Severe Graft Disease Research Articles

Serum gamma-glutamyltransferase activity: a new marker for coronary artery bypass graft disease

Serum gamma-glutamyltransferase (GGT) activity has been shown to be related to the development of atherosclerosis and cardiovascular events. We evaluated the association between GGT and severe graft disease in patients undergoing coronary artery bypass graft (CABG) surgery. We evaluated 113 patients (mean age 62±9 years; range 21 to 81 years) who underwent control coronary angiography after a mean of 39 months (range 18 to 84 months) following CABG surgery. A graft was considered patent if there was <70% stenosis or severely diseased if there was ≥70% stenosis on coronary angiography. Preoperative serum GGT levels were measured in all the patients and none had severe systemic or hepatobiliary disease. The association between serum GGT level and severe graft disease was investigated. The grafts were also evaluated separately. Coronary angiography showed severe graft disease involving at least one graft in 65 patients (57.5%). Serum GGT level was significantly higher in patients with severe graft disease (p=0.001). ROC curve analysis yielded a cut-off value of 29.5 U/l for serum GGT level to predict severe graft disease (area under the curve: 0.69) with 48% sensitivity and 82% specificity. While GGT levels were similar for internal mammary artery grafts (p>0.05), radial artery grafts and saphenous vein grafts (SVG) with severe graft disease were associated with significantly higher GGT levels (p=0.003 and p<0.001, respectively). In multivariate analysis, family history of coronary artery disease at a young age (OR 2.46, 95% CI 1.08-5.61, p=0.03) and serum GGT (OR 1.03, 95% CI 1.00-1.07, p=0.05) were independent predictors of severe graft disease. Separate analysis based on the graft types showed that GGT was an independent predictor of severe graft disease for only SVG (OR 1.02, 95% CI 1.00-1.04, p=0.03). Serum GGT level may be an independent marker for the development of severe SVG disease in patients undergoing CABG surgery.

Elevated Levels of Homocysteine Predict Cardiovascular Death, Nonfatal Myocardial Infarction, and Symptomatic Bypass Graft Disease at 2‐Year Follow‐Up Following Coronary Artery Bypass Surgery

Severe graft disease occurs in patients at a rate of approximately 15% within the first year of coronary artery bypass grafting (CABG). In this study, the authors examined predictors of the combined end point of death, nonfatal myocardial infarction (MI), and bypass graft disease at 2-year follow-up after CABG. One hundred twenty-one consecutive patients were included in this study after informed consent was obtained. In univariate analysis, there was a significantly (P<.05) higher homocysteine level (11.0 ng/mol vs 9.7 ng/mol, P=.04) in patients who met the combined end point vs those who did not. There were no statistically significant differences in the following: low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and lipoprotein(a) values; age; body mass index; smoking and diabetes status; statin or aspirin use; creatinine level; hematologic markers; left ventricular ejection fraction; number of bypass grafts; and distribution of coronary artery disease. Logistic regression analysis modeling for low-density lipoprotein cholesterol, lipoprotein(a), fibrinogen, and homocysteine showed that homocysteine value (P=.016) was an independent predictor of the primary combined end point.

Combined Coronary Artery Re-Operation and Pulmonary Resection for Hemoptysis

We present a 59-year-old woman who underwent combined pulmonary resection for bronchiectasis with massive, recurrent hemoptysis and redo coronary artery bypass. She had previously been hospitalized four times for massive hemoptysis. She had also undergone coronary artery bypass and had symptomatic severe graft disease. We performed simultaneous right middle lobectomy and redo triple bypass. At surgery, lobectomy was performed before heparinization, then redo bypass was performed using on-pump cardiopulmonary bypass. The postoperative course was uneventful.

Hepatitis C virus (HCV) reinfection after liver transplantation: Outcome and factors associated with severe graft disease: [formula omitted]. Liver Section and Department of Pathology#, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain

Cow calves were infected with Japanese encephalitis virus (JEV) by parenteral inoculation. One batch was reinfected with JEV, followed by West Nile virus (WNV), while another batch was reinfected directly with WNV. No viraemia due to either JEV or WNV was demonstrated in any of the calves. Culex tritaeniorhynchus mosquitoes fed on 4 of the calves infected with JEV during the first 10 d had no detectable virus, nor did they transmit the virus by bite to susceptible baby chickens. In another experiment, calves did not develop viraemia after infected C. tritaeniorhynchus mosquitoes were allowed to feed on them. Neutralizing and/or haemagglutination-inhibiting antibodies against JEV were demonstrated in 6 of the 11 calves, which explains the high proportion of JE seropositives among cattle in India. All the 5 calves that were infected with WNV subsequent to JEV developed neutralizing and haemagglutination-inhibiting antibodies against WNV also. The study indicates that cattle do not play a role in the maintenance of JEV in nature.

Hepatitis C virus infection after liver transplantation (OLT) is associated with severe graft disease

Hepatitis C virus infection after liver transplantation (OLT) is associated with severe graft disease