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Kinds of Grafting
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CT02 A STUDY TO EVALUATE VARIOUS TECHNIQUES OF CORONARY ARTERY BYPASS GRAFTINGANZ JOURNAL OF SURGERY, Issue 2007
Introduction In Wellington Hospital, CABG is being performed by various techniques like OPCAB, On-pump cardioplegic arrest, fibrillatory arrest and On-pump beating heart. Aim This study was undertaken to compare morbidity and mortality between On- pump CABG and OPCAB on basis of Euroscore. Material and Method From January 2003 till December 2004, data were collected according to Australasian society of Cardiothoracic surgery data set. Euroscores were calculated and patients were divided into 3 groups. Results of OPCAB and On-pump CABG were compared on basis of Euroscore group. In this period we performed 350 On-pump CABG and 254 OPCAB. Results OPCAB group had less number of grafts per patients. Even for triple vessel disease numbers of grafts were lower in OPCAB group. OPCAB group had more patients with total arterial revascularization. There were 10 deaths in On-pump group and 1 in OPCAB group. In the low and moderate risk group there was no significant difference in hospital stay, ventilation hours and ICU stay. However inotropic requirement and requirements of blood products were less in OPCAB group. There was no statistically significant difference between Incidence of new renal failure or arrhythmia in two groups. 2 patients in each group had blocked graft in immediate postop period and required revascularization. There were only 5 patients in the high-risk group in OPCAB making intergroup comparisons difficult. Conclusion OPCAB does not offer any significant advantage in terms of mortality and morbidity over On-pump CABG. To evaluate the effects of number of grafts and total arterial revascularization, it needs a long-term follow-up. [source]
EMERGENCY CORONARY ARTERY BYPASS GRAFTING: A MOVING TARGETANZ JOURNAL OF SURGERY, Issue 9 2006
Brian F. Buxton
No abstract is available for this article. [source]
Frontal Fibrosing Alopecia in a Man: Results of Follicular Unit Test GraftingDERMATOLOGIC SURGERY, Issue 6 2010
BERNARD P. NUSBAUM MD
The authors have indicated no significant interest with commercial supporters. [source]
Segmental Vitiligo Treated by the Combination of Epidermal Grafting and Systemic CorticosteroidsDERMATOLOGIC SURGERY, Issue 4 2010
DONG-YOUN LEE MD
No abstract is available for this article. [source]
"Halo" Grafting,A Simple and Effective Technique of Skin GraftingDERMATOLOGIC SURGERY, Issue 1 2010
M PHIL, SHARAD P. PAUL MD
Sharad P. Paul, MD, M Phil, has indicated no significant interest with commercial supporters [source]
Randomized Nonblinded Comparison of Convalescence for 2 and 7 Days After Split-Thickness Skin Grafting to the Lower LegsDERMATOLOGIC SURGERY, Issue 4 2009
BEN TALLON MBChB
BACKGROUND There is an increasing expectation of shortened postoperative recovery times and a suggestion that shorter convalescence times may not compromise lower leg split-thickness skin graft results. OBJECTIVE To determine whether mobilization after 2 days of convalescence compromises graft survival or patient morbidity. METHODS AND MATERIALS A pilot study was initiated in which patients undergoing split-thickness skin grafting to the lower legs were randomized to 2 or the routine 7 days of convalescence. Baseline characteristics were determined, and patients were followed up in dressing clinics and with a standardized telephone interview. RESULTS There was no difference in baseline patient comorbidities and no significant difference in the number of grafts lost, the number of dressing clinics, bleeding, or wound infections. CONCLUSION The results suggest that 2 days of convalescence after split-thickness skin grafting to the lower legs may not compromise graft survival or increase patient morbidity. Further study with larger numbers is required to confirm this finding. [source]
Treatment of Vitiligo on Difficult-to-Treat Sites Using Autologous Noncultured Cellular GraftingDERMATOLOGIC SURGERY, Issue 1 2009
SANJEEV V. MULEKAR MD
BACKGROUND Because of the limitations of medical treatment, various surgical therapies have been developed and are being accepted to treat vitiligo. However, certain areas such as the fingers and toes, palms and soles, lips, eyelids, nipples and areolas, elbows and knees, and genitals are considered difficult-to-treat areas. OBJECTIVE To evaluate data pertaining to individual sites considered to be difficult to treat and highlight that noncultured melanocyte,keratinocyte transplantation (MKT) does not require any special precautions to treat these anatomical sites. METHODS AND MATERIALS Forty patients (13 male and 27 female) with bilateral vitiligo and nine (4 male and 5 female) with unilateral vitiligo were treated using noncultured MKT, for "difficult-to-treat" sites at the National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia, and were analyzed for response according to region. Repigmentation was graded as excellent with 95% to 100% pigmentation, good with 65% to 94%, fair with 25% to 64%, and poor with 0% to 24% of the treated area. RESULTS For bilateral vitiligo, more than 50% of patients treated for difficult sites showed more than 65% repigmentation of the treated areas. For unilateral vitiligo, all of the patients except for two treated for the eyelids showed more than 65% repigmentation of the treated area. CONCLUSIONS The concept of a "difficult-to-treat site" is a relative term and depends upon the technique used. The noncultured MKT does not require any special precautions to treat these anatomical sites. This review may help physicians to change the concept of "difficult-to-treat site." [source]
Epidermal Grafting After Chemical Epilation in the Treatment of VitiligoDERMATOLOGIC SURGERY, Issue 10 2001
Chi-Yeon Kim MD
Background. Vitiligo on hairy areas like the scalp and eyebrows is frequently associated with leukotrichia and repigmentation by photochemotherapy is usually difficult because of a deficient melanocyte reservoir. Although epidermal grafting to supply melanocytes is very effective for stable vitiligo, hair growth inhibits successful transfer of melanocytes from grafted epidermis in dense hair-bearing regions. Objective. To investigate the effectiveness of preoperative chemical epilation to improve the results of epidermal graft by suction blister on hairy areas. Methods. Two patients who had vitiligo with leukotrichia on the face and scalp were treated with epidermal grafting using suction blister after chemical epilation. Two weeks after the graft they were treated with topical psolaren plus ultraviolet A (PUVA) therapy. Results. Epidermal grafting was performed successfully, and successful repigmentation of the skin with significant improvement of leukotrichia was observed in each of two patients. Conclusion. Chemical epilation followed by epidermal grafting is a safe, easy, and effective treatment for vitiligo affecting hairy regions. [source]
Long-Term Follow-Up After Autologous Fat Grafting: Analysis of Results from 116 Patients Followed at Least 12 Months After Receiving the Last of a Minimum of Two TreatmentsDERMATOLOGIC SURGERY, Issue 12 2000
Sorin Eremia MD
Background. The effectiveness of long-term results for correction of facial rhytides with single or multiple autologous fat transplants remains controversial. Objective. This study is a retrospective review of short- and long-term results for 116 patients who underwent multiple autologous fat grafting sessions into the nasolabial and melolabial (lateral oral commissure) fold, and in some cases additional sites such as lips and glabella. Methods. Criteria for inclusion into the study included at least two treatment sessions and at least a 12-month follow-up evaluation after the last treatment received. A 14-gauge needle cannula was used to aspirate the donor fat and to inject the fat grafts. Results. For the nasolabial and melolabial folds, short-term results at 3,4 months were uniformly excellent. Gradual correction loss was noted between 5 and 8 months, with 25% of patients still rated as excellent and 40% as good. Most patients continued to show correction loss between 9 and 14 months. Only 3,4% of the patients truly maintained long-term correction for more than 14 months. Multiple re-treatments did not significantly increase the percent of patients showing long-term results. For the glabella, the results were very disappointing, with most patients showing complete loss of correction after 3,4 months. For lip augmentation, correction loss was slower than in the glabella, but most patients showed complete loss of correction by 5,8 months. Complications were minimal. Conclusion. Autologous fat grafting is most effective for relatively short-term improvement of facial aging changes in the nasolabial and oral commissures areas. It is less effective for lip augmentation and completely ineffective for the glabella area. [source]
Alar Batten Cartilage GraftingDERMATOLOGIC SURGERY, Issue 10 2000
Clark C. Otley MD
Suction Device for Epidermal Grafting in Vitiligo: Employing a Syringe and a Manometer to Provide an Adequate Negative PressureDERMATOLOGIC SURGERY, Issue 7 2000
Han-uk Kim MD
Background. Suction devices for epidermal grafting need a suction pump to provide a negative pressure. The authors have developed a suction device in which a syringe and a manometer are employed to provide a negative pressure. Objective. The purpose of this study was to evaluate the efficacy of our suction device in vitiligo patients. Methods. The suction device was used to obtain epidermal blisters from the donor site. A CO2 laser was employed to remove the depigmented epidermis. The blister roofs of the donor site were harvested and were placed onto the recipient area. Ten patients with stable vitiligo were treated by epidermal grafting. Results. Epidermal blisters were produced by suction in all patients. Also, all 10 patients regained repigmentation. Conclusion. Our suction blister device is simple and inexpensive to make, and it may become an alternative to the other suction devices. [source]
Left Ventricular Pseudoaneurysm Developing as a Late Complication of Coronary Artery Bypass Grafting with Apicoseptal PlicationECHOCARDIOGRAPHY, Issue 8 2005
Ozcan Ozeke M.D.
Left ventricular pseudoaneurysm is a false aneurysm, which results from a left ventricle rupture contained by adherent pericardium or scar tissue. The most common etiology of left ventricular pseudoaneurysm is acute myocardial infarction but one-third of pseudoaneurysms develop following surgery. We present a case report of a patient who developed a false aneurysm of the left ventricle 2 months following surgical repair of a left ventricular aneurysm with a concomitant coronary bypass. [source]
Silicon-Assisted Direct Covalent Grafting on Metal Oxide Surfaces: Synthesis and Characterization of Carboxylate N,N,-Ligands on TiO2EUROPEAN JOURNAL OF INORGANIC CHEMISTRY, Issue 11 2010
Abstract The easy covalent bonding of an OH-bearing molecule onto a metal oxide surface can be done by transesterifying a trimethylsilylated hydroxy function with the surface OH groups. This results in the grafting of the organic molecule directly on the matrix, accompanied by the formation of trimethylsilanol, which can easily be eliminated as volatile hexamethyldisiloxane and water. This was accomplished on a TiO2 matrix with three carboxylic acids: acetic, isonicotinic, and 2,2,-bipyridyl-4,4,-dicarboxylic acids. The N,N,-immobilized ligand was then used for a dioxidomolybdenum entity and tested as such at room temperature and under atmospheric pressure O2 oxidation of ethylbenzene. All intermediates and grafted species were fully characterized by 13CMAS NMR spectroscopy, and thermogravimetric and elemental analysis. [source]
A New Donor-Stabilized Ditungsten Amido Alkoxido Species: Synthesis, Crystal Structure, Fluxionality, and Grafting onto SilicaEUROPEAN JOURNAL OF INORGANIC CHEMISTRY, Issue 35 2007
Abstract A new dimeric tungsten(III) complex containing amidoand chelating pyridine,alkoxido ligands was synthesized through protonolysis of [W2(NMe2)6] by 2-(2-pyridyl)propan-2-ol and fully characterized by X-ray diffraction and infrared and NMR spectroscopy. Intramolecular exchange processes were studied by variable-temperature NMR spectroscopy. The compound was grafted onto dehydroxylated silica by protonolysis of an amido,tungsten bond, and the structure of the supported species was investigated by infrared and solid-state (bidimensional) NMR spectroscopy. The reactivity of the molecular and grafted species toward alkynes was probed. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007) [source]
Surface Activation of a Ferrimagnetic Glass,Ceramic for Antineoplastic Drugs GraftingADVANCED ENGINEERING MATERIALS, Issue 7 2010
A ferrimagnetic glass,ceramic, belonging to the system SiO2,Na2O,CaO,P2O5,FeO,Fe2O3, has been studied as potential carrier for antineoplastic agents, in order to exploit the combination of hyperthermia and chemotherapy. Different material pre-treatments, such as ultrasonic washing, water, or simulated body fluid dipping, were evaluated to promote the surface activation of the glass,ceramic, i.e., the hydroxyl groups formation on it. X-ray photoelectron spectroscopy, scanning electron microscopy, energy dispersion spectrometry, and wettability measurements were performed to observe the samples surface modification. The best results in terms of free hydroxyl groups exposition were obtained by dipping the samples in distilled water for 7 days at 37,°C. Two different anticancer drugs were selected in order to test the reactivity of the activated surface: cisplatinum and doxorubicin. The uptake and release of doxorubicin and cisplatinum were evaluated on glass,ceramic powders, by using UV,Visible spectrometry and graphite furnace atomic absorption spectroscopy, respectively. After 1 day of uptake at 37,°C, the quantity of doxorubicin incorporated into the glass,ceramic is 77,±,7 wt%, while only 42,±,9.6 wt% of cisplatinum is grafted onto the material surface. For both antitumoral agents, the maximum drug release after soaking in aqueous solutions at 37,°C was obtained in few hours, with a randomly distributed kinetics trend. [source]
Grafting of Molecularly Ordered Mesoporous Phenylene-Silica with Molybdenum Carbonyl Complexes: Efficient Heterogeneous Catalysts for the Epoxidation of OlefinsADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 10 2010
Abstract Arenetricarbonyl complexes, or the general formula C6H4Mo(CO)3, were incorporated into crystal-like mesoporous phenylene-silica by liquid-phase deposition of molybdenum hexacarbonyl [Mo(CO)6]. By adjusting the reaction conditions, different molybdenum loadings of 1.5 and 5.9,wt% were obtained, which correspond to 3% and 14% of the phenylene contents. The texture properties of the materials as well as the nature of the surface-fixed complexes were characterized by powder X-ray diffraction, transmission electron microscopy (TEM), N2 adsorption, FT-IR, UV-vis and MAS (13C, 29Si) NMR spectroscopy. The derivatized organosilicas were examined as catalyst precursors for the liquid-phase epoxidation of cis -cyclooctene, 1-octene, trans -2-octene and (R)-(+)-limonene at 55,°C, using tert -butyl hydroperoxide as the oxidant. For each olefin the corresponding epoxide was the only product detected. In the case of cyclooctene, the intrinsic reaction rates per surface molybdenum atom were similar for both Mo loadings (TOF,1150 mol,molMo,1,h,1), suggesting that the resultant materials act as single site epoxidation catalysts. Leaching tests and metal analyses of reaction solutions showed that the catalytic activity stemmed from the immobilized species and not from the leaching of active species into solution. The oxidation of limonene gave limonene oxide as the only product in 95% yield at 3,h, which reveals an outstanding regioselectivity to the epoxidation of the endocyclic double bond. [source]
Grafting of poly(N -isopropylacrylamide) onto nylon and polystyrene surfaces by atmospheric plasma treatment followed with free radical graft copolymerizationJOURNAL OF APPLIED POLYMER SCIENCE, Issue 6 2007
Abstract Stimuli-responsive polymer materials (SRPs) have potential uses in drug delivery, tissue engineering, bioreactors, and cell-surface adhesion control. Temperature-responsive surfaces were fabricated by grafting poly(N -isopropylacrylamide) (PNIPAM) onto nylon and polystyrene surfaces via a new procedure, i.e., He atmospheric plasma treatment followed by free radical graft copolymerization. The atmospheric plasma exhibits the activation capability to initiate graft copolymerization. The procedure is suitable for integration into a continuous manufacturing process. To reduce homopolymerization and enhance graft yield, Mohr's salt was added. The graft of PNIPAM was confirmed by Fourier transform infrared spectroscopy and atomic force microscopy. Dramatic water contact angle increase was found for PNIPAM-grafted polymers at about 32°C, indicating the temperature sensitivity of the grafted surface, i.e., the change of surface from hydrophilic to hydrophobic when temperature increases above the lower critical solution temperature (LCST). The addition of Mohr's salt enhances the grafting reaction and the magnitude of temperature sensitivity. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 104: 3614,3621, 2007 [source]
Functional finishing by using atmospheric pressure plasma: Grafting of PET nonwoven fabricJOURNAL OF APPLIED POLYMER SCIENCE, Issue 6 2007
Abstract Poly (ethylene terephtalate) (PET) nonwoven fabric was treated with He/O2 plasma to produce peroxides and grafted with acrylic acid (AA) for introducing carboxyl groups onto PET surface. The graft yield increased with AA concentration from 1.5M to 2.5M, and then decreased with further increase in AA concentration. Graft yield increased with sodium pyrosulfite (SPS) concentration from 0.005M to 0.02M, and then decreased with further increase of SPS concentration. X-ray photoelectron spectroscopy results indicated that both of plasma treatment and AA grafting increased oxygen content and decreased carbon content on the PET nonwoven fabric surface. The grafted PET nonwoven fabric showed increase in moisture regain and dye uptake. And drastic increase in wettability was observed after grafting. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 103: 3655,3659, 2007 [source]
Comparison of two approaches to grafting hydrophilic polymer chains onto polysulfone filmsJOURNAL OF APPLIED POLYMER SCIENCE, Issue 6 2007
Abstract To reduce the surface protein adsorption of polysulfone (PSf) film, we improved the hydrophilicity of this film by photochemical grafting of methoxypoly (ethylene glycol) (MPEG) derivatives on its surface. Grafting was achieved with both the simultaneous method and the sequential method. Surface analysis of the grafted film by X-ray photoelectron spectroscopy (XPS) revealed that the PEG chains had successfully grafted onto the surface of the film. The grafting efficiencies by simultaneous and sequential methods were 20.8% and 10.2%, respectively. With an atomic force microscope (AFM), the surface topography of PEG-grafted films by these two methods was compared. Static water contact angle measurement indicated that the surface hydrophilicity of the film had been improved. Protein adsorption measurement showed that the surface protein adsorption of the modified film was significantly reduced compared with that of the unmodified PSf film. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 103: 3818,3826, 2007 [source]
ACQUIRED CARDIOVASCULAR DISEASE Original Articles: A Prospective Observational Study to Compare Conventional Coronary Artery Bypass Grafting Surgery with Off-Pump Coronary Artery Bypass Grafting on Basis of EuroSCOREJOURNAL OF CARDIAC SURGERY, Issue 5 2010
Pawan Singhal M.Ch.
Off-pump coronary bypass (OPCAB) surgery has become a widely used technique during recent years. EuroSCORE risk scale is the most rigorously evaluated scoring system in cardiac surgery to preoperatively quantify the risk of death and other serious postoperative complications. The aim of this prospective observational study was to compare the mortality and morbidity between OPCAB and conventional CABG in three major preoperative groups as assessed by EuroSCORE. Material and Method: All consecutive patients undergoing isolated coronary artery bypass surgery between January 2003 and December 2004 at Wellington Hospital were included. In this period, 347 patients had conventional CABG and 254 patients had OPCAB. Data were prospectively collected according to Australasian Society of Cardiothoracic Surgeons' cardiac surgery data set. The preoperative additive EuroSCORE was computed in each patient and the patients were divided into three risk groups. Results of OPCAB and conventional CABG were compared on basis of EuroSCORE group. Results: OPCAB surgery is preferably performed in patients with low-risk. OPCAB group had lesser number of grafts per patient. When adjusted with risk score, there was no statistically significant difference in mortality in any of the three groups. No significant difference was found for stroke, renal dysfunction, atrial fibrillation, re-exploration for bleeding, deep sternal wound infection, or pulmonary complications in either of three groups. However, inotropic requirement and requirements of blood products were less in OPCAB group. Conclusion: OPCAB does not offer any significant advantage in terms of mortality and morbidity over conventional CABG.,(J Card Surg 2010;25:495-500) [source]
Results of Treatment Methods in Cardiac Arrest Following Coronary Artery Bypass GraftingJOURNAL OF CARDIAC SURGERY, Issue 3 2009
Mehmet R. Guney M.D.
We evaluated the short- and long-term consequences of these two methods and discussed the indications for re-revascularization. Methods: Between 1998 and 2004, a total of 148 CABG patients, who were complicated with cardiac arrest, were treated with emergency re-revascularization (n = 36, group R) and ICU procedures (n = 112, group ICU). Re-revascularizations are mostly blind operations depending on clinical/hemodynamic criteria. These are: no response to resuscitation, recurrent tachycardia/fibrillation, and severe hemodynamic instability after resuscitation. Re-angiography could only be performed in 3.3% of the patients. Event-free survival of the groups was calculated by the Kaplan-Meier method. Events are: death, recurrent angina, myocardial infarction, functional capacity, and reintervention. Results: Seventy percent of patients, who were complicated with cardiac arrest, had perioperative myocardial infarction (PMI). This rate was significantly higher in group R (p = 0.013). The major finding in group R was graft occlusion (91.6%). During in-hospital period, no difference was observed in mortality rates between the two groups. However, hemodynamic stabilization time (p = 0.012), duration of hospitalization (p = 0.00006), and mechanical support use (p = 0.003) significantly decreased by re-revascularization. During the mean 37.1 ± 25.1 months of follow-up period, long-term mortality (p = 0.03) and event-free survival (p = 0.029) rates were significantly in favor of group R. Conclusion: Better short- and long-term results were observed in the re-revascularization group. [source]
Harvesting of the Radial Artery for Coronary Artery Bypass Grafting: Comparison of Ultrasonic Harmonic Scalpel Dissector with the Conventional TechniqueJOURNAL OF CARDIAC SURGERY, Issue 3 2009
Hosam F. Fawzy M.D.
We started routine use of the ultrasonic dissecting scalpel in harvesting radial arteries aiming to minimize harvesting time, improve graft quality, and reduce wound complications. Methods: Radial artery harvesting technique using harmonic scalpel (HS; 43 patients) was compared with the conventional technique (Hemostatic clips and scissors; 53 patients). To avoid spasm, the radial artery was not skeletonized and papaverine was used to irrigate radial artery routinely in all patients. Results: Compared to the conventional technique, radial artery harvesting using the HS has a significantly shorter harvesting time (25 minutes vs. 50 minutes, p < 0.001) and required a significantly smaller number of hemostatic clips (3 vs. 40, p < 0.001). In situ free blood flow was significantly higher in HS group (80 mL/min vs. 40 mL/min, p < 0.001). There was no forearm wound infection in the HS group. There was no graft failure, reoperation for bleeding, or hand ischemia with the use of either technique. Conclusion: Harvesting the radial artery using the HS is less time consuming and decreased the use of hemostatic clips rather atraumatic with good quality graft. [source]
The Right Gastroepiploic Artery in Coronary Artery Bypass GraftingJOURNAL OF CARDIAC SURGERY, Issue 4 2008
Hideki Sasaki M.D.
Although some reports presenting good results justify its use in clinical settings, there is still much concern about using the RGEA in bypass surgery. The RGEA demonstrates different behaviors from the internal thoracic artery (ITA) in bypass surgery due to its histological characteristics and anatomical difference, which might contribute to the long-term outcome. Now that left ITA (LITA) to left anterior descending artery (LAD) is the gold standard, other grafts are expected to cover the rest of the coronary arteries. It should be elucidated how we can use other grafts and what we can expect from them. RGEA, as an arterial graft, can be used as an in situ graft or a free graft. The RGEA is mainly used to graft to the right coronary artery (RCA) because of its anatomical position, and its patency is not inferior to that of the saphenous vein (SVG). The RGEA can cover the lateral walls when its length is long enough or by making a composite graft with other grafts. However, when used to graft to the LAD, its mid-term patency is not favorable. [source]
The Clinical Noncompliance of Oral Sotalol/Magnesium for Prophylactic Treatment of Atrial Fibrillation After Coronary Artery Bypass GraftingJOURNAL OF CARDIAC SURGERY, Issue 4 2007
Giovanni Mariscalco M.D.
The present aim was to study the clinical compliance of a suggested prophylactic treatment, oral sotalol, and magnesium. Methods: Coronary-bypass patients without clinical contraindications to receive oral sotalol (80 mg twice daily) and magnesium supplementation were enrolled (n = 49) with an intention-to-treat strategy and being compared with a matched control group (n = 844). A protocol listed exclusion criteria of clinical compliance that was postoperatively evaluated prior to and during treatment. Results: Twenty-seven of the 49 enrolled patients (55%) were compliant to sustain the treatment according to the protocol. The remaining patients were postoperatively excluded, mainly because of hemodynamic reasons, of whom 14 were noncompliant to initiate any treatment. The AF occurrence in the compliant group was 7% versus 36% in noncompliant patients (p = 0.035), and 24% in the control group (p = 0.076). However, with an intention-to-treat policy the overall AF incidence became 18%. The subgroups of enrolled patients demonstrated skewing phenomena. The noncompliant group had higher requirement for inotropic support (p = 0.029) and longer aortic cross-clamp time (p = 0.048) compared to compliant patients. Further, the body weight of noncompliant patients was markedly lower than in the compliant counterpart (p = 0.015). Conclusions: The tested treatment protocol showed limited compliance among routine cardiac-surgery patients, and further, introduced a biased selection of patients that skewed the results and may have partly explained the treatment effect. [source]
Introduction of an OPCAB Program Aimed at Total Arterial Grafting in a Multidisciplinary Setting: Feasible and Safe?JOURNAL OF CARDIAC SURGERY, Issue 2 2007
Xavier M. Mueller M.D.
Uniform surgical and anesthetic protocols were established and applied throughout the study period. Methods: From March 2003,when the first OPCAB procedure of the program was performed,to July 2004, the data related to all the coronary artery bypass grafting procedures (N = 408) were prospectively recorded. The program was divided into two stages: the purpose of the first stage was to perform OPCAB in more than 90% of the patients, and that of the second stage was to proceed toward total arterial revascularization. The patients were grouped into four periods (102 patients for each period). Comparisons were performed with analysis of variance test and chi-square test where appropriate. Results: For periods 1 to 4, the number of OPCAB procedures was 65/102 (64%), 82/102 (80%), 97/102 (95%), and 99/102 (97%), respectively (p < 0.001). The number of conversions did not vary significantly throughout the study (overall: 7/408, 1.7%), neither did the number of bypass/patient (overall: 3.05 ± 0.86). The number of arterial graft/patient was 1.03 ± 0.64, 1.01 ± 0.4, 1.29 ± 0.64, and 2.56 ± 1, respectively (p < 0.001). During the last period, 81% (253/312) of the grafts were arterial. Overall mortality was 4.6% (19/408). For the OPCAB group, mortality was 2.9% (10/343) and perioperative myocardial infarction rate was 1.5% (5/343) with no statistically significant difference between the periods. Conclusions: With predefined standardized and coordinated protocols, an OPCAB program aimed at total arterial revascularization can be implemented rapidly and safely in a multidisciplinary setting. [source]
Invited Commentary: Introduction of An Opcab Program Aimed at Total Arterial Grafting In A Multidisciplinary Setting: Feasible and Safe?JOURNAL OF CARDIAC SURGERY, Issue 2 2007
F.A.C.S., F.R.C.S.C., M.Sc., Richard J. Novick M.D.
No abstract is available for this article. [source]
Transient Beneficial Effects of Glutamate-Aspartate-Enriched Cardioplegia on Ventricular Functions in Coronary Artery Bypass GraftingJOURNAL OF CARDIAC SURGERY, Issue 5 2006
Ümit Duman M.D.
No abstract is available for this article. [source]
Elective Intraaortic Balloon Counterpulsation in High-Risk Off-Pump Coronary Artery Bypass GraftingJOURNAL OF CARDIAC SURGERY, Issue 1 2006
Hunaid A. Vohra M.R.C.S.
However, the benefits of insertion of IABP electively in high-risk off-pump coronary artery bypass grafting (OPCAB) have not been established. Six hundred and twenty-five patients who underwent OPCAB form the study group. High-risk patients fulfilling two or more of the following: left main stem stenosis >70%, unstable angina, and poor left ventricular function, who had elective insertion of IABP preoperatively by the open technique (group I; n = 20) were compared with a similar high-risk group that did not (group II; n = 25). There were no significant differences in risk factors between the two groups (Euroscore 5.68). The mean number of grafts was similar. Postoperatively, there were no significant differences in the need for inotropes, duration of ventilation, arrhythmias, cerebrovascular, gastrointestinal, and infective complications (p = NS). There were no IABP-related complications. Acute renal failure requiring hemofiltration was higher in group II (n = 5; p < 0.05). Four patients (16%) in group II required postoperative IABP. Although intensive care stay was longer in group I (27.6 ± 15.3 vs. 18.6 ± 9.1 hours; p < 0.05), patients in group I were discharged earlier from hospital. There was no difference in mortality between the two groups (n = 1 in each group). In high-risk patients undergoing OPCAB, routine preoperative insertion of IABP electively reduces the incidence of acute renal failure. In addition it avoids the need for emergency insertion postoperatively and may result in earlier discharge. [source]
Coronary Artery Bypass Grafting in a Patient with Glanzmann's ThrombastheniaJOURNAL OF CARDIAC SURGERY, Issue 6 2005
Jon G. Ryckman M.D.
First described by Dr. Glanzmann in 1918, the disorder is characterized clinically by mucocutaneous bleeding and physiologically by absent platelet aggregation to collagen, epinephrine, and adenosine diphosphate stimulation. While there are multiple reports of patients with Glanzmann's thrombasthenia undergoing surgery, to our knowledge there has been no report of a patient with Glanzmann's undergoing coronary artery bypass grafting. We present the first such report of a patient who successfully underwent operative coronary artery revascularization, and offer suggestions for future management of these patients. [source]
Myocardial Protection in Reoperative Coronary Artery Bypass Grafting:JOURNAL OF CARDIAC SURGERY, Issue 4 2004
Mortality, Toward Decreasing Morbidity
Myocardial infarction and dysfunction contribute significantly to the increased risk of redo CABG. Results of reoperative coronary surgery have gradually improved, largely because of improvements in myocardial protection techniques. In the present review we will highlight the principles of myocardial protection in redo CABG patients with an emphasis on retrograde cardioplegia. [source]