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CABG Procedure (cabg + procedure)
Selected AbstractsPEEP Therapy for Patients With Pleurotomy During Coronary Artery Bypass GraftingJOURNAL OF CARDIAC SURGERY, Issue 3 2000Susumu Ishikawa M.D. We studied the efficacy of intraoperative positive end-expiratory airway pressure (PEEP) therapy for the prevention of postoperative pulmonary oxygenation impairment. A total of 66 patients with solitary CABG procedure were included in this study. The pleural cavity was intraoperatively opened in 44 patients and not opened in 22. PEEP therapy was not used in any patient before May 1996 (referred to herein as the former period) and was used more recently in eight patients with pleurotomy (referred to herein as the latter period). PEEP was initiated immediately after pleurotomy during the harvest of the internal mammary artery graft. Without PEEP therapy, values of PaO2, A-aDO2, and respiratory index (RI) were worse in patients with pleurotomy than in those without pleurotomy. Meanwhile, there were no major differences in these values between patients with or without pleurotomy after the induction of PEEP therapy. Respiratory insufficiency (A-aDO2 > 400 mmHg and RI > 1.5) was detected in six patients with pleurotomy in the former period. Three of these six patients required over 1 week of long-term mechanical respiratory support. No respiratory insufficiency occurred in patients of the latter period. In conclusion, PEEP therapy, which is initiated just after pleurotomy, may prevent oxygen impairment and pulmonary atelectasis after extracorporeal circulation (ECC) and is recommended for patients with pleurotomy, especially for patients with preoperative low respiratory function. [source] Statins Decrease Adverse Outcomes in Coronary Artery Bypass for Extensive Coronary Artery Disease as well as Left Main Coronary StenosisCARDIOVASCULAR THERAPEUTICS, Issue 2 2010Hui-Li Gan The aim of this study was to evaluate the effects of preoperative and postoperative statins on coronary artery bypass grafting (CABG) for extensive coronary artery disease as well as left main coronary stenosis (LMS). The data of 626 cases of extensive coronary artery disease as well as LMS patients in Anzhen Hospital between January 1998 and March 2008 for CABG procedure were retrospectively analyzed, and were classified as preoperative statin therapy group (Group A, n = 320) or preoperative no statin therapy group (Group B, n = 306). Propensity scores were estimated to determine the probability of inclusion into statin therapy group, resulting in the successful matching of 267 pairs. The incidence of in-hospital death, and atrial fibrillation or flutter and disabling stroke was higher in Group B than in Group A. The actuarial freedom from late events at 5 yrs were 98.75%± 0.73% for the postoperative statin therapy group and 88.33%± 3.71% for the postoperative no statin therapy group respectively, P= 0.000. The logistic regression revealed that CRP (>5.0 mg/L), and elevated Troponin I, and emergent procedure, and preoperative IABP support, and EF < 40% were the independent risk factors, and preoperatively statins was the protective factor for the perioperative death; and the Cox proportional hazard also revealed that preoperative IABP support and preoperative cardiac arrest, and EF < 40% were independent risk factors, and postoperatively statins were the protective factor for the late cardiac events. Preoperative statin therapy could provide protective effect in the perioperative period. Postoperative statin usage could provide protective effect on the late cardiac events. [source] Increased infiltration of Chlamydophila pneumoniae in the vessel wall of human veins after perfusionEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2008K. Kupreishvili ABSTRACT Background Several studies have suggested an association between Chlamydophila pneumoniae (Cp) infection and atherosclerosis. A recent study detected Cp DNA in the saphenous vein of 12% of all patients before bypass grafting and in 38% of failed grafts. We used a system in which human veins were perfused with autologous blood under arterial pressure. Materials and methods, Veins were surplus segments of saphenous veins of coronary artery bypass grafting (CABG) patients. Vein grafts were perfused with the blood of the same patient after CABG procedures. Veins were analysed for Cp -specific membrane protein using immunohistochemical and PCR analysis. Veins were analysed before and after perfusion (up to 4 h). The number of Cp positive cells was then quantified in the vein layers. Results Cp protein was detected within macrophages only. In non-perfused veins, Cp was present in the adventitia in 91% of all patients, in the circular (64%) and longitudinal (23%) layer of the media. No positivity was found in the intima. Perfusion subsequently resulted in a significant increase of Cp positive cells within the circular layer of the media that, however, differed strongly between different patients. Cp DNA was not detected by PCR in those specimens. Conclusion Cp protein was present in 91% of veins, but the number of positive cells differed remarkably between patients. Perfusion of veins resulted in increased infiltration of Cp into the circular layer. These results may point to a putative discriminating role of Cp with respect to graft failure between different patients. [source] Does 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] | ||||||||||