Fibrinolysis system indicators during aorto-coronary bypass surgery in terms of cardiopulmonary bypass with minimized circuit

2019 ◽  
Vol 1 (4) ◽  
pp. 58-65
Author(s):  
V. I. Kornev ◽  
N. M. Kalinina ◽  
D. A. Shelukhin ◽  
O. N. Startseva
Keyword(s):  
Cardiopulmonary Bypass ◽  
Bypass Surgery ◽  
Group Performance ◽  
Structural Parameters ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Fibrin Clot ◽  
Fibrinolytic System ◽  
Control Group ◽  
Extracorporeal Bypass

Introduction. The problem of irregularities in the fibrinolysis system during extracorporeal circulation is investigated closely and does not lose its relevance. The aim of research. To research and identify fibrinolysis system violations performed in cardiac surgical patients undergoing cardiopulmonary bypass surgery with minimized extracorporeal circuit (MiECC). Materials and methods. 50 patients were examined with coronary artery bypass grafting: 15 ones operated with MiECC (main group); 35 ones operated with heparin-coated extracorporeal bypass circuits (control group). Performance evaluation of fibrinolytic system was carried out prior to surgery, after protamine, 12 hours after operation, 7 days later, on discharge and one month after surgery. Results. Balance of fibrinolytic system after the operation shifts to the side of the oppression. Structural parameters of a fibrin clot (size CS and D density) according to thrombodynamics test correlate well with Xll-dependent fibrinolysis. Patients after surgery with MiECC in comparison with the conventional circuit have lower thrombinemia, minimal number of activated platelets, faster recovery of plasma fibrinolytic capacity, and accordingly lower risks of thrombotic complications. Conclusion. Fibrinolysis system indicators show the advantage of usage at aorto-coronary bypass with minimized heparin-coated extracorporeal bypass circuits.

The Relationship between Low Intraoperative Hematocrit Levels during Cardiopulmonary Bypass and Postoperative Neurological Events

2013 ◽  
Vol 16 (5) ◽  
pp. E243-E247
Author(s):  
Metin Yılmaz ◽  
Anıl Özen ◽  
Kerem Yay ◽  
Ertekin Utku Ünal ◽  
Ömer Faruk Çiçek ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Bypass Surgery ◽  
Pathological Finding ◽  
Coronary Bypass ◽  
Control Group ◽  
Open Heart ◽  
Left Hand ◽  
The Mean ◽  
The Relationship

Objective: The objective of our study is to analyzewhether low intraoperative hematocrit levels have an effectupon postoperative neurological events.Methods: Our study included 140 patients who underwentisolated coronary bypass under cardiopulmonary bypassbetween 2009 and 2012. The main group of the study was70 patients with intraoperative hematocrit levels lower than22%. These patients’ 30-day postoperative neurological (particularlystroke) follow up was registered as the main data ofthe study. Another group of 70 patients possessing the samedemographic features who underwent open heart surgerywith hematocrit levels remaining above 22% were registeredas the control group for perioperative neurological data.Results: The average age of the patients with hematocritlevels below and above 22% was 56.8 ± 5.8 years and 54.1± 7.3 years, respectively. The mean follow-up period of thepatients was 37.2 ± 8.6 days. None of the patients had anyneurological postoperative sequalae. No mortalities occurred.One patient who had mild paresthesia and motor weaknessof the left hand had no pathological finding on computedtomography and was diagnosed with peripheral neuropathydue to intraoperative sternal retraction.Conclusion: Because our study revealed no cerebrovascularevents, coronary bypass surgery under cardiopulmonarybypass may be safely conducted even in patients with hematocritlevels lower than 22%.

scholarly journals Remote Ischemic Preconditioning With the Use of Lower Limb Before Coronary Artery Bypass Surgery With Cardiopulmonary Bypass and Anesthesia With Propofol

Kardiologiia ◽  
2019 ◽  
Vol 59 (2) ◽  
pp. 38-44
Author(s):  
D. S. Tuter ◽  
R. N. Komarov ◽  
O. S. Glasachev ◽  
A. L. Syrkin ◽  
L. P. Severova ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Ischemic Preconditioning ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Troponin I ◽  
Artery Bypass ◽  
Remote Ischemic Preconditioning ◽  
Control Group

Objective:to study potantial of remote ischemic preconditioning (RIP) as method of cardioprotection during coronary artery bypass surgery with cardiopulmonary bypass (CPB) and anesthesia with propofol.Materials and methods.We included in this study 87 patients (7 were excluded) with ischemic heart disease, hospitalized in the clinic of aortic and cardiovascular surgery of the I. M. Sechenov First Moscow State Medical University clinical hospital № 1. All patients had indications for direct myocardial revascularization by coronary artery bypass surgery. One day before operation patients were randomly assigned to 2 groups depending on preparation scheme: main group of RIP and the control group. The frequency of complications during surgery and in the postoperative period was assessed. Troponin I level was measured before, and in 2 and 24 hours after surgery. The level of lactate in the venous blood was measured before and after surgery.Results. Numbers of intraoperative and early postoperative complications in the main and control groups were similar. There were no differences between groups in troponin I and lactate levels after surgery.Conclusions.Remote ischemic preconditioning has no effect on the outcome of coronary artery bypass surgery with cardiopulmonary bypass and anesthesia with propofol.

scholarly journals Minimal invasive coronary bypass surgery the robotic total endoscopic approach

2019 ◽  
Vol 147 (3-4) ◽  
pp. 243-247
Author(s):  
Dusko Terzic ◽  
László Göbölös ◽  
Jehad Ramahi ◽  
Johannes Bonatti
Keyword(s):  
Cardiopulmonary Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Cleveland Clinic ◽  
Myocardial Revascularization ◽  
Coronary Bypass ◽  
Coronary Bypass Surgery ◽  
Postoperative Treatment ◽  
Routine Practice ◽  
Eligibility Criteria

The aim of this paper is to present the latest recommendations for practitioners for preoperative preparation, surgical procedures and postoperative treatment in patients with myocardial revascularization using robotic total endoscopic coronary artery bypass grafting (CARG), which is applied as daily clinical routine practice at the Heart and Vascular Institute, Cleveland Clinic Abu Dhabi. Many patients indicated for coronary bypass surgery may be candidates for robotic total endoscopic CARG. The paper illustrates eligibility criteria of this procedure, preoperative assessment and preparation principles, peripheral access for cardiopulmonary bypass and port insertion, then graft harvesting procedure, initiation of cardiopulmonary bypass and application of endoaortic clamping, identification and exposure of the target vessels, anastomosis procedure and postoperative care in this group of patients.

One Month Follow-up of Haemostatic Variables in Patients Undergoing Aortocoronary Bypass Surgery

1995 ◽  
Vol 73 (03) ◽  
pp. 356-361 ◽  
Author(s):  
L Mannucci ◽  
P S Gerometta ◽  
L Mussoni ◽  
C Antona ◽  
A Parolari ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Bypass Surgery ◽  
Fibrinolytic System ◽  
Aortocoronary Bypass ◽  
Protamine Sulphate ◽  
Aortocoronary Bypass Surgery ◽  
Intraoperative Period ◽  
Pai 1 ◽  
D Dimer

SummaryIt is already known that activation of the coagulation and fibrinolytic system occurs in patients undergoing cardiopulmonary bypass (CPB). We have thus studied twenty patients (10 treated with aprotinin during CPB and 10 untreated) both during the intraoperative period and during thirty days follow up. In untreated patients D-dimer levels increased 4-fold during CPB and the levels were above baseline for the whole follow up (p<0.0001). D-dimer levels were reduced in aprotinin treated patients in comparison to untreated patients (p = 0.0172); levels then gradually increased to the values of the untreated patients over the following 24 h later and remained higher during the thirty day follow up. The behavior of haemostatic variables in the 24 h after CPB did not vary between untreated and aprotinin treated patients. In particular, five minutes after protamine sulphate administration, levels of F1 + 2 and TAT rose significantly (p = 0.0054, p = 0.0022 respectively), whereas fibrinogen significantly decreased (p<0.0001) and PAI-1 antigen levels were reduced. Two days after CPB the concentrations of F1 + 2 and TAT lowered, whereas fibrinogen and PAI-1 antigen levels increased. On the 5th, 8th and 30th days after CPB, F1 + 2 and TAT levels remained higher than those reported at baseline in both groups of patients, whereas fibrinogen levels increased over basal levels in aprotinin treated patients only.Thus, in addition to the activation of the coagulation and fibrinolytic system occurring during the intraoperative period, in patients undergoing CPB, there are alterations of haemostatic variables up to thirty days from surgery.

The Comparison between Minimally Invasive Coronary Bypass Grafting Surgery and Conventional Bypass Grafting Surgery in Proximal LAD Lesion

2015 ◽  
Vol 18 (2) ◽  
pp. 042 ◽  
Author(s):  
Mehmet Ezelsoy ◽  
Baris Caynak ◽  
Muhammed Bayram ◽  
Kerem Oral ◽  
Zehra Bayramoglu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Robotic Group ◽  
Bypass Group

<strong>Background</strong>: Minimally invasive bypass grafting surgery has entered the clincal routine in several centers around the world, with an increasing popularity in the last decade. In our study, we aimed to make a comparison between minimally invasive coronary artery bypass grafting surgery and conventional bypass grafting surgery in isolated proximal left anterior descending artery (LAD) lesions. <br /><strong>Methods</strong>: Between January 2004 and December 2011, patients with proximal LAD lesions, who were treated with robotically assisted minimally invasive coronary artery bypass surgery and conventional bypass surgery, were included in the study. In Group 1, coronary bypass with cardiopulmonary bypass and complete sternotomy were applied to 35 patients and in Group 2, robotically assisted minimally invasive bypass surgery was applied to 35 patients. The demographic, preoperative, perioperative, and postoperative data were collected retrospectively.<br /><strong>Results</strong>: The mean follow-up time of the conventional bypass group was 5.7 ± 1.7 years, whereas this ratio was 7.3 ±1.3 in the robotic group. There was no postoperative transient ischemic attack (TIA), wound infection, mortality, or need for intra-aortic balloon pump (IABP) in any of the patients. In the conventional bypass group, blood transfusion and ventilation time were significantly higher (P &lt; .05) than in the robotic group. The intensive care unit (ICU) stay and hospital stay were remarkably shorter in the robotic group <br />(P &lt; .01). The postoperative pneumonia rate was significantly higher (20%) in the conventional bypass group <br />(P &lt; .01). Postoperative day 1 pain score was higher in the robotic group (P &lt; .05), however, postoperative day 3 pain score in the conventional bypass group was higher (P &lt; .05). Graft patency rate was 88.6% in the conventional bypass group whereas this ratio was 91.4% in the robotic bypass group, which was not clinically significant (P &gt; .05).<br /><strong>Conclusion</strong>: In isolated proximal LAD stenosis, robotic assisted minimally invasive coronary artery bypass grafting surgery requires less blood products, is associated with shorter ICU and hospital stay, and lesser pain in the early postoperative period in contrast to conventional surgery. The result of our studies, which showed similarities to the past studies, lead us to recognize the importance of minimally invasive interventions and the need to perform them more frequently in the future.

Thoracic Epidural Anesthesia for Coronary Bypass Surgery Affects Autonomic Neural Function and Arrhythmias

2005 ◽  
Vol 1 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Noriyoshi Yashiki ◽  
Go Watanabe ◽  
Shigeyuki Tomita ◽  
Satoru Nishida ◽  
Tamotsu Yasuda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
General Anesthesia ◽  
Sympathetic Activity ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Thoracic Epidural ◽  
Group A ◽  
Group B

Background In recent years, the invasiveness of coronary reconstruction has been markedly reduced. Awake off-pump coronary artery bypass (AOCAB), coronary bypass surgery with thoracic epidural anesthesia (TEA) without general anesthesia and cardiopulmonary bypass), has been reported in the literature. Because the details of this technique are still unclear, we evaluated its usefulness by examining the autonomic neural state and the incidence of arrhythmia. Methods Fifty-five patients who underwent elective coronary artery bypass grafting (CABG) between April and December 2003 were included in the study. Patients who underwent CABG under high TEA alone comprised group A, those who underwent CABG under general anesthesia combined with TEA comprised group B, and those who underwent CABG under general anesthesia alone comprised group C. Holter electrocardiography was performed before and after surgery, and perioperative electrocardiograms were recorded (before surgery and during surgery, postoperative days 0–3, and postoperative day 7). On obtained electrocardiograms, the autonomic neural state was evaluated by analysis of heart rate variability, and the incidence of atrial fibrillation. Results Concerning the autonomic neural state, sympathetic inhibition was observed during TEA in both groups A and B. After discontinuation of TEA, sympathetic activity recovered. Vagal activity was not inhibited in group A, but decreased during surgery and gradually recovered after surgery in group B. Evaluation of the balance between sympathetic and vagal activities showed that sympathetic activity became predominant rapidly on postoperative day 2 in group B but gradually after surgery in group A. The incidence of postoperative atrial fibrillation was the highest in group B. Conclusions In AOCAB, because there is no vagal inhibition, vagal dominance can be maintained after surgery. This may be associated with the lower incidence of postoperative atrial fibrillation in group A compared with group B. Further studies are necessary to evaluate the details of AOCAB.

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