RESUMEN
BACKGROUND: Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. It occurs most often between the 2nd and 3rd postoperative day. The aim of this study was to compare the daily distribution of AF incidence between patients operated on with the standard coronary artery bypass grafting (CABG) technique and off-pump coronary artery bypass grafting on the beating heart (OPCABG) without extracorporeal circulation. MATERIAL/METHODS: This was a prospective analysis of 1067 patients with coronary artery disease (CAD) operated on at our institute. 891 patients underwent CABG and 176 subjects were operated on by beating heart surgery using the OPCABG technique. Heart rhythm was analyzed continuously, and additionally a standard 12-lead ECG was performed once a day and continually in the case of clinical manifestations of arrhythmia. The observation period included 7 postoperative days (POD). RESULTS: 164 patients in the CABG group (18.43%) developed AF compared with 28 (16%) in the OPCABG group (OR=1.18; 95% CI (0.75-1.85); p=0.451). The peak of AF incidence in the CABG group appeared on the 2nd POD, while in contrast the peak of AF incidence after OPCABG was observed on the 1st POD. CONCLUSIONS: We found no statistically significant difference in AF incidence after CABG and OPCABG. Different trends were noticed in the timing of occurrence of AF in these two groups.
Asunto(s)
Fibrilación Atrial/etiología , Puente Cardiopulmonar/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Complicaciones Posoperatorias/etiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: There is increasing evidence that plasma homocysteine level is an independent risk factor for atherosclerosis. Low levels of serum folates, cobalamin and pyridoxine are associated with increased risk of cardiovascular disease. Most dietary products contain cholesterol as well as methionine, so hyperlipidemia could be associated with a higher level of homocysteine and inversely with lower levels of B vitamins. The aim of this study was to investigate the differences in levels of lipids and vitamins affecting homocysteine metabolism in different groups of patients. MATERIAL/METHODS: We examined 38 healthy persons, 55 patients hospitalised for cardiac surgery, and 62 patients without clinical evidence of atherosclerosis but with one of the atherosclerosis risk factors (hypercholesterolemia, NIDDM or chronic renal insufficiency). The levels of total cholesterol, triglycerides, vitamin B12, folic acid and vitamin B6 index in serum were determined using routine laboratory methods. RESULTS: We found no association between lipids and B vitamins in any examined group. There were significant differences between concentrations of analysed parameters in all groups of patients as compared to controls. CONCLUSIONS: The lack of correlation between the levels of lipid parameters and B vitamins in serum indicates that these may be independent, additional risk factors for atherosclerosis. Higher vitamin B6 deficiency in dialysis patients is probably caused by low intake combined with the increased requirements of uremic patients. Permanent monitoring of B vitamins in serum is necessary in patients with elevated risk of atherosclerosis, as well as long-term education, careful diet planning and supplementation.
Asunto(s)
Arteriosclerosis/sangre , Arteriosclerosis/etiología , Lípidos/sangre , Complejo Vitamínico B/sangre , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos , Estudios de Casos y Controles , Colesterol/sangre , Femenino , Ácido Fólico/sangre , Homocisteína/sangre , Humanos , Hiperlipidemias/sangre , Hiperlipidemias/complicaciones , Masculino , Persona de Mediana Edad , Factores de Riesgo , Triglicéridos/sangre , Vitamina B 12/sangre , Vitamina B 6/sangreRESUMEN
Coronary bypass graft procedures still remain a surgical challenge in patients with severe left ventricular dysfunction. The study was designed to compare off pump myocardial revascularization with conventional bypass procedures in patients with ejection fraction below 35%. Our results suggest that in selected patients off pump bypass procedure, may be used as a suitable and safe alternative to conventionalon pump coronary surgery, permitting complete revascularization with comparable short-term results.
Asunto(s)
Puente de Arteria Coronaria Off-Pump/métodos , Isquemia Miocárdica/complicaciones , Revascularización Miocárdica/métodos , Disfunción Ventricular Izquierda/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Puente de Arteria Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Disfunción Ventricular Izquierda/etiologíaRESUMEN
During the coronary artery bypass off pump procedure thermal angiography was evaluated for the intraoperative assessment of the patency and the flow in the left internal mammary to the left anterior descendens. Our observation confirms that thermal angiography may be used as an intraoperative method which improves graft quality control during coronary bypass procedures.
Asunto(s)
Puente de Arteria Coronaria Off-Pump/métodos , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/cirugía , Monitoreo Intraoperatorio/métodos , Termografía/métodos , Anciano , Angiografía Coronaria/métodos , Humanos , Masculino , Grado de Desobstrucción VascularRESUMEN
After an initial learning experience in the early 70's, radial artery is now used as the second arterial graft of choice (after both ITAs). The aim of the study was to compare patency rates of venous and arterial grafts--especially radial artery--in mid-term follow up period. 19 patients with stable angina and 11 with unstable angina underwent coronary artery bypass grafting with CPB. The type of conduits used for grafting were the same in all patients. All patients underwent catheterization control. 28 LIMA grafts and 27 radial artery grafts were patent 31 months after CABG. Vein grafts were found patent in 80%.
Asunto(s)
Angina de Pecho/cirugía , Angina Inestable/cirugía , Puente de Arteria Coronaria , Arteria Radial/trasplante , Grado de Desobstrucción Vascular , Venas/trasplante , Adulto , Anciano , Angina de Pecho/diagnóstico por imagen , Angina Inestable/diagnóstico por imagen , Angiografía Coronaria , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: Transmyocardial laser revascularization (TMLR) is a modem approach in the management of coronary artery disease. It can be considered as a method of choice in some cases unsuitable for coronary angioplasty or bypass grafting. Transmyocardial laser revascularization is expected to relieve angina and to improve patient quality of life and survival. The aim of the study was to determine whether the laser energy released during TMLR induces any myocardial deterioration, which could affect the heart status and function in early postoperative period. METHODS: A group of 80 patients with CAD (37 TMLR/CABG, 43 CABG) was evaluated within 24 hours after the procedure for CK-MB and cTnT concentrations to determine myocardial injury. Elective hemodynamic indexes were used to determine the heart function. The cardiac rhythm disturbances were recorded by Holter monitoring. Homeostatic disturbances and postoperative complications were also recorded. RESULTS: The postoperative CK-MB and cTnT levels were significantly higher in the TMLR g roup (ANOVA: p < 0.001 and p = 0.013), with significantly high correlation of laser energy and number of channels with CK-MB(max) concentration (Pearson coefficient of correlation 0.614 and 0.561, p < 0.0001) and non significant correlation with cTnT(max) concentration. No significant differences between the TMLR and the CABG group regardinghemodynamic indexes were observed. Significantly more patients in the TMLR group had ventricular events (VE) within 24 postoperative hours (27 vs 10, chi 2: p < 0.0001), reguiring antyarrhythmic drugs administration (13 vs 2, chi2: p < 0.0008). The number of channels created in a group of patients with VE was significantly higher (21.8+/- 7.66 vs 15.7 +/- 7.63; p = 0.0255). No significant difference in postoperative blood loss was observed. Significantly more patients from the TMLR group received blood (37/37 vs 36/43 in CABG group, chi2: p = 0.029), but no significant difference in number of blood units used was observed (3.22 +/- 1.8 U. in TMLR group vs 2.92 +/- 1.52 U. in CABG group: p = 0.445). Significantly more patients needed postoperatively inotropic support in the TMLR group (10 vs 2, chi2; p = 0.019). One patient from the TMLR group had low output syndrome (IAB support) and one from the CABG group had postoperative myocardial infarction. CONCLUSION: The laser energy released during TMLR injures th e myocardium (CK-MB, cTnT, VE) but does notaffect the heart function (hemodynamic status, postoperative course).