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Results for “Coronary revascularization”

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At least 19 recordsLinked to original sources
PubMed1978

Ventricular venting during coronary revascularization: assessment of benefit by intraoperative ventricular function curves.

Although the physiological benefits of left ventricular venting during cardiopulmonary bypass have been documented experimentally, air embolus is still a concern clinically, and surgeons, therefore, continue to debate whether or not to vent routinely during coronary revascularization. In this study, 10 patients vented during revascularization and 10 not vented were studied immediately before and after cardiopulmonary bypass using Sarnoff ventricular function curves to assess changes in ventricular performance. Stroke work index by each patient before and after bypass was compared at common left atrial pressures and concomitant similar systemic resistances. In patients who were vented, there was overall no change in function (98 +/- 7% of control; range, 146--73%). In patients who were not vented, there was overall significant depression of function (67 +/- 5% of control; range, 91--45%, p less than 0.01). The overall absence of depression in patients who were vented, several of whom had very poor ventricles before bypass, strongly supports venting for coronary revascularization.

Cardiopulmonary Bypass↗
PubMed1977

Coronary revascularization in patients maintained on chronic hemodialysis.

Thirty-two thousand patients are presently maintained in chronic dialysis programs. Cardiovascular complications have been shown to be responsible for 50 to 65% of the deaths in such patients. Despite this and the increasingly frequent use of coronary bypsss surgery in the general population, only two patients have previously been reported to have successfully undergone coronary bypass surgery while maintained on chronic hemodialysis. This reports two additional such patients who successfully underwent coronary revascularization without difficulty. Pertinent details of preoperative, intraoperative, and postoperative management are outlined for these patients and the other 13 chronic dialysis patients who have had cardiopulmonary bypass for other reasons. With careful planning, coronary revascularization can be successfully carried out in this group of patients with minimally increased operative risk.

Coronary Artery Bypass↗
PubMed1977

Thallium-201 myocardial imaging before and after coronary revascularization: assessment of regional myocardial blood flow and graft patency.

Twenty patients underwent myocardial imaging with Thallium-201 (201Tl) before and subsequent to coronary artery bypass grafting. All patients had rest and maximal treadmill exercise imaging postoperatively. Eleven of the 20 patients had rest and exercise 201Tl images preoperatively; 9/20 only had rest imaging preoperatively. Postoperative regional exercise perfusion was improved in seven of the 11 patients who had preoperative exercise images, and was associated with regional graft patency in each case. Thirteen of 20 patients showed no new defect with postoperative exercise imaging. The remaining seven patients developed or had an increased defect with exercise. The patients with no new perfusion defects during postoperative study has 26/30 grafts patent (87%). Patients developing a new perfusion defect with exercise had fewer grafts patent (7 of 13 [54%]; P less than 0.03). In these seven cases, a new exercise-induced defect was associated with regional graft closure or residual nonoperated disease. Knowledge of the preoperative coronary anatomy allowed the distinction between ungrafted areas and regional graft dysfunction. We conclude that preoperative and postoperative 201Tl imaging may noninvasively predict graft closure and/or improved regional perfusion with patent grafts.

Angina Pectoris↗
PubMed1978

Potassium-induced cardioplegia. Additive protection against ischemic myocardial injury during coronary revascularization.

Potassium-induced cardioplegia during anoxic arrest was utilized in a study of 190 consecutive patients undergoing revascularization (average 2.8 grafts per patient) from August, 1975, through August, 1976. Surgical technique, moderate systemic hypothermia with intermittent anoxic arrest, and the surgeon were the same for all patients. One hundred thirty-five patients (KC1-treated) received a bolus (150 ml.) of potassium solution injected into the proximal aortic root whenever the aortic cross-clamp was applied; 55 others served as control subjects. The mortality rate was 2.2% (three of 135) in the KCl-treated group and one of 55 in the control group. New Q waves appeared in 5.9% (eight of 135) of the KCl-treated patients and 11% (6 of 55) of control subjects (p = N.S.). Catecholamine drips were required after bypass in 4.4% (six of 135) of patients given potassium and 18% (10 of 55) of control patients (p less than 0.05). Profound myocardial relaxation was of added technical value with potassium. It is our impression that hearts treated with potassium exhibited more prompt cardioversion, separated from cardiopulmonary bypass with less need for inotropic support, and exhibited less myocardial injury during the revascularization procedure.

Cardiopulmonary Bypass↗
PubMed1979

Indices of myocardial oxygenation during coronary-artery revascularization in man with morphine versus halothane anesthesia.

A prospective study in 12 adult male patients undergoing coronary-artery revascularization was conducted to compare the effects of a morphine versus a halothane anesthetic technique on several indices of myocardial oxygen supply and demand. Indices reflecting myocardial contractility, preload, afterload, and heart rate were measured. Undesirable increases in systemic and pulmonary capillary wedge pressure were minimized using sodium nitroprusside as needed. In the period after sternotomy but before revascularization, patients anesthetized with morphine (mean 2.1 mg/kg) had significant (P less than .05) increases in rate-pressure product, tension-time index, blood pressure, and heart rate, as well as relative myocardial ischemia, evidenced by significant ST-segment depression in the V5 lead of the EKG and a decreased diastolic pressure-time index/tension-time index compared with patients anesthetized with halothane (mean .75 per cent inspired). Few difficulties associated with myocardial depression were seen in patients anesthetized with halothane. Halothane, at least in a well-monitored environment, is safe for use in patients without severe ventricular dysfunction undergoing coronary-artery revascularization.

Anesthesia, General↗
PubMed1978

Aorta--coronary artery revascularization with an expanded polytetrafluoroethylene vascular graft. A preliminary report.

Patients requiring coronary artery surgery may have had bilateral saphenous vein stripping, and the arm veins may not be adequate for use for coronary artery grafting. The internal mammary artery may not be long enough for use for the circumflex or right coronary artery anastomoses. A suitable substitute would be most welcome for these patients or for those with marked varicosities of the saphenous vein. Five patients received expanded polytetrafluoroethylene (PTFE) grafts (Gore-Tex vascular grafts) for coronary artery revascularization because veins of adequate size or length were not available at the time of operation. These five patients are alive 9 to 14 months after graft insertion. Four of the five grafts were patent at the time of restudy 3 to 6 months postoperatively. More follow-up studies for far longer periods of time will be necessary before Gore-Tex vascular grafts can be recommended as the ideal material for coronary artery bypass surgery.

Adult↗
PubMed1978

Pre- and postoperative pulmonary function abnormalities in coronary artery revascularization surgery.

Pulmonary function studies were conducted one to two days prior to, two weeks after, and an average of 116 days after coronary artery revascularization surgery. Preoperation it was found that 11 of 19 patients had mild to moderate obstruction, 8 of 17 had diffusing capacity less than 80 percent of predicted, and 9 of 17 had mild hypoxemia. Many of these abnormalities seemed related to smoking. After surgery, significant reductions in volumes, diffusion and PaO2 were found at two weeks. By the last study, there was improvement in volumes and diffusion, but they remained significantly reduced in comparison to preoperative levels. Arterial oxygen tension (PaO2) had returned to preoperative levels. Correction of diffusion for volume showed there to be no change in any of the study periods suggesting chest wall alteration is a major component of the abnormality. It is concluded that close monitoring of pulmonary function is indicated before and after operation in this patient population even if the patient is asymptomatic.

Carbon Monoxide↗
PubMed1979

Emergency coronary artery revascularization: a possible therapy for acute myocardial infarction.

Cardiac muscle death caused by coronary artery occlusion is a dynamic process that often takes hours or days. Emergency revascularization (saphenous vein bypass graft (SVBG) during acute myocardial infarction (MI) can interrupt myocardial necrosis, salvage ischemic myocardium and revascularize vessels with obstructive lesions not involved in the MI. In this report we describe a preliminary experimental study of 75 patients in which emergency SVBG was the therapy for acute MI. Group 1, 16 patients, required vasoactive medications and/or intraaortic balloon pumping to maintain their blood pressure preoperatively. There was one operative death and two late deaths. Group 2 consisted of 59 hemodynamically stable patients. There were no deaths. The average preop CPK in group 1 was 892 vs 504 in group 2 (p greater than 0.05). Surgical techniques were routine. The average time from the onset of chest pain that continued to surgery was 6.5 hours. Forty patients were restudied. Post- vs presurgical hemodynamics revealed ejection fraction increased by 34% (p greater than 0.05), left ventricular end-diastolic pressure reduced by 40% (p greater than 0.01). End-systolic and end-diastolic volume reduced by 30% (p greater than 0.05), and 15% (p greater than 0.01), and stroke volume improved 25% (p greater than 0.05). Operative mortality was 1.3% and late mortality 2.8%. These results suggest that cautious continued trial of emergency SVBG in patients with evolving MI is warranted.

Acute Disease↗
PubMed2026

Complete Revascularization Guided by Functional Coronary Angiography in STEMI.

BACKGROUND: Complete coronary-artery revascularization is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, but the preferred strategy for identifying nonculprit lesions that warrant treatment remains uncertain. METHODS: In this international, randomized trial, we assigned patients with STEMI and multivessel disease in whom the culprit lesion had been successfully treated to undergo complete coronary-artery revascularization guided by functional coronary angiography (physiology-guided group) or by conventional angiography (angiography-guided group). The primary outcome was a composite of death from any cause, myocardial infarction, cerebrovascular accident (stroke or transient ischemic attack), or ischemia-driven revascularization, assessed in a time-to-event analysis. The primary safety outcome was a composite of contrast-associated acute kidney injury or major bleeding. RESULTS: A total of 1823 patients underwent randomization; 913 were assigned to the physiology-guided group and 910 assigned to the angiography-guided group. The median age of the patients was 66 years (interquartile range, 58 to 76), and 24% were women. At a median follow-up of 17.9 months, a primary-outcome event had occurred in 81 patients (8.9%) in the physiology-guided group and in 125 patients (13.7%) in the angiography-guided group (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.83; P<0.001). A primary-safety-outcome event occurred in 42 patients (4.6%) in the physiology-guided group and in 65 patients (7.1%) in the angiography-guided group (hazard ratio, 0.63; 95% CI, 0.43 to 0.93; P&#x2009;=&#x2009;0.02). CONCLUSIONS: In patients with STEMI and multivessel coronary artery disease, a strategy of complete coronary-artery revascularization guided by functional coronary angiography resulted in a lower risk of a primary-outcome event (death, myocardial infarction, cerebrovascular accident, or ischemia-driven revascularization) than a strategy guided by conventional angiography. (Funded by the Italian Health Ministry and others; AIR-STEMI ClinicalTrials.gov number, NCT05818475.).

Aged↗
PubMed1977

A planned approach to coexistent cerebrovascular disease in coronary artery bypass candidates.

Of a series of 874 consecutive candidates for coronary artery bypass screened for cerebrovascular disease, 49 (5.6%) were found to have significant extracarnial lesions. Combined surgical management of both carotid and coronary artery lesions was then undertaken, using a planned approach based on clinical and angiographic criteria. Cerebrovascular reconstruction was undertaken prior to establishment of cardiopulmonary bypass, utilizing staged procedures in good-risk and simultaneous reconstruction in poor-risk candidates. Our experience indicates that combined surgical treatment of the patient with unilateral carotid obstruction and coronary disease is attended by no greater risk than that attached to coronary revascularization alone. The coronary bypass candidate with bilateral carotid artery disease represents a more advanced clinicopathological state whose treatment is attended by greater risk of operative morbidity and mortality.

Aged↗