Results Of Coronary Artery Surgery Research Articles

The results of coronary artery surgery in women and men under the age of 45

Background: This study aims to investigate possible risk factors with the morbidity and mortality rates in women and men under the age of 45 undergoing coronary artery bypass graft (CABG) surgery. Methods: Between August 2009 and May 2012, a total of 230 patients (189 males, mean age 41.4±3.4 years; range 35 to 45 years; 41 females, mean age 41.9±3.0; range 32 to 45 years) under the age of 45 who underwent CABG in our clinic were included. Patients were divided into two groups according to their gender and a comparative analysis was performed. Results: The mean age was 41.9 years (range, 32 to 45 years) in women and 41.4 years (range, 35 to 45 years) in men. Unstable angina pectoris (p

Coronary artery bypass graft surgery in the elderly patients

Abstract The purpose of this retrospective study was to determine the results of coronary artery surgery in the elderly patients and to compare the outcome with a younger group. Two hundred thirteen patients aged 70 years and older who underwent on-pump coronary artery surgery were retrospectively studied and data were compared with those of 524 patients aged 50–69. The groups were similar with respect to preoperative characteristics except for sex distribution and the incidences of peripheral vascular disease and prior cerebrovascular accident. The use of internal mammarian artery grafts was significantly lower in the elderly patients (80.3% versus 91.6%, p<0.001). The 30-day mortality for the elderly group was 4.7% while that of younger group was 2.3%. The elderly patients had a significantly higher incidence of postoperative low cardiac output, pulmonary complications and acute renal failure. The elderly group also had also significantly longer intensive care unit length of stay (1.9 versus 1.7 days, p=0.006) and postoperative length of stay (10.1 versus 7.4 days, p<0.001). Although mortality and complication rates are higher, coronary artery surgery can be performed with acceptable risk in the elderly patients. Old age alone should not be a deterrent factor for surgical revascularization in coronary artery disease.

Segmentation-based algorithms to quantify nonviable myocardium after delayed contrast-enhanced computed tomography: defining what’s dead

The ability to distinguish dysfunctional but viable myocardium from nonviable tissue after acute or chronic ischemia has important implications for the therapeutic management of patients with coronary artery disease. In the acute phase, myocardial revascularization in patients with viable myocardium can improve ventricular dysfunction 1 Alderman E.L. Fisher L.D. Litwin P. Kaiser G.C. Myers W.O. Maynard C. Levine F. Schloss M. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983; 68: 785-795 Crossref PubMed Scopus (698) Google Scholar and long-term survival, 2 Pagley P.R. Beller G.A. Watson D.D. Gimple L.W. Ragosta M. Improved outcome after coronary bypass surgery in patients with ischemic cardiomyopathy and residual myocardial viability. Circulation. 1997; 96: 793-800 Crossref PubMed Scopus (358) Google Scholar whereas image-based characterization of myocardial scar structure in the setting of chronic ischemia can identify those patients with hibernating myocardium who may achieve functional systolic recovery with revascularization. 3 Wakimoto H. Maguire C.T. Kovoor P. Hammer P.E. Gehrmann J. Triedman J.K. Berul C.I. Induction of atrial tachycardia and fibrillation in the mouse heart. Cardiovasc Res. 2001; 50: 463-473 Crossref PubMed Scopus (78) Google Scholar The assessment of both acute and chronic myocardial viability using delayed enhanced magnetic resonance imaging (de-MRI) is considered the standard for myocardial viability assessment. As the clinical indications for implantable cardiac defibrillators and biventricular pacing therapy continue to expand, however, development and validation of alternative imaging methods with similar anatomic, functional, and viability imaging capabilities are needed to accommodate this growing population of patients.

Skeletonization of internal thoracic artery affects its innervation and reactivity

The studies showing the superior characteristics of ITA graft and its impact on the clinical results of coronary artery surgery were performed with ITA harvested almost exclusively as a pedicle. This study assesses the impact of ITA skeletonization on its innervation and reactivity. Segments of skeletonized and non-skeletonized ITA were stained with antibodies against protein S-100 to look for the presence of sympathetic nerve fibers. The functional studies were performed on segments of discarded human pedicled ITA that were divided into two 3mm rings, one skeletonized and another non-skeletonized. We compared concentration-effect relationships for the contraction to norepinephrine and endothelium-dependent relaxation to acetylcholine and bradykinin, as well as endothelium-independent relaxation to sodium nitroprusside in skeletonized and non-skeletonized segments of the same ITA. Skeletonized ITA was devoid of protein S-100 positive nerve fibers. It contracted stronger (maximal response 37.0+/-2.04 vs. 25.4+/-1.83mN (P<0.001)) and was twice as sensitive to norepinephrine: pD(2) 6.03+/-0.10 vs. 5.70+/-0.12 (P=0.035). The endothelium-dependent relaxation responses did not differ between skeletonized and non-skeletonized ITA rings. The skeletonized ITA rings appeared over 10 times more sensitive to sodium nitroprusside: pD(2) 6.66+/-0.20 vs. 5.59+/-0.37 (P=0.012)-potency ratio 11.61. The maximal responses did not differ significantly: 112.0+/-6.71 vs. 129.4+/-16.4% (P=0.33). Skeletonization results in sympathectomy of ITA. It has no effect on endothelium-dependent relaxation but increases reactivity of ITA to norepinephrine. This augmented response to alpha-agonist is small, in comparison with over a ten-fold increase in sensitivity to sodium nitroprusside. Pedicled and skeletonized ITA are functionally significantly different vessels when studied in vitro.

Concomitant Carotid Endarterectomy and Coronary Bypass Surgery: Outcome of On-Pump and Off-Pump Techniques

There continues to be a dilemma regarding the best means of surgical management of significant carotid artery disease in patients requiring coronary artery bypass surgery. A combined approach of coronary artery bypass and carotid endarterectomy has shown good results in patients with concomitant carotid and coronary artery disease. We reviewed our results of coronary artery surgery using conventional cardiopulmonary bypass or off-pump techniques and carotid endarterectomy done as a combined procedure. Between January 1996 and June 2002, 358 patients underwent concomitant coronary artery bypass and carotid endarterectomy. There were 140 males (84.3%) and 26 females (15.7%) in group I. Group II consisted of 158 males (82.3%) and 34 females (17.7%). One hundred sixty-six patients (group I) were done off pump whereas in 192 patients (group II), the procedure was done using conventional cardiopulmonary bypass. Carotid endarterectomy was performed before coronary artery bypass surgery in both groups. The average number of grafts were 3.4 +/- 0.8 with average operative time of 4.2 +/- 0.4 hours in group I, and 3.3 +/- 0.8 graft with operative time of 5.3 +/- 1.2 hours in group II (p = 0.239 and p < 0.001, respectively). There were 2 deaths (1.2%) in group I and 3 deaths (1.6%) in group II (p = 0.870). No patient from group I and 1 patient (0.5%) from group II had postoperative stroke (p = 0.941). Mean hospital stay was 9.0 +/- 1.2 days in group I and 11.2 +/- 1.7 days in group II (p < 0.001). At mean follow-up of 2.8 +/- 0.9 years in group I, 2 patients (1.2%) had late death due to cardiac failure and contralateral carotid endarterectomy was done in 2 patients (1.2%). Group II had mean follow-up of 2.4 +/- 0.6 years, during which 4 patients (2.1%) had late death and contralateral carotid endarterectomy was done in 3 patients (1.6%). Late stroke was seen in 1 patient (0.6%) from group I and 2 patients (1.0%) from group II. Concomitant carotid endarterectomy and coronary artery bypass is a safe and effective procedure in patients with significant coronary and carotid artery disease. Equally good results can be reproduced using cardiopulmonary bypass or off-pump techniques for coronary artery surgery, with low morbidity, mortality, and good long-term results.

Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients.

To assess the clinical significance of coronary artery ectasia 4993 consecutive coronary arteriograms were reviewed to identify patients with this condition and to allow the assessment of their progress. Coronary ectasia was a relatively uncommon finding (overall incidence 1.4%). It was not related to the development of aortic aneurysms and did not affect the outcome, results of coronary artery surgery, or symptoms.

Late clinical results of coronary artery surgery

Late clinical results of coronary artery surgery

Results of coronary artery surgery in women.

Results of coronary artery surgery in women.

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.

Coronary arteriographic findings in patients with axis shifts or S-T-segment elevations on exercise-stress testing

The exercise ECG's and coronary arteriograms of 158 patients were examined to evaluate the relationship of exercise-induced axis shifts and S-T-segment elevations to coronary artery disease. Eighteen of the 158 patients had exercise-induced S-T-segment elevations. Seventeen of these 18 patients had severe obstruction of the major coronary artery most compatible with the zone of ischemic localization. This obstruction was greater than 85 per cent in 16 patients and greater than 50 per cent in a seventeenth patient. The remaining patient had a normal coronary arteriogram and the most minimal exercise-induced S-T-segment elevations. Nine of the 158 patients had exercise-induced right axis shifts. Only 4 of these 9 patients had greater than 50 per cent obstruction of a major coronary artery, as compared to 103 of 154 patients in the total group studied. Also, there was no trend toward predominant involvement of any particular coronary artery in these 4 patients. Hence, it appears that this finding is not predictably associated with severe localized coronary artery disease. Only 4 of the 158 patients had exercise-induced left axis shifts. Three of these four patients had complete obstruction of the left anterior descending artery. But the group size was small, and the fourth patient had a normal coronary arteriogram. Hence, it is only possible to suggest that this finding may be associated with severe disease of the left anterior descending artery. The results of coronary artery surgery are discussed in a patient who had both a left axis shift and precordial S-T-segment elevations on his preoperative exercise ECG.