scholarly journals A Wireless Wearable Doppler Ultrasound Detects Changing Stroke Volume: Proof-of-Principle Comparison with Trans-Esophageal Echocardiography during Coronary Bypass Surgery

2021 ◽  
Vol 8 (12) ◽  
pp. 203
Author(s):  
Jon-Émile Stuart Kenny ◽  
Geoffrey Clarke ◽  
Matt Myers ◽  
Mai Elfarnawany ◽  
Andrew M. Eibl ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stroke Volume ◽  
Doppler Ultrasound ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Clinically Significant ◽  
Set Up ◽  
Carotid Doppler ◽  
Proof Of Principle

Background: A novel, wireless, ultrasound biosensor that adheres to the neck and measures real-time Doppler of the carotid artery may be a useful functional hemodynamic monitor. A unique experimental set-up during elective coronary artery bypass surgery is described as a means to compare the wearable Doppler to trans-esophageal echocardiography (TEE). Methods: A total of two representative patients were studied at baseline and during Trendelenburg position. Carotid Doppler spectra from the wearable ultrasound and TEE were synchronously captured. Areas under the receiver operator curve (AUROC) were performed to assess the accuracy of changing common carotid artery velocity time integral (ccVTI∆) at detecting a clinically significant change in stroke volume (SV∆). Results: Synchronously measuring and comparing Doppler spectra from the wearable ultrasound and TEE is feasible during Trendelenburg positioning. In two representative cardiac surgical patients, the ccVTI∆ accurately detected a clinically significant SV∆ with AUROCs of 0.89, 0.91, and 0.95 when single-beat, 3-consecutive beat and 10-consecutive beat averages were assessed, respectively. Conclusion: In this proof-of-principle research communication, a wearable Doppler ultrasound system is successfully compared to TEE. Preliminary data suggests that the diagnostic accuracy of carotid Doppler ultrasonography at detecting clinically significant SV∆ is enhanced by averaging more cardiac cycles.

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.

Transient liver dysfunction increases surgical site infections after coronary surgery

2018 ◽  
Vol 26 (6) ◽  
pp. 439-445 ◽  
Author(s):  
Rakan I Nazer ◽  
Khalid A Alburikan ◽  
Anhar Ullah ◽  
Ali M Albarrati ◽  
Mazen Hassanain
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Liver Dysfunction ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Surgical Site Infections ◽  
Perioperative Period ◽  
Coronary Bypass Surgery ◽  
Cardiac Procedures

Background Surgical site infections can have a significant impact on cardiac surgical outcome. The liver plays an important role in infection prevention. This study aimed to retrospectively determine whether transient postoperative liver dysfunction after coronary bypass surgery increased surgical site infections. Methods A modified version of the Schindl scoring scale for liver dysfunction was adapted to objectively quantify transient liver dysfunction in the first 7 days after on-pump coronary artery bypass grafting. A retrospective analysis of clinical outcomes at 30 months postoperatively was performed on data of 575 patients who underwent coronary artery bypass between 2014 and 2016. The patients were categorized into a liver dysfunction group (Schindl score ≥ 4) and a non-liver dysfunction group (Schindl score < 4). Results The liver dysfunction group (47.3%) had significantly more patients who were obese, current smokers, and had diabetes, renal impairment, and peripheral vascular disease. Surgical site infections occurred predominantly in the liver dysfunction group (12.1% vs. 0.3%, p < 0.001). The independent predictors of surgical site infection were liver dysfunction, body mass index > 30 kg m−2, and coronary bypass surgery combined with other cardiac procedures. Conclusions Surgical wound infections can be precipitated by multiple factors before, during, and after coronary bypass surgery. Transient liver dysfunction in the perioperative period is associated with an increased rate of surgical infections even after adjusting for known risk factors. Considering this factor as well as other known risks may help to identify and stratify patients with a potentially higher risk of surgical site infections.

scholarly journals Predictors for New Native-Vessel Occlusion in Patients with Prior Coronary Bypass Surgery: A Single-Center Retrospective Research

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Ze Zheng ◽  
Zi chao Cheng ◽  
Shao ping Wang ◽  
Shi ying Li ◽  
Jian Wang ◽  
...  
Keyword(s):  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Postoperative Management ◽  
Careful Consideration ◽  
Coronary Bypass Surgery ◽  
Vessel Occlusion ◽  
Total Occlusion ◽  
Reduced Ejection Fraction ◽  
Occlusion Rate

Objectives. Chronic total occlusion (CTO) is prevalent in patients with prior coronary artery bypass grafting (CABG). However, data available concerning the prevalence of new-onset CTO of native vessels in patients with prior CABG is limited. Therefore, the objective of the study is to determine predictors for new native-vessel occlusion in patients with prior coronary bypass surgery. Methods. 354 patients with prior CABG receiving follow-up angiography are selected and analyzed in the present study, with clinical and angiographic variables being analyzed by logistic regression to determine the predictors of new native-vessel occlusion. Results. The overall new occlusion rate was 35.59%, with multiple CTOs (42.06%) being the most prevalent (LAD 24.60% and RCA 18.25%, respectively). Additionally, current smoking (OR: 2.67; 95% CI: 2.60 to 2.74; p=0.01), reduced ejection fraction (OR: 1.76; 95% CI: 1.04 to 2.97; p=0.04), severe stenosis (OR: 3.65; 95% CI: 2.55 to 5.24; p=0.01), and diabetes mellitus (OR: 1.86; 95% CI: 1.34 to 2.97; p=0.04) serve as the independent predictors for new native-vessel occlusion. Conclusion. As to high incidence of postoperative CTO, appropriate revascularization strategies and postoperative management should be taken into careful consideration.

scholarly journals P.054 The use of robotic technology to define post-operative neurological dysfunction in patients undergoing coronary bypass surgery: a feasibility study

2016 ◽  
Vol 43 (S2) ◽  
pp. S33-S34
Author(s):  
AL Venters ◽  
T Saha ◽  
A Hamilton ◽  
D Petsikas ◽  
S Scott ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Dysfunction ◽  
Bypass Surgery ◽  
Near Infrared ◽  
Artery Bypass ◽  
Quantitative Description ◽  
Coronary Bypass ◽  
Neurological Dysfunction ◽  
Prior History ◽  
Operative Assessment

Background: Cognitive dysfunction following coronary artery bypass surgery is a regular occurrence, but its cause is still unknown. In order to devise strategies to mitigate this acquired disability, a precise and quantitative description of the post-operative neurocognitive phenotype is necessary. This study is designed to assess the feasibility of using the KINARM robot to quantify the changes in the neurological function after cardaic surgery. Methods: Patients without prior history of cognitive dysfunction were recruited from the pre-operative cardiac surgery clinic, and underwent pre-operative assessment with the KINARM. The KINARM provides a quantitative assessment of the neurocognitive control of the upper limbs. During bypass surgery, brain tissue oxygen levels were measured with near-infrared spectroscopy. Patients were reassessed with the KINARM post-operatively at 3 months. Results: To date, 12 participants have been recruited (mean age = 65 years, all male). On straightforward tasks, such as visually guided reaching, the majority of patients scored within the normal range, both pre- and post-operatively. In more complex tasks, required visuospatial and executive functioning, post-operative deficits were more pronounced. Conclusions: It is feasible to use the KINARM robot to provide a quantitative measurement of the neurocognitive phenotype of patients after cardiac surgery.

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