Cardiac surgery

2016 ◽  
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Trials ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Artery Bypass Grafts ◽  
Bypass Grafts ◽  
Cardiac Defects ◽  
Congenital Cardiac Defects ◽  
Artery Disease

Cardiac surgery is a specialty which has seen a range of major advancements and pioneering procedures within the last century. The second half of the twentieth century saw advancements in the correction of complex congenital cardiac defects, heart-lung transplantation, and surgery for ischaemic and valvular heart disease, and many of these procedures are now viewed as routine cardiac surgery. This chapter focuses on trials in coronary artery disease, coronary artery bypass grafts, valve replacement, and aortic stenosis, and the clinical trials which have influenced treatment decisions in these areas.

18F-sodium fluoride coronary uptake in patients with coronary artery bypass grafts

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Kwiecinski ◽  
E Tzolos ◽  
S Cadet ◽  
P.D Adamson ◽  
N Joshi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Artery Bypass Grafts ◽  
Bypass Grafts ◽  
Multivessel Coronary Artery Disease ◽  
Artery Disease ◽  
Cabg Patients

Abstract   18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) provides an assessment of active calcification (microcalcification) across a wide range of cardiovascular conditions including coronary artery disease, carotid and penile atherosclerosis, aortic and mitral valve disease, and abdominal aortic aneurysms. To date the significance of 18F-NaF uptake in patients with coronary artery bypass grafts (CABG) is unknown. We aimed to characterize 18F-NaF activity in CABG patients. We performed 18F-NaF PET (30-min long single bed position acquisition 1h after a 250mB injection of 18F-NaF) and coronary CT angiography in patients with multivessel coronary artery disease and followed them for fatal or non-fatal myocardial infarction over 42 [31,49] months. On motion-corrected datasets we quantified the whole-vessel coronary 18F-NaF PET uptake (the coronary microcalcification activity (CMA)) by measuring the activity of voxels above the background (right atrium activity) + 2 * standard deviations threshold. All study subjects underwent a comprehensive baseline clinical assessment including evaluation of their cardiovascular risk factor profile with the SMART [Secondary Manifestations of Arterial Disease] risk score calculated, and the coronary calcium burden assessed with calcium scoring (CCS). Among 293 study participants (65±9 years; 84% male), 48 (16%) had a history of CABG. Although the majority 124/128 (97%) of coronary bypass grafts showed no uptake, 4 saphenous vein grafts presented with a CMA>0 (range: 2.5–11.5, Figure). While a similar proportion of patients with and without prior CABG showed increased coronary 18F-NaF uptake (CMA>0) (58.3% versus 71.4%, p=0.11) overall prior-CABG subjects had higher CMA (2.0 [0.3, 6.6] versus 0.6 [0, 2.7], p=0.001) and CCS (1135 [631, 2120] versus 225 [59, 542], p<0.001), respectively. In line with the differences in the calcification activity and the coronary calcium burden, the SMART risk scores were higher in CABG patients (23 [17, 28] versus 17 [12, 24], p=0.01), and these patients were also older (68±8 versus 64±8, p=0.01). Despite the aforementioned differences the incidence of myocardial infarction 5/48 (9%) versus 15/245 (6%) and MACE 6/48 (12%) versus 34/245 (14%) during follow-up between subjects with and without prior CABG was similar (p=0.44 and p=0.80, respectively). CABG patients have a higher coronary microcalcification activity on 18F-NaF PET than multivessel coronary artery disease patients without prior CABG. Despite evidence of higher 18F-NaF uptake there is no difference in outcome between these two groups. Figure 1. 18F-NaF uptake in CABG patients. (A) 63-year old male with prominent uptake in stented saphenous vein bypass grafts and native coronary arteries who experienced a non-fatal non ST elevation myocardial infarction during follow-up. (B) 70-year old male with evident uptake in native coronary arteries and only little 18F-NaF activity within coronary bypasses. Funding Acknowledgement Type of funding source: Other. Main funding source(s): National Heart, Lung, and Blood Institute/National Institute of Health (NHLBI/NIH), British Heart Foundation

scholarly journals Coronary artery bypass grafting in patients with coronary artery disease and COVID-19: search for an optimal strategy

2021 ◽  
Vol 26 ◽  
pp. 4342
Author(s):  
D. V. Kuznetsov ◽  
A. A. Gevorgyan ◽  
V. V. Novokshenov ◽  
A. V. Kryukov ◽  
M. V. Polyaeva ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Artery Disease

Extent of cardiac surgery aid has dropped significantly globally due to reallocation of health care resources due to COVID-19 pandemic.Aim. To evaluate the results of chosen management strategy for patients with coronary artery disease (CAD) and COVID-19 manifested in the early postoperative period after coronary artery bypass grafting.Material and methods. We present our experience of treating 19 patients with CAD and COVID-19 manifested in the early postoperative period after coronary artery bypass grafting. The main symptoms of COVID-19 in these patients were high-grade fever, severe general weakness, shortness of breath, and decreased blood oxygen saturation. Laboratory data showed significant increases in fibrinogen, C-reactive protein, ferritin, procalcitonin, and D-dimer levels. In all patients, according to the chest computed tomography, a picture of unilateral or bilateral multisegmental pneumonia in the form of ground-glass opacity areas was determined. The damaged lung area varied from 10% to 55%.Results. Patients were treated in accordance with the Russian guidelines, followed by transfer to continue therapy in specialized infectious diseases hospitals. Sixteen patients transferred to infectious diseases hospitals were subsequently discharged from in a satisfactory condition. Three patients died from various complications of COVID-19 (mortality rate, 16%).Conclusion. The development of new screening strategies, standard guidelines and protocols for the management of cardiac surgery patients in a pandemic will contribute to an earlier detection of COVID-19 and, accordingly, a timely change in treatment strategy.

Managing women with coronary artery disease

2002 ◽  
Vol 8 (3) ◽  
pp. 102-107
Author(s):  
Graham Jackson
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Clinical Trial Data ◽  
Coronary Artery Bypass Grafts ◽  
Age Bias ◽  
Atypical Chest Pain ◽  
Coronary Care ◽  
Artery Disease ◽  
Complications And Mortality

Coronary artery disease is the greatest cause of death and disability in women. Women often have atypical chest pain which should be thoroughly evaluated. Women benefit as much as men from coronary care, thrombolysis, coronary artery bypass grafts and coronary angioplasty but are more likely to have advanced disease, and be hypertensive, diabetic and older at presentation- and thereby have increased complications and mortality. All clinical trial data published so far does not identify HRT therapy as a means of preventing or treating CAD. Since women are older at presentation they are vulnerable to age bias, which may therefore appear to be gender bias.

scholarly journals Assessing the effectiveness of retrograde autologous priming of the cardiopulmonary bypass machine in isolated coronary artery bypass grafts

2013 ◽  
Vol 95 (3) ◽  
pp. 207-210 ◽  
Author(s):  
C Kearsey ◽  
J Thekkudan ◽  
S Robbins ◽  
A Ng ◽  
S Lakshmanan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Artery Bypass Grafts ◽  
Bypass Grafts ◽  
The Mean

Introduction Currently, around 35–80% of patients undergoing cardiac surgery in the UK receive a blood transfusion. Retrograde autologous priming (RAP) of the cardiopulmonary bypass circuit has been suggested as a possible strategy to reduce blood transfusion during cardiac surgery. Methods Data from 101 consecutive patients undergoing isolated coronary artery bypass grafts (where RAP was used) were collected prospectively and compared with 92 historic patients prior to RAP use in our centre. Results Baseline characteristics (ie age, preoperative haemoglobin [Hb] etc) were not significantly different between the RAP and non-RAP groups. The mean pump priming volume of 1,013ml in the RAP group was significantly lower (p<0.001) than that of 2,450ml in the non-RAP group. The mean Hb level at initiation of bypass of 9.1g/dl in patients having RAP was significantly higher (p<0.001) than that of 7.7g/dl in those who did not have RAP. There was no significant difference between the RAP and non-RAP groups in transfusion of red cells, platelets and fresh frozen plasma, 30-day mortality, re-exploration rate and predischarge Hb level. The median durations of cardiac intensive care unit stay and in-hospital stay of 1 day (interquartile range [IQR]: 1–2 days) and 5 days (IQR: 4–6 days) in the RAP group were significantly shorter than those of the non-RAP group (2 days [IQR: 1–3 days] and 6 days [IQR: 5–9 days]). Conclusions In the population group studied, RAP did not influence blood transfusion rates but was associated with a reduction in duration of hospital stay.

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