Successful Coronary Artery Bypass Surgery Research Articles

Factors associated with deterioration of myocardial inotropic function in patients with coronary artery disease

Material and methods. One hundred patients with functional class III-IV CAD, stage I-IIa heart failure with LV ejection fraction (EF) >40%, successful coronary artery bypass grafting, SYNTAX Score of 33. During hospitalization, echocardiography, matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), monocyte chemoattractant protein 1 (MCP-1) were studied, while systemic immune-inflammation index (SII) was estimated. After 6 months, echocardiography revealed a group of patients with a decrease in LVEF.Results. The following factors of decreased LVEF were identified: type 2 diabetes, chronic kidney disease (p<0,001), >4 comorbid diseases (r=-0,597, p<0,001), increase in SII by 44,6% (p<0,001), MMP-9 by 62% (p<0,001), MCP-1 by 55,1% (p<0,001), TIMP-1 by 45,8% (p<0,001). An inverse relationship was found between LVEF and the level of SII (r=-0,626, p<0,001), MCP-1 (r=-0,747, p<0,001), MMP-9 (r=-0,718, p<0,001). There were following threshold values for predicting a decrease in LVEF: SII — 356,43, MMP-9 — 318,7 ng/ml, MCP-1 — 459,6 pg/ml.Conclusion. There are following markers of decreased LVEF in patients with CAD 6 months after successful coronary artery bypass surgery: type 2 diabetes, chronic kidney disease, >4 comorbid diseases, SII, MMP-9 and MCP-1 with a threshold value of 356,43, 318,7 ng/ml and 459,6 pg/ml, respectively.

Successful coronary artery bypass surgery in an elderly patient with giant air cyst in the left lung

Lung air cysts and bullae are airborne cavities larger than 1 cm in diameter, surrounded by a thin wall, localized within the lung tissue. The bullae are often located apically in the lung. They are usually asymptomatic unless they are very large in size and are detected on chest X-ray or lung tomography. In this article, we present an asymptomatic 79-year-old male patient who was randomly detected as having an air cyst in the anterior segment of the upper lobe of the left lung during the preparation for coronary bypass. We did not find similar cases in PUBMED literature review.

Successful Coronary Artery Bypass Surgery in a Patient with Myelodysplastic Syndrome

Successful Coronary Artery Bypass Surgery in a Patient with Myelodysplastic Syndrome

Off-pump coronary artery bypass surgery in a patient with dextrocardia and situs inversus totalis: a case report

The article discusses a rare clinical case of successful off-pump coronary artery bypass surgery in a patient with dextrocardia and situs inversus totalis (SIT). SIT is a rare condition in which the arrangement of the internal organs is a mirror image of normal anatomy.

Functional assessment of improvement of myocardial ischemia using coronary flow velocity reserve after coronary artery bypass surgery in hemodialysis.

In patients with end-stage renal disease requiring hemodialysis (HD patients), myocardial ischemia after coronary artery disease is a major cause of mortality. Coronary pathophysiology, namely myocardial microvascular dysfunction, appears to differ from patients not requiring HD (non-HD patients). We compared functional improvement of myocardial ischemia after coronary artery bypass surgery (CABG) between HD and non-HD patients by transthoracic coronary flow velocity reserve (CFVR). We retrospectively reviewed isolated CABG patients from between 2008 and 2017. Finally, 161 patients were enrolled; each underwent pre- and postoperative CFVR assessment, and left anterior descending (LAD) artery revascularization with "in-situ" internal mammary artery (IMA). Graft patency was confirmed, and after successful CABG, postoperative CFVR improvement between the two groups was compared. Preoperative CFVR value in group H was 1.81 ± 0.52, group N was 1.93 ± 0.66. There was no significant difference between the groups. IMA to LAD grafts were patent in postoperative evaluation in all patients. Postoperative CFVR in group H was 2.48 ± 0.72 and group N was 2.83 ± 0.73 (P = .042). Significant difference was observed. In both groups, CFVR values improved after successful CABG, but postoperative CFVR values were significant different. In younger populations CFVR values are generally higher. Our HD group was significantly younger than the non-HD group, but CFVR values were postoperatively significantly lower. CFVR values are reportedly affected by both epicardial and microcoronary circulation. In this study population, as all grafts to the LAD were patent, the lower CFVR value in the HD group was considered to have resulted in microvascular disorders.

Functional Evaluation of the Myocardial Ischemia After Coronary Artery Bypass Surgery Using Coronary Flow Velocity Reserve in Left Ventricular Hypertrophy

Patients with left ventricular hypertrophy (LVH) have reportedly higher than normal mortality and incidences of cardiovascular events. Coronary microvascular pathophysiology also appears to differ from other populations. Such coronary microcirculation dysfunctions are considered strong causes of cardiac events. We compare the functional improvement of myocardial ischemia between LVH patients and other patients after successful coronary artery bypass surgery (CABG) using coronary flow velocity reserve (CFVR) by transthoracic echo cardiography. Patients who underwent isolated coronary artery bypass surgery, including left anterior descending artery (LAD) revascularization via "in situ" internal thoracic artery (ITA) between June 2008 and July 2017 (n = 155), were retrospectively reviewed. ITA grafts were patent in postoperative graft evaluation in all patients. CFVR was evaluated pre- and postoperatively, and data were compared between patients with severe LVH group and those without (non-LVH group). Preoperative mean CFVR was 1.77 ± 0.75 in LVH group and 1.91 ± 0.63 in non-LVH group (P = 0.188). After the operation, ITA to LAD graft patency was confirmed in all patients. Postoperative CFVR was 2.23 ± 0.70 in LVH group and 2.85 ± 0.71 in non-LVH group, respectively (P = 0.002). Significant difference was observed between the 2 groups. CFVR values improved after ITA to LAD bypass grafting in both LVH and non-LVH groups, but postoperative CFVR was significantly lower in patients with severe LVH than in patients without. Myocardial ischemia may exist in patients with LVH, despite patent graft, due to microvascular dysfunction. Comprehensive treatment, including long-term oral medication to improve microvascular dysfunction, is necessary for patients with LVH.

Infrequent cardiac manifestations of sarcoidosis

Cardiac sarcoidosis (CS) is found in 2–7% of patients with systemic sarcoidosis (SS). Its diagnosis and treatment is challenging, notwithstanding the poor prognosis and treatment. Hereby, we present a case of systemic sarcoidosis with rare cardiac manifestations of severe mitral incompetence and large coronary aneurysm in a previously healthy woman. She underwent successful mitral valve replacement and coronary artery bypass surgery and was maintained on low dose glucocorticoid therapy.

The value of coronary CT angiography to assess graftability of left anterior descending artery before coronary artery Bypass surgery

Assessment of graftability of the LAD is an important factor for decision making, when the Left anterior descending artery (LAD) is totally occluded, Multidetector computed tomographic (CT) angiography might identify the flow distal to the total occlusion better than invasive coronary angiography. To identify the value of CT coronary angiography in the assessment of LAD graftability when it is questionable invasive coronary angiography. Our study is a retrospective single center study, we included 18 patients with multivessel disease who were discussed for Coronary Artery Bypass Surgery (CABG) in combined meeting (including cardiologists and cardiac surgeons), the LAD graftability was questionable and patients referred for coronary CT angiography. From the 18 patients. There were 12 patients with concordance between both modalities that the LAD was found not graftable and those patients deferred from CABG. Four of them 4/12 underwent coronary angioplasty and stenting for other vessels and 8/12 continue on medical treatment only. There were six 6/18 patients who showed discordance between both modalities as the CT reveled graftable LAD while the invasive coronary angiography did not show it; those patients underwent successful CABG with LIMA to LAD. One of the CABG patients has LM arising from right sinus of valsalva. CT angiography detects the ominous course of LM between the aorta and pulmonary artery. Coronary CT angiography is a very valuable tool to assess graftability of the left anterior descending artery before Coronary Artery Bypass Surgery.

Familial Hypercholesterolemia with Multiple Large Tendinous Xanthomas and Advanced Coronary Artery Atherosclerosis

We herein report the case of a 53-year-old man with severe coronary ischemia who underwent successful coronary artery bypass surgery. Of note, he had hypercholesterolemia and presented with multiple large tendinous xanthomas and thickened Achilles tendons that had been present for more than two decades. Together with a family history of dyslipidemia, the patient was diagnosed as having familial hypercholesterolemia. Irrespective of an extensive search for possible mutations in the genes presumably involved in the patient's pathophysiology, including low-density lipoprotein receptor (LDLR), proprotein convertase subtilisin/kexin type 9 (PCSK9), autosomal recessive hypercholesterolemia (ARH) and apolipoprotein B (APOB), we were not able to identify the gene mutations responsible for the phenotype observed in the present case.

Novel anaesthetic approach for surgical access and haemodynamic management during off-pump coronary artery bypass through a left thoracotomy

For myocardial revascularization on a beating heart through a thoracotomy, a properly deployed endobronchial blocker (EBB) provides ideal conditions for surgical access. In addition, adequate volume replacement to achieve optimal cardiac performance is a primary goal of haemodynamic management in patients undergoing off-pump coronary artery bypass grafting. To achieve both these ends, this case report describes the combined use of a left-sided EBB along with a volumetric pulmonary artery catheter in a patient who underwent a successful off-pump coronary artery bypass surgery through an anterolateral thoracotomy.

Landiolol reduces coronary artery motion in an open-chest porcine model: implications for off-pump coronary artery bypass surgery

Reduction of target coronary artery motion is imperative for successful off-pump coronary artery bypass surgery. We hypothesized that landiolol, a novel ultra-short-acting selective β-1 blocker, would reduce such coronary artery motion. To test this hypothesis, the motion of the left anterior descending artery of the porcine heart (n = 8) was analyzed by three-dimensional digital motion capture and reconstruction technology with or without continuous landiolol infusion. Landiolol (0.12 mg/kg/min) significantly decreased the heart rate (105 ± 16 vs. 90 ± 9 beats/min), three-dimensional distance moved (-20.4% vs. control), maximum velocity (-30.0% vs. control), acceleration (-31.1% vs. control), and deceleration (-28.6% vs. control) without inducing a significant change in the systolic blood pressure (85 ± 18 vs. 81 ± 22 mmHg), cardiac output (4.3 ± 1.4 vs. 4.1 ± 1.3 l/min), or pulmonary wedge pressure (7.8 ± 3.0 vs. 8.7 ± 2.9 mmHg). Landiolol reduces the heart rate and coronary artery motion with stable hemodynamics, which may facilitate performing precise anastomosis on the beating heart.

Off-pump coronary artery bypass in poland syndrome with dextrocardia: case report

Poland Syndrome is a congenital disorder characterised by hypoplasia of the pectoral muscles along with upper extremity deformities. We encountered a patient with Poland syndrome associated with dextrocardia and also failed pectus excavatum repairs who presented to us with symptomatic ischaemic heart disease requiring intervention. He underwent successful off-pump coronary artery bypass surgery (OPCABG). As far as we are aware, this is the first case report of OPCABG in a case of Poland syndrome with dextrocardia. We describe here the management of this complex patient and wish to emphasise that the off-pump option is feasible in dextrocardia with some technical modifications.

High-Risk Left Main Coronary Artery Bypass Surgery Supported by the Impella® Recover LP 2.5 Assist Device: An Alternative Insertion Technique

Patients with high-risk coronary lesions such as left main stenosis and a severely depressed left ventricular ejection fraction are at risk of death and morbidity-related complications during coronary artery bypass surgery. Several alternative methods have been developed for managing this problem, but it is still challenging, even for highly experienced and well-equipped cardiac surgery centers. We report the case of a successful coronary artery bypass surgery supported by the Impella Recover LP 2.5 assist device and using an alternative insertion technique for the ascending aorta in a patient with high-risk coronary lesions, such as left main disease.

Prison break: getting a distal protection device out of jail

A man in his late 60s presented with worsening angina, 8 years after successful coronary artery bypass surgery. Cardiac catheterisation revealed a high-grade stenosis in a saphenous vein graft to...

Bilateral coronary ostial disease following mediastinal irradiation: a case report

IntroductionOstial coronary artery disease is rare with a reported incidence of 0.07 to 0.25% in all patients undergoing angiography. It has a strong association with previous mediastinal irradiation, which induces specific histological changes distinct from atherosclerotic lesions. The radiation also affects the myocardium and surrounding structures, which can alter the surgical approach.Case presentationWe present a case of a 62-year-old female who developed bilateral ostial coronary artery stenosis 32 years following therapeutic radiotherapy for Hodgkin’s disease. She underwent successful coronary artery bypass surgery using a combination of arterial and venous conduits. Postoperatively she developed a clinical picture of diastolic impairment not detected pre-operatively. She was managed appropriately and made a successful recovery.ConclusionsThis case highlights the cardiac pathology associated with mediastinal irradiation, which should be suspected during surgical assessment, especially in long-term survivors. It heightens the surgeon’s awareness so a more thorough evaluation of coronary anatomy, ventricular function and potential conduits is made prior to surgery.

Coronary Artery Bypass Grafting in Idiopathic Myelofibrosis: A Case Report

The concomitant presence of myeloproliferative disorders and the need for coronary artery bypass surgery is a surgical dilemma. Thrombosis and hemorrhage can cause difficult problems and might require different approaches during and after surgery. We report a patient who had idiopathic myelofibrosis and underwent a successful coronary artery bypass surgery.

Total Knee Replacement Following Coronary Artery Bypass Surgery

Four patients, following successful earlier coronary artery bypass surgery underwent successful total knee replacement. The average follow-up of these patients is 47.5 months. Three of the patients had bilateral knee replacements and there were no significant complications.

Myocardial bridging causing transmural ischemia Successful coronary artery bypass surgery

Myocardial bridging is a common and usually benign inborn coronary anomaly. We report on a 51-year-old man who presented with recent angina on minimum physical effort. Cineangiography showed myocardial bridging of the mid-left anterior descending artery (LAD), and intracoronary ultrasonography excluded atherosclerotic disease. Gated single-photon emission computed tomography (SPECT), with exercise stress, showed an extensive anterior perfusion defect, and remarkable ST-segment elevation (up to 10 mm) in recovery. Vasospasm of the LAD was the main hypothesis. Additional oral drugs did not bring about improvement, as indicated on a new SPECT; disabling angina persisted. Surgical revascularization of the LAD by left internal mammary artery graft was performed. Two years later, SPECT and exercise tests returned to normal. The patient remains asymptomatic.

A New Multisuction Cardiac Positioner for Multivessel Off-Pump Coronary Artery Bypass Grafting

: To accomplish successful multivessel off-pump coronary artery bypass grafting, safe, reproducible, and effective exposure of all coronary territories is essential. For this purpose, we developed a new, simple, multisuction cardiac positioner. : This new cardiac positioner consists of 3 small independent suction cups and suction tubes made of silicone. Unlike an apical suction cardiac positioner, this positioner has no arm. The suction cups can be applied with negative pressure of 300 mm Hg to various surfaces of the ventricle, including not only the apex but also the lateral, inferior, and right ventricular walls, according to surgeon preference. We applied this positioner in 15 clinical multivessel off-pump coronary artery bypass procedures. : In all cases, all target vessels including those on the lateral or inferior wall were successfully exposed and grafted without hemodynamic compromise. Surgical exposure, especially on the lateral and inferior walls, was quite similar to that of conventional coronary artery bypass graft procedures performed during cardiopulmonary bypass. : The multisuction cardiac positioner provided reproducible and easy access in multivessel off-pump coronary artery bypass surgery. This simple, variable, and inexpensive cardiac positioner may be used as a new tool to aid in the performance of successful multivessel off-pump coronary artery bypass surgery.

Successful coronary artery bypass surgery in a patient with AIDS

We report the case of a 47-year-old man with AIDS who underwent a successful quadruple coronary artery bypass operation. The improving prognosis of patients with HIV/AIDS, in addition to the reported incidence of plasma lipid abnormalities in patients receiving protease inhibitors, are laying the groundwork for a larger population in which premature coronary artery disease develops. Operative risk, immunosuppressive effect of cardiopulmonary bypass, and practical considerations in the care of these patients are discussed.