Simultaneous Coronary Artery Bypass Research Articles

Clinical Significance and Prognostic Factors of Simultaneous Heart Valve Surgery and Coronary Artery Bypass Grafting in Treating Patients with Valvular Heart Disease Complicated by Coronary Heart Disease

This study was designed to evaluate the clinical significance of simultaneous heart valve surgery and coronary artery bypass grafting for patients with valvular heart disease complicated by coronary heart disease and its influence on their prognosis. A total of 121 patients with valvular heart disease complicated by coronary heart disease who were surgically treated in our hospital from January 2013 to March 2017 were selected. The observation group (OG) (64 patients) underwent simultaneous valvular heart surgery and coronary artery bypass grafting. The control group (CG) (57 patients) underwent non-synchronous heart valve surgery and coronary artery bypass grafting. The operation, hospitalization, occurrence of adverse events and changes of cardiac function indexes of patients from the two groups were compared, and the factors affecting their prognosis were confirmed in multivariate analysis. The ventilator application time, postoperative ICU monitoring time, postoperative general ward time and total incidence of adverse events in the OG were lower than those in the CG (P<0.05). After treatment, the cardiothoracic ratio, left ventricular end-diastolic volume and BNP content in the two groups were markedly higher than before treatment, and the increase in the OG was more obvious (P<0.05); the left ventricular ejection fraction in both groups was markedly lower than that before treatment (P<0.05), and the decrease in the OG was more obvious (P<0.05). Multivariate analysis showed that hypertension, treatment methods, course of disease and age were independent risk factors affecting the prognosis of patients with valvular heart disease complicated by coronary heart disease. Simultaneous heart valve surgery and coronary artery bypass grafting can reduce the occurrence of adverse events and improve cardiac function indexes, which is worthy of clinical application. Hypertension, treatment methods, course of disease and age are independent risk factors affecting the prognosis of those patients.

Симультанное аортокоронарное шунтирование и гастрэктомия у больного раком желудка и ишемической болезнью сердца

Симультанное аортокоронарное шунтирование и гастрэктомия у больного раком желудка и ишемической болезнью сердца

PECULIARITIES OF CORONARY REVASCULARIZATIONS IN PATIENTS WITH DIAGNOSED LUNG CANCER AND CONCOMITANT ISCHEMIC HEART DISEASE

The object of the study: coronary revascularization in patients with malignant lung diseases and concomitant ischemic heart disease. The problem to be solved: selection of the optimal tactics for coronary bypass grafting simultaneously with lung resections. Main scientific results: an individual approach to the choice of tactics for carrying out simultaneous operations in patients with malignant lung diseases and concomitant ischemic heart disease is proposed. It has been shown that performing coronary artery bypass grafting simultaneously with lung resections, according to the proposed methods, allows minimizing surgical trauma and eliminating the influence of additional risk factors associated with cardiopulmonary bypass (CPB). The area of practical use of research results: surgical hospitals. An innovative technological product: methods for performing simultaneous coronary (artery) bypass grafting in patients with malignant lung diseases, based on the use of sternotomy, thoracotomy and mini-thoracotomy approaches. The area of application of an innovative technological product: clinical practice of performing simultaneous operations for combined pathology of the heart and lungs in medical institutions of a general surgical profile.

The results of simultaneous revascularization operations of the carotid and coronary territory in patients with multifocal atherosclerosis

Objective : To determine the effectiveness of simultaneous surgical interventions for revascularization of the carotid and coronary basins. Materials and methods : The effectiveness of the surgical intervention was assessed in 34 patients (31 male patients, 3 female patients, average age 61.8 ± 1.52 years) who underwent simultaneous carotid endarterectomy and coronary artery bypass grafting. The indications for surgical treatment for carotid arteries disease were determined by a neurosurgeon, and for coronary artery bypass grafting — by a cardiac surgeon. Results : Postoperative complications were observed in 55.9 % of patients. In 3 (8.8 %) patients, an acute ischemic stroke with a neurological deficit developed on the first day after the operation. One patient (2.9 %) presented with both an acute myocardial infarction in the postoperative period and an acute heart failure. Perioperative rhythm disturbances in the form of atrial fibrillation were observed in 6 (17.6 %) cases. Postoperative mortality was 2.9 %. During the first year after surgery, an improvement in the quality of life was observed in 31 (93.9 %) patients in the form of an improvement in the functional state of angina pectoris, a reduction of the heart failure symptoms, or a complete regression of cardiac symptoms. Two (6.06 %) patients needed for repeated myocardial revascularization. Within 3 years of follow-up, no patient developed an ischemic stroke. The patients who developed cerebral event immediately after surgery had a stable neurological status. The commutative survival rate (percentage of patients who survived within the indicated period) of patients for 1 year of observation was 100 %, for 3 years — 96 %. A significant drop in survival function was observed in the fourth year of observation up to 75 % due to the development of repeated acute myocardial infarction. Conclusions: The simultaneous revascularization of the carotid and coronary territory in the form of a carotid endarterectomy and aortocoronary bypass surgery is an effective modern method for preventing the development of stroke and acute myocardial infarction, improving the neurological and general somatic status, quality of life of patients with combined atherosclerotic lesions of the carotid and coronary arteries.

Simultaneous bilateral aortic-carotid replacement and coronary artery bypass grafting by using of microvascular technique and surgical microscope

Simultaneous bilateral aortic-carotid replacement and coronary artery bypass grafting by using of microvascular technique and surgical microscope

Early results of simultaneous carotid endarterectomy and off-pump coronary artery bypass grafting: experience from a single center

Background: The optimal management of patients with concomitant carotid and coronary artery disease remains controversial. Methods: The records of 113 consecutive patients who underwent either simultaneous carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) (CEA/CABG, n=15) or offpump CABG alone (CABG, n=98) between January 2013 and July 2015 were reviewed. We retrospectively analyzed the baseline characteristics and 30-day results of both groups. Results: The two groups were similar with regard to age, gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, chronic renal failure, prior MI, previous PCI, ejection fraction, LM or triplevessel disease, stable and unstable angina. Peripheral vascular disease was more prevalent in the CEA/CABG group (53.3% vs. 6.1%, P vs. 24.5%, P 0.05). No death within 30 days occurred in both groups. There was no significant different between the two groups in postoperative complications [stroke, myocardial infarction (MI), transient ischemic attack (TIA), atrial fibrillation/atrial flutter, cardiac tamponade, cardiac arrest, pulmonary infection, Wound infection, and bleeding requiring re-operation] (all P>0.05). The cumulative complications at 30 days was 3 (20%) in the CEA/CABG group compared with 16 (16.3%) in the CABG group (P=0.72). The differences in total intubation time, intensive care unit (ICU) stay and hospital stay were also not statistically significant (all P>0.05). Conclusions: Our results showed that addition of CEA to CABG would not increase the risk of mortality and morbidity relative to patients underwent CABG alone. Our study adds to the controversy of simultaneous CEA/CABG procedure. Large-scale, multi-center, randomized clinical trials are required to further evaluate the outcomes of simultaneous CEA/CABG.

Does the presence of coronary artery disease affect the outcome of aortic valve replacement?

The purpose of this study is to compare the late outcome of aortic valve replacement with or without preoperative coronary artery disease, and with or without coronary artery bypass. Between 2014 and 2015, 291 patients underwent aortic valve replacement. Average follow-up term was 2.5±2.2years. The retrospective comparative study was performed between the patients with (n=115) or without (n=176) preoperative coronary artery disease (Study 1) and with (n=93) or without (n=198) coronary artery bypass grafting (Study 2). Study 1: male patients were more, and diabetes was more in the patients with coronary artery disease. Long-term survival rate was significantly low in the patients with coronary artery disease (p=0.0002 by log rank test). Freedom from repeat coronary revascularization rate was lower in the patients with coronary artery disease (p=0.02 by log rank test). Study 2: operation time (419±130 vs 290±101; p=0.0001) was longer in the patients with coronary artery bypass grafting. Improvement of ejection fraction at follow-up was more in the patients with coronary artery bypass(114±43 vs 104±26%; p=0.03). Long-term survival rate and freedom from major adverse cardiac event rater were not different with or without coronary artery bypass grafting (p=0.26 and p=0.59, respectively, by log rank test). Although prevalence of coronary artery disease inversely affected the long-term outcome of the aortic valve replacement, simultaneous coronary artery bypass did not. Aggressive simultaneous coronary revascularization would be important to improve the long-term outcome of aortic valve replacement.

経カテーテル大動脈弁植込み術と人工心肺を使用しない心拍動下冠動脈バイパス術との同時手術

経カテーテル大動脈弁植込み術と人工心肺を使用しない心拍動下冠動脈バイパス術との同時手術

Early and Late Outcomes of Surgical Treatment in Carcinoid Heart Disease

BackgroundSymptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival. ObjectivesThis study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care. MethodsWe retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012. ResultsThe records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70%). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), and simultaneous coronary artery bypass (11%). There were 20 perioperative deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 43%), and 24% (18% to 32%), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit. ConclusionsOperative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team.

Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy

BackgroundThe advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure.Clinical caseA simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma.DiagnosisPostoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease.TreatmentWe successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients.

Simultaneous coronary artery bypass and carotid operations

Coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) were performed in 43 patients either at the same or in different operations. In all, 48 CEAs were performed. Simultaneous operations were performed 32 times (17 CEAs before cardiopulmonary bypass [CPB], 15 CEAs after the beginning of CPB). Thirteen CEAs were performed at different operations prior to CABG and 3 CEAs after CABG. One patient whose left carotid artery was operated on during CPB suffered from left-sided hemiparesis one day postoperatively. There were no other hemipareses or deaths related to the operation. The control group consisted of 49 patients in whom CABG was performed. The number of risk factors (family predilection, smoking, diabetes, hyperlipidemia, and acute myocardial infarction) was significantly higher in the study group (2.1, SD 1.0 versus 1.4, SD 1.0). The number of significant left main coronary artery stenoses was double in the study group compared with the control group, but the difference was not statistically significant. Also there were no statistical differences in frequencies of one-, two- or three-vessel disease. There were no statistical differences between the groups in New York Heart Association (NYHA) classification. This study shows that CEA can be safely done simultaneously with CABG.

Simultaneous Cesarean Delivery and Coronary Artery Bypass Grafting (CABG)

Simultaneous Cesarean Delivery and Coronary Artery Bypass Grafting (CABG)

Efficacy and safety of beating heart coronary revascularization coupled with ascending aorta-bifemoral grafting: Analysis of short term results

Introduction Coronary Artery Disease (CAD) frequently coexists with Peripheral Vascular Disease (PVD) and poses management issues. When there is a concomitant infrarenal aortic occlusive disease, abdominal aorta is the traditional donor of bypass inflow to the lower limbs. However, the ascending aorta may also be used as the source of inflow to both the femoral and coronary arteries in patients who present with combined CAD and PVD. Here, 5 year follow up results of simultaneous off-pump coronary artery bypass grafting (OPCAB) and Ascending Aorto-Bifemoral Grafting [AABG] are presented and merits of the procedure are discussed.

Combined esophagogastric resection for cancer at esophagogastric junction and off pump CABG through left posterolateral thoracotomy

Carcinoma of the esophagus can coexist with significant Coronary Artery Disease (CAD) in the elderly. A staged approach to the two problems, carrying out Coronary Artery Bypass Grafting (CABG) first followed by cancer resection at two anesthetic settings is a logical way of tackling the conditions. But it lengthens morbidity and increases economic burden. Simultaneous tackling of these two problems, i.e. operation at the same anesthetic settings can offer a better outcome albeit at the cost of a longer operative time. We present such a patient who underwent simultaneous Off Pump Coronary Artery Bypass Grafting (OPCAB) and esophago-gastric resection successfully through a posterolateral thoracotomy and upper midline laparotomy.

Infrarenal abdominal aortic aneurysm repair in presence of coronary artery disease: Optimization of myocardial stress by controlled phlebotomy

The repair of abdominal aortic aneurysm (AAA) in the presence of significant coronary artery disease (CAD) carries a high-risk of adverse peri-operative cardiac event. The options to reduce cardiac risk include perioperative beta-blockade, preoperative optimization by myocardial revascularization and simultaneous (combined) coronary artery bypass grafting and aneurysm repair. We describe intra-operative controlled phlebotomy to optimize myocardial stress during repair of infrarenal AAA in a patient with significant stable CAD.

Abstract 2295: Current Outcomes of Simultaneous Carotid Endarterectomy and Coronary Artery Bypass in North America

OBJECTIVE: Management of patients with concomitant carotid and coronary artery disease has been controversial. Divergent strategies have been employed, including simultaneous carotid endarterectomy and coronary bypass (SCC) versus various staged procedures. While no strict comparison group is available, this study defines current outcomes of SCC, as compared qualitatively to two reference categories. METHODS: Utilizing the STS database from 2003 to 2007, patients having SCC were compared to cerebrovascular disease patients undergoing coronary bypass with prior carotid endarterectomy (Ref Gp I), and those with carotid Doppler stenosis >75% and no carotid intervention (Ref Gp II). Logistic regression analysis adjusted for differences in baseline characteristics, and operative mortality (OM) and a composite of neurological complications (NC) were assessed. RESULTS: Of 747,932 patients undergoing isolated CABG with/without CEA, 108,271 (14.4 %) had cerebrovascular disease. In this group, 5,732 (5.3%) underwent SCC. The SCC group had more males and less severe coronary disease (both p<0.001). After statistical adjustment for all baseline differences, SCC had clinically and statistically higher OM and NC as compared to any of the reference groups (TABLE ). CONCLUSION: Although no proper control group exists for comparison, SCC as recently performed in North America carries a high risk, as compared to any of the reference groups. Suboptimal results associated with the SCC strategy suggest a need for quality improvement and research on the optimal management of patients with simultaneous carotid and coronary disease.

Simultaneous Off-Pump Coronary Artery Bypass Grafting and Ascending Aortobifemoral Bypass Graft via Ventral Abdominal Route

Aortoiliac disease often coexists with coronary artery disease. It is not uncommon to subject a patient to two separate interventions. We report two cases in which in simultaneous off-pump coronary artery bypass grafting was done with an ascending aortobifemoral bypass graft through the ventral abdominal route without any additional morbidity. Combining a technically simple method of limb bypass with an off-pump cardiac surgery is a promising procedure for revascularization of myocardium and lower limbs. We discuss the merits of combining an off-pump coronary artery bypass grafting procedure with a limb bypass.

Simultaneous carotid endarterectomy and coronary artery bypass surgery in Canada

Simultaneous carotid endarterectomy and coronary artery bypass surgery in Canada

Simultaneous off-pump coronary artery bypass surgery and pulmonary resection

To summarize the experience of combined off-pump coronary artery bypass grafting (OPCAB) and pulmonary resection. Seven patients with unstable angina or a history of myocardial infarction and pulmonary disease underwent combined OPCAB and pulmonary resection. All of them underwent coronary angiography, and neither coronary angioplasty nor stenting was feasible. OPCAB preceded the lung resections. The preferred approach to the heart and lung was by sternotomy. Left upper lobectomy was performed in 2 patients, right upper lobectomy was performed in 1 patient, right lower lobectomy was performed in 1 patient, right upper and middle bilobectomy was performed in 1 patient, left lung volume reduction surgery (LVRS) was performed in 1 patient and bilateral LVRS was performed in 1 patient. There were no hospital mortality in this group of patients, however there were one late death. Sternal dehiscence occurred in 1 patient which was observed with a need for re-sternotomy and atrial fibrillation was observed in 1 patient. Five patients were diagnosed as malignant tumor by pathology test, and 2 patients were severe chronic obstructive pulmonary disease (COPD). Follow-up ranging from 2 months to 31 months was available for these patients. None of the patients showed evidence of myocardial ischemia after surgery. In one patient, who underwent right upper and middle bilobectomy, local recurrence was found at 19 months after surgery. OPCAB carried out simultaneously with lung resection is a safe and effective approach in patients diagnosed with concomitant coronary artery and pulmonary disease. OPCAB may decrease the incidence of postoperative complications.

Clinical experience of simultaneous aortic operation and coronary artery bypass grafting

To summarized the experience of simultaneous aortic operation and coronary artery bypass. Between November 1997 and September 2004, thirty-six patients who underwent combined aortic operation and coronary artery bypass graft (CABG) were reviewed with a mean age of (57 +/- 12) years (range 31 to 75). Nineteen patients were suffered from aortic dissection. There were 17 patients of aortic aneurysm, 5 aortic root aneurysm, 5 ascending aortic aneurysm, 4 aortic arch aneurysm, 3 abdominal aneurysm. Preoperational coronary angiography was performed in 1 of 10 acute type A dissection patients. The coronary arteries were involved by dissection in 7 acute type A dissection patients. The artherosclerosis of coronary artery was found during operation in 2 patients. Among 7 patients with chronic type A aortic dissection, coronary angiography was performed in 2, coronary artery was involved by dissection in 2 and coronary arterosclaerosis was founded in 3. There were 2 patients with acute or chronic type B aortic dissection. The stenosis of coronary artery was confirmed by preoperative angiography in the patients with aortic aneurysm. There were 57 coronary bypass grafts, 6 of them were artery grafts, and others were venous grafts. The mean cardiopulmonary bypass time was (157 +/- 54) min, and the mean aortic cross clamp time was (98 +/- 31) min. Five patients with type A aortic dissection died postoperatively, 3 from heart failure leading to multi organ system failure, 1 from cerebral hernia and one from ischemia of intestinal tract. Postoperative complication included reoperation for hemorrhage in 1 patient, respiratory failure in 1 patient. Type A aortic dissection with coronary involvement or arterosclaerosis is associated with high mortality rate. Coronary artery angiography should be performed in the elder than 50 years patient with aortic aneurysm. Combined aortic aneurysm operation and CABG is a safe procedure.