University Corum Education and Research Hospital. Material and Method: Between November 2012 and November 2013, a total of 110 open-heart surgeries were performed. Ten out of these (9.1% were emergency operations for acute ST elevation myocardial infarction Off-pump technique was used in 31 (29.2% patients and cardiopulmonary bypass was used in 75 (70.8%. A total of 106 patients received coronary artery bypass grafting, 1 received mitral reconstruction, 1 received Bentall procedure, 1 received tricuspid valve repair, 1 received mitral valve replacement, 1 received aortic valve replacement with aortic root enlargement and 1 received aortic supracoronary graft replacement. Results: Hospital mortality occurred in 1 (0.9% patient. Four patients (3.6% who were on dual antiaggregants underwent a revision for bleeding on the day of the operation. Morbidities occurred in 3 (2.7% patients. Atrial fibrillation occurred in 11 (10% patients and the normal sinus rhythm was achieved by amiodarone. Intraaortic balloon counterpulsation was used in 5 (4.5% patients. Discussion: The newly introduced cardiac surgery department of the Hitit University Corum Education and Research Hospital, which provides tertiary care to a wide rural community, serves with low morbidity and mortality.

  6. Cardiac rehabilitation outcomes no different after on-pump versus off-pump coronary artery bypass surgery.

    Science.gov (United States)

    Aron, Adrian; Klinger, Troy A; McConnell, Timothy R

    2007-01-01

    Clinical evidence supports lower morbidity with off-pump coronary revascularization surgery as well as superior short- and mid-term outcomes, equivalent graft patency, and reduced cost. The purpose of this study was to compare cardiac rehabilitation (CR) outcomes between patients undergoing on-pump versus off-pump coronary artery bypass surgery. Data were retrospectively examined for patients who participated in CR between 1996 and 2004. Two hundred ninety-five patients who underwent bypass surgery and completed at least 80% of their 36 required sessions were divided into on-pump and off-pump groups. Pre- and post-CR measures included grip strength, flexibility, energy expended during class, quality of life, and self-efficacy. Both groups were similar with respect to age, sex, ejection fraction, and mean number of grafts. There were no statistical differences between the on-pump and off-pump groups (P > .05) for weight, abdominal and hip circumferences, grip strength, flexibility, and total energy expenditure. In addition, there were no between-group differences regarding quality of life and self-efficacy. Grip strength, flexibility, and energy expenditure during class improved with CR regardless of the surgical procedure (P = .001). Quality of life (P = .001) and self-efficacy (P = .001) also improved. The present data support the concept that although there are clinical advantages to off-pump surgery, there is no benefit over on-pump surgery regarding CR. Subsequently, patients undergoing off-pump surgery should be managed similarly as their on-pump counterparts.

  7. Effect of methylprednisolone on the oxidative burst activity, adhesion molecules and clinical outcome following open heart surgery

    DEFF Research Database (Denmark)

    Toft, P; Christiansen, K; Tønnesen, Else Kirstine

    1997-01-01

    Following cardiac surgery with cardiopulmonary bypass (CPB), activated granulocytes may be involved with ischaemia/ reperfusion injury. The purpose of this study was to investigate whether steroids could reduce the oxidative burst activity of granulocytes, the expression of adhesion molecules...... and the control group regarding the expression of adhesion molecules or the oxidative burst activity. In the steroid group the fluid gain during extracorporeal circulation (ECC) was 683 ml (median) compared to 1488 ml in the control group. Steroids prevented hyperthermia in the postoperative period but did...... not improve the weaning from the ventilator or reduce the stay in the intensive-care unit. In conclusion, treatment with steroids prevented hyperthermia following open heart surgery with CPB and reduced capillary leak during ECC. Methylprednisolone, however, did not reduce the oxidative burst activity...

  8. 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.…

  9. Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomised control trial.

    Science.gov (United States)

    Nilsson, Ulrica

    2009-08-01

    To evaluate the effect of bed rest with music on relaxation for patients who have undergone heart surgery on postoperative day one. Music intervention has been evaluated as an appropriate nursing intervention to reduce patients 'pain, stress and anxiety levels in several clinical settings, but its effectiveness in increasing patients' subjective and objective relaxation levels has not been examined. A randomised controlled trial. Forty patients undergoing open coronary artery bypass grafting and/or aortic valve replacement surgery were randomly allocated to either music listening during bed rest (n = 20) or bed rest only (n = 20). Relaxation was assessed during bed rest the day after surgery by determining the plasma oxytocin, heart rate, mean arterial blood pressure, PaO2 SaO2 and subjective relaxation levels. In the music group, levels of oxytocin increased significantly in contrast to the control group for which the trend over time was negative i.e., decreasing values. Subjective relaxation levels increased significantly more and there were also a significant higher levels of PaO2 in the music group compared to the control group. There was no difference in mean arterial blood pressure, heart rate and SaO2 between the groups. Listening to music during bed rest after open-heart surgery has some effects on the relaxation system as regards s-oxytocin and subjective relaxations levels. This effect seems to have a causal relation from the psychological (music makes patients relaxed) to the physical (oxytocin release). Music intervention should be offered as an integral part of the multimodal regime administered to the patients that have undergone cardiovascular surgery. It is a supportive source that increases relaxation.

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

    Directory of Open Access Journals (Sweden)

    Predrag M. Mitrovic

    2009-01-01

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

  11. Changes in activities performed in leisure time after open heart surgery.

    Science.gov (United States)

    Bunzel, B; Eckersberger, F

    1989-06-01

    To assess any changes made in the leisure activities performed after open heart surgery, 94 patients (48 with aortocoronary bypass operation, 46 with valve replacements) were asked exactly one year postoperatively whether activities, collected in a list of 21 items, had increased, decreased or remained equal since their operation. In spite of the fact that most leisure activities seemed to have remained unchanged, after operation patients seem to undertake activities quite contrary to their motivations for undergoing surgery in the first place: active participation (such as involvement in some kind of sport, going out to cinema, theatre, restaurants,...) decreases, whereas passive activities (such as watching sports on television, listening to music,...) increases significantly. Although 90% of the patients stated their physical, and 67% their emotional status, as being clearly improved compared to preoperative values, the experience of body limitations as well as of fear and anxiety seems to be so durable that the patients, now in good condition, become passive onlookers and cease to participate in social life.

  12. The decline in hip bone density after gastric bypass surgery is associated with extent of weight loss.

    Science.gov (United States)

    Fleischer, J; Stein, E M; Bessler, M; Della Badia, M; Restuccia, N; Olivero-Rivera, L; McMahon, D J; Silverberg, S J

    2008-10-01

    Bariatric surgery is common and may be associated with deleterious effects on the skeleton. Our objective was to assess bone metabolism and bone mineral density (BMD) after Roux-en-Y gastric bypass. We conducted a 1-yr prospective longitudinal study at a university hospital bariatric surgery practice and metabolic bone disease unit. Participants included 23 obese (mean body mass index 47 kg/m(2)) men and women, aged 20-64 yr. Serum PTH, 25-hydroxyvitamin D, osteocalcin, and urinary N-telopeptide, and BMD were assessed. Patients lost 45 +/- 2 kg 1 yr postoperatively (P rose (P hip (8.0%, P hip: r = 0.65, P = 0.02). Lumbar spine and distal radius sites did not change. After Roux-en-Y gastric bypass, there was evidence of calcium and vitamin D malabsorption. Bone turnover increased, and hip bone density rapidly declined. The decline in hip BMD was strongly associated with weight loss itself. Vigilance for nutritional deficiencies and bone loss in patients both before and after bariatric surgery is crucial.

  13. [Emergency Bypass Surgery for Progressive Cerebral Infarction Following Hemorrhagic Onset of Moyamoya Disease:A Case Report].

    Science.gov (United States)

    Hatakeyama, Junya; Yanagisawa, Toshiharu; Kudo, Erina; Togashi, Shuntaro; Shimizu, Hiroaki

    2016-10-01

    Progressive cerebral infarction in patients with hemorrhagic onset of moyamoya disease is rare, and a treatment strategy is not well established. Here, we report a case that was successfully treated with emergency bypass surgery. A 58-year-old woman presented with a sudden disturbance of consciousness and right-sided hemiparesis. Computed tomography(CT)showed intraventricular hemorrhage involving the head of the left caudate nucleus. Ventricular drainage was immediately performed, and the patient was treated conservatively. Magnetic resonance(MR)angiography revealed bilateral stenosis of the supraclinoid internal carotid artery(ICA), and arterial spin labeling(ASL)showed low signal intensity in the left cerebral hemisphere. The patient was diagnosed with hemorrhagic onset of moyamoya disease with cerebral infarction. Her neurological symptoms worsened on the 7th day after ictus despite medical treatment. MR imaging showed a new infarction in the left insular cortex. Based on the diagnosis of progressive stroke, emergency anastomoses between the superficial temporal artery and the middle and anterior cerebral arteries, along with encephalo-duro-myo-synangiosis, were performed. Her symptoms gradually improved following surgery, and 1 month later, she was able to regain independent function. Emergency bypass surgery may be the treatment of choice for patients with hemorrhagic onset of moyamoya disease presenting with progressive cerebral infarction, despite conservative treatments.

  14. Geographical Difference of the Interaction of Sex With Treatment Strategy in Patients With Multivessel Disease and Left Main Disease: A Meta-Analysis From SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery), PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and BEST (Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease) Randomized Controlled Trials.

    Science.gov (United States)

    Sotomi, Yohei; Onuma, Yoshinobu; Cavalcante, Rafael; Ahn, Jung-Min; Lee, Cheol Whan; van Klaveren, David; de Winter, Robbert J; Wykrzykowska, Joanna J; Farooq, Vasim; Morice, Marie-Claude; Steyerberg, Ewout W; Park, Seung-Jung; Serruys, Patrick W

    2017-05-01

    The impact of sex on clinical outcomes of percutaneous coronary intervention and coronary artery bypass graft for patients with multivessel coronary disease and unprotected left main disease could be dissimilar between Western and Asian populations. To assess clinical outcomes after percutaneous coronary intervention or coronary artery bypass graft in women and men with multivessel coronary disease and unprotected left main disease, a pooled analysis (n=3280) was performed using the patient-level data from 3 large randomized trials: SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery), PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease), and BEST (Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials. The primary end point was all-cause death. Of 3280 patients, 794 patients (24.2%) were women. The median follow-up period was 1806 days (1611-1837 days). In women, a high heterogeneity of the treatment effect among the 3 trials was found for all-cause death ( I 2 >50%), whereas in men, it was consistent across the 3 trials. In the Western trial (SYNTAX), female sex favored coronary artery bypass graft compared with percutaneous coronary intervention (hazard ratio (percutaneous coronary intervention) 2.213; 95% confidence interval, 1.242-3.943; P =0.007), whereas in the Asian women (PRECOMBAT and BEST), the treatment effect was neutral between both strategies. Sex interaction with treatment strategy was evident in the Western trial ( P interaction =0.019) but not in the Asian trials (PRECOMBAT P interaction =0.469 and BEST P interaction =0.472; I 2 =58%). The present meta-analysis suggested the presence of the heterogeneous sex-treatment interaction across Asian and Western trials. Considering the ongoing globalization of our medical practice, the heterogeneity of the sex-treatment interaction needs to be

  15. Utility of thromboelastography versus routine coagulation tests for assessment of hypocoagulable state in patients undergoing cardiac bypass surgery.

    Science.gov (United States)

    Sharma, Seema; Kumar, Sujeet; Tewari, Prabhat; Pande, Shantanu; Murari, Manjula

    2018-01-01

    Peri-operative monitoring of coagulation is important to diagnose potential cause of hemorrhage, to manage coagulopathy and guide treatment with blood products in patients undergoing cardiac surgery with cardiopulmonary bypass. This study was done to evaluate usefulness of Thromboelastography (TEG) and routine coagulation tests (RCT) in assessing hemostatic changes and predicting postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass. Fifty adult patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled in this prospective study. Preoperative and post-operative samples were collected for routine coagulation tests and TEG. Regression analysis and test of significance using Pearson's correlation coefficient was performed to assess correlation between routine coagulation tests and corresponding TEG parameters .Regression analysis was done to study relation between blood loss at 24 hours and various coagulation parameters. The Routine coagulation test i.e. PT, INR, APTT showed no significant correlation with corresponding TEG parameters in pre-operative samples. However platelet count significantly correlated (p = 0.004) with MA values in postoperative samples. A significant correlation (p = 0.001) was seen between fibrinogen levels and alpha angles as well as with MA in both baseline preoperative and postoperative samples. TEG parameters R time and MA in postoperative samples were the only parameters that predicted bleeders with fair accuracy. Though the techniques of RCT and TEG are different, a few RCT e.g. platelet count and fibrinogen correlated with corresponding TEG parameters i.e. MA and Alpha angle. TEG parameters (R time and MA in postoperative samples) were able to predict blood loss better than RCT.

  16. Percutaneous Coronary Intervention of Left Main Disease: Pre- and Post-EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) Era.

    Science.gov (United States)

    Park, Duk-Woo; Park, Seung-Jung

    2017-06-01

    For nearly half a century, coronary artery bypass grafting has been the standard treatment for patients with obstructive left main coronary artery (LMCA) disease. However, there has been considerable evolution in the field of percutaneous coronary intervention, and especially, percutaneous coronary intervention for LMCA disease has been rapidly expanded with adoption of drug-eluting stents. Some, but not all randomized trials, have shown that percutaneous coronary intervention with drug-eluting stents might be a suitable alternative for selected patients with LMCA disease instead of bypass surgery. However, none of previous trials involving early-generation drug-eluting stents was sufficiently powered and comparative trials using contemporary drug-eluting stents were limited. Recently, primary results of 2 new trials of EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) were reported. However, these trials showed conflicting results, which might pose uncertainty on the optimal revascularization strategy for LMCA disease. In this article, with the incorporation of a key review on evolution of LMCA treatment, we summarize the similarity or disparity of the EXCEL and NOBLE trials, focus on how they relate to previous trials in the field, and finally speculate on how the treatment strategy may be changed or recommended for LMCA treatment. © 2017 American Heart Association, Inc.

  17. Open heart surgery in Ilorin: case report and experience with the first ...

    African Journals Online (AJOL)

    Open heart surgery is uncommonly done in Nigeria and restricted to few centres despite the burden of congenital heart disease. We present our first experience with open heart surgery at the University of Ilorin Teaching Hospital. A 15 years old female adolescent presented with a 2 years history of easy fatigability, ...

  18. Evaluation of insulin resistance improvement after laparoscopic sleeve gastrectomy or gastric bypass surgery with HOMA-IR.

    Science.gov (United States)

    Zhu, Yubing; Sun, Zhipeng; Du, Yanmin; Xu, Guangzhong; Gong, Ke; Zhu, Bin; Zhang, Nengwei

    2017-01-01

    Our purpose was to explore the remission of insulin resistance after bariatric surgery to discover the mechanism of diabetes remission excluding dietary factors. A retrospective case control study was conducted on patients with type 2 diabetes, who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric bypass surgery (LGB) in Beijing Shijitan Hospital from April 1, 2012 to April 1, 2013. The laboratory and anthropometric data was analyzed pre-surgery and during a 2-year follow-up. HOMA-IR was calculated and evaluated. The two surgical procedures were compared. No significant difference in complete remission rate was observed between the two groups (LGB group: 62.1%, LSG group: 60.0%, p = 0.892). HOMA-IR was reduced to a stable level at the 3 rd month after surgery. The cut-off value of HOMA-IR was 2.38 (sensitivity: 0.938, specificity: 0.75) and 2.33 (sensitivity: 0.941, specificity: 0.778) respectively for complete remission after LSG or LGB surgery. Insulin resistance was improved while GLP-1 and Ghrelin was changed significantly in patients with type 2 diabetes prior to weight loss either in the LSG or LGB group. HOMA-IR decreased to less than the cut-off value at the 3 rd month and was closely related to complete remission. The mechanism of bariatric surgery was not due just to simply dietary factors or body weight loss but also the remission of insulin resistance.

  19. Minimally invasive extracorporeal circulation: excellent outcome and life expectancy after coronary artery bypass grafting surgery.

    Science.gov (United States)

    Winkler, Bernhard; Heinisch, Paul Philipp; Zuk, Grzegorz; Zuk, Katarzyna; Gahl, Brigitta; Jenni, Hans-Jörg; Kadner, Alexander; Huber, Christoph; Carrel, Thierry

    2017-07-11

    Coronary artery bypass grafting (CABG) remains the gold standard for complex revascularisation in multivessel disease. The concept of the minimally invasive extracorporeal circulation circuit (MiECC) was introduced to minimise pathophysiological side effects of conventional extracorporeal circulation. This study presents early and long-term outcomes after CABG with use of MiECC in a single-centre consecutive patient cohort. From 1 January 2005 to 31 December 2010, 2130 patients underwent isolated CABG with MiECC at our centre. We evaluated morbidity and mortality follow-up data with a median follow-up of 3.6 years. Kaplan-Meier curves and estimates of the primary end-point for all-cause mortality were compared with the life expectancy of the general population. Mortality in CABG patients was comparable to the general population beginning 1 year after surgery for the whole observation period. All-cause 30-day mortality was 0.8%. The mean estimated logistic EuroSCORE and EuroSCORE II were 5.8 ± 8.6 and 3.0 ± 5.1, respectively. Mean perfusion time was 71.1 ± 23.8 min with a cross-clamp time of 44.9 ± 16.3 min. Mortality was predicted by the presence of diabetes mellitus (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.40-2.46; p <0.001), peripheral arterial disease (OR 2.36, 95% CI 1.64-3.38; p <0.001), severe obstructive pulmonary disease (OR 3.21, 1.42-7.24; p = 0.005), chronic renal failure (OR 3.68, 2.49-5.43; p <0.001) and transfusion of more than one unit of erythrocyte concentrate in the perioperative period (OR 1.46, 1.09-1.95; p = 0.015). Cerebrovascular events occurred in 36 patients (1.7%). CABG with use of MiECC is associated with a mortality rate comparable to the overall life expectancy of the general population. MiECC is the first choice for routine and emergency CABG at our centre with a 30-day mortality rate of 0.8% and a low complication rate.

  20. Comparison of the quality of life after conventional versus off-pump coronary artery bypass surgery.

    Science.gov (United States)

    Kapetanakis, Emmanouil I; Stamou, Sotiris C; Petro, Kathleen R; Hill, Peter C; Boyce, Steven W; Bafi, Ammar S; Corso, Paul J

    2008-01-01

    Numerous studies have focused on off-pump coronary artery bypass graft (off-pump CABG) morbidity and mortality outcomes, but few looked at the patient's perception of the technique and its effect on postoperative quality of life (QOL). We investigated and compared postoperative QOL in patients who had undergone either conventional or off-pump CABG myocardial revascularization. During a six-month period, 191 patients who underwent CABG surgery were prospectively studied through preoperative and six-month postoperative short-form 36 (SF-36) general health status surveys. One hundred-sixteen (60.7%) off-pump CABG patients and 75 (39.3%) conventional on-pump CABG patients were enrolled. Sixteen (13.8%) off-pump patients reported improvement in physical score QOL, 84 (72.4%) reported no change, and 16 (13.8%) reported a decrease. In comparison, 20 (80.0%) patients in the on-pump CABG group reported an improvement in QOL, 42 (56.0%) were unchanged, and 13 (17.3%) reported deterioration (p = 0.28). For postoperative change in mental score, 19 (16.4%) off-pump patients reported an improvement, 85 (73.3%) stayed unchanged, and 12 (10.3%) reported a decrease compared with 8 (10.7%) conventional CABG patients reporting improvement, 60 (80.0%) showing no change, and 7 (9.3%), having a score decline (p = 0.52). In multivariate logistic regression analysis, hypertension (odds ratio [OR] 2.2, 95% confidence intervals [CI], 1.08 to 4.40, p = 0.03) and multivessel coronary artery disease (OR 2.1, 95% CI, 1.11 to 4.13, p = 0.02) emerged as independent predictors of worse physical score component score. Diabetes was associated with an improved physical score component score after CABG (OR 0.4, 95% CI, 0.17 to 0.76, p = 0.01), regardless of the surgical approach. This prospective study reveals no significant differences in the expected QOL at six months after either on-pump or off-pump CABG. Patients with hypertension and multivessel coronary artery disease were more likely to have

  1. Differences in perioperative femoral and radial arterial blood pressure in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass

    OpenAIRE

    Cho, Hwa Jin; Lee, Sang Hoon; Jeong, In Seok; Yoon, Nam Sik; Ma, Jae Sook; Ahn, Byoung Hee

    2018-01-01

    Abstract Objective: Several reports claim that blood pressure (BP) in the radial artery may underestimate the accurate BP in critically ill patients. Here, the authors evaluated differences in mean blood pressure (MBP) between the radial and femoral artery during pediatric cardiac surgery to determine the effectiveness of femoral arterial BP monitoring. Method: The medical records of children under 1 year of age who underwent open-heart surgery between 2007 and 2013 were retrospectively rev...

  2. Body Contouring Surgery and the Maintenance of Weight-Loss Following Roux-En-Y Gastric Bypass: A Retrospective Study.

    Science.gov (United States)

    Smith, Oliver J; Hachach-Haram, Nadine; Greenfield, Max; Bystrzonowski, Nicki; Pucci, Andrea; Batterham, Rachel L; Hashemi, Majid; Mosahebi, Afshin

    2018-02-17

    Bariatric surgery leads to significant weight loss with reduced morbidity and mortality. However, excess skin as a consequence of weight loss represents a major problem, impacting upon patient's functionality with potential negative effects on weight loss. We evaluated the effect of body-contouring surgery on weight-loss maintenance following bariatric surgery. We undertook a retrospective analysis of patients undergoing Roux-en-Y gastric bypass (RYGB) +/- body-contouring surgery (BC). The control group (n = 61) received RYGB, the test group (n = 30) received RYGB+BC 12 to 18 months after bariatric surgery. Each RYGB+BC patient was matched to two control patients for age, sex, glycaemic status, and weight on day of surgery. Per cent weight loss (%WL) was calculated at 3, 6, 12, 24, 36, 48, and 60 months post-RYGB for both groups. The %WL was similar at 3, 6, and 12 months post-RYGB. At 24 months, %WL was 35.6% in the RYGB+BC group and 30.0% in the RYGB group (P RYGB+BC group maintained their weight loss (%WL 33.0%), in contrast, the RYGB gained weight (%WL = 27.3%, P RYGB+BC vs RYGB) at 48 months (%WL 30.8% vs 27.0%) and at 60 months (%WL 32.2% vs 22.7%, P < 0.05). Our results suggest patients who undergo body contouring after bariatric surgery are able to lose significantly more weight and maintain weight loss at five years of follow up compared to those undergoing bariatric surgery alone. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  3. Roux-en-Y Gastric Bypass Surgery But Not Vertical Sleeve Gastrectomy Decreases Bone Mass in Male Rats

    Science.gov (United States)

    Stemmer, Kerstin; Bielohuby, Maximilian; Grayson, Bernadette E.; Begg, Denovan P.; Chambers, Adam P.; Neff, Christina; Woods, Stephen C.; Erben, Reinhold G.; Tschöp, Matthias H.; Bidlingmaier, Martin; Clemens, Thomas L.

    2013-01-01

    The most effective treatment for obesity is bariatric surgery. However, there is increasing concern that bariatric surgery can cause nutrient deficiencies that translate into metabolic bone disease. Whether this is true for all surgery types is not yet clear. We therefore investigated the effects of 2 commonly applied bariatric surgeries (Roux-en-Y gastric bypass [RYGB] and vertical sleeve gastrectomy) on energy and bone metabolism in rats 60 days after surgery. Both surgeries resulted in similar reductions of body weight, body fat, and food intake. Glucose tolerance was improved to a similar extent after both surgeries and was accompanied by increased postprandial secretion of glucose-dependent insulinotropic peptide. Using microcomputed tomography, we found that, relative to sham-operated rats, bone volume was significantly reduced after RYGB but not vertical sleeve gastrectomy. RYGB rats also had markedly reduced lipid absorption from the intestine and significantly lower serum 25-hydroxyvitamin D and calcium levels. Importantly, dietary supplementation with calcium and vitamin D could not fully rescue the reduced bone volume after RYGB surgery. Both surgeries resulted in a significant increase in stomach pH, which may have worsened the malabsorption in RYGB rats. Our findings suggest that bone loss in RYGB rats is not exclusively driven by calcium and vitamin D malabsorption but also by additional factors that may not be rescuable by dietary supplementation. These data point toward important similarities and differences between bariatric procedures that should be considered in clinical settings as guidance for which procedure will be best for specific patient populations. PMID:23554454

  4. Bypass or not? Adjustment of surgical strategies according to motor evoked potential changes in large middle cerebral artery aneurysm surgery.

    Science.gov (United States)

    Chen, Liang; Lang, Liqin; Zhou, Liangfu; Song, Donglei; Mao, Ying

    2012-02-01

    To report the use of neuroelectrophysiologic monitoring to alter the course in aneurysm surgery to minimize postoperative infarction and bypass-related adverse events. Two patients with large middle cerebral artery (MCA) aneurysms were admitted to the authors' hospital. Direct clipping seemed to be difficult, and postoperative paralysis was not rare in the authors' experience owing to prolonged temporal occlusion of the parent artery. Balloon test occlusion (BTO) was positive in one patient, who developed paralysis and aphasia 3 minutes after balloon occlusion of the feeding M1 artery. A bypass procedure seemed to be inevitable in both patients. Motor evoked potentials (MEPs) and sensory evoked potentials (SEPs) were used for monitoring during the operation. For the patient with a positive BTO result, MEP waves did not change until 17 minutes after temporary clip placement. The aneurysm was clipped, and the occlusion time was 24 minutes. MEP waves recovered quickly after reperfusion. In the other patient, there were early changes in MEP waves after temporary clipping. After bypass construction from the temporal artery to the inferior M2 trunk, the time window of safe occlusion was prolonged to 7-8 minutes. Both the aneurysm and the bypassed branch were obliterated, and the clip reconstruction was done to preserve the flow from M1 to the superior M2 trunk. Permanent postoperative disability did not occur in either patient. Intraoperative physiologic monitoring is a complementary method to preoperative BTO to evaluate the window of safe occlusion with high reliability. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Cevdet Ugur Kocogulları

    Full Text Available Abstract INTRODUCTION: Elevated hemoglobin A1c levels in patients with diabetes mellitus have been known as a risk factor for acute kidney injury after coronary artery bypass grafting. However, the relationship between hemoglobin A1c levels in non-diabetics and acute kidney injury is under debate. We aimed to investigate the association of preoperative hemoglobin A1c levels with acute kidney injury in non-diabetic patients undergoing isolated coronary artery bypass grafting. METHODS: 202 non-diabetic patients with normal renal function (serum creatinine <1.4 mg/dl who underwent isolated coronary bypass were analyzed. Hemoglobin A1c level was measured at the baseline examination. Patients were separated into two groups according to preoperative Hemoglobin A1c level. Group 1 consisted of patients with preoperative HbA1c levels of < 5.6% and Group 2 consisted of patients with preoperative HbA1c levels of ≥ 5.6%. Acute kidney injury diagnosis was made by comparing baseline and postoperative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease Improving Global Outcomes (KDIGO definition. RESULTS: Acute kidney injury occurred in 19 (10.5% patients after surgery. The incidence of acute kidney injury was 3.6% in Group 1 and 16.7% in Group 2. Elevated baseline hemoglobin A1c level was found to be associated with acute kidney injury (P=0.0001. None of the patients became hemodialysis dependent. The cut off value for acute kidney injury in our group of patients was 5.75%. CONCLUSION: Our findings suggest that, in non-diabetics, elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. Prospective randomized studies in larger groups are needed to confirm these results.

  6. 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 dual antiplatelet therapy use. Off-pump coronary artery 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 dual antiplatelet therapy use in patients with acute coronary syndrome who underwent coronary artery 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.

  7. Four years’ follow-up changes of physical activity and sedentary time in women undergoing roux-en-Y gastric bypass surgery and appurtenant children

    OpenAIRE

    Sellberg, Fanny; Willmer, Mikaela; Tynelius, Per; Berglind, Daniel

    2017-01-01

    Background Objectively measured levels of physical activity (PA) in patients undergoing Roux-en-Y Gastric Bypass (RYGB) surgery remain essentially unchanged from before to one year after surgery. Effects from RYGB on objectively measured levels of PA among women undergoing RYGB and appurtenant children beyond one year post-surgery are unknown. The aim of the present study was to objectively assess longitudinal changes in PA and sedentary time (ST), among women undergoing RYGB and appurtenant ...

  8. Aortic Valve Stenosis and Atrial Fibrillation Influence Plasma Fibulin-1 Levels in Patients Treated with Coronary Bypass Surgery

    DEFF Research Database (Denmark)

    Hansen, Maria Lyck; Dahl, Jordi S; Argraves, W Scott

    2013-01-01

    Objectives: Aortic valve stenosis (AS) causes cardiac fibrosis and left ventricular hypertrophy, and over time heart failure can occur. To date, a reliable marker to predict progression of AS or the development of heart failure is still lacking. In this study, we addressed the hypothesis that fib......Objectives: Aortic valve stenosis (AS) causes cardiac fibrosis and left ventricular hypertrophy, and over time heart failure can occur. To date, a reliable marker to predict progression of AS or the development of heart failure is still lacking. In this study, we addressed the hypothesis...... that fibulin-1 levels reflect myocardial fibrosis. Methods: Patients undergoing heart surgery at the Odense University were investigated. By 2012 data on outcome were obtained. Results: In 293 patients, plasma fibulin-1 levels were measured. Patients with AS or atrial fibrillation (AF) had significantly higher...

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    BACKGROUND: The purpose of this study was to estimate the costs and health benefits of routinely administered postoperative amiodarone as prevention of atrial fibrillation for patients undergoing coronary artery bypass grafting (CABG) for stable angina. METHODS: This cost-effectiveness study...... intravenous bolus and subsequent 5 days of oral amiodarone therapy after coronary artery bypass grafting reduces the risk of atrial fibrillation and decreases the total costs of care by 175 euros per patient....... of atrial fibrillation compared with 32 in the control group (p cost per patient was 7,639 euros in the amiodarone group and 7,814 euros in the placebo group (p

  10. Preoperative Prevention of Heart Failure in Noncardiac Surgery

    Directory of Open Access Journals (Sweden)

    V. V. Likhvantsev

    2016-01-01

    Full Text Available Congestive heart failure is consistently associated with adverse outcomes, and is characterized by a twofold increase in mortality in noncardiac surgery. In this regard, developing the methods aimed to prevent and treatacute heart failure (AHF in the intraoperative period remain a challenging problem.Objective. To evaluate the efficacy of preoperative levosimendan infusion in reduction both mortality and duration of treatment of elderly patients with reduced left ventricular ejection fraction in noncardiac surgery.Material and Methods. Design: Multicenter blind randomized placebocontrolled study. Patients: 81 patients operated on abdominal organs. The main endpoint of the study: The length of stay in the Intensive Care Unit (ICU and at the hospital were chosen as the primary endpoints. The secondary endpoints of the study were 30 day and annual mortality, the rate of acute myocardial infarction and stroke.Results. Levosimendan infusion at a rate of 0,05 μg/kg/min — 0,1 μg/kg/min to patients with low left ven tricular ejection fraction just before the surgery reduced the length of stay in ICU for 2 days and required hospital stay for 3 days. NTproBNP showed the best ratio of sensitivity/specificity in predicting 30day mortality in cumulative group: AUC=0,86 (90,77 to 0,93, P<0,0001. From other indicators the most informative were the Inotropes scoring, no change or decrease of a left ventricular ejection fraction, and cardiac index.Conclusion. To reduce perioperative mortality, the intravenous infusion of levosimendan at a rate of 0,05—0,1 μg/kg/min in elderly patients with low left ventricular ejection fraction is recommened as a preoperative preparation the day before the alleged noncardiac surgery.

  11. Surgical models of Roux-en-Y gastric bypass surgery and sleeve gastrectomy in rats and mice.

    Science.gov (United States)

    Bruinsma, Bote G; Uygun, Korkut; Yarmush, Martin L; Saeidi, Nima

    2015-03-01

    Bariatric surgery is the only definitive solution currently available for the present obesity pandemic. These operations typically involve reconfiguration of gastrointestinal tract anatomy and impose profound metabolic and physiological benefits, such as substantially reducing body weight and ameliorating type II diabetes. Therefore, animal models of these surgeries offer unique and exciting opportunities to delineate the underlying mechanisms that contribute to the resolution of obesity and diabetes. Here we describe a standardized procedure for mouse and rat models of Roux-en-Y gastric bypass (80-90 min operative time) and sleeve gastrectomy (30-45 min operative time), which, to a high degree, resembles operations in humans. We also provide detailed protocols for both pre- and postoperative techniques that ensure a high success rate in the operations. These protocols provide the opportunity to mechanistically investigate the systemic effects of the surgical interventions, such as regulation of body weight, glucose homeostasis and gut microbiome.

  12. Gastric bypass surgery has a weight-loss independent effect on post-challenge serum glucose levels

    DEFF Research Database (Denmark)

    Hofsø, Dag; Birkeland, Kåre I; Holst, Jens J

    2015-01-01

    -h glucose levels were significantly lower in the surgery group than in the lifestyle group, 4.7 (0.4) versus 5.4 (0.7) mmol/l and 3.4 (0.8) versus 6.0 (2.4) mmol/l, respectively (both p ... (95 % CI) 1.4 (0.6-2.3) mmol/l and 0.4 (0.1-0.7) mmol/l per 10 % weight-loss, respectively]. Fasting glucose levels were determined by weight change [0.2 (0.1-0.3) mmol/l per 10 % weight-loss] and not by type of treatment. CONCLUSIONS: Gastric bypass surgery has a clinically relevant glucose...

  13. Strategies for Prevention and Management of Bleeding Following Pediatric Cardiac Surgery on Cardiopulmonary Bypass: A Scoping Review.

    Science.gov (United States)

    Siemens, Kristina; Sangaran, Dilanee P; Hunt, Beverley J; Murdoch, Ian A; Tibby, Shane M

    2018-01-01

    We aimed to systematically describe, via a scoping review, the literature reporting strategies for prevention and management of mediastinal bleeding post pediatric cardiopulmonary bypass surgery. MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL Register. Two authors independently screened publications from 1980 to 2016 reporting the effect of therapeutic interventions on bleeding-related postoperative outcomes, including mediastinal drain loss, transfusion, chest re-exploration rate, and coagulation variables. Inclusions: less than 18 years, cardiac surgery on cardiopulmonary bypass. Data from eligible studies were extracted using a standard data collection sheet. Overall, 299 of 7,434 screened articles were included, with observational studies being almost twice as common (n = 187, 63%) than controlled trials (n = 112, 38%). The most frequently evaluated interventions were antifibrinolytic drugs (75 studies, 25%), blood products (59 studies, 20%), point-of-care testing (47 studies, 16%), and cardiopulmonary bypass circuit modifications (46 studies, 15%). The publication rate for controlled trials remained constant over time (4-6/yr); however, trials were small (median participants, 51; interquartile range, 57) and overwhelmingly single center (98%). Controlled trials originated from 22 countries, with the United States, India, and Germany accounting for 50%. The commonest outcomes were mediastinal blood loss and transfusion requirements; however, these were defined inconsistently (blood loss being reported over nine different time periods). The majority of trials were aimed at bleeding prevention (98%) rather than treatment (10%), nine studies assessed both. Overall, this review demonstrates small trial sizes, low level of evidence, and marked heterogeneity of reported endpoints in the included studies. The need for more, higher quality studies reporting clinically relevant, comparable outcomes is highlighted. Emerging fields such as the use of coagulation factor

  14. Feasibility study on robot-assisted retinal vascular bypass surgery in an ex vivo porcine model.

    Science.gov (United States)

    Chen, Yi Qi; Tao, Ji Wei; Li, Liang; Mao, Jian Bo; Zhu, Chen Ting; Lao, Ji Meng; Yang, Yang; Shen, Li-Jun

    2017-09-01

    To describe a new robot-assisted surgical system for retinal vascular bypass surgery (RVBS) and to compare the success rate with freehand RVBS. A robot-assisted system for retinal microsurgery was constructed to include two independent robotic arms. A 23-gauge light probe and an intraocular forceps were affixed to the arm end effectors to perform the intraocular manipulation. Harvested porcine eyes were introduced to be established animal models of closed-sky eyeballs after that pars plana vitrectomy using temporary keratoprosthesis was performed by a skilful surgeon. Retinal vascular bypass surgery (RVBS) was performed by an inexperienced ophthalmologist to test the ease of use. A stainless steel wire (45-μm pipe diameter) was used as an artificial vessel. Before RVBS, the wires were prepositioned at the retinal surface of the eyes. The Control group (n = 20) underwent freehand RVBS, and the Experimental group (n = 20) underwent robot-assisted RVBS. To create the simulated bypass, the distal end of the wire was inserted into the selected vessel and advanced ~4 mm away from the optic disc. If successful, then the proximal wire end was inserted and advanced ~2 mm towards the optic disc. The difference in the success rate for the freehand and robot-assisted procedures was analysed by the chi-square test. The success rate for the freehand RVBS was 5% (1/20 eyes). In contrast, the robot-assisted success rate was 35% (7/20) of eyes (p robot-assisted RVBS in ex vivo porcine eyes. The robotic system increased the accuracy and stability of manipulation by eliminating freehand tremor, leading to a higher surgical success rate. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  15. Roux-en-Y gastric bypass surgery reduces bone mineral density and induces metabolic acidosis in rats.

    Science.gov (United States)

    Abegg, Kathrin; Gehring, Nicole; Wagner, Carsten A; Liesegang, Annette; Schiesser, Marc; Bueter, Marco; Lutz, Thomas A

    2013-11-01

    Roux-en-Y gastric bypass (RYGB) surgery leads to bone loss in humans, which may be caused by vitamin D and calcium malabsorption and subsequent secondary hyperparathyroidism. However, because these conditions occur frequently in obese people, it is unclear whether they are the primary causes of bone loss after RYGB. To determine the contribution of calcium and vitamin D malabsorption to bone loss in a rat RYGB model, adult male Wistar rats were randomized for RYGB surgery, sham-operation-ad libitum fed, or sham-operation-body weight-matched. Bone mineral density, calcium and phosphorus balance, acid-base status, and markers of bone turnover were assessed at different time points for 14 wk after surgery. Bone mineral density decreased for several weeks after RYGB. Intestinal calcium absorption was reduced early after surgery, but plasma calcium and parathyroid hormone levels were normal. 25-hydroxyvitamin D levels decreased, while levels of active 1,25-dihydroxyvitamin D increased after surgery. RYGB rats displayed metabolic acidosis due to increased plasma lactate levels and increased urinary calcium loss throughout the study. These results suggest that initial calcium malabsorption may play a key role in bone loss early after RYGB in rats, but other factors, including chronic metabolic acidosis, contribute to insufficient bone restoration after normalization of intestinal calcium absorption. Secondary hyperparathyroidism is not involved in postoperative bone loss. Upregulated vitamin D activation may compensate for any vitamin D malabsorption.

  16. Differential Changes in Gut Microbiota After Gastric Bypass and Sleeve Gastrectomy Bariatric Surgery Vary According to Diabetes Remission.

    Science.gov (United States)

    Murphy, Rinki; Tsai, Peter; Jüllig, Mia; Liu, Amy; Plank, Lindsay; Booth, Michael

    2017-04-01

    It is unclear whether specific gut microbiota is associated with remission of type 2 diabetes (T2D) after distinct types of bariatric surgery. The aim of this study is to examine gut microbiota changes after laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery in obese patients with T2D. Whole-metagenome shotgun sequencing of DNA fragments using Illumina HiSeq2000 was obtained from stool samples collected from 14 obese T2D patients pre-operatively (while on very low calorie diet) and 1 year after randomisation to laparoscopic SG (n = 7) or RYGB (n = 7). Resulting shotgun reads were annotated with Kyoto Encyclopedia of Genes and Genomes (KEGG). Body weight reduction and dietary change was similar 1 year after both surgery types. Identical proportions (n = 5/7) achieved diabetes remission (HbA1c surgery types. KEGG Orthology and pathway analysis predicted contrasting and greater gut microbiota metabolism changes after diabetes remission following RYGB than after SG. Those with persistent diabetes post-operatively had higher Desulfovibrio species pre-operatively. Overall, RYGB produces greater and more predicted favourable changes in gut microbiota functional capacity than SG. An increase in Roseburia species was the only compositional change common to both types of surgery among those achieving diabetes remission.

  17. Pancreatic stone protein predicts postoperative infection in cardiac surgery patients irrespective of cardiopulmonary bypass or surgical technique.

    Science.gov (United States)

    Klein, Holger J; Csordas, Adam; Falk, Volkmar; Slankamenac, Ksenija; Rudiger, Alain; Schönrath, Felix; Rodriguez Cetina Biefer, Hector; Starck, Christoph T; Graf, Rolf

    2015-01-01

    We investigated the role of pancreatic stone protein (PSP) in predicting the occurrence of infection in the postoperative course of cardiac surgery patients. Several biomarkers indicating the presence of inflammation and infection are available in the clinical routine; yet, their utility in the postoperative course of patients following cardiac surgery remains uncertain. Moreover, cardiopulmonary bypass, also referred to as "on-pump surgery", increases the susceptibility to an exaggerated inflammatory state. However, the impact of such extracorporeal circulation on circulating PSP levels remains poorly understood. In a prospective cohort of unselected patients undergoing cardiac surgery, we set out to elucidate the diagnostic accuracy of serum PSP levels as opposed to canonical biomarkers (CRP, WBC) of inflammation to discriminate between the presence of infection and surgical trauma,. In addition, we investigated whether the biomarkers were influenced by the surgical technique employed, i.e. on-pump vs. off-pump and minimally invasive surgery vs. sternotomy. Levels of circulating PSP and routine inflammatory biomarkers (CRP, WBC) were measured in samples taken from 120 patients at baseline as well as at postoperative day 1-3. Univariate analysis showed that among the biomarkers investigated, only PSP levels had discriminatory power to differentiate infection from surgical trauma in the postoperative course of the entire cohort of patients following cardiac surgery. With regard to cardiac surgical interventions, there was no significant association between the absence or presence of extracorporeal circulation and PSP levels. However, there was a significant difference in the slope of the rise of postoperative PSP between minimally invasive surgery as opposed to patients subjected to sternotomy. In an unselected population of cardiac surgery patients, post-operative serum PSP levels were significantly associated with the presence of infection in both the on-pump and

  18. Pancreatic stone protein predicts postoperative infection in cardiac surgery patients irrespective of cardiopulmonary bypass or surgical technique.

    Directory of Open Access Journals (Sweden)

    Holger J Klein

    Full Text Available We investigated the role of pancreatic stone protein (PSP in predicting the occurrence of infection in the postoperative course of cardiac surgery patients. Several biomarkers indicating the presence of inflammation and infection are available in the clinical routine; yet, their utility in the postoperative course of patients following cardiac surgery remains uncertain. Moreover, cardiopulmonary bypass, also referred to as "on-pump surgery", increases the susceptibility to an exaggerated inflammatory state. However, the impact of such extracorporeal circulation on circulating PSP levels remains poorly understood.In a prospective cohort of unselected patients undergoing cardiac surgery, we set out to elucidate the diagnostic accuracy of serum PSP levels as opposed to canonical biomarkers (CRP, WBC of inflammation to discriminate between the presence of infection and surgical trauma,. In addition, we investigated whether the biomarkers were influenced by the surgical technique employed, i.e. on-pump vs. off-pump and minimally invasive surgery vs. sternotomy. Levels of circulating PSP and routine inflammatory biomarkers (CRP, WBC were measured in samples taken from 120 patients at baseline as well as at postoperative day 1-3.Univariate analysis showed that among the biomarkers investigated, only PSP levels had discriminatory power to differentiate infection from surgical trauma in the postoperative course of the entire cohort of patients following cardiac surgery. With regard to cardiac surgical interventions, there was no significant association between the absence or presence of extracorporeal circulation and PSP levels. However, there was a significant difference in the slope of the rise of postoperative PSP between minimally invasive surgery as opposed to patients subjected to sternotomy.In an unselected population of cardiac surgery patients, post-operative serum PSP levels were significantly associated with the presence of infection in both

  19. Quality of life-associated factors among patients undergoing coronary artery bypass surgery as measured using the WHOQOL-BREF.

    Science.gov (United States)

    Najafi, Mahdi; Sheikhvatan, Mehrdad; Montazeri, Ali

    2009-01-01

    This was a study of the pre-operative factors that influence quality of life (QoL) in patients with coronary artery disease and the relationship between pre-operative QoL and early outcome after coronary artery bypass surgery (CABG). Using the WHOQOL-BREF questionnaire, 283 patients who underwent isolated coronary artery bypass surgery were interviewed and scores were obtained for the physical, psychological, social and environmental components. The study found that the independent physical component predictors for higher QoL included male gender and diabetes mellitus, while the independent psychological component predictors were male gender and high ejection fraction. Males, diabetics and patients with low education levels had higher social well-being than others. Among the postoperative complications, only respiratory failure was found to have a relationship with physical and psychological components. Women with coronary artery disease who were candidates for CABG had lower scores than the men in respect of all components of QoL. Furthermore, a lower pre-operative psychological score in patients undergoing CABG can influence postoperative complications, especially respiratory failure.

  20. 78. Coronary bypass using bilateral internal mammary arteries in an achondroplast

    Directory of Open Access Journals (Sweden)

    Mohamed Abdulwahab Alassal

    2015-10-01

    Full Text Available Coronary bypass grafting for ischemic heart disease in achondroplastic dwarfs is very rare. Shortage of veins and sometimes, inadequate vein quality can cause difficulties during surgery. Only two achondroplastic cases were reported in literature that underwent coronary bypass surgery, in which the left internal mammary artery and vein grafts were used. To the best of our knowledge using bilateral internal mammary arteries in such patients was not reported. We report here a 55 years old male achondroplastic dwarf who had triple vessels coronary disease that underwent successful coronary bypass surgery using bilateral mammary arteries. Anatomic and surgical challenges in achondroplasia are highlighted

  1. Exercise-based cardiac rehabilitation for adults after heart valve surgery:review

    OpenAIRE

    Sibilitz, Kirstine L; Berg, Selina K; Tang, Lars H; Risom, Signe S; Gluud, Christian; Lindschou, Jane; Kober, Lars; Hassager, Christian; Taylor, Rod S; Zwisler, Ann-Dorthe

    2016-01-01

    BACKGROUND: Exercise-based cardiac rehabilitation may benefit heart valve surgery patients. We conducted a systematic review to assess the evidence for the use of exercise-based intervention programmes following heart valve surgery.OBJECTIVES: To assess the benefits and harms of exercise-based cardiac rehabilitation compared with no exercise training intervention, or treatment as usual, in adults following heart valve surgery. We considered programmes including exercise training with or witho...

  2. Pulsatile cardiopulmonary bypass and renal function in elderly patients undergoing aortic valve surgery

    NARCIS (Netherlands)

    Milano, Aldo Domenico; Dodonov, Mikhail; Van Oeveren, Willem; Onorati, Francesco; Gu, Y. John; Tessari, Maddalena; Menon, Tiziano; Gottin, Leonardo; Faggian, Giuseppe

    OBJECTIVES: To evaluate if pulsatile cardiopulmonary bypass (CPB) has any protective influence on renal function in elderly patients undergoing aortic valve replacement (AVR). METHODS: Forty-six patients (>= 75 years old) with aortic valve stenosis underwent AVR with either pulsatile perfusion (PP)

  3. Femoro-distal bypass surgery at Groote Schuur Hospital — 4-year ...

    African Journals Online (AJOL)

    Enrique

    femoro-distal bypass in patients presenting with defined critical limb ischaemia at Groote Schuur Hospital, Cape. Town, is presented. Materials and methods. A retrospective ... no statistically significant difference in the graft patency between the two .... gramme; 11 grafts required a secondary procedure to main- tain patency.

  4. Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in Patients With Unprotected Left Main Disease

    NARCIS (Netherlands)

    Cavalcante, Rafael; Sotomi, Yohei; Lee, Cheol W.; Ahn, Jung-Min; Farooq, Vasim; Tateishi, Hiroki; Tenekecioglu, Erhan; Zeng, Yaping; Suwannasom, Pannipa; Collet, Carlos; Albuquerque, Felipe N.; Onuma, Yoshinobu; Park, Seung-Jung; Serruys, Patrick W.

    2016-01-01

    Currently available randomized data on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for the treatment of unprotected left main coronary disease (LMD) lacks statistical power due to low numbers of patients enrolled. This study assessed

  5. Prevalence and impact of dumping syndrome on qol after primary gastric bypass surgery

    NARCIS (Netherlands)

    Emous, M.; Ubels, F.L.; Apers, J.A.; Wolffenbuttel, B.H.R.; Totté, E.; Van Beek, A.P.

    2014-01-01

    Introduction: Worldwide gastric bypass is still the most frequent performed weight loss operations for morbid obesity and it's effectively is proven. Although dumping has been widely recognized as complication after RYGB, almost no data are available on the prevalence and the consequences of this

  6. 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...

  7. Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Thorsteinsson, Kristinn; Fonager, Kirsten; Mérie, Charlotte

    2016-01-01

    OBJECTIVES: An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG. METHODS: All patients who underwent isol...

  8. Off-pump coronary artery bypass surgery in selected patients is superior to the conventional approach for patients with severely depressed left ventricular function

    Directory of Open Access Journals (Sweden)

    Guido Marco Caputti

    2011-01-01

    Full Text Available OBJECTIVES: Patients with coronary artery disease and left ventricular dysfunction have high mortality when kept in clinical treatment. Coronary artery bypass grafting can improve survival and the quality of life. Recently, revascularization without cardiopulmonary bypass has been presented as a viable alternative. The aim of this study is to compare patients with left ventricular ejection fractions of less than 20% who underwent coronary artery bypass graft with or without cardiopulmonary bypass. METHODS: From January 2001 to December 2005, 217 nonrandomized, consecutive, and nonselected patients with an ejection fraction less than or equal to 20% underwent coronary artery bypass graft surgery with (112 or without (off-pump (105 the use of cardiopulmonary bypass. We studied demographic, operative, and postoperative data. RESULTS: There were no demographic differences between groups. The outcome variables showed similar graft numbers in both groups. Mortality was 12.5% in the cardiopulmonary bypass group and 3.8% in the off-pump group. Postoperative complications were statistically different (cardiopulmonary bypass versus off-pump: total length of hospital stay (days-11.3 vs. 7.2, length of ICU stay (days-3.7 vs. 2.1, pulmonary complications-10.7% vs. 2.8%, intubation time (hours-22 vs. 10, postoperative bleeding (mL-654 vs. 440, acute renal failure-8.9% vs. 1.9% and left-ventricle ejection fraction before discharge-22% vs. 29%. CONCLUSION: Coronary artery bypass grafting without cardiopulmonary bypass in selected patients with severe left ventricular dysfunction is valid and safe and promotes less mortality and morbidity compared with conventional operations.

  9. Kosovo’s Experience for Children with Feeding Difficulties after Cardiac Surgery for Congenital Heart Defect

    Directory of Open Access Journals (Sweden)

    Ramush Bejiqi

    2017-11-01

    CONCLUSION: Feeding disorder is often and a frequent long-term sequel in children after neonatal or early infancy heart surgery. Patients with chromosomal and associated anomalies who underwent multiple cardiac surgeries are at risk of developing feeding difficulties.

  10. The use of technetium-99m hexamethylpropylene amine oxime labelled white blood cells to detect subclinical inflammation of the heart after cardiopulmonary bypass in children with congenital heart disease

    International Nuclear Information System (INIS)

    Kao Chiahung; Wang Yenliang; Wang Shyhjen; Hsieh Kaisheng

    1992-01-01

    Ten children (6 boys and 4 girls, aged 1-9 years old) underwent operations with a cardiopulmonary bypass, and the technetium-99m hexamehtylpropylene amine oxine ( 99m Tc-HMPAO) labelled white blood cell (WBC) heart scans were used to detect postoperative leukocyte infiltration in the hearts. The results showed that 80% (8/10) of the cases had subclinical inflammation in the hearts (grading of WBC scans ≥score 2), and a positive correlation (R=0.77) was noted between the severity of the inflammation (grading of the WBC scans) and the duration of the cardiopulmonary bypass in the operations. Another control group (9 boys and 2 girls, aged 2-13 years old) underwent operations without a cardiopulmonary bypass, and subclinical inflammation of hearts was demonstrated in only 1 case (9%) by the 99m Tc-HMPAO labelled WBC scans (grading of WBC scans 99m Tc-HMPAO labelled WBC heart scans may provide non-invasive and directly discernible evidence of subclinical inflammation in the heart due to a transient ischaemic state during a cardiopulmonary bypass, even if the clinical symptoms and signs of carditis are not apparent. (orig.)

  11. 56. Endoscopic vein graft harvest for coronary artery bypass surgery: Single center experience in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    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

  12. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch.

    Science.gov (United States)

    Homan, Jens; Betzel, Bark; Aarts, Edo O; van Laarhoven, Kees J H M; Janssen, Ignace M C; Berends, Frits J

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain and other complications are reported. Demand for secondary surgery is rising, partly for these reasons. To review the indications and effects of secondary surgery, biliopancreatic diversion with duodenal switch (BPD/DS) versus laparoscopic Roux-en-Y gastric bypass (LRYGB), after LSG. Data from all patients who underwent revision of LSG was retrospectively analyzed, concerning data on indications for secondary surgery, weight loss, and complications. 43 Patients underwent secondary surgery after LSG; 25 BPD/DS and 18 LRYGB, respectively. Main indications for secondary surgery were inadequate weight loss (n = 17 [40%]) and weight regain (n = 8 [19%]). For these indications, the median excess weight loss was greater for BPD/DS (59% [range 15-113]) compared to LRYGB (23% [range -49-84]) (P = .008) after 34 months (range 14-79). In case of dysphagia or gastroesophageal reflux disease the complaints resolved after converting to LRYGB. BPD/DS patients were more likely to develop a short-term complication and vitamin deficiencies compared to LRYGB. Secondary surgery of LSG to BPD/DS or LRYGB is feasible with slightly more complications after BPD/DS. Conversion to LRYGB is preferred in cases of dysphagia or gastroesophageal reflux disease. In cases of weight regain or insufficient weight loss after LSG, patients had better weight loss with a BPD/DS; however, this procedure has the risk of complications, such as severe vitamin deficiencies. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  13. Intensive hyperglycemia control reduces postoperative infections after open heart surgery

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    Riccardo Sinatra

    2010-05-01

    Full Text Available Background: Diabetes mellitus increases the risk of infections in patients undergoing cardiac surgery. We hypothesized that intensive perioperative hyperglycemia control by intravenous insulin infusion reduces postoperative infections in all patients undergoing open heart surgical procedures. Methods: Sixty diabetics patients who underwent CABG operation (Group 1 were compared with fifty-five patients who underwent other cardiac surgery (Group 2 between January 2004 and March 2005. A continuous infusion of insulin was used in all these patients. Results: There were no 30-day mortalities in either group. There was no difference in the incidence of infections between the two groups: in Group 1, 3 (5% patients were diagnosed to have postoperative infection (superficial sternal wound infections in 1 (1.66% and lung infection in 2 (3.33% patients; postoperative infection occurred in only 2 patients (3.63% in Group 2, 1 superficial sternal wound infections (1.81% and 1 lung infection (1.81%. Conclusions: Our analysis indicates that continuous intravenous insulin infusion improves outcome and reduces postoperative infections in patients undergoing CABG as well as those undergoing other cardiac surgery procedures. (

  14. Predictors of Health-Promoting Behaviors in Coronary Artery Bypass Surgery Patients: An Application of Pender's Health Promotion Model.

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    Mohsenipoua, Hossein; Majlessi, Fereshteh; Shojaeizadeh, Davood; Rahimiforooshani, Abbas; Ghafari, Rahman; Habibi, Valiollah

    2016-09-01

    Advances in coronary artery surgery have reduced patient morbidity and mortality. Nevertheless, patients still have to face physical, psychological, and social problems after discharge from hospital. The objective of this study was to determine the efficacy of Pender's health promotion model in predicting cardiac surgery patients' lifestyles in Iran. This cross-sectional study comprised 220 patients who had undergone coronary artery bypass graft (CABG) surgery in Mazandaran province (Iran) in 2015. The subjects were selected using a simple random sampling method. The data were collected via (1) the health-promoting lifestyle profile II (HPLP II) and (2) a self-designed questionnaire that included two main sections: demographic characteristics and questions based on the health-promoting model constructs. Spiritual growth (28.77 ± 5.03) and physical activity (15.79 ± 5.08) had the highest and lowest scores in the HPLP II dimensions, respectively. All the health promotion model variables were significant predictors of health-promoting behaviors and explained 69% of the variance in health-promoting behaviors. Three significant predictors were estimated using regression coefficients: behavioral feelings (β = 0.390, P health-promoting model-based self-care behaviors can help identify and predict cardiac surgery patients' lifestyles in Iran. This pattern can be used as a framework for discharge planning and the implementation of educational interventions to improve the lifestyles of CABG patients.

  15. Postoperative serum levels of Endocan are associated with the duration of norepinephrine support after coronary artery bypass surgery.

    Science.gov (United States)

    Bouglé, Adrien; Allain, Pierre-Antoine; Favard, Séverine; Ait Hamou, Nora; Carillion, Aude; Leprince, Pascal; Granger, Benjamin; Amour, Julien

    2018-02-21

    Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response and an endothelial dysfunction, whose qualitative assessment appears to be a major issue. Endocan (ESM-1, endothelial cell specific molecule-1) is a protein preferentially expressed by the endothelium and previously associated with prognosis of septic shock or acute respiratory distress syndrome. In this pilot study, we investigated the kinetic of Endocan in planned coronary artery bypass grafting (CABG) surgery with CPB. We conducted an observational, prospective, mono centre study. All adult patients with left systolic ejection fraction>50%, undergoing planned on-pump CABG, were screened for inclusion. A written informed consent was obtained. Measurements and main results Serum Endocan concentrations were respectively 2.4 [2.1-3.0] ng. mL -1 , 10.4 [7.4-13.9] ng.mL -1 , 5.7 [4.4-8.2] ng.mL -1 , and 5.4 [4.1-7.5] ng.mL -1 at day 0, day 1, day 3 and day 5. Endocan concentrations increased at day 1, day 3, and day 5 in comparison with preoperative concentration (P<0.001). In the multivariate analysis, age (P=0.002), history of acute coronary syndrome (P=0.024) and the catecholamine-free days at day 28 (P=0.007) were associated to the increase of perioperative Endocan concentrations. Serum Endocan concentration increases after CABG surgery with CPB until day 1. The norepinephrine support increases the risk of Endocan release, suggesting a relationship between the kinetic of Endocan and the vasoplegic syndrome. At day 3, Endocan concentration decreases slowly but is