Aortic Coronary Bypass Grafting Research Articles

Limitation of Interpreting a Single COVID Cycle Threshold Value

Abstract The United States reported its first case of coronavirus disease 2019 (COVID-19) in January 2020. There was limited testing capacity at the time, and the causative agent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was indeed extremely infectious. Testing, therefore, has become a vital part of controlling the COVID-19 pandemic. Nucleic acid amplification tests, such as polymerase chain reaction platform, a value called cycle threshold (Ct) is reported. This number represents the number of polymerase chain reaction test cycles it takes for the sample to become positive. It is inversely proportional to the amount of viral RNA present in the sample. Therefore, a high Ct value infers a low quantity of viral RNA, and conversely, a low Ct value implies high viral RNA, which in turn correlates with infectivity. When interpreted appropriately with the right clinical context, it could be used to assess the infectiousness of an individual. In September 2021, a 73-year-old man who previously completed a primary series of Moderna vaccine (2 injections) presented to the hospital with chest pain. Cardiac catheterization showed multivessel coronary artery disease and was deemed to have unstable angina. The plan was to undergo coronary aortic bypass graft surgery. Preoperative routine testing revealed a positive COVID-19 polymerase chain reaction test with a high Ct value. During the hospital stay, it was shown that he had a decreased Ct value and thus was determined to have an acute case of asymptomatic COVID-19 infection. His surgery was delayed according to the isolation protocol per Centers for Disease Control and Prevention for safety precautions. He eventually underwent coronary aortic bypass graft after completion of isolation and had an uneventful postoperative course. It was also documented that he had serological seroconversion consistent with acute COVID-19 infection. This case illustrates that reporting Ct values is useful in a certain clinical context, but clinicians need to be familiar with the transmissibility and history of SARS-CoV-2 infection as well as understanding the interpretation of positive tests. The appropriate clinical approach and management should be assessed based on exposure history, epidemiology, physical examination, radiographic assessment, and laboratory studies.

Peculiariities of diagnostic parameters in patients with acute myocardial lesion after coronary artery bypass grafting

Annually, up to 850 000 coronary aortic bypass graft operations are performed worldwide. Despite modern technical equipment ensuring a high level of safety of the procedure, currently important remains a problem related to intraoperative myocardial damage in using artificial circulation. Early detection and clinical assessment of myocardial ischaemia often present a difficult task. This article deals with clinical, instrumental and laboratory methods of diagnosis, aimed at verification of an intraoperative cardiac lesion associated with graft dysfunction in coronary artery bypass grafting. Isolated electrocardiographic and echocardiographic signs of myocardial ischaemia between the comparison groups did not differ significantly. Analysing the markers of myocardial lesions, statistically significant differences were obtained only after 48 hours which, from the point of view of saving viable myocardium, is an utterly long-term interval. Studying the findings of intraoperative flowmetry showed statistically significant dependence between velocity characteristics, pulse index of shunts and their patency on angiographic examination. Thus, only combination of diagnostic parameters makes it possible to detect myocardial damage related to shunt dysfunction. This enables early determination of indications for performing bypass angiography and selection of the required therapeutic policy. Timely coronary artery angiography makes it possible to reveal defects of shunts and to timely perform surgical correction, preventing myocardial infarction.

Feasibility and safety of minimally invasive cardiac coronary artery bypass grafting surgery for patients with multivessel coronary artery disease: Early outcome and short-mid-term follow up results

To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery. Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD). There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (P>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (P=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% vs. 3.52%), reoperation (2.34 vs. 3.52%), new-onset atrial fibrillation rate (4.70% vs. 3.52%) or new-onset renal insufficiency rate (1.17% vs. 0%) between MICS CABG group and OPCABG group (P>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min vs. (246.8±56.9) min, P < 0.05], while the time of ventilator supporting(16.9 h vs. 29.6 h), hospitalization in ICU [(29.3±20.8) h vs. (51.5±48.3) h] and total hospitalization [(18.3±3.2) d vs. (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group (P < 0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) vs. 3.61%(3/83), P>0.05] in 1-year follow up. The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.

Iatrogenic acute aortic dissection caused by intervention for spontaneous coronary artery dissection: a surgical case report

BackgroundIatrogenic acute aortic dissection (AAD) caused by cardiovascular intervention is rare. Also rare is spontaneous coronary artery dissection (SCAD), a form of acute coronary syndrome, which develops in relatively young women without coronary risk factors. We encountered type A iatrogenic AAD caused by an intervention for SCAD.Case presentationA 53-year-old woman was brought to our hospital after cardiopulmonary resuscitation. She was diagnosed with acute coronary syndrome caused by SCAD, and percutaneous coronary intervention was carried out on her distal left anterior descending artery. The dissection proceeded to the proximal left anterior descending artery and left main coronary artery trunk, so additional percutaneous coronary intervention was performed on the left circumflex artery. After the intervention, type A AAD occurred with a primary entry tear from the left main coronary artery trunk, and computed tomography showed a type A AAD of the aortic arch. We performed emergency ascending aorta replacement and coronary artery bypass grafting to the left anterior descending artery and left circumflex artery. The patient had an uneventful recovery after the operation and was discharged on postoperative day 25.ConclusionTo our knowledge, this is the first report of an iatrogenic AAD caused by percutaneous coronary intervention for SCAD.

Influence of age factor and age-associated predictors on remote results of coronary artery bypass grafting

This study was undertaken to analyse long-term survival and its predictors, depending on age of patients who underwent isolated coronary aortic bypass grafting. Our study included a total of 177 consecutive patients operated on during 2014. For the purpose of statistical analysis, the patients were divided into two groups according to their age at the time of surgery: <60 years (n=96) and >60 years (n=81). The mean age in the groups <60 years and >60 years amounted to 54.5±2.9 years and 63.5±2.5 years, respectively. All data were obtained from the patients' medical histories, outpatient follow-up records, and operative reports. The average duration of follow-up in the overall cohort amounted to 5.1±1.7 years. Chronic obstructive pulmonary disease, peripheral artery disease, and acute impairment of cerebral circulation were of significantly less common occurrence in the younger patient cohort. However, the frequency of a body mass index of ≥30 kg/m2, unstable angina, previously endured myocardial infarction and left ventricular systolic dysfunction in the preoperative period appeared to be significantly higher in this population. At 5 years after surgery, freedom from survival amounted to 94.8% in patients younger than 60 years (5 patients) and to 90.1% (8 patients) in those aged 60 years and older (p<0.001). Based on the findings of a multivariate analysis, independent predictors of mortality turned out to be a history of myocardial infarction, chronic kidney disease, diabetes mellitus, chronic obstructive pulmonary disease, lesions of peripheral arteries and the trunk of the left coronary artery. The area under the receiver operating characteristic curve was 0.834 (p<0.001, 95% CI: 0.724-0.902). Despite the fact that coronary artery bypass grafting is an effective method of treatment of ischaemic heart disease for both groups, special attention should be paid to the development and improvement of preventive strategies aimed at decreasing the impact of specific risk factors for cardiovascular diseases such as diet, lifestyle, weight control, and more aggressive medical therapy in younger patients. It is necessary to elaborate a reasonable strategy and optimization of the choice of an optimal approach to myocardial revascularization for elderly patients with multivessel and truncal lesions of coronary arteries, which are potential risk factors of death in the postoperative period.

P5983Pre-operative physical performance as an independent predictor of in-hospital outcomes in older patients undergoing elective cardiac surgery

Abstract Introduction Risk stratification of patients candidate to cardiac surgery is usually based on the Society of Thoracic Surgeons (STS) score or on the Euroscore II. However, these risk scores has limited predictive value in elderly patients. Purpose We conducted a study to determine whether the Short Physical Performance Battery (SPPB), a tool assessing physical performance, predicts hospital death and major morbidity, beyond STS risk score. The outcome was a composite end-point as defined by STS Major Morbidity or Operative Mortality (STS-MM) in STS Risk Model Outcomes: operative mortality, stroke, renal failure, prolonged mechanical ventilation, deep sternal wound infection, and reoperation. Methods In this prospective, single-center, cohort, hospital-based study, conducted at Careggi University Hospital, Florence, Italy, all patients aged 75+ years referred for an elective coronary aortic by-pass grafting, valvular surgery or combined cardiac surgery were evaluated pre-operatively. Assessment included SPPB, cognitive and functional status and evaluation of comorbidity. Patients receiving emergency/urgent cardiac surgery or a procedure not considered in the STS risk score calculator, who reported previous cardiac surgery or were clinically unstable were excluded. Participants were classified according to the STS-Predicted Risk Of Mortality (STS-PROM) as at low (&lt;4%), intermediate (4 to 8%) or high risk (&gt;8%). Results Out of 250 participants (females: 48.4%; mean age: 79.9 years), 148 (59.2%) were at low, 73 (29.2%) at intermediate and 29 (11.6%) at high risk, based on the STS-PROM. Mean±SEM SPPB score was 8.8±0.2, 7.1±0.4 and 6.0±0.7 in participants at low, intermediate, and high risk, respectively (p&lt;0.001). The outcome occurred in 67 subjects (26.8%). SPPB score predicted the outcome in the entire study sample, controlling for STS-MM score, CKD, and anaemia (adjusted OR: 0.89, 95% CI 0.81–0.98 per each point increase; p 0.017). When analyses were repeated separately in participants with STS-PROM indicative of low (&lt;4%) and in those at medium-high risk, the predictive value of SPPB was enhanced in the formers (adjusted OR 0.73, 95% CI 0.62–0.86 per each point increase; p&lt;0.001- controlling for STS score), whereas was lost in the latter. An alternative model was subsequently tested, where STS score was not included and peripheral artery disease and creatinine (variables contributing to the STS score) were individually entered: SPPB was confirmed as a significant predictor also in this model, controlling for anaemia, peripheral artery disease, and creatinine. The corresponding AUC was 0.813 (Figure 1). Figure 1 Conclusions SPPB predicts mortality and major morbidity in older patients undergoing elective cardiac surgery, in particular in those classified as low-risk with the STS risk score. Use of SPPB should therefore be recommended to improve preoperative risk stratification of older patients.

Guidelines versus reality: is coronary stent application in three-vessel disease standard or the exception?

The national guidelines for treatment of chronic coronary heart disease (CHD) recommend surgical coronary aortic bypass grafting (CABG) rather than percutaneous coronary intervention (PCI) for patients with a coronary three-vessel disease. The epidemiology of three-vessel CHD and data about the application of different revascularisation strategies raise suspicion of deviation from the guidelines in the treatment of those patients. Claims data containing records of almost 10 million patients of the largest German statutory health insurance fund (Techniker Krankenkasse) were utilised to measure adherence to the guidelines for treatment of groups of patients with one-, two-, and three-vessel CHD, respectively. The impact of age, sex, and comorbidity on each patient's revascularisation procedure was investigated as well. There was no significant difference in the rate of PCI between the groups. In conclusion, the hypothesis that patients with a coronary three-vessel disease are not always treated according to the recommendations of the national guidelines could not be disproved by this study. Finally, the results of this study suggest that the best revascularisation strategy for each patient with two- and three-vessel disease should be decided upon by an interdisciplinary discussion between both cardiologists and cardiac surgeons.

A case of giant saphenous vein graft aneurysm followed serially after coronary artery bypass surgery.

Saphenous vein graft aneurysm (SVGA) is one of the chronic complications after coronary aorta bypass grafting (CABG) and may be caused by atherosclerosis-like phenomena of the vein graft, weakness around the vein valve, rupturing of the suture of the graft anastomosis, or perioperative graft injury. We describe a case of a large, growing saphenous vein graft aneurysm that was followed serially by chest radiography and computed tomography. Eighteen years after CABG, an SVGA (23 × 24 mm) was incidentally detected. The patient was asymptomatic and was followed conservatively. Four years later, coronary computed tomographic angiography showed that the giant aneurysm had grown to 52.1 by 63.8 mm and revealed a second, smaller aneurysm. Finally, the SVG was ultimately resected without bypass via off-pump surgery. Therefore, this case suggested that aggressive treatment that includes surgical intervention should be considered before the aneurysm becomes larger, even if it is asymptomatic.

THE COMPARISON OF ARRHYTHMOGENICITY OF DIFFERENT SURGICAL APPROACHES TO ATRIAL FIBRILLATION IN PATIENTS WITH CORONARY HEART DISEASE

Aim. To estimate the prevalence of iatrogenic atrial flutter in patients with coronary heart disease (CHD) and atrial fibrillation (AF) after two types of surgical operations: radiofrequency pulmonary veins isolation and radiofrequency modified mini Maze procedure; and to compare the results with control group of patients undergone aortic-coronary bypass grafting (CABG).Material and methods. Totally 95 patients included with CHD and persistent AF. Subjects were randomized into three groups: 1st (n=31) — with simultaneous CABG and radiofrequency ablation of pulmonary veins ostiums; 2nd (n=30) — simultaneous CABG and mini Maze procedure; 3rd control (n=34) — CABG only. For prolonged ECG monitoring the implanted devices Reveal XT were used in 53 subjects.Results. The patients escaped from left-atrial flutter were 90% in the 1st group. In the 2nd there was 1 case of left-atrial flutter (according to electrophysiological investigation — the leap through the mitral valve line), meaning 96,9% patients free from it. However there was no significant difference between 1st and 2nd groups (p=0,6). In the 3rd group postprocedure flutter developed in one case too, due to the scar on the left atrium wall after mitral valve regurgitation correction; so 97% patients escaped from flutter, but the difference was still not significant (p=0,4).Conclusion. In patients with CHD and AF it is recommended to perform radiofrequency modified mini Maze procedure combined with CABG due to its lower proarrhythmogenic effect. The rate of iatrogenic flutter is 3,1% after mini Maze and 10% after pulmonary veins ostiums isolation.

A false aneurysm with an aorto-superior vena cava fistula after replacement of the ascending aorta: report of a case

A 58-year-old female presenting with congestive heart failure due to a fistula between an aortic false aneurysm and the superior vena cava (SVC) is described. She had a history of Takayasu’s arteritis (TA) and she had undergone aortic valve and ascending aorta replacement and coronary artery bypass grafting 6 years before. The false aneurysm had occurred 1 year after the surgery, and she had been conservatively managed. The operation revealed that the cause of the false aneurysm was the detachment of the two proximal saphenous vein anastomoses to the ascending aortic graft. After the surgery, the patient made an uneventful recovery. A false aneurysm of the ascending aorta is one of the most serious complications after replacement of the ascending aorta for patients with TA (Miyata et al. in J Vasc Surg 27:438–445, 1998). We herein present the exceptional case of a fistula between an aortic false aneurysm and the SVC that occurred after ascending aorta graft replacement.

Prognostic Impact of Coronary Endothelial Dysfunction on Long-Term Adverse Outcome in Patients with Chest Pain and Non-Obstructive Coronary Artery Disease

Coronary endothelial dysfunction is known to be related with adverse cardiovascular outcome. We obtained a long-term follow-up of patients without significant coronary atherosclerosis, complaining of chest pain, in whom intra-coronary acetylene testing was performed in order to assess endothelial function. The study included 41 patient (35 with endothelial dysfunction, 6 with preserved endothelial function). Events considered as adverse outcome were cardiovascular death, acute myocardium-dial infarction, unstable angina pectoris, percutaneous coronary intervention, coronary-aortic by-pass grafting, ischemic stroke and peripheral artery re-vascularization. A high cardiovascular event rate was observed in patients with and without endothelial dysfunction, 34,3% and 50% respectively. Adverse outcome was related not only to endothelial dysfunction but also to traditional cardiovascular risk factors. Thus, evaluation of endothelial function or its determinants seems to be helpful in identifying a subgroup of patients at high risk.

Preoperative atrial fibrillation is an independent risk factor for mid-term mortality after concomitant aortic valve replacement and coronary artery bypass graft surgery

Preoperative atrial fibrillation (PAF) has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery. Few studies, however, have evaluated the impact of PAF on early and mid-term outcomes after concomitant aortic valve replacement and coronary aortic bypass graft (AVR-CABG) surgery. Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program was retrospectively analysed. Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded. Demographic and operative data were compared between patients undergoing concomitant AVR-CABG who presented with PAF and those who did not using chi-square and t-tests. The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression, respectively. Concomitant AVR-CABG surgery was performed in 2563 patients; 322 (12.6%) presented with PAF. PAF patients were generally older (mean age 76 vs 74 years; P < 0.001) and presented more often with comorbidities including congestive heart failure, chronic pulmonary disease and cerebrovascular disease (all P < 0.05). PAF was associated with 30-day mortality on univariate analysis (P = 0.019) but not multivariate analysis (P = 0.53). The incidence of early complications was not significantly higher in the PAF group. PAF was independently associated with reduced mid-term survival (HR, 1.58; 95% CI, 1.14-2.19; P = 0.006). PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery. Patients with PAF undergoing AVR-CABG should be considered for a concomitant surgical ablation procedure.

Dementia and amputation

To our experience dementia seems to play an increasing role for major amputation in patients suffering from peripheral arterial disease (PAD). To confirm our impression, we analysed the rate of dementia associated with different surgical procedures using the information of the federal statistics in Germany. Detailed lists of cases hospitalized with the principal diagnosis (PAD), abdominal aortic aneurysm (AAA), myocardial infarction (MI) and hip fracture (HF), and of the procedures minor or major amputation, endovascular aortic repair (EVAR), total endoprosthesis for hip replacement (THR) and coronary aortic bypass graft (CABG) in Germany in the years 2008 to 2010 were provided by the Federal Statistical Office. Dementia is documented as additional diagnosis in approximately one fourth of cases having the principal diagnosis HF, 5% to 6% of cases with the principal diagnosis MI and PAD, but only in approximately 2% of AAA cases. Dementia is documented as principal or additional diagnosis in one fourth of amputation procedures (major amputation approximately 18% and minor amputation approximately 8%), in approximately 5% THR, 2% of EVAR and only 0.3% of CABG. The rate of documentation of dementia is higher in patients treated by major amputation than in the hospitalized PAD population. Vice versa, the rate of documentation of dementia is lower in patients getting THR than in the hospitalized HF population. The presented analysis supports the assumption that dementia plays a relevant role in older patients suffering from PAD receiving major amputation in Germany.

E0466 Various therapeutic proportion of the patients with type 2 diabetes mellitus undergone coronary angiography in the era of development in MSCT

IntroductionDiabetic patients are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases their likelihood of requiring evascularization. This study was to examine the various therapeutic proportion of...

The structure of myocardial nerve plexus of human auricle of the right atrium and its relation to myocardial ischemia, functional status of the heart, and age

The aim of this study was to investigate and evaluate morphometrically the relationship between changes in the structure of myocardial nerve plexus of the right atrium auricle and myocardial ischemia, parameters reflecting functional status of the heart, and age. A total of 56 females and males aged 20-94 years were investigated. Ischemic heart disease group consisted of 39 persons (their mean age was 63.83+/-15.67 years). The control group comprised 17 persons (the mean age was 60.53+/-9.89 years). Control group consisted of deceased persons who according to the pathologic and anatomic examination were not diagnosed with cardiac pathology leading to heart lesions or overload. Ischemic heart disease group consisted of patients who underwent aorta-coronary artery bypass grafting surgery. In ischemic heart disease group, degree of coronary artery stenosis was evaluated as well as the major indicators reflecting the size of atria and formation of postinfarction scar. After examination, postinfarction scars were found in 18 (46.2%) persons; no scars were found in 21 (53.8%) persons. Neurohistochemical method and video microscopy were employed for the evaluation of quantitative changes in the structure of the myocardial nerve plexus. In ischemic heart disease group, the structures of nerve plexus occupied 5.0+/-1.0% of the area, perimeter was 10 488+/-2134 microm, and number of the structures was 2698+/-981; the same parameters in the control group were 6.0+/-1.4%, 13 008+/-443 microm, and 3469+/-1511, respectively. In persons with postinfarction scar, the number of nerve plexus structures was lower by 9.3%, area by 8.9%, perimeter by 9.7% on average as compared to ischemic heart disease group without a scar. Regression analysis did not reveal any statistically significant correlation between the degree of coronary artery stenosis and quantitative parameters of nerve plexus (P>0.05). Changes in quantitative parameters of nerve plexus were not related to compensatory dilation of the atria--echoscopy parameters of long and short axes. The results showed that the number, area, and perimeter of nerve plexus structures decreases at the same rate both in healthy subjects and patients with ischemic heart disease starting the fifth decade of life.

&lt;b&gt;Clinical Outcomes and Left Ventricular Function in Diabetic Patients With Acute Myocardial Infarction Treated by Primary Coronary Angioplasty&lt;/b&gt;

The objective of the present study was to compare left ventricular (LV) function and clinical outcomes in diabetics versus nondiabetics with acute myocardial infarction (AMI) treated by primary coronary angioplasty. A total of 327 consecutive AMI subjects were reperfused by primary coronary angioplasty within 12 hours from onset. Diabetes mellitus (DM) was present in 104 of the 327 patients. LV function was serially determined by left ventriculograms taken in the acute and chronic phases (6 months after onset). (I) The early ST-segment resolution rate was lower in DM patients compared with non-DM patients (59% versus 83%, P < 0.0001). (II) During a 6-month follow-up, the percentages of target vessel revascularization (TVR), coronary aorta bypass grafting (CABG), and cardiac death were higher in the DM patients compared with the non-DM patients (TVR: 29% versus 19%; P < 0.05, CABG: 10% versus 5% ; P < 0.05, cardiac death: 12% versus 4%; P = 0.01). (III) The differences in left ventricular ejection fraction (LVEF) between two stages (delta-LVEF) were significantly lower in the DM patients than the non-DM patients (1 +/- 9% versus 7 +/- 10%, P < 0.0001). (IV) Multivariate analysis identified DM as an independent predictor of cardiac death (Odds ratio 5.5, 95% CI, 1.3-23.7, P < 0.05) and as a sole independent predictor of LVEF deterioration (Odds ratio 5.8, 95% CI, 2.8-11.8, P < 0.001). In patients with AMI treated using primary coronary angioplasty, DM is closely related to left-ventricular systolic dysfunction and a poor patient outcome, including mortality.

Study in three different types of cardiopulmonary bypass on arterial ketone body ratio: its prognostic implication and participation of body temperature

The aim of this study was to investigate the change of hepatic metabolic activity presented by the ketone body ratio (AKBR) during and after cardiopulmonary bypass (CPB) and to evaluate the prognostic value. AKBR were measured in 20 cases of coronary aortic bypass grafting using moderate hypothermic CPB (group M), ten cases of aortic arch surgery using deep hypothermia with selective cerebral perfusion (DHSCP) with an open technique (group D) and 15 cases of descending thoracic aortic replacement using partial CPB (group N). AKBR decreased significantly in all groups 5 min after CPB compared with the value before CPB. There was a significant difference in AKBR 1 h after CPB among the three groups and AKBR returned to the prebypass value in group N (group M, 0.32 +/- 0.16; group D, 0.14 +/- 0.04; group N, 0.48 +/- 0.14; P < 0.0001). AKBR rose significantly after the discontinuation of CPB compared with the value during CPB and returned to the prebypass value in groups M and D. The patients who underwent DHSCP with an open technique had a value of AKBR below 0.2, but liver function still recovered normally. The value of AKBR correlated with temperature significantly and a very low level of AKBR below 0.2 was observed during core cooling to 20 degrees C without negative prognostic implications. AKBR decreased 5 min after CPB in group N which suggested decreased hepatic perfusion at an early stage of partial CPB. The prognostic implication of AKBR during CPB is whether low level AKBR recovers or not.

Carotid stenosis and peripheral artery disease in Japanese patients with coronary artery disease undergoing coronary artery bypass grafting.

The combination of a change in lifestyle toward Western habits and an aging society, has led to a steady increase in the incidence of atherosclerotic diseases in the Japanese population. Coronary artery disease (CAD), carotid stenosis (CS), and peripheral artery disease (PAD) are major manifestations of generalized atherosclerosis and increase the risk of cardiovascular events. However, the incidence of CS and PAD in Japanese patients with CAD is not well known, so the present study investigated this in 380 consecutive patients with CAD undergoing elective coronary aorta bypass grafting (CABG) at Kishiwada Tokushukai Hospital between October 1999 and October 2001. The coexistence of CS and PAD in all patients was preoperatively evaluated by duplex ultrasonography and the ankle - brachial index (ABI). The average age of the study population was 66.09.1 years (range, 42-87). The number of male patients was 293 (77.1%). The incidence of CS was 13.7% and 15.3% for PAD. Multivariate logistic regression analysis demonstrated that no particular traditional atherosclerotic risk factor, such as hypertension, hyperlipidemia, diabetes mellitus, and smoking, was able to predict either CS or PAD, but CS and PAD were independent predictors of each other. The results of the study suggest that CS and PAD were not only highly prevalent but also strongly associated with each other in this cohort of CAD patients. Accordingly, extracoronary atherosclerotic disease should be assessed in Japanese CAD patients.

Bilateral surgical coronary ostial angioplasty with a superficial femoral artery patch in Takayasu aortitis

J Thorac Cardiovasc Surg ;:

Reoperative coronary bypass surgery: Effect of patent grafts and retrograde cardioplegia

Objective: To determine the effects of patent or diseased aorta-coronary bypass grafts and retrograde cardioplegia on mortality during reoperative coronary bypass surgery. Methods: We conducted a retrospective review of prospectively gathered data, supplemented by systematic chart review, of all patients (n = 744) undergoing reoperative coronary bypass surgery at our institution between 1990 and 1997. Independent predictors of survival were determined by stepwise logistic regression analysis. Results: At least one patent or stenosed graft to the left anterior descending artery was present in 50% of patients, to the circumflex territory in 27% of patients, and to the right coronary artery territory in 33% of patients. The previous left anterior descending graft was a saphenous vein in 82% and a left internal thoracic artery in 18% of patients. In-hospital mortality occurred in 42 (5.6%) patients. Patent or diseased grafts of any coronary artery territory did not significantly increase the risk of mortality. Retrograde cardioplegia use increased in more recent years, was more frequent in patients with stenosed grafts, and was associated with improved survival. Independent predictors of mortality were as follows (with odds ratios and 95% confidence intervals in parentheses): failure to use retrograde cardioplegia (odds ratio 2.81; 1.28-6.20), New York Heart Association class (odds ratio 2.69; 1.25-5.81), peripheral vascular disease (odds ratio 2.60; 1.25-5.41), and left ventricular grade (2.07; 1.31-3.27). Conclusions: In this series, patent or stenosed grafts were not associated with an increased risk of mortality during reoperative coronary bypass surgery, possibly because of increased use of retrograde cardioplegia in this patient group. We strongly recommend the routine use of retrograde cardioplegia during redo coronary bypass surgery. (J Thorac Cardiovasc Surg 2001;121:83-90)