THE TOPOLOGICAL FEATURES OF THE BRAIN ACTIVITY DURING MULTITASK COGNITIVE TRAINING IN THE POSTOPERATIVE PERIOD CORONARY ARTERY BYPASS GRAFTING

Transatlantic Editorial: The Use of Multiple Arterial Grafts for Coronary Revascularization in Europe and North America

Surgical collateralization: The hidden mechanism for improving prognosis in chronic coronary syndromes

Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques.

Gender-Specific Practice Guidelines for Coronary Artery Bypass Surgery: Perioperative Management*

Coronary surgery in women: How can we improve outcomes.

Objective: The goal of this pilot study was to assess whether a single session of ankle robot (anklebot) training would improve paretic ankle motor control with concurrent changes in brain electrical activity in sub-acute stroke survivors. Background Nearly 800,000 new cases of stroke are reported each year according to the American Heart Association, making it the leading cause of serious, long-term disability in the U.S. For many stroke survivors, hemiparetic gait and balance dysfunction are ongoing issues that limit mobility and increase energy demands for performing the activities of daily living. The ankle is a prime target for intervention because of the crucial role it plays in forward propulsion, shock absorption, and dynamic balance during locomotion. Design/Methods: Two subjects, who presented with subcortical lesions, performed ankle targeting movements in plantar/dorsiflexion and inversion/eversion ranges with robotic assistance needed, while 64 channels of EEG were collected. Results: Both subjects improved their paretic ankle motor control as indexed by increased targeting accuracy, faster speed and smoother movements. These changes were accompanied by concomitant decreases in gamma power within the motor planning region in the hemisphere contra-lateral to the paretic ankle. In addition, increased networking (beta coherence) between motor planning and visuo-spatial regions was observed in both subjects. Conclusions: The results of this study suggest that a single session of anklebot training leads to short-term gains in motor control at the hemiparetic ankle that are accompanied by changes in EEG power and coherence. Increases in task relevant and regionally specific coherence have been associated with the early stages of learning. The ability to correlate single session improvements in ankle motor control with concurrent changes in brain electrical activity will allow for the development of more efficacious anklebot training interventions that may translate to gains in gait function during the early stages of stroke. Supported by: American Academy of Neurology. Disclosure: Dr. McGehrin has nothing to disclose. Dr. Roy has nothing to disclose. Dr. Goodman has nothing to disclose. Dr. Rietschel has nothing to disclose. Dr. Forrester has nothing to disclose. Dr. Bever has nothing to disclose.

Coronary artery bypass surgery in patients with acute coronary syndromes is difficult to predict

Off-pump coronary artery bypass surgery: To do or not to do? Current best available evidence

Objective To investigate the effect of early coronary artery bypass grafting (CABG)to the left ventricular wall motion state and the significance of CABG to awake hibernating myocardial in dogs with acute myocardial infarction.Methods The anterior descending coronary of all thirty dogs were ligated into MI model.According to the operation date,the experimental groups included the 1 st week (n =6),the 2nd week (n =4),the 4th week (n =6) and the 6th week (n =6) CABG,and established control group (n =2) for every experimental group.Operators marked hibernate myocardial and determined the room wall motion score by means of dobutamine ultrasound load test (DSE) combining with tissue doppler imaging (DTI)technology before CABG and after eight weeks CABG through thoracotomy surgery for the experimental group and the control group.Every dog was executed and detected the area of MI.Results Four dogs of experimental group and all dogs of control group survived to the end of the study.The change of ventricular room wall motion score in the 1st and the 2nd week CABG was smaller than that in the 4th and the 6th week CABG and MI group(0.03 ±0.06,0.05 ±0.09,0.23 ±0.08,0.27 ±40.06,0.32 ±0.05,P ＜0.05).The change of room wall motion score in all CABG groups was smaller than that in MI group(1.195 ±0.09,1.25 ±0.18,1.30 ±0.18,1.36 ±0.11,1.65 ±0.17,P＜0.05).The hibernate myocardial were more awaken in all CABG groups than that in MI group (0.27 ± 0.12,0.22 ± 0.04,0.31 ± 0.09,0.23 ± 0.03,0.03 ± 0.04,P ＜ 0.05).The area of MI became smaller in 1 and 2 weeks CABG than that in 4 and 6 weeks CABG and MI group(20.75 ± 2.63,21.25 ± 2.5,27.25 ± 1.71,27.75 ± 2.22,P ＜ 0.05).Conclusions Early CABG surgery for dogs acute MI could improve the ventricular room wall motion obviously and wake up more hibernate myocardial.Especially,CABG surgery among two weeks could lessen the effect of MI to the ventricular room wall motion and reduce the scope of myocardial infarction maximatily. Key words: Myocardial infarction ; Coronary artery bypass, off-pump ; Models, animal; Ventricular wall motion

Evidence-based selection of the second and third arterial conduit

Investigation of aortocoronary artery bypass grafts by multislice spiral computed tomography with electrocardiographic-gated image reconstruction

BackgroundCurrently, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are commonly used in the treatment of coronary atherosclerotic heart disease. But the optimal timing for CABG after acute myocardial infarction (AMI) is still controversial. The purpose of this article was to evaluate the optimal timing for CABG in AMI.MethodsWe searched the PubMed, Embase, and Cochrane library databases for documents that met the requirements. The primary outcome was in-hospital mortality. The secondary outcomes were perioperative myocardial infarction (MI) incidence and cerebrovascular accident incidence.ResultsThe search strategy produced 1,742 studies, of which 19 studies (including data from 113,984 participants) were included in our analysis. In total, 14 studies compared CABG within 24 h with CABG late 24 h after AMI and five studies compared CABG within 48 h with CABG late 48 h after AMI. The OR of in-hospital mortality between early 24 h CABG and late 24 h CABG group was 2.65 (95%CI: 1.96 to 3.58; P < 0.00001). In the undefined ST segment elevation myocardial infarction (STEMI)/non-ST segment elevation myocardial infarction (NSTEMI) subgroup, the mortality in the early 24 h CABG group (OR: 3.88; 95%CI: 2.69 to 5.60; P < 0.00001) was significantly higher than the late 24 h CABG group. Similarly, in the STEMI subgroup, the mortality in the early 24 h CABG group (OR: 2.62; 95% CI: 1.58 to 4.35; P = 0.0002) was significantly higher than that in the late 24 h CABG group. However, the mortality of the early 24 h CABG group (OR: 1.24; 95%CI: 0.83 to 1.85; P = 0.29) was not significantly different from that of the late 24 h CABG group in the NSTEMI group. The OR of in-hospital mortality between early 48 h CABG and late 48 h CABG group was 1.91 (95%CI: 1.11 to 3.29; P = 0.02). In the undefined STEMI/NSTEMI subgroup, the mortality in the early 48 h CABG group (OR: 2.84; 95%CI: 1.31 to 6.14; P < 0.00001) was higher than the late 48 h CABG group. The OR of perioperative MI and cerebrovascular accident between early CABG and late CABG group were 1.38 (95%CI: 0.41 to 4.72; P = 0.60) and 1.31 (95%CI: 0.72 to 2.39; P = 0.38), respectively.ConclusionThe risk of early CABG could be higher in STEMI patients, and CABG should be delayed until 24 h later as far as possible. However, the timing of CABG does not affect mortality in NSTEMI patients. There was no statistical difference in perioperative MI and cerebrovascular accidents between early and late CABG.

In their recent editorial “Minimally Invasive Coronary Bypass: A Dissenting Opinion,” Bonchek and Ullyot1 express concerns about ill-guided attempts to deviate from the conventional revascularization procedure that is “safe, effective, durable, reproducible, complete, versatile, and teachable.” In the present editorial, an experimental perspective on the search for less invasive surgical strategies is provided that will convey an opposite opinion. First, a brief reappraisal is warranted of the safety of coronary artery bypass graft surgery (CABG) during cardiac arrest supported by cardiopulmonary bypass (CPB). The great majority of CABG patients benefit greatly from coronary revascularization, but the surgical procedure is not without adverse effects. The Society of Thoracic Surgeons (STS) National Cardiac Surgery Database (January 1998) lists complications of 170 895 CABG-only operations, including 13 736 reoperations, performed in the United States in 1996. Operative mortality was 2.9% (2.5% in men, 4.0% in women). Operative mortality increases with age, from 1.1% at age 20 to 50 years to 7.2% at 81 to 90 years. In only 65.4% of procedures were no complications reported. Most complications are listed in the Table⇓. View this table: Table 1. Complications CABG-Only Patients in the United States, 1996 Another way to assess the clinical outcome of conventional CABG is to analyze hospital discharge data from health insurance records.2 Of 101 812 patients ≥65 years old operated on in January through October 1993 in the United States, 4.3% died in hospital. Of particular concern are patients (3.6%) who were discharged to a non–acute-care facility.3 Owing to complications, 10.2% were discharged late (>14 days) to home. Thus, 81.9% were discharged to home in ≤14 days. In the first 2 months after discharge to home, 0.7% died and 9.9% were readmitted for cardiovascular, respiratory, or cerebrovascular reasons. Although each of these numbers needs to be carefully interpreted in its …

Low-volume coronary artery bypass surgery: Measuring and optimizing performance

Intraoperative graft patency validation: Friend or foe?