RESUMEN
BACKGROUND: Female gender has been reported to be an independent risk factor for coronary artery bypass grafting (CABG) in European System for Cardiac Risk Evaluation. The effect of the body size on the CABG outcome is less clear. There is ongoing debate about obesity as a risk factor for adverse outcomes after cardiovascular procedures. The goal of this retrospective study is to evaluate the in hospital and early postoperative outcomes in severe obese, obese and normal-slightly obese female patients after CABG. METHODS: In a four year period a total of 427 female patients underwent isolated CABG under cardiopulmonary bypass. The patients were allocated into three groups according to the Body Mass Index (BMI) as follows; group 1: severe obese patients; BMI > 35, group 2: obese patients; 30≤BMI≤35, group 3: normal-slightly obese patients; BMI < 30. RESULTS: The patients in group 3 were older than the group1 and group 2 (65,6 ± 8,3 year vs 63,01 ± 8,0 and 63,57 ± 8,4 year p < 0,05). In group 1 diabetic patients were more than in group 2 and group 3 respectively (54,4% vs 43,4% and 40%, p < 0,05). Urgent operation was more in group 1 than in group 2 and 3 respectively (37,6% vs 17,2% and 21,2% p < 0,05). The patients in group 3 had significantly greater postoperative drainage at 24 h compared with values in group 1 and group 2 (647 ± 142 ml vs. 539 ± 169 ml and 582 ± 133 ml, p < 0,05). Mortality rate in group 1 was 0,8%, 0% in group 2 and 1,2% in group 3 respectively. Wound problem has occurred in 41 patients (9,6%).The percentage of postoperative wound problems was higher in group 1 but did not show statiscially difference. Following discharge a total of 43 (10,1%) patients re-hospitalized within 30 days. Re-hospitalization rate was 16,1% in group1, 9,8% in group 2 and 6,5% in group 3 (p < 0,05). CONCLUSION: This study may give an aspect for evaluations of the inhospital-early mortality and morbidity after CABG in female patients in different BMI. Severe obesity is not a risk factor in-hospital mortality in female patients. However, severe obese female patients appear to have more wound problems and re-hospitalization rate after CABG compared to obese and normal-slightly obese patients.
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Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/cirugía , Obesidad Mórbida/complicaciones , Anciano , Índice de Masa Corporal , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Persona de Mediana Edad , Obesidad Mórbida/mortalidad , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Resultado del TratamientoRESUMEN
Right Coronary Artery (RCA) originating from left anterior descending artery is a very rare congenital coronary artery anomaly. A 66-year-old man presented with hypertension and complaints of exertional chest pain. The angiography was performed. Aortic root angiography showed no coronary ostium originating from the right sinus of valsalva. Right coronary artery was visualized as anomalously originating from the midportion of left anterior descending artery. Severe stenosis were seen in ostium of anomalous right coronary artery, in midportion of left anterior descending and in midportion of circumflex artery. The patient was referred for coronary artery bypass grafting. The patient underwent coronary artery bypass surgery for three vessels. He was discharged home on postoperative day 7 without any complication. His echocardiogram on follow-up visit revealed good biventricular function.
Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anciano , Angiografía Coronaria , Puente de Arteria Coronaria , Anomalías de los Vasos Coronarios/cirugía , Humanos , MasculinoRESUMEN
BACKGROUND: Skeletonization of the internal thoracic artery (ITA) has advantages, but the variation of ITA preparation may be traumatic for the arterial wall. We sought to compare intraoperative results and endothelial nitric oxide synthase (e-NOS) expression on the vessel wall after left ITA harvesting with skeletonization and the conventional technique. METHODS: A prospective evaluation of 84 consecutive patients undergoing coronary artery bypass grafting was performed: 40 patients with skeletonized and 44 patients with pedicled left ITA. The lengths of ITA and free ITA blood flow were measured. Distal ITA segments were analyzed histopathologically and stained by antibodies against e-NOS. RESULTS: In the skeletonized group, the length of the ITA were significantly longer than in the pedicled group (15.7 +/- 0.4 cm versus 19.0 +/- 0.6 cm; P = .001). Also, the free-flow capacity of the ITA was significantly higher than in the pedicled group (62.4 +/- 4.8 mL/min versus 88.6 +/- 6.9 mL/min; P = .001). e-NOS expressions on endothelial cells were similar between the groups. Dense e-NOS immunostaining was observed in vaso vasorum of the adventitia in the pedicled group. However, there was not any e-NOS immunostaining in vaso vasorum of the adventitia in the skeletonized group. CONCLUSIONS: Although skeletonization of the ITA is a more technically demanding procedure, it provides some advantages such as increased available graft length and reduced sternal devascularization. This technique did not have any detrimental effects on the endothelial cell lining and e-NOS expressions on the endothelial layer. To reach a definitive judgment for using skeletonized ITA, we need information about the long-term angiographic patency rates.
Asunto(s)
Puente de Arteria Coronaria/métodos , Arterias Mamarias/patología , Arterias Mamarias/cirugía , Recolección de Tejidos y Órganos/métodos , Anciano , Anastomosis Quirúrgica/métodos , Distribución de Chi-Cuadrado , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/cirugía , Femenino , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Inmunohistoquímica , Masculino , Arterias Mamarias/trasplante , Persona de Mediana Edad , Monitoreo Intraoperatorio , Probabilidad , Pronóstico , Radiografía , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento , Grado de Desobstrucción Vascular/fisiologíaRESUMEN
PURPOSE: The aim of this study is to compare the long-term graft patency between patients who had sequential or individual right posterior descending artery (RPDA) anastomosis. MATERIALS AND METHODS: Two hundred and forty-two patients underwent coronary artery bypass grafting (CABG) between June 1994 and December 2003. They were examined retrospectively with respect to coronary angiograghic data. [Group 1] Individually right system grafts in RPDA position (n=139). [Group 2] RPDA anastomosis sequentially with left system (n=103). Patency rates for posterior descending arteries in each group were separately calculated for each vessel quality category. RESULTS: The mean interval from operation to angiography was 50.6+/-48.9 months in group 1 vs 57.5+/-39.2 months in group 2 respectively. The overall patency rate was 66.2% (92/139) in group 1 and 78.6% (81/103) in group 2 (p=0.04). When the RPDA has good run-off capacity, the patency rate was 69.1% in group 1 and 85.2% in group 2. CONCLUSION: When the RPDA has good run-off capacity, snake grafts show excellent results and right and left coronary systems could be anastomosed sequentially.
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Angiografía Coronaria , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Anciano , Anastomosis Quirúrgica , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/etiología , Reestenosis Coronaria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
The Edwards MIRA bileaflet mechanical prosthesis, a heart valve not yet available in the United States, is designed with a unique hinge mechanism, curved leaflets, and thin titanium housing. We performed this study to investigate its clinical performance and postoperative hemodynamic results. We implanted 58 Edwards MIRA prostheses in 51 patients in the aortic (n = 18), mitral (n = 26), and aortic and mitral (n = 7) positions. Patients' ages ranged from 25 to 84 years (mean age, 53.7 +/- 13.6). Operative mortality was 2% (n = 1), and late mortality was 4% (n = 2). Thromboembolic events were observed in 2 patients (valve thrombosis in 1 and a cerebrovascular event in 1). There were no complications related to anticoagulation. No signs of valvular dysfunction or paravalvular leakage were observed. Peak transvalvular gradients of the aortic prostheses ranged from 24.25 +/- 5.32 mmHg for the 21-mm valve to 11 +/- 1.41 mmHg for the 25-mm valve. The effective orifice area ranged from 1.99 +/- 0.12 cm2 for the 21-mm valve to 2.44 +/- 0.17 cm2 for the 25-mm valve. The mean transvalvular gradients of the mitral prostheses ranged from 5.85 +/- 2.91 mmHg for the 27-mm valve to 4.5 +/- 0 mmHg for the 31-mm valve. The effective orifice area ranged from 2.31 +/- 0.03 cm2 for the 27-mm valve to 2.64 +/- 0.05 cm2 for the 33-mm valve. These preliminary data suggest good hemodynamic function and a low rate of valve-related complications in the use of the Edwards MIRA mechanical prosthesis.
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Válvula Aórtica , Prótesis Valvulares Cardíacas , Válvula Mitral , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Enfermedades de las Válvulas Cardíacas/etiología , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis , Reoperación , Resultado del TratamientoRESUMEN
We designed this study to compare long-term results of St. Jude Medical and CarboMedics mechanical heart valves in the aortic position. We retrospectively analyzed the results of 174 consecutive patients who received either a St. Jude (n=80) or a CarboMedics (n=94) mechanical aortic valve from March 1992 through October 2004. The follow-up rate was 97.7%. The mean follow-up duration for the St. Jude group was 79.3 +/- 35.0 and for the CarboMedics group, 70.0 +/- 34.3 months. The cumulative follow-up was 523.8 and 530.1 patient-years, respectively The 30-day mortality rates for the St. Jude and CarboMedics patients were 1.3% and 3.2%, respectively. The actuarial survival rate for the St. Jude group at 138.0 +/- 4.7 months was 75.9% +/- 0.1% and for the CarboMedics group at 130.8 +/- 4.8 months was 69.8% +/- 0.1% (P=NS). There was no structural valve deterioration in either group. Freedom from thromboembolic events was 87.7% for the St. Jude group and 83.0% for the CarboMedics group (P=NS). Freedom from bleeding events for the St. Jude group was 93.6% and for the CarboMedics group, 89.7% (P=NS). The results obtained from this study indicate that standard St. Jude Medical and CarboMedics aortic valve prostheses offer similar excellent clinical performance. Definitive judgment must await trials that are extensive, randomized, and prospective.
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Válvula Aórtica , Prótesis Valvulares Cardíacas , Adulto , Anticoagulantes/uso terapéutico , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Tromboembolia/epidemiología , Resultado del Tratamiento , Warfarina/uso terapéuticoRESUMEN
OBJECTIVE: The intraaortic balloon pump (IABP) is usually the first choice of mechanical device used for perioperative cardiac failure. The aim of this retrospective study was to determine the effectiveness of intraoperative IABP use in patients who could not be weaned from cardiopulmonary bypass (CPB) and to determine the possible perioperative and early postoperative prognostic factors for mortality. METHODS: Between June 1992-December 2001 a total of 69 patients who underwent coronary artery bypass grafting and required IABP support in weaning from CPB due to cardiac pump failure were included into the study. The mean age was 61.9+/-7.5 years. The effectiveness of IABP and preoperative, operative and postoperative risk factors for mortality were evaluated retrospectively. RESULTS: Following the insertion of IABP, 59 (85.5%) patients could be weaned from CPB whereas 10 patients (14.5%) could not. In the early postoperative period, 13 (22%) patients died due to cardiac pump failure. The average in-hospital mortality rate for patients who were treated with an IABP was found as 33.3% (23 patients). Univariate analysis identified left ventricular enddiastolic pressure, ventricular performance score, urgent operation and perioperative myocardial infarction as the risk factors for early death. The minor and major IABP related complications occurred in only 8 patients. CONCLUSION: Due to the contributory effects, effectiveness and low complication rate, IABP may be used in patients who cannot be weaned from CPB.
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Gasto Cardíaco Bajo/mortalidad , Gasto Cardíaco Bajo/cirugía , Puente de Arteria Coronaria , Contrapulsador Intraaórtico , Desconexión del Ventilador , Anciano , Puente de Arteria Coronaria/mortalidad , Femenino , Humanos , Contrapulsador Intraaórtico/mortalidad , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Turquía , Desconexión del Ventilador/mortalidadRESUMEN
OBJECTIVE: In trying to answer the question about the controversial use of sequential grafts, we determined the mid-term angiographic outcome of patients in whom coronary artery bypass was performed with different types of vein grafts. METHODS: A total of 1034 coronary anastomoses on 724 saphenous vein grafts (SVGs) (apart from 497 left internal mammarian artery (LIMA) anastomoses) were assessed in 509 patients in an average of 55.4 +/- 17.6 months after coronary artery bypass grafting. RESULTS: The patency rates of sequential conduits were markedly higher than those of individual ones (86.6% vs 69.6%, p = 0.0001). Also, the anastomoses on the sequential conduits had better patency rates (80.6% vs 69.6%, p = 0.0001). This difference was even more pronounced in coronary arteries of poor quality/small (< 1.5 mm) diameter (68.9% vs 51.6%) for the sequential and individual grafts, respectively (p = 0.03). Also, the patency of the entire sequential conduit was lower when most distally located anastomosis was of poor runoff (45.2%). CONCLUSIONS: The patency of a sequential vein conduit is generally superior than that of an individual one, especially for poor runoff coronary vessels, provided that the most distally located anastomosis is performed on a good coronary artery in terms of quality and diameter. Using a minimal length of SVG is another advantage. However, failure of a single sequential conduit jeopardizes all of the anastomoses along that graft segment. Besides, being technically more demanding, technical expertise in performing a sequential anastomosis is probably among the important predictors of patency.
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Angiografía Coronaria , Puente de Arteria Coronaria/métodos , Adulto , Anciano , Anastomosis Quirúrgica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vena Safena/trasplante , Grado de Desobstrucción VascularRESUMEN
OBJECTIVE: The aim of this prospective study was to demonstrate the effectiveness of posterior pericardiotomy in reducing the incidence pericardial effusions and consequently reducing the related supraventricular tachyarrhythmias and development of delayed posterior cardiac effusions. METHODS: This prospective randomized study was carried out in 150 patients undergoing coronary artery bypass grafting in Bayindir Hospital Department of Cardiovascular Surgery between April 2000 and October 2001. One hundred and fifty patients were divided into two groups; each group included 75 patients. A 4-cm longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in posterior pericardiotomy group (group I). Posterior pericardiotomy was not performed in conventional treatment group (group II). RESULTS: Atrial fibrillation was developed in seven patients (9.3%) in group I and in 24 patients (32%) in group II (P<0.001). Atrial flutter and other supraventricular tachyarrhythmia (SVT) prevalence was not statistically significant. Early pericardial effusion was developed 42.6% (32/75) and 10.6% (8/75), respectively, in group II and group I (P<0.0001), but no late pericardial effusion developed in group I despite seven (9.3%) late pericardial effusions developing in group II (P<0.013). CONCLUSION: Posterior pericardiotomy is a simple, safe and effective technique for reducing not only the prevalence of early pericardial effusion and related atrial fibrillation but also delayed posterior pericardial effusion and tamponade.
Asunto(s)
Fibrilación Atrial/prevención & control , Puente de Arteria Coronaria , Derrame Pericárdico/prevención & control , Pericardiectomía/métodos , Complicaciones Posoperatorias/prevención & control , Taquicardia Supraventricular/prevención & control , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Derrame Pericárdico/epidemiología , Derrame Pericárdico/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Taquicardia Supraventricular/epidemiología , Taquicardia Supraventricular/etiología , Resultado del TratamientoRESUMEN
BACKGROUND: Early and late surgical outcomes of endocardial resection and aneursymectomy repaired with an autologous pericardial patch were studied. METHODS: We studied 125 patients who underwent endoaneurysmorrhaphy with pericardial patch during the period from June 1993 until June 2000. Preoperative, early and late postoperative results, annual postoperative echocardiography of all patients and hemodynamic controls of 35 patients within a mean follow-up of 64+/-8 months were analyzed. RESULTS: Mean NYHA improved to postoperative 2.1+/-0.5 from preoperative 2.8+/-0.4. Mean number of bypass grafts was 2.6+/-1.1. Left ventricular ejection fraction rate improved to 36.2+/-8% in one month, 39.3+/-9% in 6 months, 42.3+/-8% in one year versus preoperative 29.2+/-9% (P< or =0.05).Perioperative mortality was 6.4% (eight patients) and 11 deaths were observed in the late follow-up (9.4%). CONCLUSION: Endoaneurysmorrhaphy with pericardial patch may be an alternative option in the management of left ventricular aneurysms within acceptable surgical results.
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Procedimientos Quirúrgicos Cardíacos/métodos , Aneurisma Cardíaco/cirugía , Pericardio/trasplante , Anciano , Femenino , Estudios de Seguimiento , Aneurisma Cardíaco/complicaciones , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVES: Microalbuminuria is a predictor of microvascular disease and a marker for multiorgan damage in diabetic patients. It has been proposed that in diabetic patients who would undergo coronary artery bypass surgery (CABG), microalbuminuria is associated with poor postoperative outcome, higher incidence of early and late morbidity and mortality. METHODS: Microalbuminuria was prospectively studied preoperatively in 24-h urinary collections for 257 consecutive diabetic patients in a 2-year period. One hundred and sixty-eight patients (65.4%) were defined as microalbuminuria negative (Group A), and 89 (34.6%) were microalbuminuria positive (Group B) with respect to the cut-off point 30 mg/24 h. RESULTS: The two groups did not differ with respect to preoperative and operative data, except that preoperative blood glucose levels (P=0.046), blood urea nitrogen (P=0.001), and creatinine (P=0.001) were higher and creatinine clearance was lower (P=0.025) in Group B. Postoperative serum creatinine levels on different days were higher in microalbuminuria positive patients (P=0.04). Also, positive inotropic agent usages at the time of leaving the operating room (21.3 vs. 10.1%; P=0.013) and on the 1st day in the intensive care unit (ICU; 29.2 vs. 14.9%; P=0.014), ICU stay day (2.3+/-2 vs. 2.4+/-1.6; P=0.02) and also atrial fibrillation rate (30.3 vs. 17.9%) were higher in Group B (P=0.019). Total hospital stay (7.5+/-2.9 vs. 7.2+/-1.3) was similar. The 30-day mortality was 5.6 times higher (3.4 vs. 0.6%) but statistically not significant (P=0.088) in Group B. The mean follow-up was 30.6+/-16. 2 months in total (30.9+/-16.2 in Group A and 30.1+/-16.5 in Group B). There were 12 late deaths, nine were cardiac, and no differences were detected between groups. CONCLUSIONS: Our findings suggest that postoperative period may be more problematic in diabetic patients with microalbuminuria, but microalbuminuria does not seem to have a major effect on the postoperative course in patients undergoing CABG.
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Albuminuria/complicaciones , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Complicaciones de la Diabetes , Complicaciones Posoperatorias/epidemiología , Albuminuria/epidemiología , Estudios de Casos y Controles , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/orina , Diabetes Mellitus/orina , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVE: This prospective randomized study aims at evaluation and comparison of the prophylactic effects of amiodarone versus digoxin and metoprolol combination in postcoronary bypass atrial fibrillation. METHODS: A total of 241 consecutive patients undergoing elective coronary artery bypass grafting were randomly allocated into three groups. Patients in Group1 (n=77) received metoprolol 100 mg/24 h per oral (P.O.), preoperatively, 2x0.5 mg digoxin intravenously on the operating day and digoxin 0.25 mg P.O.+metoprolol 100 mg P.O. on the first postoperative day until discharge. Patients in Group 2 (n=72) received totally 1200 mg intravenous/24 h amiodarone which the 300 mg - bolus dose/1 h was given as soon as the operation had been finished. On the next day patients were administered 450 mg/24 h amiodarone i.v. and 600 mg/day in three doses P.O. were given until discharge. Group 3 (n=92) was the control group with no antiarrhythmic prophylaxis. RESULTS: Preoperative patient characteristics and operative parameters were similar in three groups. Atrial fibrillation occurred in 13 patients (16.8%) in Group 1, six patients (8.3%) in Group 2 and 31 patients (33.6%) in Group 3. CONCLUSION: Both study groups were effective in the prevention of postcoronary bypass atrial fibrillation with respect to control (P<0.01 in Group 1 and P<0.001 in Group 2).
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Amiodarona/uso terapéutico , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/prevención & control , Puente de Arteria Coronaria , Digoxina/uso terapéutico , Metoprolol/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Antiarrítmicos/administración & dosificación , Digoxina/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Masculino , Metoprolol/administración & dosificación , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: As off-pump coronary artery bypass grafting (OPCAB) has gained wide attention, the quality of surgical revascularization, which showed favorable initial results, is being frequently questioned. This study was undertaken to assess the midterm outcome of beating-heart coronary anastomosis. METHODS: Seventy-four of 315 patients who underwent beating-heart coronary artery bypass grafting via median sternotomy between March 1994 and December 1995 were randomly selected for angiographic assessment. RESULTS: The mean period of control angiography was 50.1 +/- 22.6 months (range, 22 to 83 months). A total of 109 (1.52 +/- 0.55) anastomosis procedures were performed in 74 patients; 38 had single-vessel disease, and 36 had double-vessel disease or disease involving more than 2 vessels. There were no perioperative returns to cardiopulmonary bypass, no major complications, and no hospital deaths. The causes of the need for occlusion included 2 (2.5%) instances of left internal mammary artery-left anterior descending artery anastomosis; 2 (2.5%) of anastomotic site stenosis in left internal mammary artery-left anterior descending artery anastomosis; 7 (19.4%) of saphenous vein graft anastomosis; and 3 (8.3%) of anastomotic site stenosis of saphenous vein graft. Statistical analysis revealed hypercholesterolemia as an independent predictor for graft occlusion (P =.014). The patency rates were not affected by endarterectomy, length of the anastomosed segment, or coronary artery structure. Event-free survival was 73.61% and myocardial infarction-free survival was 91.67%. Reintervention and reoperation rates were 24.3% (18 instances) and 1.4% (1 instance), respectively. CONCLUSIONS: Our results were encouraging for OPCAB, supporting its safety and effectiveness, patency rates and clinical outcome comparable to those of cardiopulmonary bypass, and overall benefits such as reduced hospital costs and postoperative length of stay.