Coronary Artery Surgery Patients Research Articles

Coronary artery bypass surgery--impact upon a patient's wife--a pilot study.

A pilot study of the wives of 19 coronary artery surgery patients assessed levels and predictors of affective symptoms. A substantial proportion of wives (40 to 50%) reported levels of depression (but not anxiety) severe enough to warrant treatment, and many attributed this to the effects of their husband's operation. Neither the wives' expectations of patient outcome, nor the objectively assessed surgical outcome bore any relationship to the wives' affective state. A previous psychiatric history in a wife was possibly related to her affective state, but her 'N' score (emotionality) on the Eysenck Personality Questionnaire was very strongly related to her state.

Coronary artery bypass surgery morbidity

A retrospective analysis was undertaken of 365 consecutive patients, 75 women and 290 men with a mean age of 59.9 +/- 9.7 years, who had coronary artery bypass surgery during 1981. Complications classified as major were: mediastinal hemorrhage, pericardial tamponade, wound dehiscence, sternal osteomyelitis, myocardial infarction, bacterial endocarditis, dissecting aneurysm and diabetes insipidus. Complications classified as minor were: atrial fibrillation, postpericardiotomy syndrome, cellulitis, thrombophlebitis and phrenic nerve palsy. There were 48 patients (13%) with 52 major complications. Age more than 60 years, cardiopulmonary bypass time longer than 150 minutes, aortic cross-clamp time longer than 100 minutes, number of grafts greater than five and presence of diabetes mellitus were significantly associated with major complications. Complications tended to occur more frequently in women, obese patients and those with emergency operation or ejection fraction less than 30%, but the associations were not statistically significant. Physicians referring patients for coronary artery surgery should be cognizant of the incidence of morbidity along with the other risks and benefits when considering coronary artery bypass surgery.

A Strategy for Cost Containment in Coronary Surgery

Patients with multivessel coronary atherosclerosis and stable angina pectoris were examined by outpatient testing and admitted to a staging area with their families on the morning of coronary bypass surgery. This experimental group was not hospitalized before surgery. Their hospital charges were compared with those of cohorts of coronary artery surgery patients from 1977 to 1981 who met the same entrance criteria. Length of stay in the hospital was reduced by two days. A 10% savings in hospital charges was realized in the 1981 experimental group as compared with the 1981 control group. A comparison of total hospital charges, adjusted for inflation, shows that 1981 experimental group patients paid 35% less for their hospital room, 45% less for their intensive care period, and 17% less in total charges than the 1977 control group. Interviews indicated that these patients with stable cardiac conditions preferred to stay with their families or friends before surgery.

Clinical and angiographic predictors of operative mortality from the collaborative study in coronary artery surgery (CASS).

Fifteen institutions participating in the Collaborative Study in Coronary Artery Surgery (CASS) have performed isolated coronary artery bypass surgery upon 6630 patients (1061 women and 5569 men) for coronary artery disease. The overall operative mortality (OM) was 2.3% (range 0.3-6.4%). Mortality increased with age, from 0 in the group 20-29 years old to 7.9% in the group 70 years and older. OM was higher for women in each group, ranging from 2.8% for ages 30-39 years to 12.3% for age 70 years and older (0.8% and 5.8% for men). Clinical manifestations of congestive heart failure were associated with increased OM. Mortality was 1.4% in one-vessel, 2.1% in two-vessel and 2.8% in three-vessel disease (diameter narrowing greater than or equal to 70%). Among 1019 patients with left main coronary artery (LMCA) stenosis, OM ranged from 1.6% in patients with mild stenosis and a right-dominant system to 25% in patients with severe (greater than or equal to 90%) stenosis and left dominance. OM varied with ejection fraction (EF) (1.9% for EF greater than or equal to 50% to 6.7% for EF less than 19%) and left ventricular wall motion score (1.7% for least abnormal to 9.1% for most abnormal). For elective surgery, OM was 1.7%, for urgent surgery 3.5%, and for emergency surgery 10.8%. Mortality was 40.0% among 30 patients with severe LMCA stenosis who underwent emergency revascularization. Advanced age, female sex, symptoms of heart failure, LMCA stenosis, impaired left ventricular function and nonelective surgery are associated with a higher OM. These factors should be considered in the selection of patients for coronary artery surgery.

Coronary-artery surgery in patients with end-stage renal disease.

Between 1975 and 1979 we performed coronary arteriography on 15 patients with end-stage renal failure and clinical evidence of severe ischemic heart disease. One patient died after the procedure of severe pump failure. Ten patients subsequently received coronary-artery bypass grafts, and two of these patients also received mitral-valve replacement. One patient, a diabetic, died of sepsis after surgery. Eight of the nine surviving patients, including the two patients who had undergone mitral-valve replacement, are markedly improved as a result of surgery. Our experience indicates that these patients can undergo angiography and coronary-artery bypass surgery at an increased but acceptable risk, provided dialysis is done before and after cardiac catheterization and surgery to control extracellular volume overload and hyperkalemia. The operation benefits patients with end-stage renal failure and severe ischemic heart disease by relieving angina and improving their level of activity. It is unclear whether survival is improved for these patients.

The ischemic segment and left ventricular function during exercise angina.

AbstractImprovement of the quality of transpulmonary left ventriculograms by exercise was demonstrated in 5 patients in a pre‐study. In the main study transpulmonary left ventriculography was performed in 10 patients with coronary artery disease (CAD) at rest and during exercise, producing maximum angina pectoris (AP). Left ventricular pressure was recorded simultaneously. The extent of CAD, demonstrated in all patients by coronary angiography, was quantitated by a score. In the exercise ventriculograms, local wall motion was quantitated by 14 hemiaxes. During exercise AP, all patients developed wall motion abnormalities not present at rest. There was a significant linear correlation between coronary score and number of abmormally shortening hemiaxes (< 30% shortening) during exercise‐AP (y = 0.16 × + 4.34; r = 0.933). The number of anormal hemiaxes correlated significantly (p < 0.05) with left ventricular enddiastolic pressure (LVEDP), dp/dt min, endsystolic volume index, enddiastolic volume index, ejection fraction, stroke work index, minute work, compliance SV/ Δ PD/ESV, and cardiac index. During exercise AP the extent of ischemic wall motion abnormalities is determined by localization and severity of coronary artery lesions. The extent of ischemic impairment of wall motion determines the severity of impairment of left ventricular pump function, filling pressure, and maximum speed of relaxation. Transpulmonary left ventriculography during exercise AP is a safe and relatively simple method to quantitate the extent of ischemic wall motion abnormalities. It could be useful in the selection of patients for coronary artery surgery and in the assessment of the results of this operation.

Improved survival after coronary artery surgery in patients with extensive coronary artery disease

Survival in patients with ischemic heart disease is closely related to the extent of coronary artery obstruction as determined angiographically. One hundred forty-nine consecutive patients underwent coronary artery bypass surgery from November, 1971, to October, 1974. There were 2 late cardiac deaths, 1 late noncardiac death, and 1 hospital death, an operative mortality rate of 0.7 per cent and a total mortality rate of 2.7 per cent. Coronary angiograms were scored according to the method of Friesinger, Page, and Ross. Fifty-four per cent (80/149) had scores of 10 or greater. Cumulative survival was analyzed according to life-table techniques; in the 80 surgically managed patients with scores of 10 or greater, survival at 3 years was 98 per cent. Friesinger's 47 nonoperated patients with similar angiographic scores had a 3 year cumulative survival of 68 per cent. Although this study compares different groups, the surgical series was composed of older patients (mean age 52 as compared to 44 years), includes 22 patients operated on urgently for preinfarction angina pectoris, and includes 18 patients with abnormal ventricular function. These data suggest that coronary artery bypass surgery can favorably influence prognosis in patients with severe coronary artery disease.

Results of coronary artery surgery in patients receiving propranolol

Beta adrenergic blockade at the time of direct coronary revascularization has theoretical disadvantages and is considered by some to be dangerously depressing to the myocardium in the immediate period after pump oxygenation. A review of 100 consecutive cases of bypass surgery revealed that 25 patients had been taking propranolol to within 24 hours or less before surgery in dosages ranging from 40 to 200 mg. per day. The over-all operative mortality rate was 2 per cent. Neither of the patients who died had been receiving propranolol. Seven of the patients taking the drug required emergency surgery for the preinfarction state. In this group the doses were largest and most proximate to surgery. Nevertheless, none of these patients died. The magnitude of surgery was similar in elective and emergency settings and in those with and without propranolol therapy. We have concluded that coronary revascularization is safe in patients receiving propranolol so long as complete revascularization is done.

Maximal cardiac output before and after coronary artery surgery in patients with angina

Maximal cardiac output before and after coronary artery surgery in patients with angina

Clinical studies in the selection of patients for coronary artery surgery.

The purpose of this communication is to present an analysis of a series of patients who have undergone coronary bypass surgery to determine if certain parameters influence the surgical results. The parameters are: (1) anatomic distribution of disease (2) left ventricular function

Coronary Artery Surgery in Patients with Impaired Left Ventricular Function

During the past three years, we have performed 250 vein bypass operations to the coronary arteries. Almost without exception, patients were not turned down because of evidence of left ventricular dysfunction.

Pulmonary venous admixture before, during, and after halothane: oxygen anesthesia in man.

ArticlePulmonary venous admixture before, during, and after halothane: oxygen anesthesia in man.B E Marshall, P J Cohen, C H Klingenmaier, and S AukbergB E Marshall, P J Cohen, C H Klingenmaier, and S AukbergPublished Online:01 Nov 1969https://doi.org/10.1152/jappl.1969.27.5.653MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByPulmonary Gas Exchange in Coronary Artery Surgery Patients During Sevoflurane and Isoflurane AnesthesiaAnesthesia & Analgesia, Vol. 94, No. 5The Ventilation-Perfusion Relation and Gas Exchange in Mitral Valve Disease and Coronary Artery Disease Implications for Anesthesia, Extracorporeal Circulation, and Cardiac SurgeryAnesthesiology, Vol. 86, No. 4Effects of halothane and isoflurane on rat ventricular action potentials recorded in situLife Sciences, Vol. 58, No. 16Pulmonary circulation during inhalation anaesthesiaBaillière's Clinical Anaesthesiology, Vol. 7, No. 4Tidal Volume, Lung Hyperinflation and Arterial Oxygenation during General Anaesthesia22 January 2019 | Anaesthesia and Intensive Care, Vol. 21, No. 6References and further readingMinimum oxygen requirements during anaesthesia with the Triservice anaesthetic apparatus A study of drawover anaesthesia in the young adultAnaesthesia, Vol. 46, No. 1References and further readingDiazepam sedation reduces functional residual capacity and alters the distribution of ventilation in manCanadian Anaesthetists’ Society Journal, Vol. 30, No. 5Intravenous versus Inhalation Anesthesia - Pulmonary EffectsActa Anaesthesiologica Scandinavica, Vol. 26Einfluß von Inhalationsanaesthetika auf Lungenventilation und -perfusionThe Effect of Inhalation Anaesthetics on Pulmonary Ventilation and PerfusionEffect of general anaesthesia on respiratory functionLung, Vol. 159, No. 1Anaesthesia and the respiratory systemCanadian Anaesthetists’ Society Journal, Vol. 26, No. 6Pulmonary shunt as a prognostic indicator in head injuryJournal of Neurosurgery, Vol. 50, No. 6Pulmonary shunts in the prone positionAnaesthesia, Vol. 33, No. 6Hypoxia-induced Vasoconstriction in Isolated Perfused Lungs exposed to Injectable or Inhalation AnestheticsActa Anaesthesiologica Scandinavica, Vol. 21, No. 2LiteraturMagill circuit and controlled ventilationCanadian Anaesthetists’ Society Journal, Vol. 23, No. 2Pulmonary shunting during anaesthesia in manCanadian Anaesthetists’ Society Journal, Vol. 22, No. 6Hypoxemia, atelectasis, and the elevation of arterial pressure and heart rate in paralyzed artificially ventilated ratLife Sciences, Vol. 16, No. 7Influence of induction agent on pulmonary venous admixture during halothane: Oxygen anaesthesia with controlled respiration in manCanadian Anaesthetists’ Society Journal, Vol. 21, No. 5Pulmonary Consequences of Upper Abdominal Surgery—Therapeutic Considerations14 January 2019 | Anaesthesia and Intensive Care, Vol. 2, No. 3Effects of Halothane and Hydrogen Ion Concentration on the Alteration of Pulmonary Vascular Resistance Induced by Graded Alveolar Hypoxia in the Isolated Perfused Cat Lung14 January 2019 | Anaesthesia and Intensive Care, Vol. 2, No. 3An up-dated method for determining v̇a/Q̇ inequalities and direct shunt using 02, CO2 and N2Respiration Physiology, Vol. 19, No. 2 More from this issue > Volume 27Issue 5November 1969Pages 653-7 https://doi.org/10.1152/jappl.1969.27.5.653PubMed5360438History Published online 1 November 1969 Published in print 1 November 1969 Metrics

Location of coronary arterial occlusions and their relation to the arterial pattern.

The present study shows that the coronary artery pattern is not related to the prognosis after infarction nor can it be correlated with the incidence of occlusion or with the severity of atherosclerosis. This analysis re-emphasizes the severity of the occlusive process in patients with angina pectoris and, conversely, the relatively large percentage of patients having coronary occlusion who had either congestive heart failure or who were asymptomatic. The proper selection of patients for coronary artery surgery requires accurate angiography. The occurrence of multiple occlusions in a large number of cases points to certain difficulties in the interpretation of the coronary angiogram and also indicates the extremely limited role endarterectomy may be expected to play in the therapy of angina pectoris. Until such a time as the operative mortality and secondary failure rate, due to restenosis, can be reduced through new surgical technics, coronary endarterectomy should be considered an experimental procedure to be investigated vigorously in the laboratory but not to be applied for therapeutic purposes in man.