scholarly journals Diaphragm Paralysis After Cardiac Surgery: A Frequent Cause of Post-Operative Respiratory Failure

2020 ◽  
Author(s):  
Driss LAGHLAM ◽  
Minh-Pierre Lê ◽  
Alexandre Sr ◽  
Raphael Monsonego ◽  
Philippe Estagnasié ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Arterial Hypertension ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Coronary Bypass Grafting ◽  
Time Motion ◽  
Incidence Risk ◽  
Hospital Stays ◽  
Mode Tm

Abstract BackgroundDiaphragmatic dysfunction (DD) is found in 1.2-60% of patients after cardiac surgery. The aim of this study was to reinvestigate the incidence, risk factors and outcomes of DD with actual cardiac surgery procedures.MethodsThis is an observational study based on a prospectively collected database in one cardiac surgery centre. The DD group included patients with clinically perceptible diaphragmatic paralysis, which was confirmed by chest ultrasound (amplitude of the diaphragm movement in time-motion mode [TM] at rest, after a sniff test). The primary endpoint was the incidence of DD. ResultsA total of 3577 patients were included between January 2016 and September 2019. We found 272 cases of DD (7.6%). Individuals with DD had more arterial hypertension (64.3% vs. 52.6%; p<0.0001), higher body mass index (BMI) (28[25–30] kg/m2 vs. 26[24-29] kg/m2; p<0.0002) and higher incidence of coronary bypass grafting (58.8% vs. 46.6%; p=0.0001). DD was associated with more postoperative pneumonia (23.9% vs. 8.7%; p<0.0001), reintubation (8.8% vs. 2.9%; p<0.0001), tracheotomy (3.3% vs. 0.3%; p<0.0001), non-invasive ventilation (45.6% vs. 5.4%; p<0.0001), duration of mechanical ventilation (5[4-11] h vs. 4[3-6] h; p<0.0001), and ICU and hospital stays (14[11-17] days vs. 13[11–16] days; p<0.0001). In multivariate analysis, DD was associated with coronary artery bypass grafting (OR=1.9[1.5-2.6]; p=0.0001), arterial hypertension (OR=1.4[1.1- 1.9]; p=0.008), and BMI (OR per point =1.04[1.01-1.07] kg/m2; p=0.003).ConclusionThe incidence of symptomatic DD after cardiac surgery was 7.6%, leading to respiratory complications and increased ICU stay. Coronary bypass grafting was the principal factor associated with DD.

Percutaneous coronary intervention for unprotected and protected left main stem disease

2010 ◽  
pp. 313-332
Author(s):  
Christine Hughes ◽  
Bruno Farah ◽  
Jean Fajadet
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Left Main ◽  
Coronary Bypass Grafting ◽  
Percutaneous Coronary

Significant unprotected left main coronary artery (ULMCA) disease occurs in 5–7% of patients undergoing coronary angiography (and patients with ULMCA disease treated medically have a 3-year mortality rate of 50%. Several studies have shown a significant benefit following treatment of left main (LM) stenosis with coronary bypass grafting compared with medical treatment. Until recently coronary bypass grafting has been the gold standard therapy for LM disease. However, advances in percutaneous intervention techniques and stent technology have allowed re-evaluation of the role of percutaneous coronary intervention (PCI) for LM disease. Recent studies have focused on the safety and efficacy of stenting the left main coronary artery (LMCA) to determine if it does provide a true alternative to coronary artery bypass grafting (CABG). So should we stent the LM?

scholarly journals Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass

2010 ◽  
Vol 2010 ◽  
pp. 1-3
Author(s):  
Temucin Noyan Ogus ◽  
Filiz Erdim ◽  
Ozer Selimoglu ◽  
Fatih Tekiner ◽  
Murat Ugurlucan
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Management Strategy ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.

Chylothorax as a complication of coronary artery bypass grafting operation

2012 ◽  
Vol 153 (14) ◽  
pp. 553-558 ◽  
Author(s):  
Miklós Szabó ◽  
Margit †Jáger ◽  
Eszter Krizsó ◽  
Ibolya Gilányi ◽  
Andrij Leny ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Surgical Interventions ◽  
Artery Bypass Grafting ◽  
Coronary Bypass Grafting ◽  
Triglyceride Content

The authors present the case of a 72-year-old woman who underwent coronary bypass grafting. Left sided chylothorax due to accidental dissection of a thoracic duct branch developed 2 months after sternotomy. As conservative therapy has failed, surgical pleurodesis was performed successfully. Chylothorax is a rare and underestimated complication of coronary bypass grafting. The worldwide increasing number of coronary artery bypass grafting surgeries makes it important to pay attention to this condition. Thus diagnosis of the chyle is relatively easy by its high chylomicron and triglyceride content, but identification of the etiology and its treatment is sometimes challenging for the physician. The treatment of chylothorax is usually conservative. The main goal is to keep the volume of the chyle under control. The number of surgical interventions because of chylothorax is increasing due to an increase of iatrogenic etiology. Orv. Hetil., 2012, 153, 553–558.

scholarly journals Interleukin 6 as a predictive biomarker for atrial fibrillation after coronary bypass grafting: a systematic review

2021 ◽  
Vol 8 ◽  
Author(s):  
Roberta Gomes da Mata ◽  
Ana Luisa Adorno de Lima ◽  
Antonio Da Silva Menezes Junior
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Interleukin 6 ◽  
Plasma Levels ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Cochrane Library ◽  
Bypass Grafting ◽  
Coronary Bypass Grafting ◽  
Mesh Terms

Atrial fibrillation (AF) progresses after coronary bypass grafting in 11–40% of patients. Plasma biomarkers such as interleukin 6 (IL-6) can assess the risk of AF development. We performed a systematic review using as sources:  PubMed, LILACS, and Cochrane Library databases were investigated using Boolean operators and MeSH terms (Medical Subject Headings Terms) “Atrial Fibrillation AND Interleukin AND Biomarkers”.  As the following eligibility criteria: observational studies, studies with coronary artery bypass grafting with plasma levels of IL-6 recorded after screening, 11 articles were selected. Three studies met the inclusion and exclusion criteria. Results: IL-6 levels on AF group - Ishida et al. reported the plasma levels of IL-6 during the post-operative period as 360 ± 143 pg/mL, while Pretorius et al. reported it to be 380.6 ± 151.1 pg/mL. Lastly, Ziabakhsh-Tabari et al. reported a post-operative plasma IL-6 level of 38.2 ± 32 pg/mL. It is considered that new studies about the object are necessary, and these studies should be more standardized. Preferably, it would be important for the daily measurement of IL-6 and its correlation with AF development for statistical analysis to set the best time for sample collection and cut-off value.

Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting

2018 ◽  
Vol 13 (5) ◽  
pp. 344-348 ◽  
Author(s):  
Hagen Gorki ◽  
Jun Liu ◽  
Marius Sabau ◽  
Guenther Albrecht ◽  
Andreas Liebold
Keyword(s):  
Coronary Artery ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Minimal Invasive ◽  
Bypass Grafting ◽  
Coronary Bypass Grafting ◽  
Left Anterior Descending Artery ◽  
Internal Mammary

Objective At present, minimal invasive direct coronary artery grafting is the least invasive nonrobotic surgical approach to revascularize the left anterior descending artery with the left internal mammary artery. Total endoscopic coronary bypass grafting is performed with the help of a telemanipulator (“robot”). A prospective proof-of-concept study was initiated to investigate a nonrobotic total endoscopic coronary bypass grafting approach. Methods Twenty patients with significant left anterior descending artery or left main stem lesion were operated on via three or four left thoracic access ports. Under exclusive endoscopic vision, the left internal mammary artery was harvested and anastomosed to the left anterior descending artery manually. Cardiopulmonary bypass and cardioplegic arrest were planned in all cases. Results In 10 patients, the operation was completed successfully as nonrobotic total endoscopic coronary bypass grafting. Reasons for conversions to minimal invasive direct coronary artery grafting or conventional sternotomy were dense pleural adhesions (3 patients), bleeding of the anastomosis (3), diffuse bleeding during left internal mammary artery harvesting (2), identification problems of the target artery (1), or left internal mammary artery failure (1). Postoperative angiography in five primarily successful nonrobotic total endoscopic coronary bypass grafting patients showed patent anastomoses in four cases. One patient was reoperated on for early anastomotic failure in a 1.0-mm target vessel. Until now, a percutaneous coronary intervention of remaining lesions as staged hybrid procedure was performed in three patients (2 nonrobotic total endoscopic coronary bypass grafting, 1 minimal invasive direct coronary artery grafting). Conclusions With a thoroughly surveyed learning curve, nonrobotic total endoscopic coronary bypass grafting procedure could become an alternative to other available treatment options; however, the value of the procedure has to be further investigated.

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