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Arterial Revascularization (arterial + revascularization)
Selected AbstractsDoes the Trainee's Level of Experience Impact on Patient Safety and Clinical Outcomes in Coronary Artery Bypass Surgery?JOURNAL OF CARDIAC SURGERY, Issue 1 2008L. Ray Guo M.D. We designed this study to determine if there were any significant differences in patient demographics and clinical outcomes of coronary artery bypass procedures (CABG) performed by residents of PGY 4/lower, residents of PGY 5/6, fellows, or consultants. Methods: Standardized preoperative, intraoperative, and postoperative variables were prospectively collected and analyzed on 2906 isolated CABG procedures, performed between July 1999 and March 2006 with the primary surgeon prospectively classified as PGY4/lower, PGY5/6, fellow, and consultant. Results: The number of cases performed by residents of PGY4/lower, PGY5/6, fellows and consultants were 179, 263, 301, and 2163, respectively. Preoperative demographics and comorbidities were similar except PGY4/lower group had more diabetics and consultant group had more patients requiring IABP. More non-LIMA arterial conduits were used in the consultant and fellow groups. However, there were neither significant differences in the mean number of grafts nor in the composite postoperative morbidity, median ICU, and hospital lengths of stay. Observed in-hospital mortality was 2.2%, 1.5%, 1.7%, and 2.7% (p = 0.49), respectively. Conclusions: Preoperative patient demographics and operative data were similar in all groups except that patients requiring IABP preoperatively were more likely operated on by consultants and arterial revascularization was performed more commonly by consultants and fellows. Postoperative mortality and morbidity rates were similar among all groups, thus demonstrating that with appropriate supervision, trainees of all levels can safely be taught CABG. [source] Introduction of an OPCAB Program Aimed at Total Arterial Grafting in a Multidisciplinary Setting: Feasible and Safe?JOURNAL OF CARDIAC SURGERY, Issue 2 2007Xavier 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] Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graftLIVER TRANSPLANTATION, Issue 11 2006Carlos Moreno We performed a prospective, randomized study of adult patients undergoing orthotopic liver transplantation, comparing hemodynamic and tissular oxygenation during reperfusion of the graft. In 30 patients, revascularization was started through the hepatic artery (i.e., initial arterial revascularization) and 10 minutes later the portal vein was unclamped; in 30 others, revascularization was started through the portal vein (i.e., initial portal revascularization) and 10 minutes later the hepatic artery was unclamped. The primary endpoints of the study were mean systemic arterial pressure and the gastric-end-tidal carbon dioxide partial pressure (PCO2) difference. The secondary endpoints were other hemodynamic and metabolic data. The pattern of the hemodynamic parameters and tissue oxygenation values during the dissection and anhepatic stages were similar in both groups At the first unclamping, initial portal revascularization produced higher values of mean pulmonary pressure (25 ± 7 mm of Hg vs. 17 ± 4 mm of Hg; P < 0.05) and wedge and central venous pressures. At the second unclamping, initial portal revascularization produced higher values of cardiac output and mean arterial pressure (87 ± 15 mm of Hg vs. 79 ± 15 mm of Hg; P < 0.05) and pulmonary blood pressure. Postreperfusion syndrome was present in 13 patients (42.5%) in the arterial group and in 11 patients (36%) in the portal group. During revascularization, the values of gastric and arterial pH decreased in both groups and recovered at the end of the procedure, but were more accentuated in the initial arterial revascularization group. In conclusion, we found that initial arterial revascularization of the graft increases pulmonary pressure less markedly, so it may be indicated for those patients with poor pulmonary and cardiac reserve. Nevertheless, for the remaining patients, initial portal revascularization offers more favorable hemodynamic and metabolic behavior, less inotropic drug use, and earlier normalization of lactate and pH values. Liver Transpl, 2006. © 2006 AASLD. [source] CT02 A STUDY TO EVALUATE VARIOUS TECHNIQUES OF CORONARY ARTERY BYPASS GRAFTINGANZ JOURNAL OF SURGERY, Issue 2007P. Singhal 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] | ||||||||||