Myocardial revascularization: Tips and tricks for performing a coronary anastomosis

2021 ◽  
Keyword(s):  
Cardiac Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Surgical Techniques ◽  
Artery Bypass Graft ◽  
Tips And Tricks ◽  
Cardiac Operation ◽  
The 1960S ◽  
First Time

Coronary artery bypass graft surgery was performed for the first time in the 1960s [(1]). Today, it is still one of the pillars of cardiac surgery and the most common cardiac operation. Many improvements have been developed since it was first introduced, but such operations remain technically challenging. We focus here on the surgical exposure and suture techniques for different grafts and targets. The goal of standardizing surgical techniques is to improve intraoperative and postoperative outcomes, especially for young practitioners.

Cardiac Surgery Nurse Practitioner Home Visits Prevent Coronary Artery Bypass Graft Readmissions

2014 ◽  
Vol 97 (5) ◽  
pp. 1488-1495 ◽  
Author(s):  
Michael H. Hall ◽  
Rick A. Esposito ◽  
Renee Pekmezaris ◽  
Martin Lesser ◽  
Donna Moravick ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Nurse Practitioner ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Home Visits ◽  
Artery Bypass Graft

scholarly journals The relationship between intraoperative cerebral oximetry and postoperative delirium in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Leerang Lim ◽  
Karam Nam ◽  
Seohee Lee ◽  
Youn Joung Cho ◽  
Chan-Woo Yeom ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Postoperative Delirium ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cerebral Oximetry ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Pump Coronary Artery Bypass ◽  
The Relationship

Abstract Background Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery. Despite its popularity, there have been inconsistent results on the use of cerebral oximetry during cardiac surgery, and few studies have evaluated cerebral oximetry during off pump coronary artery bypass graft surgery (OPCAB). Methods To evaluate the relationship between intraoperative cerebral oximetry and postoperative delirium in patients who underwent OPCAB, we included 1439 patients who underwent OPCAB between October 2004 and December 2016 and among them, 815 patients with sufficient data on regional cerebral oxygen saturation (rSO2) were enrolled in this study. We retrospectively analyzed perioperative variables and the reduction in rSO2 below cut-off values of 75, 70, 65, 60, 55, 50, 45, 40, and 35%. Furthermore, we evaluated the relationship between the reduction in rSO2 and postoperative delirium. Results Delirium occurred in 105 of 815 patients. In both univariable and multivariable analyses, the duration of rSO2 reduction was significantly longer in patients with delirium at cut-offs of < 50 and 45% (for every 5 min, adjusted odds ratio (OR) 1.007 [95% Confidence interval (CI) 1.001 to 1.014] and adjusted OR 1.012 [1.003 to 1.021]; p = 0.024 and 0.011, respectively). The proportion of patients with a rSO2 reduction < 45% was significantly higher among those with delirium (adjusted OR 1.737[1.064 to 2.836], p = 0.027). Conclusions In patients undergoing OPCAB, intraoperative rSO2 reduction was associated with postoperative delirium. Duration of rSO2 less than 50% was 40% longer in the patients with postoperative delirium. The cut-off value of intraoperative rSO2 that associated with postoperative delirium was 50% for the total patient population and 55% for the patients younger than 68 years.

SYNTAX score and coronary artery bypass graft surgery in Bangladesh

2019 ◽  
Vol 27 (7) ◽  
pp. 542-547
Author(s):  
Redoy Ranjan ◽  
Asit Baran Adhikary
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Syntax Score ◽  
Artery Bypass Graft ◽  
Artery Disease

Background The SYNTAX score is a helpful tool for determining the optimal myocardial revascularization strategy in complex coronary artery disease. The aim of this study was to assess whether the SYNTAX score predicts postoperative mortality in patients undergoing coronary artery bypass grafting. Methods The study included 1100 consecutive patients referred for coronary artery bypass graft surgery over a 4-year period. Angiographic data were interpreted by both experienced intervention cardiologists and cardiac surgeons. The patients were divided into three groups based on SYNTAX score tertiles: low ≤22 ( n =  560), intermediate 23–32 ( n =  360), and high ≥33 ( n =  180). Results Compared to patients with a low SYNTAX score, those with intermediate and high scores were significantly older ( p <  0.001), had a lower left ventricular ejection fraction ( p <  0.001), higher pulmonary artery pressure ( p <  0.001), and higher incidences of acute coronary syndrome and left main coronary artery disease. A significantly higher EuroSCORE ( p =  0.003) was also observed in patients with a higher SYNTAX score. Patients with intermediate and high SYNTAX scores had higher 5-year mortality rates (18.6% and 19.5%, respectively) than patients with low SYNTAX scores (9.5%, p <  0.05). In multivariate analysis, SYNTAX score was not an independent predictor of late mortality. Conclusion Although SYNTAX score is not independently predictive of late mortality in patients with complex coronary artery disease undergoing myocardial revascularization surgery, patients with lower SYNTAX scores had a lower mortality rate after coronary artery bypass graft surgery.

scholarly journals Trends in Reoperative Coronary Artery Bypass Graft Surgery for Older Adults in the United States, 1998 to 2017

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Makoto Mori ◽  
Yun Wang ◽  
Karthik Murugiah ◽  
Rohan Khera ◽  
Aakriti Gupta ◽  
...  
Keyword(s):  
Older Adults ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The United States ◽  
Fee For Service ◽  
Artery Bypass Graft ◽  
First Time

Background The likelihood of undergoing reoperative coronary artery bypass graft surgery (CABG) is important for older patients who are considering first‐time CABG. Trends in the reoperative CABG for these patients are unknown. Methods and Results We used the Medicare fee‐for‐service inpatient claims data of adults undergoing isolated first‐time CABG between 1998 and 2017. The primary outcome was time to first reoperative CABG within 5 years of discharge from the index surgery, treating death as a competing risk. We fitted a Cox regression to model the likelihood of reoperative CABG as a function of patient baseline characteristics. There were 1 666 875 unique patients undergoing first‐time isolated CABG and surviving to hospital discharge. The median (interquartile range) age of patients did not change significantly over time (from 74 [69–78] in 1998 to 73 [69–78] in 2017); the proportion of women decreased from 34.8% to 26.1%. The 5‐year rate of reoperative CABG declined from 0.77% (95% CI, 0.72%–0.82%) in 1998 to 0.23% (95% CI, 0.19%–0.28%) in 2013. The annual proportional decline in the 5‐year rate of reoperative CABG overall was 6.6% (95% CI, 6.0%–7.1%) nationwide, which did not differ across subgroups, except the non‐white non‐black race group that had an annual decline of 8.5% (95% CI, 6.2%–10.7%). Conclusions Over a recent 20‐year period, the Medicare fee‐for‐service patients experienced a significant decline in the rate of reoperative CABG. In this cohort of older adults, the rate of declining differed across demographic subgroups.

Establishing the Content Validity of an Early Extubation Protocol: A Quality Improvement Project for Improving Early Extubation of Coronary Artery Bypass Graft Patients

2016 ◽  
Vol 9 (2) ◽  
pp. 236-248
Author(s):  
Alicia Williams ◽  
Lyn Stankiewicz Murphy
Keyword(s):  
Cardiac Surgery ◽  
Content Validity ◽  
Patient Population ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Interrater Agreement ◽  
Early Extubation ◽  
Artery Bypass Graft ◽  
Validity Index ◽  
Item Content

Introduction:Patients undergoing coronary artery bypass graft surgery will require intubation and the use of mechanical ventilation during and after surgery. It is well accepted that early extubation is associated with not only positive patient outcomes but also organizational outcomes as well. Patients who are not extubated early are at risk for complications associated with prolonged intubation. The literature supports the use of protocol aid with early extubation. The goal and expected outcome of this project is to establish the usability of an early extubation protocol by assessing its appropriateness for use in the postoperative cardiac surgical adult patient.Methods:For the purpose of establishing content validity of an early extubation protocol, 2 protocols were chosen from the literature. Fifteen cardiac surgery experts were invited to select the protocol they felt was most appropriate for use in this patient population. These reviewers were then asked to further analyze the protocol based on a 5-question survey. Their response was used to calculate a scale-content validity index (S-CVI) and an item-content validity index (I-CVI).Results:Twelve of 15 experts participated in the project. The content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI) and (b) S-CVI. The means were established for each item. Content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI: 0.75–1.00); and the S-CVI/average = 0.92. Cronbach’s alpha was estimated to establish reliability (0.972).Conclusion:Selecting an appropriate protocol to be used in this patient population is the first step in implementing an effective early extubation process. The results highly suggest that the content of this protocol is quite relevant in this patient population. It is hoped that this will set the stage for early extubation in postoperative cardiac surgery patients.

Internal mammary artery bypass graft in reoperative myocardial revascularization

1976 ◽  
Vol 37 (6) ◽  
pp. 890-895 ◽  
Author(s):  
Floyd D. Loop ◽  
Nestor R. Carabajal ◽  
Paul C. Taylor ◽  
Manuel J. Irarrazaval
Keyword(s):  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Artery Bypass Graft ◽  
Internal Mammary

scholarly journals 458 Blood Loss Following First Time Coronary-Artery-Bypass-Graft (CABG)

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Ishak ◽  
K Morcos ◽  
P Curry
Keyword(s):  
Coronary Artery ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Coronary Artery Bypass Graft ◽  
Renal Dysfunction ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
First Time

Abstract Introduction Blood loss following cardiac surgery is a recognised complication associated with post-operative mortality and morbidity. Aim To identify parameters associated with blood loss and need for blood transfusion following first time coronary-artery-bypass-graft (CABG). Method Data was collected retrospectively on 50 patients who underwent a first time CABG between 12/02/2020 – 21/09/2020 at the Golden Jubilee National Hospital (GJNH). Parameters included pre-operative and post-operative haemoglobin, platelets, INR, calcium levels, patient age, body-mass-index (BMI), creatinine clearance (CrCl), presence of co-morbidities, anti-coagulant drug use, cross-clamp time, bypass time, re-exploration rates and number of grafts. Patients who required a blood transfusion post-operatively were compared with those who did not require transfusion. Results Seventeen of the 50 patients required a blood transfusion. This group had a lower mean post-operative haemoglobin levels (90.82 vs 107.82, p = &lt;0.001), lower mean post-operative platelet levels (138.47 vs 187.09, p = 0.02), higher post-operative INR (1.25 vs 1.15, p = 0.15), higher mean BMI (27.93 vs 30.433, p = 0.063), higher mean renal dysfunction severity grades (0.7 vs 0.3, p = 0.044) and lower mean CrCl (78 vs 97, p = 0.025). The transfused patient group had older mean age (68.29 vs 64.84, p = 0.065) and a longer mean post-operative hospital stay (9.38 vs 6.67 days, p = 0.043). More patients had pre-operative haemoglobin &lt;120 (p = 0.26), post-operative haemoglobin &lt;90 (p = &lt;0.0001) and post-operative platelets &lt;100 (p = 0.0029). One patient in the transfused group died post-operatively. Conclusions Sub-optimal peri-operative blood levels, renal dysfunction, patient age and patient BMI can influence blood loss and requirement for transfusion following first time CABG.

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