Identification of Periopathogens in Atheromatous Plaques Obtained from Carotid and Coronary Arteries

Increasing attention has been paid to the possible link between periodontal disease and atherosclerosis over the past decade. The aim of this study is to investigate the presence of five periopathogens: Porphyromonas gingivalis (P.g.), Aggregatibacter actinomycetemcomitans (A.a.), Tannerella forsythia (T.f.), Treponema denticola (T.d.), and Prevotella intermedia (P.i.) in atheromatous plaques obtained from the carotid and coronary arteries in patients who underwent coronary artery bypass graft surgery and carotid endarterectomy. Group I (carotid arteries) consisted of 30 patients (mean age: 54.5 ± 14.8 ), and group II (coronary arteries) consisted of 28 patients (mean age: 63 ± 12.1 ). Clinical periodontal examinations consisted of plaque index, gingival index, sulcus bleeding index, and periodontal probing depth and were performed on the day of vascular surgery. The presence of periopathogens in periodontal pockets and atherosclerotic vessels was detected using polymerase chain reaction. In both subgingival plaque and atherosclerotic plaque of carotid arteries, P.g., A.a., T.f., T.d., and P.i. were detected in 26.7%, 6.7%, 66.7%, 10.0%, and 20.0%, respectively, while for coronary arteries, P.g. was detected in 39.3%, A.a. in 25%, T.f. in 46.4%, T.d. in 7.1%, and P.i. in 35.7%. The presence of five periopathogens in carotid and coronary atherosclerotic vessels showed correlation in regard to the degree of periodontal inflammation. The present study suggests the relationship between periodontal pathogenic bacteria and atherogenesis. Further studies are necessary in relation to the prevention or treatment of periodontal disease that would result in reduced mortality and morbidity associated with atherosclerosis.

Download Full-text

Postoperative Complication in Overweight Patients Undergoing Coronary Artery Bypass Graft Surgery

QJM ◽

10.1093/qjmed/hcaa042.009 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M A Fedala ◽

H A Metwaly ◽

T S Hikal ◽

M A Abdelmotaleb

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Hospital Stay ◽

Wound Infection ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Mortality And Morbidity ◽

Group I

Abstract Background Considering the impact of obesity on mortality and morbidity after coronary artery bypass graft surgery (CABG), we had to investigate the association between central obesity and the body mass index (BMI) and the post-CABG mortality and morbidity. Methods 98 patients with multi-vessel CAD and candidate for CABG were included in the study, and divided into two groups Group I: 53 patients with BMI over 30.Group II: 45 patients with BMI under 30. The primary end point was wound infection and mediastinitis. Secondary end points included mortality, prolonged ICU and hospital stay, stroke,renal and hepatic impairment Results Total of 98 patients (36 female) with amean age 54 + 6.5.group 1(53 patients) with BMI more than 30 and group2 (45 patients) with BMI under 30.wound infection ,mediastinitis, intensive care unit (ICU ) and in-hospital stay were significantly increased in patients with BMI ≥ 30 with (p value = 0.025, 0.02, 0.04) respectively. Conclusion Obesity was associated with wound infection and mediastinitis more than non-obese patients This lead to long ICU and in-hospital stay. And not associated with other morbidity or mortality

Download Full-text

Dexmedetomidine as an Anaesthetic Adjunct in Patients Undergoing Elective Off-Pump Coronary Artery Bypass Graft Surgery

Anesthesia and Clinical Research ◽

10.31487/j.acr.2021.02.02 ◽

2021 ◽

pp. 1-7

Author(s):

Sanjula Virmani ◽

Vishnu Datt ◽

C S Joshi ◽

Harpreet Singh Minhas ◽

...

Keyword(s):

Coronary Arteries ◽

Artery Bypass ◽

Bypass Graft ◽

Distal Anastomosis ◽

Pancuronium Bromide ◽

Loading Dose ◽

Off Pump ◽

Group I ◽

Group Ii ◽

Pump Coronary Artery Bypass

Background: The aim of the present study was to study the hemodynamic profile of dexmedetomidine during induction and distal anastomosis of coronary arteries in patients undergoing OPCAB in comparison to the institutional practice of using midazolam. Methods: In Group I, (n=25) patients were anaesthetised using fentanyl, pancuronium bromide, Isoflurane and midazolam. Group II (n=25) patients received a loading dose of dexmedetomidine infusion (1µg/Kg) over 10 minutes followed by an infusion of dexmedetomidine at the rate of 0.6 µg/Kg/hour, along with fentanyl, Pancuronium bromide and isoflurane. Heart rate (HR) mean arterial pressure (MAP), pulmonary artery (PA) catheter derived data and BIS were recorded at baseline, at 1 and 3 minutes after induction, at 1, 3 and 5 minutes after intubation, and at 5 and 30 minutes after protamine administration. MAP and HR were recorded every 10 min during the operation, except during distal anastomosis of the coronary arteries when it was recorded every 5 minutes after application of the Octopus tissue stabilising system. Results: The intubation response by way of increase in HR was much less in group II and stabilized by 5 min after intubation. The accompanying hypotension at 1 minute after induction was more in group II, but it was clinically acceptable (81.68±21.74 mm Hg). During distal graft anastomoses HR was in the range of 68 beats/min to 85 beats/min in group II vs. 85 beats/min to 100 beats/min in Group I. The MAP was lower in this group during the distal anastomosis, but it was within clinically acceptable range (> 65 mm Hg). Conclusion: Dexmedetomidine is a viable option as an anaesthetic adjunct in a loading dose of 1µg/Kg followed by an infusion of 0.6 µg/Kg. Future studies will be necessary to show if this provides any outcome benefits.

Download Full-text

Presence of Tannerella forsythia in patients with chronic periodontal disease and atherosclerosis

Vojnosanitetski pregled ◽

10.2298/vsp180321121s ◽

2020 ◽

Vol 77 (6) ◽

pp. 614-619

Author(s):

Danijela Staletovic ◽

Ibrachim Kannosh ◽

Meliha Sehalic ◽

Vladanka Vukicevic ◽

Zoraida Milojkovic ◽

...

Keyword(s):

Periodontal Disease ◽

Blood Vessels ◽

Bacterial Species ◽

Strong Relationship ◽

Systemic Circulation ◽

Bacterial Biofilm ◽

Periodontal Pocket ◽

Mortality And Morbidity ◽

Periodontal Inflammation ◽

Atheromatous Plaques

Background/Aim. Periodontal disease is an inflammatory disease that occur in the tissues surrounding the teeth in response to bacterial biofilm accumulation (dental plaque). Among others, Tannerela forsythia (Tf) was recognized as one of the most significant and specific bacterial species in periodontal pocket (?red complex? bacteria). Atherosclerosis is a progressive narrowing of arteries that may lead to occlusion, as a consequence of lipid deposition. It underlies coronary heart disease (80%), as well as myocardial and cerebral infarctions. Increasing evidence over the past decade suggests a link between periodontal disease and atherosclerosis, where Tf can enter the systemic circulation directly or indirectly, and be present in atherosclerotic blood vessels. Therefore, the aim of this study was to detect the presence of Tf in atheromatous plaques obtained from different blood vessels in patients with chronic periodontitis. Methods. Ninety patients (male 61, female 29) with periodontal disease and atherosclerosis [recruited for either carotid artery stenosis requiring endartectomy or percutaneous transluminal coronary angioplasty (PTCA)] were included in this study. Clinical periodontal examinations consisted of plaque index (PI) (according to Silness L?u), gingival index (GI) (according to L?e Silnes), sulcus bleeding index (according to M?hleman-Son) and periodontal probing depth (PPD). Presence of Tf in periodontal pockets and atherosclerotic vessels was detected using polymerase chain reaction (PCR) method with positive control Tf ATCC 43037. Results. Tf was present in subgingival plaques of 68 (75.6%) of the patients, while its presence in atheromatous plaques were registered in 42 (53.3%) of the patients. It was significantly present in coronary blood vessels (41.7%), followed by carotid arteries (35.4%) and a. abdominalis aneurism (12.5%), a. mamaria (8.5%) and a. femoralis (2.1%) while in a. iliaca Tf was not detected at all. Conclusion. The present study suggests strong relationship between periodontal inflammation and atherogenesis; therefore, it should be considered as potential risk factor for atherosclerosis. Accordingly, it would be necessary to control periodontal disease in order to reduce mortality and morbidity associated with atherosclerosis.

Download Full-text

Quantification of Coronary Artery Stenosis with 16-Slice MSCT in Patients before CABG Surgery: Comparison to Standard Invasive Coronary Angiography

The Heart Surgery Forum ◽

10.1532/hsf98.20041144 ◽

2005 ◽

Vol 8 (1) ◽

pp. 42 ◽

Cited By ~ 12

Author(s):

C. Probst ◽

A. Kovacs ◽

C. Schmitz ◽

W. Schiller ◽

H. Schild ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Artery Bypass ◽

Invasive Coronary Angiography ◽

Bypass Graft ◽

Heart Association ◽

Artery Stenosis ◽

Vessel Disease ◽

Selective Coronary Angiography

Objective: Invasive, selective coronary angiography is the gold standard for evaluation of coronary artery disease (CAD) and degree of stenosis. The purpose of this study was to compare 3-dimensional (3D) reconstructed 16-slice multislice computed tomographic (MSCT) angiography and selective coronary angiography in patients before elective coronary artery bypass graft (CABG) procedure. Methods: Sixteen-slice MSCT scans (Philips Mx8000 IDT) were performed in 50 patients (42 male/8 female; mean age, 64.44 8.66 years) scheduled for elective CABG procedure. Scans were retrospectively electrocardiogram-gated 3D reconstructed. The images of the coronary arteries were evaluated for stenosis by 2 independent radiologists. The results were compared with the coronary angiography findings using the American Heart Association segmental classification for coronary arteries. Results: Four patients (8%) were excluded for technical reasons. Thirty-eight patients (82.6%) had 3-vessel disease, 4 (8.7 %) had 2-vessel disease, and 4 (8.7%) had an isolated left anterior descending artery stenosis. In the proximal segments all stenoses >50% (56/56) were detected by MSCT; medial segment sensitivity was 97% (73/75), specificity 90.3%; distal segment sensitivity was 90.7% (59/65), specificity 77%. Conclusion: Accurate quantification of coronary stenosis greater than 50% in the proximal and medial segments is possible with high sensitivity and specificity using the new generation of 16-slice MSCTs. There is still a tendency to overestimate stenosis in the distal segments. MSCT seems to be an excellent diagnostic tool for screening patients with possible CAD.

Download Full-text

CURRENT ASPECTS OF CORONARY HEART DISEASE DIAGNOSIS AND TREATMENT

International Medical Journal ◽

10.37436/2308-5274-2020-1-1 ◽

2020 ◽

pp. 5-10

Author(s):

O. M. Korzh

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Drug Therapy ◽

Coronary Arteries ◽

Artery Bypass ◽

Myocardial Revascularization ◽

Disease Diagnosis ◽

Percutaneous Coronary Angioplasty ◽

Mortality And Morbidity ◽

Intravascular Thrombosis

Among the cardiovascular diseases associated with atherosclerosis, chronic coronary heart disease, including angina, is the most common form. It is the myocardium lesion that develops as a result of an imbalance between the coronary circulation and metabolic needs of heart muscle. The presence of angina symptoms often indicates a pronounced narrowing of one or more coronary arteries, but also occurs in non−obstructive arterial impairment and even in normal coronary arteries. Factors of functional damage to the coronary arteries are spasm, temporary platelet aggregation and intravascular thrombosis. Today there are opportunities not only to use the therapy with proven effectiveness, aimed at reducing the risk of complications, including fatal, but also to treat angina (ischemia), which improves the patient's life quality. The drug protocol includes the ones with a proven positive effect on this disease prognosis, which are mandatory if there are no direct contraindications to use, as well as a large group of antianginal or anti−ischemic drugs. The choice of a particular drug or its combinations with other drugs is carried out in accordance with generally accepted recommendations: taking into account the individual approach, the severity of angina, hemodynamic parameters (heart rate and blood pressure, presence of comorbid conditions). If drug therapy is ineffective, the option of coronary myocardial revascularization (percutaneous coronary angioplasty or coronary artery bypass grafting) is considered. Due to the high mortality and morbidity rates of coronary heart disease worldwide, one of the priorities of practical health care is the prevention of diseases caused by atherosclerosis. Key words: coronary heart disease, angina, family physician, prognosis, drug therapy.

Download Full-text

Functional features of innate immunity in the development of postpericardiotomy syndrome in patients after coronary artery bypass grafting

Medical Herald of the South of Russia ◽

10.21886/2219-8075-2019-10-4-71-79 ◽

2019 ◽

Vol 10 (4) ◽

pp. 71-79

Author(s):

I. F. Shlyk ◽

L. P. Sizyakina ◽

R. V. Sidorov ◽

S. V. Shlyk

Keyword(s):

Innate Immunity ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Control Group ◽

Natural Killers ◽

Postpericardiotomy Syndrome ◽

Group I ◽

Functional Features

Objective: to study the functional characteristics of innate immunity in the formation of postpericardial syndrome (PPS) in patients undergoing coronary artery bypass graft ing (CABG).Materials and methods: the study involved 60 people, 40 of them made up the main group of patients with coronary artery disease, which retrospectively aft er 1 month of observation was divided into 2 groups. Group I CABG and PPS, group II CABG without PPS. The control group consisted of 20 patients without IHD. Before surgery, aft er 5, 14 days and 1 month, the expression of toll-like receptors (TLRs) 2, 4, 9, the content of CD16+ and Granzyme B lymphocytes, the HCT test and serum α-defensin were evaluated in blood cells. Statistical analysis of the results of the study was carried out using the program Statistica 12.0 (StatSoft , USA). The difference in mean values between groups was evaluated by the Mann-Whitney test. Statistical signifi cance was considered signifi cant at p ≤ 0.05.Results: when comparing the initial indices of the main groups and the control group, an increase in the expression of TLRs 2, 4, 9 was revealed. An increase in the content of CD16+, as well as an increase in the cytotoxic activity of natural killers and an increase in the production of α-defensin.Conclusions: on the basis of the study, activation of the cellular link of innate immunity, an increase in the cytotoxic potential of natural killers and a signifi cantly high level of α-defensin both before and aft er CABG were revealed, which can play an important role in the development of PPS.

Download Full-text

The impact of minimal invasive extracorporeal circulation on postoperative kidney function

Perfusion ◽

10.1177/0267659120954601 ◽

2020 ◽

pp. 026765912095460

Author(s):

Ara Shwan Media ◽

Peter Juhl-Olsen ◽

Nils Erik Magnusson ◽

Ivy Susanne Modrau

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Kidney Function ◽

Extracorporeal Circulation ◽

Artery Bypass ◽

Bypass Graft ◽

Kidney Injury ◽

Minimal Invasive ◽

Mortality And Morbidity ◽

The Impact

Introduction: Acute kidney injury following cardiac surgery is a frequent complication associated with increased mortality and morbidity. Minimal invasive extracorporeal circulation is suggested to preserve postoperative renal function. The aim of this study was to assess the impact of minimal invasive versus conventional extracorporeal circulation on early postoperative kidney function. Methods: Randomized controlled trail including 60 patients undergoing elective stand-alone coronary artery bypass graft surgery and allocated in a 1:1 ratio to either minimal invasive (n = 30) or conventional extracorporeal circulation (n = 30). Postoperative kidney injury was assessed by elevation of plasma neutrophil gelatinase-associated lipocalin (NGAL), a sensitive tubular injury biomarker. In addition, we assessed changes in estimated glomerular filtration rate (eGFR), and the incidence of acute kidney injury according to the Acute Kidney Injury Network (AKIN) classification. Results: We observed no differences between groups regarding increase of plasma NGAL (p = 0.31) or decline of eGFR (p = 0.82). In both groups, 6/30 patients developed acute kidney injury according to the AKIN classification, all regaining preoperative renal function within 30 days. Conclusion: Our findings challenge the superiority of minimal invasive compared to conventional extracorporeal circulation in terms of preservation of renal function following low-risk coronary surgery.

Download Full-text

Aborted Off-Pump Coronary Artery Bypass Patients Have Much Worse Outcomes Than On-Pump or Successful Off-Pump Patients

Circulation ◽

10.1161/circulationaha.104.526228 ◽

2005 ◽

Vol 112 (9_supplement) ◽

Author(s):

Ruyun Jin ◽

Loren F. Hiratzka ◽

Gary L. Grunkemeier ◽

Albert Krause ◽

U. Scott Page

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Operative Mortality ◽

Risk Model ◽

Artery Bypass ◽

Bypass Graft ◽

Left Ventricular ◽

Mortality And Morbidity ◽

Off Pump ◽

Pump Coronary Artery Bypass

Background— Off-pump coronary artery bypass graft (CABG) surgery is purported to reduce perioperative mortality and morbidity compared with on-pump coronary bypass graft surgery. However, the outcomes of patients for whom an off-pump strategy must be changed to an on-pump procedure during surgery have not been extensively studied. Methods and Results— The Merged Cardiac Registry (Health Data Research, Inc) contains 70 514 isolated CABG performed from January 1998 to March 2004 in 40 facilities. Among them, 62 634 patients begun and completed on-pump bypass (CPB); 7880 patients begun off-pump, of which 7424 (94.2%) completed off-pump coronary artery bypass (OPCAB), whereas 456 (5.8%) were converted to on-pump (CONVERT). CONVERT patients were more severely ill. The observed mortality of CONVERT, CPB, and OPCAB was 9.9%, 3.0%, and 1.6%, respectively, and the observed-to-predicted ratio was 2.77, 1.20, and 0.74, respectively. CONVERT also had more morbidity than either OPCAB or CPB. Finally, a risk model was created to identify patients who might be at risk for conversion from off-pump to on-pump CABG. Conclusions— Patients who are intended for an off-pump strategy and then require conversion to on-pump have significantly higher operative mortality and morbidity than either completed OPCAB or CPB patients. In addition, the operative mortality and morbidity are far in excess of that predicted preoperatively. Based on these results, strong consideration should be given for a planned strategy of CPB for those patients with preoperative hemodynamic instability requiring a salvage CABG operation, left ventricular hypertrophy, or previous CABG.

Download Full-text

Neurological and neuropsychological examination and outcome after use of an intra-aortic filter device during cardiac surgery

Perfusion ◽

10.1191/0267659103pf628oa ◽

2003 ◽

Vol 18 (1_suppl) ◽

pp. 55-60 ◽

Cited By ~ 20

Author(s):

S Eifert ◽

H Reichenspurner ◽

T Pfefferkorn ◽

B Baur ◽

C von Schlippenbach ◽

...

Keyword(s):

Cardiac Surgery ◽

Artery Bypass ◽

Bypass Graft ◽

Neurological Deficits ◽

Focal Neurological Deficit ◽

Group I ◽

Tenfold Increase ◽

Group Ii ◽

Magnet Resonance ◽

The Brain

Cerebral embolization of particles after cardiac surgery is frequently associated with neurological deficits. Aortic crossclamp manipulation seems to be the most significant cause of emboli release during cardiac surgery. The goal of this study was to demonstrate whether the use of an intra-aortic filter device has an effect on the magnet resonance imaging (MRI) and functional neurological outcome. Twenty-four patients undergoing cardiosurgical procedures using cardiopulmonary bypass (CPB) were selected: coronary artery bypass graft (CABG) surgery (n=17), aortic valve replacement (AVR) surgery (n= 4) or combined procedures (n=3). Patients were evaluated by diffusion weighted MRI of the brain, neurological examination and neuropsychological assessment regarding alertness as well as divided and selective attention before and five to seven days after surgery. The patients were divided into two groups. In group I, 12 patients received a filter through a modified 24 F arterial cannula immediately before the aortic crossclamp was released. Filters remained in the aorta until CPB was discontinued. Intraoperatively, bilateral middle cerebral artery transcranial Doppler (TCD) was monitored at baseline, at the beginning of CPB, at a timepoint when the aorta was crossclamped, when the filter was inserted and while the crossclamp was switched to partial clamping until the CPB was discontinued. TCD was used for detection of microembolic signals (MES). The captured material in the filter was examined histologically. Twelve patients served as controls without aortic filtration (group II). The MRI of the brain did not show any diffusion alterations in either group before or after surgery. No patient developed a focal neurological deficit or stroke. Intraoperative quantitative MES detection revealed a four to tenfold increase in patients of group I compared with group II (5 - 6 versus 0.5 - 1 MES/min) during the filter dwell time. There was no consistent pattern regarding the neurobehavioural sequelae. Filters showed arteriosclerotic debris in 75% of the patients. The use of the intra-aortic filter device did not show a positive effect on neurological, neuroradiographical and neuropsychological outcomes. The increase of the MES rate in group I patients may be due to microbubbles generated as microcavitations by the filter or the aortic filter cannula. The intra-aortic filter was able to capture atheromatous material in 75% of the patients.

Download Full-text

Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery

Open Medicine ◽

10.2478/s11536-009-0094-6 ◽

2010 ◽

Vol 5 (3) ◽

pp. 308-314 ◽

Cited By ~ 1

Author(s):

Mahmood Shirzad ◽

Abbasali Karimi ◽

Samaneh Dowlatshahi ◽

Seyed Ahmadi ◽

Saeed Davoodi ◽

...

Keyword(s):

Coronary Artery ◽

Length Of Stay ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Resource Utilization ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Preoperative Anemia ◽

Mortality And Morbidity

AbstractAnemia is an indisputable finding in patients scheduled for coronary artery bypass graft (CABG) that can occur any time preoperatively. In presence of severe coronary artery disease, anemia can dramatically affect surgical outcomes. Therefore, we conducted this study to determine the effect of low preoperative hemoglobin (Hgb) on postoperative outcome in patients who underwent coronary artery bypass graft (CABG). In all, 4432 patients who had undergone isolated CABG at Tehran Heart Center over the 2-year period from March 2006 to February 2008 were studied. All medical records of the aforementioned patients were derived from our hospital surgery data bank. After adjustment for confounders, the association of different preoperative levels of Hgb with risk of cardiac, pulmonary, infectious, and ischemic complications, and also with prolonged ventilation and resource utilization, were assessed in a multivariable model. After adjustment for confounders that may affect mortality and morbidities, we found that cardiac, infectious, ischemic, and pulmonary complications, as well as postoperative mortality, were significantly higher in anemic patients compared to those with normal Hgb levels. In addition, total ventilation time, total intensive care unit hour stay (ICU), hospital length of stay (HLOS), and postsurgery length of stay (PLOS) were significantly longer in anemic patients. We concluded that isolated CABG patients with preoperative anemia have significantly higher mortality and morbidity, and use more health care resources. Preoperative anemia is an independent variable for increased resource utilization, morbidity, and mortality.

Download Full-text