Cardiac Tamponade After Removal of Temporary Pacer Wires

2012 ◽  
Vol 21 (6) ◽  
pp. 432-440 ◽  
Author(s):  
Linda Mahon ◽  
James F. Bena ◽  
Shannon M. Morrison ◽  
Nancy M. Albert
Keyword(s):  
Cardiac Tamponade ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Vital Signs ◽  
Smoking History ◽  
Initial Surgery ◽  
Temporary Pacemaker ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background After removal of temporary pacemaker wires, nurses measure vital signs frequently to assess for cardiac tamponade; however, evidence for this procedure is limited. Objectives To determine risk factors for cardiac tamponade after temporary pacemaker wire removal. Methods Retrospective review of data for coronary artery bypass graft and valve surgery (N = 23 717) performed from January 1999 to December 2008. Patients were categorized by reason for reoperation: bleeding less than 3 days after initial surgery (n = 812, group 1), bleeding 3 days or more after index surgery but not for cardiac tamponade (n = 171, group 2), bleeding 3 days or more after index surgery for cardiac tamponade after temporary pacemaker wire removal (n = 23, group 3), and no reoperation (n = 22 711, group 4). Results Less than 1% (9.7 cases/10 000) of patients required reoperation for cardiac tamponade after removal of temporary pacer wires. Of patient-related factors studied, only smoking history differed for group 3 vs group 1 (P = .03) and group 2 (P = .01). Of vital sign changes, 1 patient (4%) had tachycardia and 3 patients had cardiac arrest, but only 1 of the 3 had hypotension before the arrest. In total, 12 patients (52%) had hypotension; however, it was mild or intermittent in 5 cases, and did not occur within the 4 hours after wire removal in 3 cases. After removal of temporary pacing wires, common early signs/symptoms were bleeding (26%) and dyspnea (26%). Other documented changes were pressure in the chest, diaphoresis, cold and clammy skin, dizziness, and mental status changes. Conclusions Tamponade related to pacer wire removal was rare and not consistently associated with changes in vital signs. Dyspnea, bleeding, and other factors may indicate early onset of cardiac tamponade after removal of temporary pacer wires.

Comparison of Antihypertensives after Coronary Artery Surgery

2005 ◽  
Vol 13 (4) ◽  
pp. 302-306 ◽  
Author(s):  
Fevzi Toraman ◽  
Hasan Karabulut ◽  
Onur Goksel ◽  
Serdar Evrenkaya ◽  
Sumer Tarcan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Sodium Nitroprusside ◽  
Artery Bypass ◽  
Effective Control ◽  
Hemodynamic Effects ◽  
Double Product ◽  
Myocardial Infraction ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Hypertension following coronary artery bypass grafting is a common problem that may result in postoperative myocardial infraction or bleeding, Hemodynamic effects were compared in 45 hypertensive coronary bypass patients randomized to receive either diltiazem, nitroglycerin, or sodium nitroprusside. Diltiazem was administered as an intravenous bolus of 0.3 mg·kg−1 within 5 min, followed by infusion of 0.1–0.8 mg·kg−1·h−1 in group 1. Nitroglycerin was infused at a rate of 1–3 μg·kg·h−1 in group 2, and sodium nitroprusside was given at a rate of 1–3 μg·kg−1·min−1 in group 3. Hemodynamic measurements were carried out before infusion (T1) and at 30 min (T2), 2 h (T3), and 12 h (T4) after initiation of treatment in the intensive care unit. Mean arterial pressure decreased significantly in all groups. There were no differences among groups at T1 and T2. At T3, heart rate in group 2 was significantly higher than group 1. At T3 and T4, the double product was highest in group 3 (group 1 vs. 3, p < 0.001). These results suggest that the hemodynamic effects of the 3 drugs are similar within the first 30 min. However, after 30 min, diltiazem affords better myocardial performance and more effective control of hypertension.

Influence of aspirin or heparin on platelet function and postoperative blood loss after coronary artery bypass surgery

Perfusion ◽  
2006 ◽  
Vol 21 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Edmundas Sirvinskas ◽  
Audrone Veikutiene ◽  
Pranas Grybauskas ◽  
Jurate Cimbolaityte ◽  
Ausra Mongirdiene ◽  
...  
Keyword(s):  
Platelet Count ◽  
Coronary Artery ◽  
Platelet Aggregation ◽  
Blood Loss ◽  
Platelet Function ◽  
Artery Bypass ◽  
Postoperative Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the study was to assess the effect of aspirin or heparin pretreatment on platelet function and bleeding in the early postoperative period after coronary artery bypass grafting (CABG) surgery. Seventy-five male patients with coronary artery disease who underwent CABG with cardiopulmonary bypass (CPB) were studied. The patients were divided into three groups: Group 1 ( n = 25) included patients receiving aspirin pretreatment, Group 2 ( n = 22) received heparin pretreatment, and Group 3 ( n = 28) included patients who received no antiplatelet or anticoagulant pretreatment. Twenty-four hours after surgery, all patients were administered aspirin therapy that was continued throughout their hospitalization period. We assessed the following preoperative blood coagulation indices: activated partial thromboplastin time (aPTT), international normalized ratio (INR), and fibrinogen. We compared platelet count and platelet aggregation induced by adenosinediphosphate (ADP) before surgery, 1 h after surgery, 20 h after surgery and on the seventh postoperative day. We assessed drained blood loss within 20 postoperative hours. Preoperative blood coagulation indices did not differ among the groups. Platelet count was also similar. One hour after surgery, platelet count significantly decreased in all groups ( p <0.001), after 20 postoperative hours it did not undergo any marked changes, and on the seventh postoperative day, it significantly increased in all groups ( p <0.001). Before surgery, the lowest index of ADP-induced platelet aggregation was found in Group 1 ( p <0.05). One hour after surgery, platelet aggregation significantly decreased in all groups, most markedly in Group 3 ( p <0.001), yet after 20 h, its restitution tendency and a significant increase in all groups was noted. On the seventh day, a further increase in the statistical mean platelet aggregation value was noted in Groups 2 and 3. Comparison of platelet aggregation after 20 postoperative hours and on the seventh day after surgery revealed a significantly higher than 10% increase of the index in 32% of patients in Group 1 ( p <0.05), 27.3% of patients in Group 2 ( p <0.05) and in 35.7% of patients in Group 3 ( p <0.001). The lowest statistically significant value of postoperative blood loss was noted in Group 2 ( p <0.01). Our study has shown that aspirin or heparin pretreatment had no impact on the dynamics of platelet function in the early postoperative period after CABG. The lowest postoperative blood loss was noted in patients pretreated with heparin.

Abstract 18855: Outcomes after Coronary Artery Bypass Graft Surgery in Patients Treated with Thoracic Radiotherapy for Cancer

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jackson J Liang ◽  
Terence T Sio ◽  
John M Stulak ◽  
Ryan J Lennon ◽  
Abhiram Prasad ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Triple Vessel Disease ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Introduction: Thoracic external beam radiation therapy (XRT) for cancer is associated with a multitude of long-term cardiotoxic side effects. Previous studies have suggested worse outcomes in XRT-treated cancer survivors who undergo revascularization with CABG, but sample sizes have been small. In addition, XRT after CABG is thought to portend decreased patency and survival. We aimed to examine outcomes after CABG in patients with XRT compared with to those without XRT. Methods: We identified all patients who were treated with both CABG (between 1999 and 2013) and curative thoracic XRT for cancer (between 1971 and 2013) (>30 Gray). Baseline clinical characteristics and comorbidities at time of CABG, as well as long-term outcomes after CABG and XRT were compared with propensity matched control cohorts. Results: A total of 38 patients underwent CABG following XRT [Group 1] (mean age 67.9, 63% female) and 43 patients underwent XRT after CABG [Group 2] (mean age 69.3, 63% female). Compared with propensity-matched controls (Group 1: n=141; Group 2: n=167), baseline clinical and demographic characteristics between cases and controls were similar in both groups, except a lower incidence of triple vessel disease in XRT cases in Group 2 (64 vs 80%, p=0.02). For Group 1, there was no significant difference in all-cause survival in long-term follow-up after CABG (Fig. 1, p=0.72). Meanwhile, Group 2 cases had significantly higher all-cause mortality following XRT (Fig. 2, p<0.001). Conclusions: Patients previously treated with thoracic XRT who subsequently undergo CABG for coronary artery disease have a similar overall mortality rate compared to patients without prior XRT. This suggests that CABG is an effective method of revascularization in these patients. The higher mortality rates in CABG patients who subsequently develop disease requiring thoracic XRT is likely due to oncologic rather than cardiovascular causes, but more data are necessary to evaluate this finding.

Diagnostic performance of sensitive measurements of serum thyrotropin during severe nonthyroidal illness: their role in the diagnosis of hyperthyroidism.

1987 ◽  
Vol 33 (12) ◽  
pp. 2178-2184 ◽  
Author(s):  
M F Bayer ◽  
J A Macoviak ◽  
I R McDougall
Keyword(s):  
Thyroid Disease ◽  
Artery Bypass ◽  
Hospital Setting ◽  
Transplant Recipients ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Serial Measurements ◽  
Group 1

Abstract Serum thyrotropin (TSH) concentrations were measured serially in 14 heart-transplant recipients (group 1) and 21 patients undergoing coronary artery bypass surgery (group 2), all without thyroid disease, and randomly in 158 patients hospitalized for various other nonthyroidal illnesses, including 144 judged euthyroid (group 3), six with increased FT4 and (or) T3 (group 4), and eight classified hypothyroid by conventional tests. The serial measurements indicated profound fluctuations. In group 1, TSH was subnormal in 21% of studies and increased in 10%. In group 2, corresponding abnormalities were found in 7% and 13%, respectively. Transiently low or high TSH tended to be associated with normal free thyroxin (FT4), prolonged subnormal TSH (greater than 1 week) with subnormal FT4. By contrast, subnormal TSH plus elevated FT4, or high TSH plus low FT4, were not encountered, making it unlikely that they occur by chance in severely ill patients who are not also hyper- or hypothyroid. In group 3, a suppressed TSH (plus borderline high FT4, T3/FT3) identified four cases of subclinical hyperthyroidism; however, another 11% of patients had subnormal and 10% had above-normal TSH, paired with normal FT4 and no evidence of thyroid disease. In group 4, suppressed TSH confirmed hyperthyroidism in five of six patients, and all in group 5 had increased TSH. We conclude that, in the hospital setting, sensitive TSH measurement can help to detect or confirm mild hyperthyroidism, but the positive predictive value of TSH alone may be as low as 35%.

scholarly journals The Differences requency of Lower Extremities Muscle Strength and Functional Capacity on the difference Supervised Exercise Frequency in Post Cardiac Bypass Graft Surgery

2017 ◽  
Vol 6 (01) ◽  
pp. 34
Author(s):  
Dewi Nur Fiana ◽  
Sunaryo B Sastradimaja ◽  
Badai Bhatara Tiksnadi
Keyword(s):  
Muscle Strength ◽  
Functional Capacity ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Optimal Time ◽  
Supervised Exercise ◽  
Cardiac Bypass ◽  
Group 2 ◽  
Adaptation Phase ◽  
Group 1

Introduction: The optimal time to do exercise in adaptation phase was 36 to 72 hours. Patients with cardiovasculardisease may have an extended adaptation phase to 96 hours and above. It was necessary to know the mosteffective supervised exercise in phase II cardiac rehabilitation between three times/week for 36-hours, and twotimes/week for 96-hours.Method: This study involved 30 patients post-Cardiac Bypass Graft Surgery (CABG) participated in phase IIcardiac rehabilitation at Hasan Sadikin Hospital, Bandung. Subjects divided into two groups; that have done twotimes/week (group 1) and three times/week of the supervised exercised (group 2) for four weeks. The Lowerextremity muscle strength (LEMS) examined by conducting a chair standing test, while functional capacity (FC)evaluated by the 6-minute walking test.Result:Subjects were 58,54±5,90 y.o (group 1) and 61,66±6,36(group 2). The FC and the LEMS before andafter exercise were 10,98 and 15,96 ml/kg(<0,001) on the FC; 7,8 and 12,9 times (<0,001) on the LEMS in group1, besides 9,6 and 14,9 ml/kg(<0,001) on the FC; 8,7 and 13,0 times (<0,001) on group 2,Conclusion. Both groups have increased of the FC and the LEMS after exercise. There were no differencebetween 2 times and 3 times of supervised exercises a week on post CABG pasientsKeywords: coronary artery bypass graft, the frequency of exercise, functional capacity, muscle strength =

Intravenous Diltiazem for Treatment of Supraventricular Tachycardia after Coronary Artery Bypass Surgery

1998 ◽  
Vol 6 (3) ◽  
pp. 203-207
Author(s):  
C Levent Birincioğlu ◽  
A Tulga Ulus ◽  
Birol Yamak ◽  
S Fehmi Katircioğlu ◽  
Binali Mavitaş ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Supraventricular Tachycardia ◽  
Artery Bypass ◽  
Inotropic Support ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Between 1995 and 1997, 180 patients who had undergone coronary artery bypass grafting were given intravenous diltiazem for conversion of supraventricular tachycardia to sinus rhythm or control of ventricular rhythm in atrial fibrillation. The patients were divided into three groups of 60 each: group 1 required no inotropic support; group 2 had mild inotropic support with dopamine; group 3 had high-dose inotropic support with adrenalin and dopamine. Thirty-eight patients in group 1 (63%), 40 in group 2 (67%), and 32 in group 3 (53%) responded to one or two doses of diltiazem. There was no difference between the groups in terms of the success rate of the treatment (p > 0.05). Additional procedures were needed in 70 patients including cardioversion in 20 (12 in group 1, 8 in group 2). Mean cardiac index was significantly increased and mean pulmonary artery pressure was significantly decreased in all three groups after diltiazem treatment. After the first dose of diltiazem (0.25 mg·kg−1), the mean heart rate decreased from 141.5mg·kg−1 ± 3.8, 136.9 ± 8.5, and 140.2 ± 4.7 to 118.2 ± 5.1, 101.2 ± 6.7, and 105.6 ± 16.8 in groups 1, 2, and 3, respectively. The maximum decrease was seen after 5 minutes. After the second dose of diltiazem (0.35 mg·kg−1), although mean heart rates were not significantly decreased, 45% of group 1, 44% of group 2, and 46% of group 3 patients who did not respond to the first dose of diltiazem, converted to sinus rhythm. In the early postoperative period after coronary artery bypass graft surgery, diltiazem was of benefit in the treatment of supraventricular tachycardia and atrial fibrillation or flutter. This treatment may be especially useful in patients who are in poor hemodynamic condition.

Clinical outcomes of single-dose cardioplegia in high-risk coronary bypass

2020 ◽  
pp. 021849232096643
Author(s):  
Serdar Gunaydin ◽  
Orhan Eren Gunertem ◽  
Seyhan Babaroglu ◽  
Atike Tekeli Kunt ◽  
Kevin McCusker ◽  
...  
Keyword(s):  
Single Dose ◽  
Coronary Artery ◽  
High Risk ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Risk Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring. Methods This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 ( n = 101) had a single dose of del Nido cardioplegia, group 2 ( n = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 ( n = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events. Results Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3. Conclusions Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.

scholarly journals The effect of omega-3 polyunsaturated fatty acids in prevention of postoperative atrial fibrillation development in patients undergoing coronary artery bypass graft surgery

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
O Rubanenko ◽  
A Rubanenko
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Omega 3 ◽  
Median Level ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Purpose. To estimate the effect of omega-3 polyunsaturated fatty acids (PUFAs) in prevention of postoperative atrial fibrillation (POAF) in patients with coronary artery disease undergoing coronary artery bypass graft (CABG) surgery. Methods. Studied were 306 patients who underwent CABG. All the patients were divided into two groups depending on the prescription of omega-3 PUFAs in the pre- and postoperative period by randomization method: 1 group comprised 158 patients without PUFAs (82.7% men, median age 63.0 (57.0;67.0) years, 2 group - 148 patients with PUFAs (89.3% men, median age 60.0 (57.0;64.0) years). PUFAs were prescribed 2000 mg daily starting with 5 days before CABG and 1000 mg daily after CABG for 21 days. In all the patients, we studied interleukin (IL)-6, IL-8, IL-10, NT-proBNP, troponin, superoxide dismutase (SOD), malondialdehyde (MDA), glutathione and omega-3 index. Results. During the observation period POAF occurred in 29.7% patients of group 1, and in 16.9% patients of group 2 (p = 0.009). In postoperative period patients of group 1 had median IL-6 level 39.3% higher (p = 0.001) and median IL-10 level - 20.2% higher (p = 0.01) comparing with group 2. In patients of group 2 we found SOD median level 78.9% lower (р&lt;0.0001) and MDA median level 33.8% lower compared to the patients of group 1 (р=0.03). In postoperative period in group 2 the median level of docosahexaenoic acid was 55% higher (p = 0.03), and omega-3 index - 43.4% higher (h = 0.04) compared with group 1. Conclusion. We found that patients with PUFAs had less activation of inflammation and oxidative stress after CABG than patients without PUFAs. The patients with PUFAs also had increased levels of docosahexaenoic acids and omega-3 index compared to the patients without PUFAs. We also found a significant decrease of the prevalence of POAF after CABG in patients with PUFAs.

Comparison of Isolated Primary CABG in Two Successive Decades in Patients Under 40 Years of Age

2016 ◽  
Vol 19 (3) ◽  
pp. 139
Author(s):  
Przemyslaw Trzeciak ◽  
Marian Zembala ◽  
Piotr Desperak ◽  
Wojtek Karolak ◽  
Michal Zembala ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Young Patients ◽  
Coronary Intervention ◽  
Off Pump ◽  
End Point ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

<strong>Background:</strong> Coronary artery bypass graft (CABG) surgery is rarely performed in very young patients. The purpose of our study is to compare the characteristics, treatments, in-hospital, and long-term outcomes of two groups of patients less than 40 years of age who had CABG in two successive decades: 1990-2000 and 2001-2011. <br /><strong>Methods:</strong> We identified 145 consecutive patients who underwent primary isolated CABG. Group 1 consisted of <br />78 patients operated between 1990-2000 and group 2 consisted of 67 patients operated between 2001-2011. Composite end point assessed at follow-up period involved death or recurrence of symptoms, which we defined as myocardial infarction, a need for percutaneous coronary intervention (PCI), reoperation, or congestive heart failure (CHF).  <br /><strong>Results:</strong> Smoking and hypercholesterolemia before CABG were noted as more frequent in group 1 than in group 2: 96.1% versus 83.6%, P = .011; 88.5% versus 61.2%, <br />P = .0001, respectively. Patients from group 2 more frequently received one graft (29.8% versus 11.5%, P = .0059), were operated with off-pump (41.8% versus 0%, P &lt; .0001) or MIDCAB (28.4% versus 0%, P = .0008) techniques, and had complete arterial revascularization (58.2% versus 23.1%, P &lt; .0001). Group 1 patients had a higher prevalence of composite end point (33.9% versus 17.9%, P = .035), with no significant difference in mortality (11.5% versus 10.4%, P = .83).<br /><strong>Conclusion:</strong> Patients operated between 1990-2000 had a higher prevalence of smoking and hypercholesterolemia and higher frequency of composite-end point during folow-up period without significant difference in mortality.

Doppler ultrasound estimation of microbubbles in the arterial line during extracorporeal circulation

Perfusion ◽  
1990 ◽  
Vol 5 (1) ◽  
pp. 23-32 ◽  
Author(s):  
M. Sellman ◽  
T. Ivert ◽  
P. Stensved ◽  
M. Högberg ◽  
Bkh Semb
Keyword(s):  
Doppler Ultrasound ◽  
Extracorporeal Circulation ◽  
Artery Bypass ◽  
Arterial Line ◽  
Membrane Oxygenator ◽  
Filter Group ◽  
S 100 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

A pulsed Doppler ultrasound system was used to analyse microbubble intensity and size in the arterial line during extracorporeal circulation (ECC). Thirty male patients, younger than 70 (range 28-69) years, underwent isolated coronary artery bypass grafting with either a bubble oxygenator (Shiley S-100) without (group 1, n = 10) or with (group 2, n = 10) a depth adsorption arterial line filter (Swank High Flow 6000); or with a membrane oxygenator (Shiley M-2000) without a filter (group 3, n = 10). Mean ECC and aortic crossclamp times were similar in the three groups. Measurements were performed during the initial five minutes of cooling, after 30-40 minutes of ECC and after 10 minutes of rewarming. Microbubble intensity and size did not differ significantly in the three groups at the different intervals. Significantly more and larger bubbles were detected in group 1 (15-150μm) compared to group 2 (< 35μm) (p< 0.001). In group 3 only a minimal number of small bubbles (< 65μm) were observed. An arterial line filter significantly reduced the number and size of microbubbles detected in the arterial line during ECC. A membrane oxygenator was associated with a further reduction of microbubble intensity.

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