Pilot study of postoperative HELP-apheresis to prevent early graft occlusion after coronary artery bypass grafting

2007 ◽  
Vol 55 (S 1) ◽  
Author(s):  
M Oberhoffer ◽  
F Blessing ◽  
I Kaczmarek ◽  
C Vicol ◽  
G Steinbeck ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Pilot Study ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Graft Occlusion ◽  
Artery Bypass Grafting ◽  
Early Graft

An Uncommon Cause of Myocardial Ischemia after Coronary Artery Bypass Grafting: "The Dangerous Drainage"

2011 ◽  
Vol 14 (3) ◽  
pp. 200
Author(s):  
Andres Beiras-Fernandez ◽  
Patrick Möhnle ◽  
Carsten Kopf ◽  
Calin Vicol ◽  
Felix Kur ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Myocardial Ischemia ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Graft Occlusion ◽  
Artery Bypass Grafting ◽  
Mediastinal Drainage ◽  
Early Graft

The most common causes of myocardial ischemia and myocardial infarction early after coronary artery bypass grafting surgery are early graft occlusion/thrombosis or occlusion/ thrombosis of coronary arteries due to advanced coronary heart disease. We describe a case of postoperative myocardial ischemia due to an uncommon and quickly reversible cause: mechanical compression of a vein graft by a 19F flexible silicone mediastinal drainage tube.

Haemostatic Factors and Inhibitors and Coronary Artery Bypass Grafting: Preoperative Alterations and Relations to Graft Occlusion

1994 ◽  
Vol 72 (03) ◽  
pp. 335-342 ◽  
Author(s):  
Elisabeth Moor ◽  
Anders Hamsten ◽  
Margareta Blombäck ◽  
Istvan Herzfeld ◽  
Björn Wiman ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Factor Vii ◽  
Bypass Grafting ◽  
Graft Occlusion ◽  
Artery Bypass Grafting ◽  
The Third ◽  
Haemostatic Factors

SummaryGraft closure remains a major problem after coronary artery bypass surgery. While a number of graft characteristics influencing the risk of occlusion have been defined, the role of haemostatic factors and inhibitors has not been studied in detail. The present study examined the time course of changes in blood coagulation and fibrinolytic function after coronary artery bypass grafting in 20 consecutive patients. Pre- and postoperative determinations of haemostatic factors and inhibitors were also related to the presence of graft occlusion assessed by angiography at three months after surgery. A broad panel of haemostatic tests was used preoperatively, on the first, third and eight postoperative days, and at three months after surgery. A particular emphasis was placed on fibrinogen, factor VII activity, von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1) activity, anticoagulant proteins C and S, thrombin-antithrombin complex and D-dimer. A marked activation of the coagulation cascade was noted postoperatively along with enhanced degradation of cross-linked fibrin. The degree of activation of blood coagulation and fibrinolysis differed widely between individuals and appeared to relate only partly to the acute phase reaction produced by the surgical trauma. Preoperative values of haemostatic factors and inhibitors showed fairly weak associations with the levels of postoperative determinations. Basal tPA and factor VIII levels, fibrinogen and TAT concentrations on the third and eighth postoperative day, and factor VII amidolytic activity on the third postoperative day differed (p <0.05) between patients with and without occluded grafts at reangiography. Accordingly, combined pre- and postoperative assessment of haemostatic function may contribute to the identification of individuals at risk for early graft closure after coronary artery bypass grafting.

scholarly journals Pleiotropic Effects of Acetylsalicylic Acid after Coronary Artery Bypass Grafting—Beyond Platelet Inhibition

2021 ◽  
Vol 10 (11) ◽  
pp. 2317
Author(s):  
Dominika Siwik ◽  
Magdalena Gajewska ◽  
Katarzyna Karoń ◽  
Kinga Pluta ◽  
Mateusz Wondołkowski ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Acetylsalicylic Acid ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Platelet Inhibition ◽  
Pleiotropic Effects ◽  
Bypass Grafting ◽  
Graft Occlusion ◽  
Artery Bypass Grafting

Acetylsalicylic acid (ASA) is one of the most frequently used medications worldwide. Yet, the main indications for ASA are the atherosclerosis-based cardiovascular diseases, including coronary artery disease (CAD). Despite the increasing number of percutaneous procedures to treat CAD, coronary artery bypass grafting (CABG) remains the treatment of choice in patients with multivessel CAD and intermediate or high anatomical lesion complexity. Taking into account that CABG is a potent activator of inflammation, ASA is an important part in the postoperative therapy, not only due to ASA antiplatelet action, but also as an anti-inflammatory agent. Additional benefits of ASA after CABG include anticancerogenic, hypotensive, antiproliferative, anti-osteoporotic, and neuroprotective effects, which are especially important in patients after CABG, prone to hypertension, graft occlusion, atherosclerosis progression, and cognitive impairment. Here, we discuss the pleiotropic effects of ASA after CABG and provide insights into the mechanisms underlying the benefits of treatment with ASA, beyond platelet inhibition. Since some of ASA pleiotropic effects seem to increase the risk of bleeding, it could be considered a starting point to investigate whether the increase of the intensity of the treatment with ASA after CABG is beneficial for the CABG group of patients.

EFFECT OF ANTIPLATELET THERAPY ON EARLY GRAFT PATENCY AFTER CORONARY ARTERY BYPASS GRAFTING: VA COOPERATIVE STUDY # 207

1987 ◽  
Author(s):  
S Goldman ◽  
J Copeland ◽  
T Moritz ◽  
W Henderson ◽  
L A Harker
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Antiplatelet Therapy ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Graft Patency ◽  
Reoperation Rate ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Early Graft

To determine if specific antiplatelet therapy improved graft patency after coronary artery bypass grafting (CABG) -we compared (1) aspirin(325 mg qd), (2)aspirin(325 mg tid),(3) aspirin and dipyridamole(325 mg and 75 mg resp.tid), (4) sulfinpyrazone(267 mg tid) and (5) placebo(tid).Therapy was started 48 hours before CABGexcept for aspirin. When aspirin was a treatment,one 325 mg dose was given12 hours before surgery. Graft patency data were obtained early, one week, and then later, one year, after surgery. Preliminarydata, based on local interpretation of the angiograms at each center, in the firs 496 patients (1711 grafts), revealed thefollowing early graft patencies: aspiri qd (93%), aspirin tid (93%), aspirin and dipyridamole (93%),and sulfinpyrazone (92%). All these therapies improved(P<0.005)early graft patency compared to placebo (84%). Chest tube drainage measured within the first 35 hours after CABG revealed that the median loss with aspirintid (1114 ml) and aspirin and dipyridamole (972 ml) exceeded (P<0.001) placebo (802 ml) while aspirinqd (880 ml) and sulfinpyrazone (750 ml) did not. The reoperation rate was greater(P<0.01) in all the treatment groups thatcontained aspirin (6.1%) compared to the two non aspirin groups (1.9%). Overall operative mortality was 2.1%. In conclusion, graft patency was improved early after CABG with antiplatelet therapy. Two regimens which included preoperative aspirin has increased blood loss after CABG and preoperative aspirin increased the reoperation rate.

scholarly journals No-Touch Versus Conventional Vein Harvesting Techniques at 12 Months After Coronary Artery Bypass Grafting Surgery: Multicenter Randomized, Controlled Trial

Circulation ◽  
2021 ◽  
Vol 144 (14) ◽  
pp. 1120-1129 ◽  
Author(s):  
Meice Tian ◽  
Xianqiang Wang ◽  
Hansong Sun ◽  
Wei Feng ◽  
Yunhu Song ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Vein Graft ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Graft Occlusion ◽  
Artery Bypass Grafting ◽  
Vein Harvesting

Background: Vein graft occlusion is deemed a major challenge in coronary artery bypass grafting. Previous studies implied that the no-touch technique for vein graft harvesting could reduce occlusion rate compared with the conventional approach; however, evidence on the clinical benefit and generalizability of the no-touch technique is scare. Methods: From April 2017 to June 2019, we randomly assigned 2655 patients undergoing coronary artery bypass grafting at 7 hospitals in a 1:1 ratio to receive no-touch technique or conventional approach for vein harvesting. The primary outcome was vein graft occlusion on computed tomography angiography at 3 months and the secondary outcomes included 12-month vein graft occlusion, recurrence of angina, and major adverse cardiac and cerebrovascular events. The generalized estimate equation model was used to account for the cluster effect of grafts from the same patient. Results: During the follow-up, 2533 (96.0%) participants received computed tomography angiography at 3 months after coronary artery bypass grafting and 2434 (92.2%) received it at 12 months. The no-touch group had significantly lower rates of vein graft occlusion than the conventional group both at 3 months (2.8% versus 4.8%; odds ratio, 0.57 [95% CI, 0.41–0.80]; P <0.001) and 12 months (3.7% versus 6.5%; odds ratio, 0.56 [95% CI, 0.41–0.76]; P <0.001). Recurrence of angina was also less common in the no-touch group at 12 months (2.3% versus 4.1%; odds ratio, 0.55 [95% CI, 0.35–0.85]; P <0.01). Rates of major adverse cardiac and cerebrovascular events were of no significant difference between the 2 groups. The no-touch technique was associated with higher rates of leg wound surgical interventions at 3-month follow-up (10.3% versus 4.3%; odds ratio, 2.55 [95% CI, 1.85–3.52]; P <0.001). Conclusions: Compared with the conventional vein harvesting approach in coronary artery bypass grafting, the no-touch technique significantly reduced the risk of vein graft occlusion and improved patient prognosis. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03126409.

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