Asunto(s)
Aterosclerosis/patología , Arterias Mamarias/patología , Anciano , Angiografía , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Humanos , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/trasplante , Cuidados Preoperatorios , Periodo Preoperatorio , Arteria Subclavia/diagnóstico por imagenAsunto(s)
Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica , Aneurisma Falso , Aorta/cirugía , Vasos Coronarios/cirugía , Injerto Vascular/efectos adversos , Adulto , Anastomosis Quirúrgica/métodos , Fuga Anastomótica/diagnóstico por imagen , Fuga Anastomótica/etiología , Fuga Anastomótica/fisiopatología , Fuga Anastomótica/cirugía , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/fisiopatología , Angiografía/métodos , Aneurisma de la Aorta/cirugía , Humanos , Masculino , Tomografía Computarizada Multidetector/métodos , Reoperación/métodos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Injerto Vascular/métodosRESUMEN
BACKGROUND: Cardiac rehabilitation programs are greatly underutilized. DESIGN: This study was a multicenter interventional controlled cohort study. METHODS: From cardiothoracic departments of five medical centers, 520 coronary artery bypass graft (CABG) patients (386 men) were enrolled in the control arm and 504 CABG patients (394 men) in the intervention arm of our study. A 1-hour seminar to medical staff on the benefits of cardiac rehabilitation followed the control phase and preceded the intervention phase. Patients in the intervention arm received written and oral explanations on cardiac rehabilitation benefits and eligibility, and a follow-up telephone call 2 weeks after hospital discharge. Patients in both study arms were interviewed in the hospital prior to CABG surgery and in their homes a year later. RESULTS: Rates of participation in cardiac rehabilitation were 16.5% (86/520) for the control arm and 31.0% (156/504) for the intervention arm (p < 0.001). Factors strongly associated with participation in cardiac rehabilitation were: belonging to the intervention arm (OR: 2.06 95% CI: 1.46-2.90, p < 0.0001), male sex, average or above average income, sports related physical activity before surgery, younger age and BMI > 30 kg/m(2). Particularly high increases in participation rates following the implementation were observed among subpopulations of 10 years or less education and those reporting below average income. "Lack of knowledge" regarding cardiac rehabilitation was the reason most commonly stated for not participating in a cardiac rehabilitation program. CONCLUSION: Participation in cardiac rehabilitation almost doubled following a low cost intervention with significant effects on subpopulations that have been underrepresented in cardiac rehabilitation programs.
Asunto(s)
Puente de Arteria Coronaria/rehabilitación , Enfermedad de la Arteria Coronaria/rehabilitación , Cooperación del Paciente , Factores de Edad , Anciano , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud , Humanos , Israel , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Educación del Paciente como Asunto , Desarrollo de Programa , Factores Sexuales , Factores Socioeconómicos , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Prótesis Valvulares Cardíacas/efectos adversos , Heparina/efectos adversos , Estenosis de la Válvula Mitral/etiología , Trombocitopenia/inducido químicamente , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Trombosis/tratamiento farmacológico , Trombosis/patología , Tomografía Computarizada por Rayos XAsunto(s)
Estenosis de la Válvula Aórtica/complicaciones , Válvula Aórtica , Ceftriaxona/administración & dosificación , Endocarditis Bacteriana , Implantación de Prótesis de Válvulas Cardíacas/métodos , Vasculitis por IgA/diagnóstico , Estreptococos Viridans/aislamiento & purificación , Lesión Renal Aguda/etiología , Anciano , Antibacterianos/administración & dosificación , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/microbiología , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Ecocardiografía Transesofágica , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/fisiopatología , Endocarditis Bacteriana/terapia , Exantema/etiología , Hematuria/etiología , Humanos , Masculino , Proteinuria/etiología , Resultado del TratamientoAsunto(s)
Estenosis de la Válvula Aórtica/complicaciones , Válvula Aórtica , Ceftriaxona/administración & dosificación , Endocarditis Bacteriana , Implantación de Prótesis de Válvulas Cardíacas/métodos , Vasculitis por IgA/diagnóstico , Estreptococos Viridans/aislamiento & purificación , Humanos , MasculinoRESUMEN
BACKGROUND: Intraoperative transesophageal echocardiography may underestimate ischemic mitral regurgitation (MR) as a result of the unloading effect of general anesthesia on the left ventricle (LV). An intraoperative loading test could prove useful to avoid underestimation of ischemic MR. METHODS: We prospectively studied 30 patients with ischemic MR referred for coronary artery bypass, mitral valve surgery, or both. Transthoracic echocardiography was performed 1.6 +/- 1.6 days preoperatively, and intraoperative transesophageal echocardiography after induction of general anesthesia before and after LV loading. Preload was adjusted using fluids (if pulmonary occlusion pressure < 15 mm Hg), and the afterload increased using intravenous phenylephrine aiming at systolic blood pressure of 160 mm Hg. MR severity was estimated using color Doppler, pulmonary venous flow, and the proximal isovelocity surface area method. RESULTS: Preoperative median MR grade was 2 (interquartile range 1-3), effective regurgitant orifice area was 0.16 +/- 0.17 cm2, and regurgitant volume was 23 +/- 23 mL. Intraoperative MR grade decreased to 1.5 (1-2.25), effective regurgitant orifice area to 0.13 +/- 0.16 cm2, and regurgitant volume to 21 +/- 26 mL (P = .02, P = .06, and P = .18). After LV loading, MR grade increased to 3 (1-4), effective regurgitant orifice area to 0.21 +/- 0.24 cm2, and regurgitant volume to 39 +/- 38 mL (P < or = .005). All patients with preoperative +3 MR or greater had +3 MR or greater after loading whereas most patients with +1 MR had +1 MR. Of the 11 patients with preoperative +2 MR, 6 had +3 and 2 had +4 MR. CONCLUSIONS: A quantitative loading test with fluids and phenylephrine is useful to avoid underestimation of ischemic MR by intraoperative transesophageal echocardiography, and may detect significant MR in some patients who had unloaded LVs and nonsignificant MR during their preoperative assessment.
Asunto(s)
Ecocardiografía Transesofágica/métodos , Pruebas de Función Cardíaca/métodos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Isquemia Miocárdica/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/cirugía , Anciano , Femenino , Humanos , Masculino , Insuficiencia de la Válvula Mitral/complicaciones , Monitoreo Intraoperatorio/métodos , Isquemia Miocárdica/etiología , Isquemia Miocárdica/cirugía , Pronóstico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Ultrasonografía Intervencional/métodos , Disfunción Ventricular Izquierda/etiologíaRESUMEN
The tangential K graft is a comfortable surgical technique aiming to increase cardiac surgeons' versatility in performing multiple arterial grafting using only two arterial conduits. One end of the free graft--either the right internal thoracic artery (RITA) or the radial artery (RA)--is attached to a marginal circumflex branch. Its other end is anastomosed end to side to a diagonal branch. After the left internal thoracic artery (LITA) is attached to the left anterior descending coronary artery, a wide-open side-to-side LITA to free RITA or RA anastomosis--resembling the letter K--is constructed.