Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.158
Filtrar
1.
Braz J Cardiovasc Surg ; 34(4): 488-490, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454205

RESUMO

Paroxysmal nocturnal hemoglobinuria (PNH) is an ultra-orphan disease. We report the first case in the literature of Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in a patient with paroxysmal nocturnal hemoglobinuria. A 36-year-old man came to the emergency department with acute non-ST elevation myocardial infarction (NSTEMI). He presented paroxysmal nocturnal hemoglobinuria diagnosed in 2016. Coronary angiography revealed tripple vessel disease. The conduits used for coronary revascularization were both internal thoracic arteries (left ITA-right ITA [LITA-RITA]). We consider that off-pump coronary artery bypass grafting (OPCABG) using Bilateral Internal Thoracic Arteries (BITA) can be safely performed with low in-hospital mortality and complications rates, even in patient with PNH.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença das Coronárias/cirurgia , Hemoglobinúria Paroxística/complicações , Adulto , Angiografia Coronária/métodos , Doença das Coronárias/complicações , Humanos , Masculino , Artéria Torácica Interna/transplante
2.
Georgian Med News ; (290): 17-20, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322507

RESUMO

Our aim was to compare early post-operative period of Endo-ACAB with OPCABG. We retrospectively studied 760 cases of all patients who had underwent urgent or planned coronary artery bypass grafting at the "Tbilisi Heart and Vascular Clinic" from November 2015 till November 2017. Patients were divided into two group: first group patients who had underwent Endo-ACAB and second group patients who had underwent OPCABG. Early postoperative complications including pneumonia, stroke, ventricular fibrillation, pain intensity, wound infection and hospital stay were studied. After analyzing both groups of the patients we concluded that no statistically significant difference was revealed in presence of preoperative risk-factors like diabetes mellitus and arterial hypertension between the study groups. Mean ejection fraction was slightly lower in Endo-ACAB group but statistical analysis showed no significant difference. Moreover, no statistical difference was seen in early postoperative complications like pneumonia, stroke, ventricular fibrillation or early mortality. Respectively severely of pain was similar in Endo-ACAB group compared with CABG. Statistical analyses revealed significant lower rate of surgical wound complication and hospital stay in Endo-ACAB group. In both group no intraoperative mortality was detected. To conclude Endo-ACAB has significantly lower rate of early postoperative complications compared to OPCABG according to the date of "Tbilisi Heart and Vascular Clinic".


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária/métodos , Doença das Coronárias/cirurgia , Isquemia Miocárdica/cirurgia , Idoso , Feminino , Georgia/epidemiologia , Humanos , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
3.
Braz J Cardiovasc Surg ; 34(3): 311-317, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310470

RESUMO

OBJECTIVE: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. METHODS: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. RESULTS: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). CONCLUSION: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.


Assuntos
Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/fisiopatologia , Ponte de Artéria Coronária sem Circulação Extracorpórea/psicologia , Eletrocardiografia/psicologia , Lorazepam/uso terapêutico , Cuidados Pré-Operatórios/métodos , Adolescente , Adulto , Idoso , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/psicologia , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
Med Sci Monit ; 25: 3454-3462, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31073116

RESUMO

BACKGROUND This study aimed to investigate the role of impedance cardiography (ICG) to evaluate hemodynamic changes in patients after off-pump coronary artery bypass graft (OPCABG) surgery. MATERIAL AND METHODS One-hundred and sixty patients who had undergone OPCAGB were enrolled and assessed using New York Heart Association NYHA functional class (II, II, and IV). ICG was used to measure the stroke volume (SV), stroke volume index (SI), cardiac output per minute (CO/min), cardiac index (CI), end-diastolic volume (EDV), pre-ejection period (PEP), left ventricular ejection time (LVET), systolic time ratio (STR), left ventricular ejection fraction (LVEF), acceleration index (ACI), systemic vascular resistance (SVR), and thoracic fluid content (TFC). The ICG parameters were correlated with brain natriuretic peptide (BNP) and echocardiography parameters using multivariate regression analysis. RESULTS The levels of CO, ACI, TFC, SVR, and BNP compared with ICG showed differences between NYHA functional class, with CO showing a significant difference (p<0.05). There were no significant differences between SV, SI, EDV, and LVEF before and after OPCAGB. Using ICG, the parameters of CI, LVEF, EDV, and TFC showed no significant correlation with BNP. SV, SI, CO, ACI, and LVET, which were negatively correlated with BNP. SVR, PEP, and STR were positively correlated with BNP (P<0.05). CONCLUSIONS In patients who had OPCABG, the findings from ICG were significantly correlated with BNP levels and the results from echocardiography for the evaluation of cardiac hemodynamic changes. ICG might have a role in the assessment of cardiac function in clinical practice.


Assuntos
Cardiografia de Impedância/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Hemodinâmica/fisiologia , Adulto , Idoso , Pressão Sanguínea , Débito Cardíaco , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/análise , Peptídeo Natriurético Encefálico/sangue , Estudos Retrospectivos , Volume Sistólico , Sístole , Função Ventricular Esquerda
5.
J Card Surg ; 34(5): 359-362, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30900318

RESUMO

Here we report a rare case of atypical Kawasaki disease (KD) in a patient presenting with systemic arteritis affecting the coronary arteries, brain, and internal mammary arteries (IMAs). A 25-year-old man was referred to our institute with angina pectoris. Coronary angiography revealed coronary artery aneurysms and triple-vessel disease. Three-dimensional brain computed tomography showed multiple small saccular aneurysms on the vertebral and posterior inferior cerebellar arteries. Off-pump coronary artery bypass (OPCAB) grafting ​​​​​​was performed; however, the bilateral IMAs were tightly adhered and not patent. OPCAB was completed using the bilateral radial and gastroepiploic arteries. This is the first report of KD involving the IMA.


Assuntos
Encéfalo/diagnóstico por imagem , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Artéria Torácica Interna , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/cirurgia , Adulto , Angina Pectoris/etiologia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/etiologia , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/etiologia , Artéria Gastroepiploica/transplante , Humanos , Imagem Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/patologia , Artéria Radial/transplante , Tomografia Computadorizada por Raios X
6.
Cardiovasc J Afr ; 30(1): 57-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30720843

RESUMO

OBJECTIVE: The rate of patients with diffuse left anterior descending artery (LAD) disease being referred for surgery has increased as a result of advances in endovascular techniques. In surgery of diffuse or multisegment LAD disease, surgical procedures with or without endarterectomy can be performed. In this article, we report our results of longsegment onlay patchplasty of the LAD with a left internal thoracic artery (LITA) graft without endarterectomy, on the beating heart, in patients with multisegment LAD disease. METHODS: We retrospectively analysed patients who underwent coronary artery bypass grafting surgery in our hospital between 1 January 2015 and 31 July 2017. We included LITA onlay patchplasty patients with multisegment LAD disease who had been operated on the beating heart. We excluded patients who underwent coronary endarterectomy and were operated on under cardiopulmonary bypass. RESULTS: In this period, 54 patients with multisegment LAD disease were treated with LITA patchplasty on the beating heart. The mean length of the arteriotomy was 42.8 ± 13.3 mm (25-75 mm). There were two postoperative myocardial infarctions (3.7%) and three deaths (5.5%). In the remaining patients, there was no haemodynamic instability that needed long-term (> 24 hour) inotropic support. Patients were discharged from hospital on postoperative 9.3 ± 7.1 days with dual antiplatalet therapy. CONCLUSIONS: Bypass grafting of the LAD with long-segment LITA onlay patchplasty can safely be performed in patients with multisegment LAD disease, with acceptable early-term results. In this procedure, proximal and distal segments of the diseased LAD are revascularised with LITA grafts, which may improve long-term survival and quality of life.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Anastomose de Artéria Torácica Interna-Coronária/métodos , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Anastomose de Artéria Torácica Interna-Coronária/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Interact Cardiovasc Thorac Surg ; 28(6): 860-867, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30726927

RESUMO

OBJECTIVES: Bilateral internal thoracic artery (BITA) grafting is associated with improved survival, but this technique is reluctantly used in women due to an increased risk of sternal wound infection. The aim of this study was to compare the long-term survival of women who underwent BITA grafting and single internal thoracic artery (SITA) grafting. METHODS: We performed a retrospective analysis of 556 consecutive female BITA patients and 685 female SITA patients. RESULTS: SITA patients were older and more likely to have comorbidities (diabetes mellitus, chronic lung disease, chronic renal failure, peripheral vascular disease and cerebral vascular disease). Operative mortality showed a trend towards a benefit for BITA (2.9% vs 5.0% for SITA, P = 0.06). The sternal wound infection rates were similar (3.4% vs 2.9%, P = 0.6); however, the occurrence of stroke was significantly lower in the SITA group (3.4% vs 1.2%, P = 0.007). The median survival of the BITA group was significantly better {13.8 years [95% confidence interval (CI) 12.8-14.9] vs 10.3 years [95% CI 9.6-11.1], P = 0.001}. After propensity score matching (491 pairs), the assignment to BITA was not associated with increased early mortality or complication rates, and the choice of BITA grafting was associated with better survival [14.5 years (95% CI 13.3-15.6) vs 11.8 years (95% CI 10.7-12.9)]. Only the choice of conduits was associated with increased late mortality (multivariable analysis, hazard ratio 1.28, 95% CI 1.024-1.591; P = 0.03). CONCLUSIONS: The low early mortality and complication rate, and the long-term survival benefit of BITA compared to SITA grafting, support the use of BITA grafting in women.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Artéria Torácica Interna/transplante , Complicações Pós-Operatórias/prevenção & controle , Pontuação de Propensão , Idoso , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Incidência , Israel/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
8.
Braz J Cardiovasc Surg ; 34(1): 62-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810676

RESUMO

OBJECTIVE: This study aims to compare the early and medium outcomes of on-pump beating-heart (OPBH) coronary artery bypass grafting (CABG) and off-pump CABG (OPCABG) in patients with left ventricular ejection fraction (LVEF) between 30% and 40%. METHODS: This is a retrospective study of ischemic heart disease patients with LVEF between 30% and 40% who underwent surgical revascularization from January 2013 to December 2017. Patients were divided into OPBH group (n=44) and OPCABG group (n=68), according to the surgical method. Clinical material with early and medium outcomes were investigated and compared between these groups. RESULTS: The two groups had similar baseline. Two OPBH patients and 3 OPCABG patients died in the hospital, which had no statistical significance (P>0.05). OPBH patients received a greater number of grafts (3.74±0.84) and presented more improved LVEF (45.92±7.11%) than OPCABG patients (3.36±0.80) and (42.81±9.29%), respectively, which had statistical significance (P<0.05). An increased amount of drainage during the first 12 hours was found in the OPBH group (P<0.05). Reoperation for bleeding, duration of mechanic ventilation, and other early outcomes had no statistical significance between the two groups. During the medium-time follow-up, OPBH patients showed significantly lower major adverse cardiovascular events (MACE)-free survival time (P=0.049) than OPCABG patients. CONCLUSION: The OPBH technique was a safe and an acceptable alternative for surgical revascularization in patients with moderate left ventricular dysfunction which provided better mid-term MACE-free survival compared with OPCABG.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária/métodos , Disfunção Ventricular Esquerda/cirurgia , Idoso , Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Ecocardiografia/métodos , Feminino , Hemodinâmica , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/mortalidade
9.
J Cardiothorac Surg ; 14(1): 22, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683137

RESUMO

BACKGROUND: Grafting vessel with LIMA to the left anterior descending coronary artery plays a most important role in the long-term prognosis of OPCABG surgery. The aim of this study was to compare the effects of isoflurane preconditioning on miRs and mRNAs levels in the left internal mammary arterie (LIMA) graft with propofol in patients undergoing off-pump coronary artery bypass surgery (OPCABG). METHODS: Patients were randomly assigned to receive either propofol (n = 15), or interrupted isoflurane (n = 15). In group P, propofol administration was continued at 3-5 mg/kg/h intravenous injection for the duration of surgery. Five minutes prior to incision, patients of the isoflurane group (group Iso) received 2 cycles of 1 MAC isoflurane. RESULTS: miR-221 were significantly lower in group Iso (P < 0 .05). E-selectin mRNA, RhoA mRNA and ROK mRNA were significantly lower at specimens of LIMA in group Iso compared with those in group P patients (P < 0 .05). The expression of NOS3 mRNA was significantly higher in group Iso patients (P < 0 .05). CONCLUSION: Our findings provide some insight that prior interrupted isoflurane administration could regulate miR-221, and downstream effectors (mRNAs) and resulted in actual attenuation of inflammation and spasm of LIMA in patients undergoing OPCABG surgery. TRIAL REGISTRATION: NCT No. ( ClinicalTrials.gov ): NCT02678650; Registration date: January 23, 2016.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/metabolismo , Precondicionamento Isquêmico Miocárdico/métodos , Isoflurano/farmacologia , Óxido Nítrico/genética , Quinases Associadas a rho/genética , Idoso , Anestésicos Inalatórios/farmacologia , Doença da Artéria Coronariana/genética , Doença da Artéria Coronariana/metabolismo , Vasos Coronários/efeitos dos fármacos , Feminino , Regulação da Expressão Gênica , Humanos , Masculino , Artéria Torácica Interna/metabolismo , Pessoa de Meia-Idade , Óxido Nítrico/biossíntese , Estudos Prospectivos , RNA/genética , Reação em Cadeia da Polimerase em Tempo Real , Quinases Associadas a rho/biossíntese
10.
J Cardiothorac Vasc Anesth ; 33(5): 1334-1339, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30477889

RESUMO

OBJECTIVES: This study's objective was to test the hypothesis that transesophageal echocardiography (TEE)-based mitral annular plane systolic excursion (MAPSE) measurement is useful in perioperative settings to detect left ventricular (LV) systolic dysfunction in patients undergoing off-pump coronary artery bypass grafting (OPCAB). DESIGN: Retrospective observational study. SETTING: Tertiary-care level hospitals. PARTICIPANTS: The study comprised 116 patients undergoing OPCAB to obtain cutoffs of MAPSE to detect LV dysfunction. These cutoffs were validated in another 105 patients from 2 other institutions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In 116 patients who had undergone OPCAB during the study period with TEE monitoring, MAPSE was measured post hoc at the lateral and septal mitral (and average) annulus using the software tool M.mode.ify (http://www.ultrasoundoftheweek.com/M.mode.ify). Receiver operating curves were constructed to obtain cutoff values of MAPSE at the lateral and septal (and average) annulus of the mitral valve to predict LV systolic dysfunction, which was defined by an ejection fraction <52% for men and <54% for women as measured using the biplane method of disks. These cutoff values then were validated in another 105 patients. LV systolic dysfunction was present in 43% patients. Youden's index values of 9mm for lateral MPASE (area under the receiver operating curve [AUC] 0.93 [confidence interval {CI} 0.87-0.97]; p < 0.0001); 7mm for septal MAPSE (AUC 0.87 [CI 0.79-0.92]; p < 0.0001); and 9mm for average MAPSE (AUC 0.92 [CI 0.86-0.96]; p < 0.0001) were obtained. These cutoffs were statistically significant in the validation cohort (p < 0.0001) with an AUC of 0.84 (CI 0.75-0.90), sensitivity of 86.2%, specificity of 80.8%, positive predictive value of 84.8%, and negative predictive value of 82.6%. CONCLUSIONS: MAPSE is a simple, rapid, and reliable method to detect LV dysfunction using TEE in patients undergoing OPCAB. Its use as screening tool for LV dysfunction is recommended.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/normas , Ecocardiografia Transesofagiana/normas , Valva Mitral/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/cirurgia , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estudos Retrospectivos , Método Simples-Cego , Disfunção Ventricular Esquerda/fisiopatologia
11.
J Cardiothorac Vasc Anesth ; 33(1): 232-244, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29753665

RESUMO

Surgical coronary artery bypass grafting (CABG) is the standard of care for revascularization of left main or three-vessel coronary artery disease. The off-pump coronary artery bypass graft (OPCAB) procedure avoids the use of cardiopulmonary bypass. Theoretically, OPCAB may improve long-term outcomes by reducing the rates of perioperative myocardial injury, stroke, neurocognitive impairment, and cardiac-related mortality. Several high-quality clinical trials have been conducted since OPCAB became popular in the 1990s and have demonstrated no benefit of OPCAB over traditional CABG with respect to these outcomes despite favorable short-term reductions in transfusion requirements and other postoperative complications. Ultimately, OPCAB is associated with less effective myocardial revascularization and does not entirely prevent complications traditionally associated with cardiopulmonary bypass. This article reviews major high-quality trials of OPCAB versus traditional CABG with respect to both short- and long-term clinical outcomes.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Cuidados Pós-Operatórios/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Humanos , Seleção de Pacientes , Resultado do Tratamento
12.
Perfusion ; 34(2): 116-124, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30070175

RESUMO

OBJECTIVES: At present, there is no effective method of evaluating the electrophysiological changes in cardiac myocytes during off-pump coronary artery bypass grafting (OPCAB). Therefore, we preliminarily explored the relationship between electrophysiological characteristics and the changes in cardiac function of 24 patients undergoing OPCAB. METHODS: We used the CARTO3 system for epicardial electrophysiological mapping before surgery, during left anterior descending branch anastomosis, diagonal branch anastomosis and after surgery for 24 patients undergoing OPCAB. Data, including local activation time (LAT), bipolar voltage value (BV) and conduction velocity, were processed and analyzed by the system. Intraoperative invasive blood pressure, heart rate and arterial blood gas analysis data were recorded. Continuous electrocardiography (ECG) monitoring was performed three days after surgery. Routine resting myocardial perfusion imaging (MPI) and adenosine stress-gated MPI were performed before surgery. Patients were re-examined before discharge. RESULTS: By analyzing the change in the LAT value, we found that the order of excitation of local myocardial cells changed after surgery. In addition, the LAT change in myocardial cells closer to the anastomosis was more significant. The earliest pacing point on the left anterior descending (LAD) coronary artery territory map was the third point (from the proximal to distal LAD) before OPCAB, but the earliest pacing point moved down to the fourth point (closer to the anastomosis) after the diagonal (DIA) anastomosis was complete. On the DIA territory map, the earliest pacing point was the fourth point before OPCAB; this moved up to the third point (closer to the anastomosis) after DIA bypass grafting. The voltages of all points were increased after myocardial revascularization. Compared with the preoperative period, the third, fourth and fifth points on the LAD territory map increased significantly after LAD anastomosis was complete (p=0.007, p=0.001, p=0.009, respectively). On the DIA territory map, the voltages of the first, second and third points were remarkably increased after completing the DIA anastomosis compared to before OPCAB and after LAD anastomosis completion (p=0.001, p=0.008, p<0.001 and p=0.006, p=0.032, p=0.002, respectively). The average conduction velocity (ACV) of all mapped points increased after OPCAB compared with before OPCAB (p<0.05). Postoperative resting MPI and adenosine stress-gated MPI showed that left ventricular global systolic function improved, the left ventricular ejection fraction (LVEF) increased significantly (p<0.05) and the left ventricular end systolic volume (LVESV) decreased significantly (p<0.05) compared to the preoperative MPI. CONCLUSIONS: Adequate surgical coronary revascularization could lead to more stable electrical activity of local cardiomyocytes, thus, illustrating the specific mechanism of coronary revascularization for improving the cardiac function from an electrophysiological perspective.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Mapeamento Epicárdico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
J Cardiothorac Vasc Anesth ; 33(5): 1187-1194, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30581107

RESUMO

OBJECTIVES: The authors sought to investigate long-term outcomes after revascularization with and without use of cardiopulmonary bypass and hypothesized that off-pump would be comparable with on-pump. The primary outcome of interest was survival, and secondary outcomes were need for reintervention for revascularization or new diagnosis of myocardial infarction occurring any time after surgery during the 8- to 12-year follow-up period. DESIGN: Retrospective cohort analysis. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: All patients undergoing primary isolated coronary bypass between January 1, 2004, and December 31, 2008 (n = 555). INTERVENTIONS: Coronary artery bypass on-pump (n = 238) or off-pump (n = 317). MEASUREMENTS AND MAIN RESULTS: Demographic and clinical variables were documented, including information on mortality, new myocardial infarction, and need for reintervention in the 8- to 12-year period after surgery. The on-pump and off-pump groups were similar regarding all demographic and clinical variables (p > 0.05), except for higher incidence of prior percutaneous coronary intervention in the off-pump group. There were more perioperative complications in the on-pump group (p = 0.007) and a greater number of grafts used (p = 0.000). Kaplan-Meier survival analysis demonstrated no significant difference (p > 0.05) in overall survival, reintervention-free survival, or postoperative myocardial infarction-free survival between patients who underwent bypass grafting on-pump or off-pump over extended follow-up averaging 10years. CONCLUSIONS: The present study's data did not show differences in key long-term outcomes between patients who underwent revascularization with or without cardiopulmonary bypass, supporting the idea that both methods achieve similar late results regarding overall survival, need for reintervention, and postoperative myocardial infarction.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/tendências , Hospitais de Veteranos/tendências , Revascularização Miocárdica/tendências , Vigilância da População , Veteranos , Idoso , Estudos de Coortes , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Vigilância da População/métodos , Estudos Retrospectivos , Resultado do Tratamento
14.
Kyobu Geka ; 71(12): 1035-1037, 2018 11.
Artigo em Japonês | MEDLINE | ID: mdl-30449874

RESUMO

Coronary artery aneurysm is a rare disease and its surgical indication is still controversial. We present a 63-year-old male having left main coronary artery aneurysm with 6 mm in diameter and symptomatic severe triple vessel disease. It was saccular and expanding into the myocardium. The patient successfully underwent off-pump quadruple coronary artery bypass and suture ligation of the aneurysmal neck. We believe that this technique is effective and less invasive to manage small or medium-sized coronary artery aneurysm in case aneurysmal shape, size, and location should be fitting for it.


Assuntos
Aneurisma Coronário/complicações , Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos
15.
Int Heart J ; 59(6): 1211-1218, 2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30305585

RESUMO

The enormous majority of previous reports focused on evaluating the safety and efficacy of sequential saphenous vein (SV) coronary bypass grafting; however, no reports to date have revealed concern regarding the impacts of the number of distal anastomoses of sequential SV grafting on graft patency after coronary artery bypass grafting (CABG). This single-center retrospective study aimed to evaluate the impacts of three versus two distal anastomoses per single SV conduit on SV graft patency after off-pump CABG, and to determine the independent risk factors for sequential SV graft failure.From January 2011 to December 2014, 1320 eligible patients were assigned to either a triple group (three distal anastomoses of sequential SV grafting, n = 758) or a double group (two distal anastomoses of sequential SV grafting, n = 562). The primary endpoint was over a 2-year follow-up SV graft failure after off-pump CABG.The triple and double group received a similar total patency rate of sequential SV conduits (86.5% versus 87.1%, P = 0.757). The number of distal anastomoses of sequential SV grafting (three versus two) was not a predictive factor for the follow-up graft failure of sequential SV conduits (HR = 0.91, 95% CI: 0.66-2.29, P = 0.137). Moreover, the two groups received a similar follow-up survival freedom from repeat revascularization (χ2 = 1.881, log-rank P = 0.170).Three versus two distal anastomoses per single SV conduit received a similar SV graft patency. The number of distal anastomoses of sequential SV grafting was not an independent risk factor for graft failure.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Veia Safena/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
16.
J Cardiothorac Surg ; 13(1): 109, 2018 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-30333028

RESUMO

BACKGROUND: We sought to evaluate the safety, efficacy, and cost-effectiveness of intraoperative blood salvage (IBS) in off-pump coronary artery bypass grafting (OPCABG) surgery with different amount of bleeding. METHODS: We retrospectively reviewed the medical records of 321 patients who underwent OPCABG between December 2012 and December 2016 at our hospital. Patients treated with IBS or allogeneic blood (AB) transfusions were divided into three groups depending on the amount of bleeding respectively: IBS1 or AB1 group (400-600 ml); IBS2 or AB2 group (600-1000 ml); IBS3 or AB3 group (1000-1500 ml). The intraoperative and postoperative conditions, blood transfusion volume, clinical and hematological outcomes, and total blood transfusion cost were examined. RESULTS: The amount of allogeneic red blood cell (RBC) transfusion in the IBSs groups were significantly lower than that in the ABs groups (P < 0.01). Furthermore, drainage volume 24 h post-surgery (P < 0.05) and white blood cell count (WBC) 2 day post-surgery (P < 0.01) in IBS3 group were significantly higher compared with the AB3 group. Additionally, when IBS cost was 230 USD per set, the total blood transfusion cost in the IBSs groups was significantly higher than that in the ABs groups (P < 0.01); however, when 199 or 184 USD, only the IBS1 group, rather than IBS2 or IBS3, showed significantly higher cost of the total blood transfusion compared with the AB1 group (P < 0.05). CONCLUSIONS: When the amount of bleeding was 600-1000 ml, IBS can significantly reduce the demand for allogeneic blood, and has no direct adverse effects on coagulation function and recuperation, and is cost-effective in OPCABG.


Assuntos
Perda Sanguínea Cirúrgica , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Custos de Cuidados de Saúde/estatística & dados numéricos , Recuperação de Sangue Operatório/métodos , Idoso , Transfusão de Sangue/economia , China , Ponte de Artéria Coronária sem Circulação Extracorpórea/economia , Análise Custo-Benefício , Transfusão de Eritrócitos/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Sangue Operatório/efeitos adversos , Recuperação de Sangue Operatório/economia , Estudos Retrospectivos
17.
Ann Card Anaesth ; 21(4): 393-401, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30333333

RESUMO

Context: Hyperglycemia has been found to occur during myocardial infarction and cardiac surgery even in nondiabetic patients. These being essentially stressful processes associated with hypoperfusion, we decided to find a possible relationship between the occurrence of global tissue hypoperfusion (GTH) and elevated blood glucose level in adult nondiabetic patients undergoing elective off-pump coronary artery bypass grafting (CABG). Aims: This study aims to observe for the occurrence of global tissue hypoperfusion and its effect on blood glucose level and whether raised blood glucose level can be used as a marker for GTH. Design: Prospective, observational study. Settings: Cardiothoracic operation theater and intensive care unit of a tertiary care teaching hospital. Materials and Methods: The occurrence of global tissue hypoperfusion were detected with the help of combined markers of mixed venous oxygen saturation and arterial lactate level at various perioperative study points together with arterial blood glucose level. Blood glucose level compared between the patients with and without GTH. Statistical Analysis Used: Numerical variables were compared between groups by Student's t-test and categorical variables by Fisher's exact test. Two-tailed P ≤ 0.05 was considered for statistically significant. Results: The incidence of GTH was 67%. Blood glucose level was raised in patients with GTH at some study time points but with poor sensitivity and specificity values. Conclusions: Global tissue hypoperfusion is a common occurrence in even nondiabetic patients undergoing elective off-pump CABG. A relationship exists between rise in blood glucose level and global tissue hypoperfusion in such patients, although it cannot be viewed as marker of the same.


Assuntos
Biomarcadores/sangue , Glicemia/análise , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Complicações Pós-Operatórias/sangue , Idoso , Anestesia , Feminino , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Perfusão , Complicações Pós-Operatórias/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Fluxo Sanguíneo Regional , Resultado do Tratamento
18.
Ann Card Anaesth ; 21(4): 413-418, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30333337

RESUMO

Context and Aims: Off-pump coronary artery bypass graft (OPCABG) is a form of CABG surgery. It is performed without the use of cardiopulmonary bypass machine as a surgical treatment for coronary heart disease. Acute kidney injury (AKI) is one of the common postoperative complications of OPCABG. Previous studies suggest important differences related to intravenous fluid (IVF) chloride content and renal function. We hypothesize that perioperative use of chloride restricted IVFs may decrease incidence and severity of postoperative AKI in patients undergoing OPCABG. Methods: Six hundred patients were randomly divided into two groups of 300 each. In Group A (n = 300), chloride liberal IVFs, namely, hydroxyethyl starch (130/0.4) in 0.9% normal saline (Voluven), 0.9% normal saline, and Ringer's lactate were used for perioperative fluid management. In Group B (n = 300), chloride-restricted IVFs, namely, hydroxyethyl starch (130/0.4) in balanced colloid solution (Volulyte) and balanced salt crystalloid solution (PlasmaLyte A), were used for perioperative fluid management. Serum creatinine values were taken preoperatively, postoperatively at 24 h and at 48 h. Postoperative AKI was determined by AKI network (AKIN) criteria. Results: In Group A, 9.2% patients and in Group B 4.6% patients developed Stage-I AKI determined by AKIN criteria which was statistically significant (P < 0.05). Conclusion: Perioperative use of chloride restricted IVF was found to decrease incidence of postoperative AKI. The use of chloride liberal IVF was associated with hyperchloremic metabolic acidosis.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Cloretos/administração & dosagem , Cloretos/uso terapêutico , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Hidratação/métodos , Complicações Pós-Operatórias/epidemiologia , Acidose/epidemiologia , Acidose/etiologia , Adulto , Idoso , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Soluções Farmacêuticas , Estudos Prospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA