COMPARISON OF THE EFFECT OF ANTEGRADE AND ANTEGRADE/RETROGRADE CARDIOPLEGIA ON THE OUTCOME OF CORONARY ARTERY BYPASS GRAFT SURGERY FOR SEVERE CORONARY ARTERY DISEASE

Objective: To compare the early outcome of Coronary Artery Bypass Graft surgery using a combination of antegrade and retrograde cardipoplegia with that utilizing antegrade cardioplegia alone in triple vessel coronary artery disease. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Adult Cardiac Surgery of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from Sep 2013 to Apr 2019. Methodology: A total of 160 patients with triple vessel coronary artery disease who underwent CABG surgery for 90% or greater stenos is in at least one major vessel in each of the three territories, namely the left anterior descending, the circumflex and the right coronary artery were investigated retrospectively. These were divided into 2 equal groups on the basis of the technique of administration of cardioplegia: in group-1 only ante grade blood cardioplegia was administered for myocardial protection and group-2 was given ante grade and retrograde cardiolplegia. Clinical outcomes like peri-operative mortality and morbidity were recorded, and serum creatine kinase MB, lactate, and mixed venous oxygen saturation levels were monitored. Two dimensional echocardiogram was performed on the 6th post-operative day and follow-up visits were planned 1 week and 4 weeksafter discharge from hospital. Results: There were 2 (2.5%) early deaths in group-1 and no peri-operative mortality in group-2. Five patients in group-1 (6.25%) and 2 (2.5%) in group-2 had non-fatal peri-operative myocardial infarction. However, significant differences included increased incidence of intra-operative ventricular dysrythmias, higher CK-MB levels at 24 hours after surgery, and increased requirement of intra-aortic balloon pump and inotropic support in Group-1. Conclusion: We conclude from this study that the combined delivery of ante grade and retrograde cardioplegia during CABG surgery for triple vessel coronary artery disease provides better myocardial protection and hence better outcome than antegrade cardioplegia alone.Keywords: , , ,

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Open repair management of a patient with aortic arch saccular aneurysm, penetrating atherosclerotic ulcer, one vessel coronary artery disease and an isolated dissection of the abdominal aorta

SAGE Open Medical Case Reports ◽

10.1177/2050313x17744072 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1774407

Author(s):

Harvey Romolo ◽

Dicky A Wartono ◽

Sugisman Suyuti ◽

Bagus Herlambang ◽

Michael Caesario ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Aortic Arch ◽

Abdominal Aorta ◽

Artery Bypass ◽

Saccular Aneurysm ◽

Penetrating Atherosclerotic Ulcer ◽

Vessel Coronary Artery Disease ◽

Artery Disease ◽

Vessel Coronary Artery

Isolated saccular compared to fusiform aneurysm is considered to be a rare entity with challenges of its own. A 62-year-old female was diagnosed with a case of saccular aneurysm and penetrating atherosclerotic ulcer of the aortic arch. Additionally, she also had one vessel coronary artery disease and type B abdominal aortic dissection. She was then managed with open aortic arch repair and coronary artery bypass grafting. If required, elective endovascular repair will be done for the abdominal aorta on a later date.

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Early Outcome of Off-pump Coronary Artery Bypass Graft Surgery in Patients with Multivessel Coronary Artery Disease

Bangladesh Medical Journal ◽

10.3329/bmj.v41i3.18951 ◽

2014 ◽

Vol 41 (3) ◽

pp. 8-14

Author(s):

NU Ahmed ◽

K Hasan ◽

SK Raha

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Sweat Glands ◽

Off Pump ◽

Artery Disease ◽

Pump Coronary Artery Bypass ◽

Vessel Coronary Artery

As there have been appreciable bodies of evidence supporting the theoretical and practical advantages of off-pump coronary artery bypass grafting (OPCAB) over the conventional coronary artery bypass graft (CABG) to avoid the harmful effects of cardiopulmonary bypass (CPB), many cardiac surgeons are using OPCAB as an effective alternative to conventional CABG. This study performed in National Institute of Cardiovascular Diseases (NICVD) evaluated the early surgical outcomes of OPCAB in terms of mortality and major post-operative morbidities and compared them with that of conventional CABG. Total 120 patients with multi-vessel coronary artery disease were allocated into two groups: a) 60 patients who underwent OPCAB and b) another 60 patients who underwent conventional CABG between January 2009 and December 2011. The sex and mean age. A reduced level or complete cessation of sweating can be caused by a variety of factors affecting sweat glands directly or indirectly through alterations in their nerve supply. The most common presentation is the syndrome of heal intolerance with or without features of dysautonomia. An acquired idiopathic form of generalized anhidrosis is characterized by loss of sweating in the absence of any neurological features or destruction of sweat glands. ldiopalhic acquired generalized anhidrosis is a very rare condition in which the pathogenesis is still unknown. Cholinergic urticaria has been associated with some cases of this acquired idiopathic form of generalized anhidrosis.Distributions of patients were similar among two groups. Smoking, diabetes mellitus, hypertension and dyslipidemia were major risk factors. All co-morbid conditions were homogenously distributed between the two groups. Majority of the patients had triple vessel disease. Nearly three-quarter (73.3%) of patients in OPCAB group and 80% in conventional CABG group received 3 grafts (p=0.470. The mean total operative time (258±39.5 minutes versus 306±44.8 minutes; p<0.001), intubation times (7.6±0.3 versus 16.3±0.5 hours; p<0.001), blood losses (377.8±22.3 ml vs. 602.0±18.9 ml, p<0.001); requirements for blood and blood products (689.7±21.1 vs. 1199.3±34.5 ml, p < 0.0010); intensive care unit stays (31.7±0.9 hours versus 41.6±1.5 hours; p<0.001) and hospital stays (6.2±0.2 days versus 8.3±0.3 days; p<0.0010) were all significantly shorter in the OPCAB group. OPCAB is a safe and effective procedure for patients with multi-vessel coronary artery disease and is associated with reduced morbidity and mortality. However, large randomized studies with long-term follow-up may show the real benefits of OPCAB compared with CABG on CPB. DOI: http://dx.doi.org/10.3329/bmj.v41i3.18951 Bangladesh Medical Journal 2012 Vol.41(3): 8-14

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MO180CHRONIC KIDNEY DISEASE IN PATIENT WITH CHRONIC CORONARY DISEASE AFTER CORONARY REVASCULARIZATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.0058 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Shavkat Muminov ◽

Durdona Saipova

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Revascularization ◽

Artery Bypass ◽

Creatinine Concentration ◽

Relative Dynamics ◽

Second Year ◽

Group 2 ◽

Artery Disease ◽

Group 1

Abstract Background and Aims to study of renal function in patients with coronary artery disease, depending on the method of revascularization and the initial state of the kidneys. Method There were 160 patients with coronary artery disease under observation who underwent re-endovascular procedures (RE). The average age of the patients was 56.6 ± 1.27 years. Coronary artery bypass grafting (CABG group) was performed in 21 patients with coronary artery disease and percutaneous coronary intervention (PCI group) - in 139 patients. The study included patients with an eGFR of at least 60 ml / min, determined by the serum creatinine concentration. Patients received standard therapy: antiplatelet therapy (double therapy), bisoprolol, valsartan, atorvastatin. All patients underwent dynamic determination of serum creatinine concentration in terms of 3 months - 1 year -2 years. Results The CABG groups (21 patients) and the PTCA group (139 patients) who received standard therapy for coronary artery disease (group B). In the CABG and PCI groups, the eGFR was 105.66 ± 3.74 ml / min and 102.71 ± 1.59 ml / min, respectively. By the 3rd month of follow-up, the dynamics of eGFR in the groups, did not differ (-16.36 ± 3.30% and -17.55 ± 1.25%, respectively), by the 3rd month eGFR observation in the CABG and PTCA groups was also comparable, although it also differed in the baseline data (90.14 ± 6.05 ml / min and 86.46 ± 2.37 ml / min, respectively, the differences with the baseline data in both groups - p < 0.001. By the end the 1st year the following pattern emerged: in patients who underwent surgical revascularization, the decrease in eGFR was more pronounced than in patients who underwent stenting of the coronary arteries (-51.80 ± 3.51% versus -42, 39 ± 1.35%, p <0.05), and the differences increased even more during the second year of observation (-57.99 ± 4.75% versus -44.76 ± 1.89%, p <0.05). The second year of observation, eGFR in the CABG group was lower than in the PTCA group (44.63 ± 5.37 ml / min versus 56.54 ± 2.01 ml / min, p <0.05). This pattern can be explained that fact in the CABG group were more patients with diabetes - 80.95% (17 patients out of 21) compared with PTCA patients - 12.23% (17 patients out of 139, chi square 49.83, p < 0.001). All patients divided into 2 subgroups depending on the degree of eGFR by the 3rd month of observation: patients with eGFR by the 3rd month of observation more than 20% (31 patients, group 1) and less than 20% (group 2 - 129 sick). Initially, eGFR in group 1 was lower than in group 2. The relative dynamics of eGFR during the entire observation period was greater in patients of group 1 compared with group 2 (-43.58 ± 1.72% versus -11.10 ± 0.58% by the end 3rd month of observation, -61.30 ± 1.44% versus -39.38 ± 1.29% by the end of the first year and -68.78 ± 2.56% versus -41.14 ± 1.85% by the end of the second year of observation, the reliability of the difference in the relative dynamics between the groups at all three observation points is p <0.001). Conclusion. In patients with coronary artery disease who underwent coronary revascularization, there is a decrease in renal function after revascularization. The most significant decrease was observed in patients undergoing coronary artery bypass grafting, as well as in patients with initially low filtration function of the kidneys.

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