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Coronary Bypass Surgery (coronary + bypass_surgery)
Selected AbstractsPreoperative Intra-Aortic Balloon Pump in Patients Undergoing Coronary Bypass Surgery: A Systematic Review and Meta-AnalysisJOURNAL OF CARDIAC SURGERY, Issue 1 2008Adel M. Dyub M.D., M.Sc. The primary outcome was hospital mortality and secondary outcomes were IABP-related complications (bleeding, leg ischemia, aortic dissection). Methods: MEDLINE, EMBASE, Cochrane registry of Controlled Trials, and reference lists of relevant articles were searched. We included randomized controlled trials (RCTs), and cohort studies that fulfilled our a priori inclusion criteria. Eligibility decisions, relevance, study validity, and data extraction were performed in duplicate using pre-specified criteria. Meta-analysis was conducted using a random effects model. Results: Ten publications fulfilled our eligibility criteria, of which four were RCTs and six were cohort studies with controls. There were statistical as well as clinical heterogeneity among included studies. A total of 1034 patients received preoperative IABP and 1329 did not receive preoperative IABP. The pooled odds ratio (OR) for hospital mortality in patients treated with preoperative IABP was 0.41 (95% CI, 0.21,0.82, p = 0.01). The number needed to treat was 17. The pooled OR for hospital mortality from randomized trials was 0.18 (95% CI, 0.06,0.57, p = 0.003) and from cohort studies was 0.54 (95% CI, 0.24,1.2, p = 0.13). Overall, 3.7% (13 of 349) of patients who received preoperative IABP developed either limb ischemia or haematoma at the IABP insertion site, and most of these complications improved after discontinuation of IABP. Conclusion: Evidence from this meta-analysis support the use of preoperative IABP in high-risk patients to reduce hospital mortality. [source] Impact of Tricuspid Regurgitation and Prior Coronary Bypass Surgery on the Geometry of the Coronary Sinus: A Rotational Coronary Angiography StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2010DAN BLENDEA M.D., Ph.D. Coronary Venous Geometry in Patients Undergoing CRT.,Introduction: The coronary sinus (CS) is often distorted in patients with advanced cardiomyopathy, making CS cannulation difficult. The objective of this study was to examine the impact of the underlying cardiac pathology on the variability of the CS anatomy, using rotational coronary venous angiography (RCVA). Methods and Results: Seventy-nine patients undergoing RCVA for cardiac resynchronization therapy (CRT) were evaluated: age 63 ± 15 years, 43% with prior coronary artery bypass grafting (CABG). Aspects of the CS anatomy which could impact cannulation were examined: the CS ostial angle, the posterior displacement of the CS away from the atrioventricular groove, a measure of CS curvature, and the presence of stenoses and aneurysmal dilatations. The CS ostial angle was variable (65,151°, mean 119 ± 19°, <90° in 8 patients) and decreased significantly (P = 0.0022) with increasing severity of tricuspid regurgitation (TR), reaching 94 ± 18° in patients with severe TR. The posterior displacement of the CS was significantly more accentuated in patients with prior CABG when compared with the patients without CABG (7.1 ± 3.7 vs 4.5 ± 2.8 mm; P = 0.0246). The decrease in luminal diameter at the CS,great cardiac vein (GCV) junction was 2.0 ± 1.0 mm, being more pronounced in patients with prior CABG versus nonCABG (26 vs 20%; P = 0.042). Stenoses and aneurysmal dilatations of the CS,GCV were encountered in 4 (5%) and 6 (8%) of patients, respectively, all of them with prior CABG, representing 12% and 18% of the CABG group. Conclusion: The CS anatomy in patients undergoing CRT is variable, and is impacted by the severity of the underlying TR and history of a prior CABG. (J Cardiovasc Electrophysiol, Vol. 21, pp. 436,440, April 2010) [source] Benefits of statin therapy in patients with special risks: Coronary bypass surgery, stable coronary disease, and acute coronary syndromesCLINICAL CARDIOLOGY, Issue S3 2003W. Virgil Brown M.D. Abstract Several major clinical studies have examined the impact of lipid lowering in patients with and without coronary heart disease and have demonstrated that lowering lipid levels can successfully and significantly delay the onset of cardiovascular events. Although epidemiologic studies and small clinical trials have suggested that more aggressive and sustained lowering of low-density lipoprotein cholesterol (LDL-C) to < 100 mg/dl (2.6 mmol/l) can result in reductions in cardiovascular events in these populations, reducing LDL-C to these concentrations has only recently been shown in larger clinical trials. However, few clinical trials have been conducted in patients with certain special high risks, such as those who have had a recent revascularization procedure or have experienced an acute coronary event. Three trials examined the short- and long-term clinical benefits of aggressive lipid lowering in patients who underwent coronary artery bypass surgery (Post-CABG), were candidates for angioplasty (AVERT), or were hospitalized for acute coronary syndromes (MIRACL). [source] Missed Diagnosis of Unruptured, Huge Left Ventricular PseudoaneurysmECHOCARDIOGRAPHY, Issue 1 2003Serdar Akgun M.D. We report a case of a huge left ventricular pseudoaneurysm following myocardial infarction. Early after myocardial infarction, the pseudoaneurysm was missed during the cardiac examination. The patient underwent coronary bypass surgery with endoaneurysmorraphy of the pseudoaneurysm, and made a satisfactory recovery. (ECHOCARDIOGRAPHY, Volume 20, January 2003) [source] Rehabilitation and guidance as reported by women and men who had undergone coronary bypass surgeryJOURNAL OF CLINICAL NURSING, Issue 4 2007Kirsi Koivunen RN Aims and objectives., The purpose of this study was to describe the experience of rehabilitation reported by coronary artery disease patients who had undergone coronary artery bypass surgery. A further purpose was to describe the kind of guidance on rehabilitation that they were given during this period. Methods., The data consisted of thematic questionnaires completed by six women and eight men who had undergone coronary artery bypass surgery. They had recorded their experiences on these questionnaires at one-month intervals for a year after the surgery. The data were analysed using the method of content analysis. Results., On the basis of the results, women had experienced the most balanced period of physical, mental and social rehabilitation during the six months following surgery. Their recovery, however, suffered a setback after the first six months. On the basis of the results, men attained a better balance of physical, mental and social rehabilitation only after the six-month period following surgery. Even men had various problems in their rehabilitation, but their recovery proceeded more smoothly than that of women. Women hoped for more guidance throughout the process of rehabilitation. The support and help from wives had a positive impact on the process of men's recovery. Peer support was another significant source support. Conclusions., A person undergoing rehabilitation needs special guidance from health care professionals, especially when his/her rehabilitation does not proceed optimally. The findings suggest that, especially, the guidance of women should be improved because women seemed to suffer from many problems during their process of rehabilitation, including loneliness, insecurity, uncertainty, fears, depression and anxiety. Relevance to clinical practice., Expanding the role of practical nurses to provide both preventive and rehabilitation guidance should be seen as an important strategy in health care. Individual needs, gender differences and support from families and peers should be taken into consideration when planning and implementing guidance. [source] Recurrent venous thromboembolism after surgery-provoked versus unprovoked thromboembolismJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2010R. H. WHITE Summary.,Background: The incidence of recurrent venous thromboembolism (VTE) varies depending on the nature of the initial provoking risk factor(s). Objectives: To compare the incidence and time course of recurrent VTE after unprovoked VTE vs. VTE provoked by nine different types of surgery. Methods: Retrospective analysis of linked California hospital and emergency department discharge records. Between 1997 and 2007, all surgery-provoked VTE cases had a first-time VTE event diagnosed within 60 days after undergoing a major operation. The incidence of recurrent VTE was compared during specified follow-up periods by matching each surgery-provoked case with three unprovoked cases based on age, race, gender, VTE event, calendar year and co-morbidity. Results: The 4-year Kaplan,Meier cumulative incidence of recurrent VTE was 14.7% (95%CI: 14.2,15.1) in the matched unprovoked VTE group vs. 7.6% (CI: 7.0,8.2) in 11 797 patients with surgery-provoked VTE (P < 0.001). The overall risk reduction was 48%, which ranged from 64% lower risk (P < 0.001) after coronary bypass surgery to 25% lower risk (P = 0.06) after disc surgery. The risk of recurrent VTE 1,5 years after the index event was significantly lower in the surgery group (HR = 0.47, CI: 0.41,0.53). Within the surgery-provoked group, the risk of recurrent VTE was similar in men and women (HR = 1.0, CI: 0.8,1.3). Conclusions: The risk of recurrent VTE after surgery-provoked VTE was approximately 50% lower than after unprovoked VTE, confirming the view that provoked VTE is associated with a lower risk of recurrent VTE. However, there was appreciable heterogeneity in the relative risk of recurrent VTE associated with different operations. [source] Myocardial Gene Expression of Angiogenic Factors in Human Chronic Ischemic Myocardium: Influence of Acute Ischemia/Cardioplegia and ReperfusionMICROCIRCULATION, Issue 3 2006YONGZHONG WANG ABSTRACT Objective: Angiogenic therapies in animals have demonstrated the development of new blood vessels within ischemic myocardium. However, results from clinical protein and gene angiogenic trials have been less impressive. The present study aimed to investigate the expression of angiogenic genes in human chronic ischemic myocardium and the influence of acute ischemia/cardioplegia and reperfusion on their expression. Methods: Myocardial biopsies were taken from chronic ischemic and nonischemic myocardium in 15 patients with stable angina pectoris during coronary bypass surgery. Tissue samples were evaluated by oligonucleotide microarray and quantitative real-time PCR for the expression of angiogenic factors. Results: There was identical baseline expression of VEGF-A and VEGF-C mRNA in chronic ischemic myocardium compared with nonischemic myocardium. Reperfusion increased the gene expression of VEGF-A and VEGF-C mRNA both in nonischemic and ischemic myocardium. VEGF-A protein was detected mainly in the extracellular matrix around the cardiomyocytes in ischemic myocardium. Conclusion: These data suggest that the nonconclusive VEGF gene therapy trials chronic coronary artery disease was not due to a preexisting upregulation of VEGF in chronic ischemic myocardium. There might be room for further therapeutic angiogenesis in chronic ischemic myocardium. [source] Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2002F. Bach Background: Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction. Microcirculation-dependent alteration of the gut mucosal barrier with subsequent translocation of endotoxins is a postulated mechanism for this inflammatory response. This study was designed to elucidate whether two different approaches to modulate splanchnic perfusion may influence systemic inflammation to CPB. Methods: We examined 40 patients scheduled for elective coronary bypass surgery in a prospective, randomized study. One group (DPX) received dopexamine (1 µg · kg,1 · min,1) continuously after induction of anesthesia until 18 h after CPB. The control group (CON) received equal volumes of NaCl 0.9% in a time-matched fashion. In a third group (EPI) a continuous epidural infusion of bupivacaine 0.25% [(body height (cm) , 100) · 10,1=ml·h,1] was administered for the whole study period. Procalcitonin (PCT), tumor necrosis factor (TNF-,), soluble TNF receptor, human soluble intercellular adhesion molecule-1, C-reactive protein (CRP) and leukocyte count were measured as parameters of inflammation. Results: All parameters significantly increased following CPB. Increases of PCT, TNF-, and leukocyte count were significantly attenuated in the DPX and EPI groups at different time points. However, neither splanchnic blood flow nor oxygen delivery and consumption were different when compared with the CON-group. Conclusion: These results do suggest that mechanisms other than an improved splanchnic blood flow by DPX and EPI treatment have to be considered for the anti-inflammatory effects. [source] The value of pulse pressure and stroke volume variation as predictors of fluid responsiveness during open chest surgeryANAESTHESIA, Issue 7 2010P. A. H. Wyffels Summary We investigated the ability of pulse pressure variation and stroke volume variation to predict fluid responsiveness during mechanical ventilation in patients undergoing open chest surgery by comparing their respective correlations with cardiac output changes induced by leg elevation. Serial leg elevation manoeuvres were performed before and after sternotomy in 15 patients scheduled for elective off-pump coronary bypass surgery. Under closed chest conditions, both pulse pressure variation and stroke volume variation correlated well with the induced cardiac output changes (r = 0.856, p = 0.002 and r = 0.897, p = 0.0012, respectively). These correlations were lost for both parameters following sternotomy. Our data show that pulse pressure variation and stroke volume variation are valid predictors of fluid responsiveness under closed chest conditions but that this property no longer holds when the chest is open. [source] Simultaneous coronary bypass surgery and same anaesthetic technique in identical twinsANAESTHESIA, Issue 5 2003D. Dal No abstract is available for this article. [source] | ||||||||||||||||||||||