Biomedical subjects

Sharif Al-Ruzzeh

Publications and source records attributed to Sharif Al-Ruzzeh.

At least 37 records · Page 2Linked to original sources

PubMed2003

Off-Pump Coronary Artery Bypass (OPCAB) surgery reduces risk-stratified morbidity and mortality: a United Kingdom Multi-Center Comparative Analysis of Early Clinical Outcome.

OBJECTIVE: Off-Pump Coronary Artery Bypass (OPCAB) surgery is gaining more popularity worldwide. The aim of this United Kingdom (UK) multi-center study was to assess the early clinical outcome of the OPCAB technique and perform a risk-stratified comparison with the conventional Coronary Artery Bypass Grafting (CABG) using the Cardio-Pulmonary Bypass (CPB) technique. METHODS: Data were collected on 5,163 CPB patients from the database of the National Heart and Lung institute, Imperial College, University of London, and on 2,223 OPCAB patients from eight UK cardiac surgical centers, which run established OPCAB surgery programs. All patients had undergone primary isolated CABG for multi-vessel disease through a midline sternotomy approach, between January 1997 and April 2001. Postoperative morbidity and mortality were compared between the CPB and OPCAB patients after adjusting for case-mix. The mortality of the OPCAB patients was also compared, using risk stratification, to the mortality figures reported by the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS) based on 28,018 patients in the national database who were operated on between January 1996 and December 1999. RESULTS: Morbidity and mortality were significantly lower in the OPCAB patients compared with the CPB patients and the UK national database of CABG patients, over the same period of time, after adjusting for case-mix. CONCLUSIONS: This study demonstrates that risk stratified morbidity and mortality are significantly lower in OPCAB patients than CPB patients and patients in the UK national database.

Adult↗

PubMed2003

Is the female gender an independent predictor of adverse outcome after off-pump coronary artery bypass grafting?

BACKGROUND: The female gender is an independent predictor of adverse outcome after conventional coronary artery bypass grafting using cardiopulmonary bypass. The aim of this study is to assess the effect of the female gender on the outcome after off-pump coronary artery bypass (OPCAB) surgery. METHODS: This study is a retrospective review of 413 consecutive patients (181 women and 232 men) who underwent OPCAB between January 1999 and May 2001. Adverse outcomes were divided into minor adverse outcomes (MINAO), major adverse outcomes (MAJAO), and prolonged length of stay (PLOS) more than 7 days. MINAO included atrial fibrillation, respiratory complications except adult respiratory distress syndrome, and any wound infection except mediastinitis. MAJAO included stroke, myocardial infarction, renal failure, adult respiratory distress syndrome, mediastinitis, low cardiac output, mechanical ventilation more than 24 hours, intensive therapy unit stay more than 24 hours, gastrointestinal complications, cardiorespiratory arrest, and mortality within 30 days. Preoperative and intraoperative variables were evaluated as predictors of MINAO, MAJAO, and PLOS by univariate and multivariate analyses. RESULTS: The groups were matched for age and Parsonnet score-predicted mortality. However, the women had a higher incidence of chronic obstructive airway disease (p = 0.04), diabetes (p = 0.01), obesity (p = 0.000), peripheral vascular disease (p = 0.000), hypertension (p = 0.000), unstable angina (p = 0.005), history of previous failed nonsurgical intervention (p = 0.02), and nonelective operation (p = 0.000). There were a fewer number of grafts performed in the female group (2.8 vs 3.4, p = 0.000), with the circumflex territory being revascularised less frequently (p = 0.001). Univariate analysis identified the female gender to be a predictor of only MINAO (p = 0.001) and PLOS (p = 0.000). However, with multivariate analysis, female gender was not found to be an independent predictor of MINAO, MAJAO, or PLOS. CONCLUSIONS: In OPCAB, the female gender is not an independent predictor of MINAO, MAJAO, or PLOS.

Coronary Artery Bypass↗

PubMed2003

Is the use of cardiopulmonary bypass for multivessel coronary artery bypass surgery an independent predictor of operative mortality in patients with ischemic left ventricular dysfunction?

BACKGROUND: l Coronary artery bypass grafting for patients with ischemic left ventricular dysfunction (ILVD) remains superior to medical therapy in terms of long-term survival. Recently, off-pump coronary artery bypass surgery has been shown to be very promising in achieving functional improvements with favorable operative mortality in this challenging group of patients. The aim of this study was to assess the risk factors responsible for operative mortality in this group of patients. METHODS: The records of 305 consecutive ILVD patients, who underwent primary isolated coronary artery bypass grafting for multivessel disease at The National Heart and Lung Institute, Imperial College, University of London, between January 1999 and January 2002, were reviewed retrospectively. Patients were considered to have ILVD if they had a left ventricular ejection fraction of 0.30 or less on preoperative coronary angiography. One hundred six patients were operated on using the off-pump coronary artery bypass surgery technique, and 199 patients were operated on using the conventional coronary artery bypass grafting technique with cardiopulmonary bypass. RESU;TS: Seven (6.6%) patients died in the off-pump coronary artery bypass surgery group, whereas 28 (14.1%) patients died in the cardiopulmonary bypass group (p = 0.05). Univariate analysis of all the preoperative characteristics was performed to identify the potential predictors of mortality in the whole group of ILVD patients. Potential predictors of mortality included symptom status (stable/unstable), chronic obstructive airway disease, dyspnea grade III and IV on the New York Heart Association classification, intravenous nitrates, preoperative use of intraaortic balloon pump, ventricular tachycardia or ventricular fibrillation, body surface area less than 2, and cardiopulmonary bypass. Only ventricular tachycardia or ventricular fibrillation was proved to act as an independent predictor of operative mortality in this group of ILVD patients, with an odds ratio of 29.6 (95% confidence interval, 8.9 to 98). CONCLUSIONS: This study showed that using cardiopulmonary bypass for multivessel coronary artery bypass grafting in patients with ILVD was not proved to act as an independent predictor of operative mortality.

Aged↗

PubMed2003

Circumflex artery stenosis induced by intraoperative radiofrequency ablation.

We report a case of circumflex artery stenosis after intraoperative radiofrequency ablation for permanent atrial fibrillation in a patient who had a previous mitral valve replacement. The patient presented with acute pulmonary edema and severe angina 1 year after an uneventful recovery. The patient underwent a diagnostic angiography that showed the presence of stenosis of a long segment of the circumflex artery, adjacent to the radiofrequency ablation site, which was reopened successfully by angioplasty. Intraoperative radiofrequency ablation caused circumflex artery stenosis. We believe that this complication could have been avoided by applying the radiofrequency ablation more distally between the left pulmonary veins and the mitral valve.

Atrial Fibrillation↗

PubMed2003

Expanded use of suction and stabilization devices in cardiothoracic surgery.

BACKGROUND: Recent developments in beating heart instrumentation have allowed surgeons to perform multivessel off-pump coronary artery bypass surgery by overcoming the factors that impair surgical performance (limited visualization, continuous movement of the target area, and hemodynamic instability during exposure of the inferior and posterior parts of the heart). We have explored the possibility of further expanding apical and epicardial suction devices beyond their ordinary use in coronary artery surgery. METHODS: A retrospective review of our cardiac surgery database was undertaken to identify the incidences in which these devices have been used in a somewhat novel manner in the field of cardiac surgery. RESULTS: During this time period we identified 20 instances in which either apical or epicardial suction devices were used alone or together. The nature of the procedures included dividing pericardial adhesions (pericardiectomy, n = 2; dividing adhesions in redo-coronary surgery, n = 4), securing epicardial hemostasis (penetrating cardiac trauma, n = 2; securing hemostasis during reexploration after cardiac surgery, n = 10), and facilitating epicardial microwave ablation (n = 2). On all 20 occasions the intended procedures were undertaken uneventfully. Furthermore, the use of apical and epicardial devices greatly facilitated the operative procedures and avoided the use of cardiopulmonary bypass on all occasions. CONCLUSIONS: In summary, we would like to highlight the expanding role for apical and epicardial suction devices to an area beyond coronary artery surgery in which we have found their use invaluable.

Atrial Fibrillation↗

PubMed2003

Differential in vitro response of the human radial artery versus left internal thoracic artery to cerivastatin: implications to bypass grafting.

BACKGROUND: This study investigated acute (in vitro) and long-term (in vivo) effects of statins on the vascular function of human radial artery (RA) and left internal thoracic artery (LITA). METHODS: RA and LITA specimens were divided into vascular rings, which were incubated in the absence or presence of 10(-6) mol/L Cerivastatin for 2 or 24 hours. In terms of preoperative statin treatment, four groups included: group 1 [preop statin(-)/in vitro cerivastatin(-)]; group 2 [preop(-)/in vitro(+)]; group 3 [preop(+)/in vitro(-)]; and group 4 [preop(+)/in vitro(+)]. Endothelial function was assessed with acetylcholine (10(-9) to 10(-5) mol/L) following contraction by 3 x 10(-8) mol/L endothelin-1. RESULTS: Although endothelium-dependent vasodilatation was higher in RA (57.7% +/- 3.5%) than in LITA (46.5% +/- 3.8%, p = 0.046), there was no significant evidence that it depended on the preoperative use of statins or incubation period. In vitro incubation with cerivastatin significantly increased endothelium-dependent vasodilatation by 14.2% +/- 2.4% (p < 0.0001) independent of artery types (RA/LITA). There was no significant evidence that endothelium-dependent vasodilatation depended on the preoperative use of statins or incubation period. CONCLUSIONS: In vitro incubation with cerivastatin preserved endothelial function more effectively than preoperative use of statins. This could have implications to perioperative use of statins for patients undergoing coronary surgery.

Acetylcholine↗

PubMed2003

Does off-pump coronary artery bypass (OPCAB) surgery improve the outcome in high-risk patients?: a comparative study of 1398 high-risk patients.

OBJECTIVE: Although there has been some evidence supporting the theoretical and practical advantages of off-pump coronary artery bypass (OPCAB) over the conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB), it has not yet been determined which group of patients would benefit most from it. It has been advocated recently that high-risk patients could benefit most from avoidance of CPB. The aim of this retrospective study is to assess the efficacy of the OPCAB technique in multi-vessel myocardial revascularization in a large series of high-risk patients. METHODS: The records of 1398 consecutive high-risk patients who underwent primary isolated CABG at Harefield Hospital between August 1996 and December 2001 were reviewed retrospectively. Patients were considered as high-risk and included in the study if they had a preoperative EuroSCORE of > or =5. Two hundred and eighty-six patients were operated on using the OPCAB technique while 1112 patients were operated on using the conventional CABG technique with CPB. The OPCAB patients were significantly older than the CPB patients (68.1+/-8.3 vs. 63.7+/-9.9 years, respectively, P<0.001). The OPCAB group included significantly more patients with poor left ventricular (LV) function (ejection fraction (EF) < or =30%) (P<0.001) and more patients with renal problems (P<0.001). RESULTS: There was no significant difference in the number of grafts between the groups. The CPB patients received 2.8+/-1.2 grafts per patient while OPCAB patients received 2.8+/-0.5 grafts per patient (P=1). Twenty-one (7.3%) OPCAB patients had one or more major complications, while 158 (14.2%) CPB patients (P=0.008) developed major complications. Thirty-eight (3.4%) CPB patients developed peri-operative myocardial infarction (MI) while only two (0.7%) OPCAB patients developed peri-operative MI (P=0.024). The intensive therapy unit (ITU) stay for OPCAB patients was 29.3+/-15.4 h while for CPB patients it was 63.6+/-167.1 h (P<0.001). There were ten (3.5%) deaths in the OPCAB patients compared to 78 (7%) deaths in the CPB patients (P=0.041) within 30 days postoperatively. CONCLUSIONS: This retrospective study shows that using the OPCAB technique for multi-vessel myocardial revascularization in high-risk patients significantly reduces the incidence of peri-operative MI and other major complications, ITU stay and mortality. Even though the OPCAB group included a significantly higher proportion of older patients with poor LV function (EF < or =30%) and renal problems, the beneficial effect of OPCAB was evident.

Aged↗

PubMed2003

Age-related changes in the protective effect of chronic administration of L-arginine on post-ischemic recovery of endothelial function.

OBJECTIVE: The aim of this study was to assess the effect of chronic administration of L-arginine (LA) on vascular functions as well as its age-related changes. METHODS: Male Sprague-Dawley rats aged 1, 4, 8 and 16 months were divided into control and LA groups, which were administered LA (4 mg/ml) for 6 weeks. Isolated heart perfusion was performed, followed by cardioplegic arrest for 4h at 4 degrees C and reperfusion. Vascular functions were assessed through observations of pre-/post-ischemic coronary flow response to 5-hydroxytryptamine (5-HT) and glyceryl trinitrate (GTN). Ultrastructure was studied after the same ischemia-reperfusion. RESULTS: A significant improvement of percentage recovery (post-/pre-ischemic value) of response to 5-HT were seen in 4 and 8 months LA group when compared to the control (84.2+/-14.0 vs. 33.9+/-12.5 (P<0.05) and 97.0+/-23.2 vs. 21.5+/-9.7 (P<0.05), respectively). Furthermore, 8 months LA group had better percentage recovery of response to GTN (124.5+/-41.6 vs. 47.7+/-6.3, P<0.05). Ultrastructural study showed no significant differences between the groups in any age. CONCLUSIONS: Chronic oral administration of LA enhanced the post-ischemic recovery of vascular function in the young adult and adult hearts, but not in the infant and elderly.

Aging↗

PubMed2003

Effect of ascorbic acid on endothelium-dependent vasodilatation of human arterial conduits for coronary artery bypass grafting.

OBJECTIVE: Techniques aimed at improving the performance of arterial conduits will maximize the clinical benefit achievable with coronary artery bypass surgery. Controlling oxidant stress could be a strategy for preventing early graft deterioration. We tested the effect of a free radical scavenger, ascorbic acid (vitamin C), on preserving the endothelium-dependent vasodilatation function in vitro of radial artery and internal thoracic artery. We also tested its effect on the amount of reactive oxygen species (ROS) generated by each graft. METHODS: Radial artery (RA, n=25) and internal thoracic (ITA, n=19) segments were obtained from coronary artery bypass grafting patients. Each segment was divided into 3-4 mm vascular rings and incubated with or without ascorbic acid (10(-3) mol/l) for 1 h or 72 h. Using the organ bath technique, the endothelium-dependent vasodilatation function was tested in vitro by the addition of cumulative concentrations of acetylcholine (10(-9)-10(-5) mol/l) following vasocontraction by endothelin-1 (3 x 10(-8) mol/l). ROS were measured by using chemiluminescence technique at 1-h and after 72 h incubation with or without ascorbic acid. RESULTS: There were no differences in the vasodilatation function between control and ascorbic acid group of both arteries in the 1-hour incubation experiment. However, in the 72 h incubation experiment, ascorbic acid preserved the endothelium-dependent vasodilatation function of RA compared with control group (35.8+/-2.2% vs. 25.9+/-2.1%; P=0.005), but not ITA (39+/-3.5% vs. 40.5+/-9.3%; P=0.438). After 72 h incubation, RA generated significantly more free radicals compared with 1 h (133.7+/-151.5 vs. 16.8+/-16.8 cps/mg x 100; P=0.01); however, AA has no statistically significant effect on decreasing the amount of free radicals generated by both arteries. CONCLUSIONS: In RA, ascorbic acid is able to preserve the endothelium-dependent vasodilatation function after 72 h incubation, but not after 1 h. However, the mechanism of action of AA is not completely understood. This finding could open the door for understanding the role of oxidant stress and antioxidants in preserving the endothelial function of coronary artery bypass grafts.

Aged↗

PubMed2003

Off-pump coronary artery bypass surgery is associated with reduced neutrophil activation as measured by the expression of CD11b: a prospective randomized study.

BACKGROUND: Coronary artery bypass grafting (CABG) surgery is associated with systemic inflammation. Activation of neutrophils is a crucial step in inflammation and results in neutrophil sequestration within the tissues. One of the potential advantages of performing off-pump coronary artery bypass (OPCAB) surgery is the attenuation of the systemic inflammatory response. This prospective randomized study compares neutrophil activation in patients undergoing OPCAB versus those undergoing CABG with cardiopulmonary bypass (CPB). METHODS: Twenty patients undergoing primary isolated CABG were randomly divided prospectively into 2 groups: 1 group underwent CABG with CPB, and the other group underwent OPCAB. Central venous blood samples were obtained before skin incision and at 15 minutes, 60 minutes, 2 hours, 5 hours, and 24 hours following the initiation of CPB or application of the stabilization device. Differential white cell counts were measured with routine laboratory techniques. CD11b surface expression on neutrophils was measured by flow cytometry. Interleukin 8 levels in the plasma were measured by enzyme-linked immunosorbent assays. RESULTS: The 2 groups were matched with respect to preoperative and operative characteristics. White cell and neutrophil counts rose in both groups following the operation but were significantly higher in the OPCAB group at 5 hours (P < .001 and P = .002, respectively). Interleukin 8 concentrations were significantly higher in the CPB group at 5 hours following the initiation of CPB (P = .034). CD11b levels were significantly higher in the CPB group at 60 minutes (P = .002). CONCLUSION: This prospective randomized study demonstrates that the activation of circulating neutrophils as measured by CD11b expression is lower following OPCAB than in CPB. Although OPCAB is associated with significantly higher neutrophil counts, these neutrophils exhibit fewer activation markers. The lower postoperative neutrophil counts occurring in the CPB group may be explained by the activation and consequent sequestration of the neutrophils in the CPB circuit and tissues.

Aged↗

PubMed2003

Pasteurella multocida aortic valve endocarditis: case report and literature review.

Pasteurella multocida is a rare cause of infective endocarditis that occurs mostly in immunocompromised patients and is therefore associated with a high mortality rate. The case is reported of a 48-year-old male patient with liver cirrhosis, who developed aortic valve endocarditis caused by P. multocida. The infection was detected by blood cultures. The patient presented with generalized symptoms and initial neurologic symptoms suggestive of meningitis. Transthoracic echocardiography conducted after the discovery of a diastolic murmur revealed a large vegetation on the aortic valve, and notable insufficiency. These findings were confirmed at surgery, where-upon the patient underwent aortic valve replacement using a bioprosthetic valve. Subsequently he developed a recurrent episode of endocarditis that was successfully treated with antibiotic therapy. Other similar cases reported in the literature are reviewed.

Aortic Valve↗

PubMed2002

Conversion to off-pump coronary bypass without increased morbidity or change in practice.

BACKGROUND: This article examines the feasibility of complete conversion from conventional coronary artery operation to routine off-pump coronary bypass operation. METHODS: Data on our first 285 off-pump procedures using the Octopus system (Medtronic Inc, Minneapolis, MN) represent our learning curve. This is a complete experience in coronary bypass surgery over 16 months. RESULTS: The cohort was nonselected. All patients had at least two-vessel disease. Eight hundred seven grafts were performed (mean, 2.8 per patient) of which 647 grafts (84%) were arterial (mean, 2.3 per patient). One hundred seventy nine patients (63%) underwent total arterial revascularization. Eight patients required cardiopulmonary bypass; all other operations were completed off-pump. Complications were: mortality, 3 patients (1.5%); renal failure, 24 patients (8%); stroke, 2 patients (< 1%); and atrial fibrillation, 60 patients (21%). The morbidity data and frequency of arterial grafting did not differ from that of 355 patients who underwent coronary bypass operations in a preceding 18-month period. CONCLUSIONS: Complete shift from routine use of cardiopulmonary bypass to nonselective off-pump coronary bypass operation is possible with a low conversion rate and without an apparent increase in morbidity or change in technique. Whereas short-term safety and efficacy seem certain, studies of long-term outcome are necessary before the eventual role of off-pump coronary bypass in myocardial revascularization can be defined.

Aged↗

PubMed2002

Early clinical and angiographic outcome of the pedicled right internal thoracic artery graft to the left anterior descending artery.

BACKGROUND: The left internal thoracic artery (LITA) graft to the left anterior descending (LAD) artery became the gold standard graft in coronary surgery. Subsequently, the right internal thoracic artery (RITA) graft was increasingly used. However, there is still some debate about the optimal way of using this conduit. The aim of the present study was to assess our experience in grafting the pedicled RITA graft to LAD in 212 consecutive patients. METHODS: The records of 212 consecutive patients who underwent isolated coronary artery bypass grafting with the pedicled RITA graft to the LAD artery at Harefield Hospital between January 1998 and May 2001 were retrospectively reviewed. We approached the last 35 consecutive patients to obtain an angiographic control group. All 35 patients (16.5%) consented and, before discharge, underwent angiography to look at the quality of anastomoses and the patency of grafts. RESULTS: Successful catheterization and engagement of the RITA grafts was performed in 32 patients. Angiography showed that 32/32 (100%) of the RITA grafts were widely patent with excellent flow. The distal anastomoses of these RITA grafts were also satisfactory. There were no deaths among the study patients. CONCLUSIONS: Our results show that the use of the pedicled RITA graft to the LAD artery provides a good early clinical and angiographic outcome, and suggests that the pedicled RITA graft to the LAD artery is a good alternative to the pedicled LITA graft to the LAD artery.

Adult↗

PubMed2002

Mitral annulus distortion during beating heart surgery: a potential cause for hemodynamic disturbance--a three-dimensional echocardiography reconstruction study.

BACKGROUND: Positioning for access to the coronary arteries leads to hemodynamic instability during off-pump cardiac surgery. External changes have been well described, but a description of the intracardiac structures in humans has not been described. METHODS: With multiplane intraoperative echocardiography, the mitral annulus at end diastole was reconstructed in the different positions and correlated with hemodynamic changes in the right heart and left atrium. RESULTS: Significant distortion of the mitral annulus with enlargement of the left atrium and pulmonary veins was demonstrated, which correlated with high left atrial pressures. CONCLUSIONS: Mitral valve distortion can significantly contribute to hemodynamic instability during positioning for off-pump cardiac surgery.

Blood Pressure↗

PubMed2002

Effects of cerivastatin on vascular function of human radial and left internal thoracic arteries.

BACKGROUND: Statins may enhance vascular function independently of effects on cholesterol. This study investigated the ability of statins to modulate the vascular recovery of arteries used as coronary bypass grafts. METHODS: Specimens of radial artery and left internal thoracic artery were obtained during coronary artery bypass grafting. The specimens were divided into vascular rings, which were incubated in the absence or presence of cerivastatin (10(-6) mol/L) for either 2 or 24 hours. Using an organ bath technique, endothelial function was examined using acetylcholine (10(-9) to 10(-5) mol/L) after contraction by 3x10(-8) mol/L of endothelin-1. RESULTS: Time-related endothelial dysfunction was shown in the control group of radial artery but not in the cerivastatin group: maximal endothelium-dependent vasodilation in the control and cerivastatin groups were 56.8% +/- 10.2% and 65.9% +/- 10.1% at 2 hours and 39.4% +/- 4.7% and 68.4% +/- 5.0% (p < 0.01, vs control) at 24 hours, respectively. On the other hand, in the left internal thoracic artery, those in the control and cerivastatin groups were 38.3% +/- 8.2% and 45.0% +/- 5.5% at 2 hours and 38.1% +/- 8.2% and 56.5% +/- 8.8% at 24 hours, respectively (NS). CONCLUSIONS: In radial artery, cerivastatin significantly preserved endothelium-dependent vasodilation, which diminished with time in the control group. This could have very important implications in the clinical practice of coronary artery bypass grafting.

Adult↗

PubMed2002

Use of radial artery graft reduces the morbidity of coronary artery bypass graft surgery in patients aged 65 years and older.

BACKGROUND: The use of the radial artery graft in patients aged 65 years and older could prevent the occurrence of leg wound infection, which is known to increase the morbidity of coronary artery bypass grafting surgery. METHODS: We reviewed, retrospectively, 261 patients aged 65 years and older (age range 65 to 93 years), who underwent coronary artery bypass grafting surgery between February 1998 and August 2001. All the patients received at least one radial artery graft in addition to either a left internal thoracic artery, right internal thoracic artery, or saphenous vein graft as required. Saphenous vein grafts were used in 141 (54.1%) patients (group 1), and these were compared to 120 (45.9%) patients (group 2) who received only arterial conduits. Angiography was performed on 26 consecutive patients. The aim of the study was to review the clinical and angiographic outcomes in this population. RESULTS: The mean number of distal anastomoses performed was 2.98. Mean global operating time was 204 minutes. This time dropped to 201 minutes in group 1 versus 231 minutes in group 2; p = 0.009. Sixteen (11.3%) patients receiving saphenous vein grafts had leg wound infection whereas only 1 (0.3%) patient of the global population had a forearm infection. The mean global hospital stay was 9.81 days; this duration increased to 13 days when leg wound infection occurred versus 9.1 days when infection did not occur; p = 0.008. Twenty-six (10%) patients underwent an early angiographic study. Twenty-four (92.3%) radial artery grafts were patent. CONCLUSIONS: The routine use of radial artery grafts in patients aged 65 years and older is feasible, safe, and does not increase mortality, morbidity, or the complexity of coronary artery bypass grafting surgery.

Aged↗

PubMed2002

The early clinical and angiographic outcome of sequential coronary artery bypass grafting with the off-pump technique.

OBJECTIVE: The emergence of the off-pump coronary artery bypass technique has made surgeons consider combining it with other techniques developed and learned with conventional coronary artery bypass grafting with cardiopulmonary bypass. One of these techniques is the construction of a sequential graft to bypass more than one coronary vessel. The purpose of this study is to review the outcome of combining sequential coronary artery bypass grafting with off-pump techniques. METHODS: We retrospectively reviewed the records of 45 consecutive patients who underwent isolated coronary bypass surgery with off-pump and sequential grafting techniques at Harefield Hospital (Harefield, UK) between July 1999 and December 2000. The registry database, medical notes and charts were studied for preoperative and postoperative data of the patients. Ten patients consented and underwent early postoperative angiography to check the quality of the grafts and anastomoses. RESULTS: There were no deaths among the study patients. Morbidity consisted of atrial fibrillation in 6 patients (13.3%), leg wound infection in 2 patients (4.4%), and pleural effusion in 1 patient (2.2%). Early angiography of the 10 consenting patients revealed 10 patent sequential grafts (100%) with 20 satisfactory end-to-side and side-to-side anastomoses (100%). CONCLUSION: The combination of sequential grafting and off-pump techniques is feasible, is safe, and provides good early clinical and angiographic outcomes.

Adult↗

PubMed2002

Subsystem organ function during coronary surgery.

Conventional coronary artery bypass grafting (CABG) carries a mortality rate of 1% to 2% in elective patients. However, despite advances in perfusion, anaesthetic, and surgical techniques cardiopulmonary bypass (CPB) is still associated with subsystem dysfunction. Off-pump coronary artery bypass grafting (OPCAB) has recently gained popularity as a potentially more physiological method to maintain the functional integrity of major organ systems. The review of observational reports, case-matched studies and prospective randomized trials seems to suggest that OPCAB surgery reduces postoperative subsystem organ dysfunction when compared with conventional coronary revascularisation.

Animals↗