scholarly journals Minimal Invasive Extra-corporeal Circulation on End Stage Coronary Artery Disease Patients Undergoing Myocardial Revascularization

2021 ◽  
Author(s):  
Ignazio Condello ◽  
Giuseppe Santarpino ◽  
Francesco Bartolomucci ◽  
Giovanni Valenti ◽  
Nicola Di Bari ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Extracorporeal Circulation ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Minimal Invasive ◽  
Artery Disease ◽  
Lactate Levels ◽  
End Stage

Abstract Background: Patients with coronary artery disease (CAD) undergoing myocardial revascularization, with concomitant heart failure defined by left ventricular ejection fraction (LVEF) lower than 35%, constitute a population at risk of poor long-term prognosis and limited survival. The benefits of minimal invasive extracorporeal circulation (MiECC) on end stage coronary artery disease patients undergoing myocardial revascularization has not been described and evidenced by scientific studies. Materials and Methods: In this single-centre control study of 60 end stage coronary artery disease patients undergoing isolated coronary artery bypass grafting.The patients was divided in two contemporary groups: in group (MiECC), n= 30 coronary artery bypass grafting (CABG) was used MiECC, whereas, in group conventional extracorporeal circulation (cECC), n=30 CABG was used cECC.Results: Procedures of Group MiECC reported (mean values) of a DO2i of 305 mL/min/m2 in relation to O2ERi 21.5% vs a DO2i of 288 mL/min/m2 in relation to O2ERi 25.6% was found in group MiECC vs cECC (p=0.037). Lactate levels >3 mmol/L were reported in 7 group MiECC patients vs 20 group cECC patients (p=0.038), with blood glucose peak. Mean nadir Hb values during CPB were 9.7 g/dL in group MiECC vs 7.8 g/dL in group cECC (p = 0.044). CI during CPB was 2.4 L/min/m2 in both groups. Total red blood cell administration was 8 units in group MiECC vs 21 units in group cECC (p=0.022). A glycemic peak was recorded in 7 patients of group MiECC vs 20 patients of group cECC (p=0.037).Conclusion:The MiECC technique on end stage coronary artery disease was associated with a higher DO2i compared to cECC. MiECC patients showed a significant reduction in red blood cells units administration, in peak intraoperative lactate levels, which correlated with better postoperative renal outcome and shorter length of stay.

scholarly journals Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ignazio Condello ◽  
Giuseppe Santarpino ◽  
Francesco Bartolomucci ◽  
Giovanni Valenti ◽  
Nicola Di Bari ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Minimally Invasive ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Extracorporeal Circulation ◽  
Myocardial Revascularization ◽  
Artery Disease ◽  
Lactate Levels ◽  
End Stage

Abstract Background Patients with coronary artery disease and concomitant heart failure (left ventricular ejection fraction < 35%) requiring myocardial revascularization are at risk of poor long-term prognosis and higher mortality. The benefits of minimally invasive extracorporeal circulation (MiECC), particularly in end-stage coronary artery disease patients undergoing myocardial revascularization, have not been completely described. Materials and methods In this single-centre control study, 60 end-stage coronary artery disease patients undergoing isolated coronary artery bypass grafting (CABG) were included. Patients were divided into two groups of 30 patients each undergoing CABG using MiECC or conventional extracorporeal circulation (cECC). Results In the MiECC group, oxygen delivery index (DO2i) was 305 mL/min/m2 in relation to indexed oxygen extraction ratio (O2ERi) 21.5%, whereas in the cECC group DO2i was 288 mL/min/m2 in relation to O2ERi 25.6% (p = 0.037). Lactate levels > 3 mmol/L were reported in 7 MiECC patients vs 20 cECC patients (p = 0.038), with blood glucose peak. Mean nadir hemoglobin values during cardiopulmonary bypass (CPB) were 9.7 g/dL in the MiECC group vs 7.8 g/dL in the cECC group (p = 0.044). Cardiac index during CPB was 2.4 L/min/m2 in both groups. Red blood cell units administered were 8 vs 21 units in the MiECC vs cECC group (p = 0.022). A glycemic peak was recorded in 7 patients of the MiECC group and in 20 patients of the cECC group (p = 0.037). Conclusion In end-stage coronary artery disease, the MiECC technique was associated with a higher DO2i compared to cECC. MiECC patients showed a significant reduction in red blood cell unit administration and peak intraoperative lactate levels, which correlated with better postoperative outcome.

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 Outcome of Coronary Artery Bypass Graft Surgery with Coronary Endarterectomy

2019 ◽  
Vol 44 (3) ◽  
pp. 124-131
Author(s):  
R Ranjan ◽  
AB Adhikary
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Atheromatous Plaque ◽  
Coronary Endarterectomy ◽  
Diffuse Coronary Artery Disease ◽  
Artery Disease

Background: Coronary Endarterectomy (CE) is the expulsion of the atheromatous plaque, and isolating the outer media and adventitia layers of arterial wall. Objective of this study was to review the consequences of coronary endarterectomy (CE) with coronary artery bypass grafting (CABG), and demonstrate the outcomes of this surgical technique for patients with diffuse coronary artery disease in a single surgeon’s practice. Methods: Retrospectively outcome of 1473 endarterectomised coronary artery in 1189 patients with diffuse coronary artery disease (CAD) was reviewed, who have had experienced CE with OPCABG in the year of 2007 to 2016. CE was performed in multi-segmental diffuse CAD, or when a calcified or extremely thick plaque making anastomosis troublesome. Results: Approximately 75.0% coronary endarterectomy were performed in the left coronary territory and most commonly left anterior descending artery was endarterectomized (42.83%). An average of 1.2 coronary endarterectomies performed per patient. Post-operative ICU and 30-days mortality rate was 2.2%, and 0.6% respectively in CE group. Post-operative atrial fibrillation, acute MI, neurological complication, and blood transfusion were significantly higher in CE group. Following CE, Kaplan–Meier cumulative survival rate was 89.5%, and about 85% patients were free from angina at follow-up of 5 years. Conclusion: Coronary endarterectomy with OPCABG is attainable, and accomplishes surgical revascularization in patients; when there is no other alternative for total myocardial revascularization. Bangladesh Med Res Counc Bull 2018; 44: 124-131

scholarly journals CHARACTERISTICS OF PHARMACEUTICAL THERAPY OF HIGH-RISK PATIENTS WITH CORONARY ARTERY DISEASE AFTER CORONARY ARTERY BYPASS GRAFTING

2021 ◽  
Vol 21 (1) ◽  
pp. 6-11
Author(s):  
O. Gogayeva
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
High Risk Patients ◽  
Pharmaceutical Therapy ◽  
Risk Patients ◽  
Artery Disease

The number of patients after surgical myocardial revascularization is growing annually. New regional centres are being created, and the cardiologists are facing the pressing issues of managing patients after cardiac surgery. The aim of this study is to analyze the characteristics of pharmaceutical therapy for high-risk patients with coronary artery disease after surgical myocardial revascularization. Material and methods: a retrospective analysis of data from 194 high-risk patients (selected by random sampling) with coronary artery disease, who were operated on and discharged from Amosov National Institute of cardiovascular surgery, National Academy of Medical Sciences of Ukraine for the period 2009–2019. The average age of the patients was 64.2+8.9 years. All patients underwent standard laboratory and clinical examinations, coronary angiography and coronary artery bypass grafting. Results: dual antiplatelet therapy has been found out as optimal for the patients with sinus rhythm. A combination of an antiplatelet agent with a vitamin K antagonist or new oral anticoaguants is effective and can be recommended for the patients with atrial fibrillation. Lipid-lowering therapy is prescribed to all patients prior to the surgery and the following parameters as the control of low-density lipoproteins, liver enzymes, and serum creatinine should be under the constant control. Gastroprotective therapy with pantoprazole is indicated to all patients after myocardial revascularization. When prescribing antihypertensive therapy in the postoperative period, it is important to consider the severity of stenosis of the carotid arteries. Conclusions: Pharmaceutical therapy of patients after coronary artery bypass surgery should be carried out in a patient-centred manner and in accordance with the principle – “non nocere” (Do not harm), taking into account the cardiac status and comorbidity.

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