RESUMEN
BACKGROUND: The aim of this study was to compare the effects of single-clamping and partial-clamping techniques on postoperative stroke during coronary artery bypass surgery. METHODS: Between December 2008 and December 2012, 2 000 patients who underwent coronary artery bypass grafting in two hospitals were analysed. Post-operative neurological complications were analysed retrospectively in these patients. The cases were divided into two groups: in group 1, 1 500 patients were analysed, in whom proximal anastomosis was performed with partial clamping in a beating heart (n = 1 500, 846 male, 654 female; mean age 63.25 ± 5.72 years; range 43-78 years). In group 2, 500 patients were analysed, in whom proximal anastomosis had been performed by other surgical teams in another hospital, with cross clamping in a resting heart with cardioplegia (n = 500, 296 male, 214 female; mean age 64.83 ± 8.12 years; range 41-81 years). During 30 days post-operatively, neurological deficits, stroke incidence and the relationship of the clinical situation to mortality were analysed. RESULTS: For both groups, patients were similar in terms of patient characteristics. In group 2, cross-clamp duration and perfusion time were longer; however, time of hospital stay was similar in the two groups. Post-operative stroke was seen in 26 patients in group 1 (1.73%) and in nine in group 2 (1.8%). The difference between the two groups was not statistically significant (p = 0.92). All stroke patients were over the age of 55 years. Seven of the stroke patients died (21.1%). In total, 31 patients died because of multiple organ failure in the postoperative 30 days (group 1: 1.6%; group 2: 1.4%) (p = 0.91). Smoking, diabetes mellitus, hypertension, atrial fibrillation, peripheral vascular disease and hypercholesterolaemia were found to be factors that affected stroke development. Mean duration of hospital stay was 5.1 ± 2.8 days in group 1 and 4.9 ± 3.6 days in group 2 and the difference between the two groups was not statistically significant (p = 0.46). CONCLUSION: In patients without plaques in the aorta, performing partial clamping did not increase stroke incidence.
Asunto(s)
Aorta/cirugía , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Accidente Cerebrovascular/etiología , Adulto , Anciano , Anciano de 80 o más Años , Aorta/patología , Aorta/fisiopatología , Constricción , Puente de Arteria Coronaria/mortalidad , Femenino , Hemodinámica , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Perfusión , Placa Aterosclerótica , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: The aim of this study was to evaluate whether poor oral hygiene is associated with carotid and popliteal arterial intima-media thickness, which is one of the predictors of future progression of sub-clinical atherosclerosis, and highsensitivity C-reactive protein (hsCRP) and fibrinogen levels. METHODS: A specialised dentist checked the patients and selected 550 patients during periodontal examinations, according to their oral hygiene. The patients had no history of atherosclerotic disease. Carotid and popliteal artery B-mode ultrasonographic examinations and hsCRP and fibrinogen levels were analysed at baseline and after a mean of 6.2 months. The patients were scored on the DMFT index for the number of decayed (D), missing (M), and filled (F) teeth (T). We also used the Silness-Loe plaque index (SLI) to evaluate oral hygiene and dental plaque. The patients were divided into two groups using the DMFT and SLI criteria. Group I had a DMFT index score from 0 to 3 and SLI index score of 0 or 1. Group II had a DMFT index score from 4 to 28 and SLI index score of 2 or 3. RESULTS: A significant association was observed between dental status, oral hygiene, carotid and popliteal artery intima-media thickness and hsCRP level. Patients with increasing DMFT and SLI scores correlated with increasing carotid artery intima-media thickness. CONCLUSIONS: The results clearly showed that chronic poor oral hygiene and tooth loss are related to sub-clinical atherosclerotic changes in the carotid arteries and may be indicative of future progression of atherosclerosis.
Asunto(s)
Proteína C-Reactiva/metabolismo , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Fibrinógeno/metabolismo , Higiene Bucal , Enfermedades Periodontales/diagnóstico , Enfermedad Arterial Periférica/diagnóstico por imagen , Arteria Poplítea/diagnóstico por imagen , Adulto , Anciano , Biomarcadores/sangre , Enfermedades de las Arterias Carótidas/sangre , Enfermedades de las Arterias Carótidas/etiología , Índice CPO , Índice de Placa Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Periodontales/sangre , Enfermedades Periodontales/complicaciones , Enfermedades Periodontales/terapia , Enfermedad Arterial Periférica/sangre , Enfermedad Arterial Periférica/etiología , Valor Predictivo de las Pruebas , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND AND PURPOSE: The aim of this study was to evaluate whether poor oral hygiene is associated with the intima-media thickness of the carotid arteries, which is one of the predictors of future progression of subclinical atherosclerosis. METHODS: We selected 108 patients during periodontal examinations according to their oral hygiene. The patients had no history of atherosclerotic disease. The results of carotid artery B-mode ultrasonography examinations were analyzed at baseline and after a mean of 7.8 months. Patients were scored on the DMFT index for the number of decayed (D), missing (M), and filled (F) teeth (T). We also used the Silness-Loe plaque index (SLI) to evaluate oral hygiene and dental plaque. The patients were divided into 2 groups according to DMFT and SLI criteria. Group I had a DMFT index of 0 to 3 and an SLI score of 0 or 1; group II had a DMFT index of 4 to 28 and an SLI score of 2 or 3. RESULTS: Dental status and oral hygiene were significantly associated with carotid artery intima-media thickness. Patients with increasing DMFT and SLI indices were correlated with intima-media thickness of the carotid artery. CONCLUSIONS: Chronic poor oral hygiene and tooth loss are related to subclinical atherosclerotic changes in the carotid arteries and might be indicative of future progression of atherosclerosis.
Asunto(s)
Aterosclerosis/diagnóstico por imagen , Aterosclerosis/epidemiología , Grosor Intima-Media Carotídeo/estadística & datos numéricos , Salud Bucal/estadística & datos numéricos , Higiene Bucal/estadística & datos numéricos , Pérdida de Diente/epidemiología , Ultrasonografía/estadística & datos numéricos , Adulto , Anciano , Causalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Turquía/epidemiologíaRESUMEN
BACKGROUND: The aim of this study is to determine the results of coronary artery bypass surgery in patients with a low ejection fraction. Between January 2007 and January 2011, 3556 consecutive patients who underwent coronary artery bypass grafting at the Cardiovascular Surgery Clinic at Sifa University Hospital, Izmir, Turkey, were analyzed retrospectively. METHODS: The patients were divided into 2 groups. Patients undergoing isolated first-time elective coronary bypass surgery were classified according to their preoperative ejection fraction; Patients in Group I had an ejection fraction between 20% and 35% with poor left ventricular function (n = 1246; 695 men and 551 women; mean age, 62.25 ± 5.72 years, range, 47-78 years). Control patients in Group II underwent elective coronary artery bypass grafting at the same time and had left ventricular ejection fraction between 36% and 49% (n = 2310; 1211 men and 1099 women; mean age, 61.83 ± 8.12 years, range, 41-81 years). The mean follow-up time for all patients was 24 ± 9.4 months (range, 12-48 months). Patients were followed postoperatively at the end of the first month and every 6 months. The left ventricular ejection fraction was assessed by transthoracic echocardiography. RESULTS: The mean number of distal anastomoses, myocardial infarction, and mean age was not significantly different between the 2 groups; however, cross-clamp time was longer in Group I. Patient recovery time was significantly longer in Group I. Morbidity (14.5% in Group I versus 7.4% in Group II, P < .005) and mortality (1.76% versus 0.30%, P < .005) were higher in Group I. During late follow-up, the 2-year survival rate (85.1% versus 94.5%) and 2-year event-free rate (77.6% versus 86.9%) were significantly lower in Group I when compared to Group II. Postoperative left ventricular ejection fraction values were significantly superior in Group I compared to Group II. CONCLUSION: Coronary artery bypass grafting can be safely performed in patients with low ejection fraction with minimal postoperative morbidity and mortality. The viable myocardium could be reliably determined by positron emission tomography. Low ejection fraction patients could greatly benefit from coronary bypass surgery regarding postoperative ejection fraction, increased long-term survival, improvement in New York Heart Association classification, and higher quality of life.
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Puente de Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/cirugía , Toma de Decisiones , Volumen Sistólico , Disfunción Ventricular Izquierda/mortalidad , Disfunción Ventricular Izquierda/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Enfermedad de la Arteria Coronaria/diagnóstico , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del Tratamiento , Turquía/epidemiología , Disfunción Ventricular Izquierda/diagnósticoRESUMEN
Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used.
Asunto(s)
Puente Cardiopulmonar/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Diabetes Insípida/etiología , Administración Intranasal , Anciano , Fármacos Antidiuréticos/administración & dosificación , Desamino Arginina Vasopresina/administración & dosificación , Diabetes Insípida/diagnóstico , Diabetes Insípida/tratamiento farmacológico , Diabetes Insípida/fisiopatología , Esquema de Medicación , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , MicciónRESUMEN
A 17-year-old girl with neurofibromatosis type 1 presented with unstable angina. Cardiac catheterization revealed an aneurysm with thrombus in the left anterior descending coronary artery. She was discharged on medical treatment but returned 2 months later with severe chest pains. Angiography revealed an increase in the size of the aneurysm in the left anterior descending coronary artery, with thrombus and dissection. The patient underwent coronary artery bypass surgery. Follow-up after 1 year revealed no problems.
Asunto(s)
Disección Aórtica/complicaciones , Aneurisma Coronario/complicaciones , Neurofibromatosis/complicaciones , Adolescente , Femenino , HumanosRESUMEN
BACKGROUND: Systemic inflammatory response after cardiopulmonary bypass (CPB) is thought to result from contact of cellular and humoral blood components with the synthetic material of the extracorporeal circulation system, leukocyte and endothelial activation caused by ischemia and reperfusion or endotoxins, or by surgical trauma. Proinflammatory cytokines, such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-8, play an important role in the inflammatory processes after CPB and may induce cardiac and lung dysfunction. This study examined the association of the increased release of TNF-alpha with increased myocardial and lung injury after CPB and its effect on postoperative morbidity. METHODS: Twenty patients undergoing elective coronary artery bypass grafting (CABG) were included in the study. Four intervals of blood samples were obtaind and assayed for TNF-alpha, white blood cells, C-reactive protein, and erythrocyte sedimentation rate. RESULTS: All patients were similar with regards to preoperative and intraoperative characteristics, and clinical outcomes were comparable. Plasma levels of TNF-alpha rose more than 20 pg/mL during and after standard CPB in 13 patients (group 1), whereas the plasma levels were less than 20 pg/mL in the remaining 7 patients (group 2) after CPB. The patients of the first group had increased mediastinal bleeding and prolonged intubation time compared to the other group. CONCLUSION: Cardiac surgery and CPB stimulate systemic inflammatory processes characterized clinically by changes in cardiovascular and pulmonary function. Significant morbidity is rare, but most patients undergoing CPB exhibit some degree of organ dysfunction due to activation of the inflammatory response. This study showed that there were no major clinical results of TNF-alpha and white blood cell level, C-reactive protein, and erythrocyte sedimentation rate after the operation, but in patients with a high level of TNF-alpha (more than 20 pg/mL), increased mediastinal bleeding and longer orotracheal intubation time was observed. A number of studies have shown the increase of TNF-alpha after open heart surgery; however, the specific level of TNF-alpha was first described as 20 pg/mL in this study.