Risk factors for radial artery harvest site infection following coronary artery bypass graft surgery.

Radial arteries increasingly are used during coronary artery bypass graft (CABG) surgery. Although risk factors for saphenous vein harvest site infection (HSI) have been reported, rates of and risk factors for radial artery HSI are not well established. We compared rates of radial artery HSI that were detected by 2 surveillance methods, regular and heightened. Risk factors were determined by a case-control study. We identified 35 radial artery HSIs ("case sites") in 26 case patients. The radial artery HSI rate was significantly higher during heightened surveillance than during routine surveillance (12.3% vs. 3.1%, respectively; P=.002). Multivariate analysis showed that diabetes mellitus with a preoperative glucose level >/=200 mg/dL (odds ratio [OR], 4.4; P=. 01) and duration of surgery >/=5 h (OR, 3.1; P=.02) were independent risk factors for radial artery HSI. Infection is a common complication of radial artery harvesting for CABG surgery, and infection rates are dependent on the intensity of surveillance. We identified preoperative hyperglycemia and surgery duration as independent risk factors for radial artery HSI.     

Preoperative and late postoperative psychosocial state following coronary artery bypass surgery.

In a prospective study of psychological and neurological reactions to coronary artery bypass surgery, 45 patients were examined preoperatively, postoperatively, and 21 to 27 months after, using a variety of neurological, psychiatric, and psychological investigations. Within the follow-up sample, three subgroups of patients could be identified by cluster analysis who differed with respect to their emotional status and life satisfaction. One group (24% of the total sample) was characterized by high levels of anxiety, depression and life dissatisfaction and appears as a risk population. The other groups could be described as either average (42%) or stable (33%). At the follow up, the risk group further indicated a preference for depressive coping styles, a slightly higher degree of cognitive impairment, more neurological and psychopathological symptoms (specifically giving-up and hostility), a considerably lower return-to-work rate, more subjective physical complaints and a poorer attitude toward the outcome. While postoperative measurements (obtained 2-3 and 6-8 days after surgery) as well as intraoperative parameters did not reveal significant group differences, the analysis yielded an increased impairment within the risk group already prior to surgery, especially emotional problems, specific health-related cognitions and a more fatalistic attitude. The results are in line with those of other studies investigating the late postoperative psychological status with regard to the proportion of patients showing psychological impairments as well as to their specific psychological characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)     

Vectorcardiographic changes following coronary artery bypass surgery

Myocardial infarction (MI) has been reported to occur in about 15 per cent of patients following coronary artery bypass (CAB) surgery. Preoperative and postoperative electrocardiograms (ECG) were evaluated in 85 patients. Thirty-four of these patients also had pre- and postoperative vectorcardiograms (VCG). Fifteen additional patients undergoing open heart surgery were used as controls. These included aortic valve replacement (in 4), mitral valve commissurotomy (in 6), mitral valve replacement (in 1), atrial septal defect repair (in 3), and repair SVC to LA shunt (in 1). Pre- and postoperative VCG's were analyzed in three planes. The angle of each 10 msec. vector was measured. The maximal voltage was determined along each axis in each plane. Mean changes in these parameters were determined for the controls. Change exceeding two standard deviations from the control mean was considered abnormal and not explainable by trauma of open heart surgery itself. Excluding the six intraoperative deaths, $\text{19}\text{79}$ (24 per cent) had QRS changes of myocardial infarction by ECG. Changes were considered significant in the postoperative VCG if they occurred in at least two consecutive angles in one plane or in the maximum voltage in one axis. The postoperative VCG depicted MI in 34 per cent ($\text{12}\text{34}$). In the absence of classic criteria for MI a significant change in VCG angle occurred in 26.4 per cent ($\text{9}\text{34}$). The voltage in at least one axis changed significantly in 11.8 per cent ($\text{4}\text{34}$). A change in the postoperative VCG was demonstrated in 73.5 per cent ($\text{25}\text{34}$). The pre- and postoperative VCG is a sensitive method of detecting subtle changes in conduction or loss of myocardium seen in the majority of patients following CAB surgery.     

Cardiac rehabilitation following coronary artery bypass surgery

Early expectations of coronary revascularization prolonging life and reducing coronary events have been modified by 15 years' experience to mostly initial palliation of ischemic symptoms. Bypass surgery represents only a single therapeutic aspect for coronary atherosclerosis. Technically successful operations often fail miserably without overall risk factor alteration and functional capacity optimization which progressive exercise initiates during the postoperative period. Regular activity program participation improves physical conditioning, raises the symptom-limited exertional level, lessens post surgical musculoskeletal discomfort, and improves morale. Yet exercise alone without comprehensive secondary prevention and risk factor modification will be no more successful at arresting atherosclerosis than any other single measure. Both operative intervention and vigorous exertion are valuable components of coronary artery disease therapy, but must be part of an all-embracing effort. Whether regular exertion combined with overall risk factor modification will prolong life and reduce future cardiac events or beneficially alter the process of atherogenesis remain areas of avid investigation.     

Video-assisted thoracic surgery for hemothorax following coronary artery bypass

A 56-year-old man complained of dyspnea and cough 9 days after coronary artery bypass grafting. Chest radiography showed opacity and left lung collapse. Following removal of clots from the pleural cavity by videothoracoscopy, he recovered without further incident. Video-assisted thoracic surgery is a feasible and safe option in the management of early hemothorax.     

Central cyanosis following coronary artery bypass graft surgery

A case of central cyanosis occurring after coronary artery bypass graft surgery is described. This was due to the development of a right ventricular infarction which facilitated shunting from right to left through a previously undiagnosed patent foramen ovale or small atrial septal defect.     

Physiologic improvement following coronary artery bypass surgery.

In this study the effects of coronary artery bypass surgery on ventricular function were evaluated at rest by quantitative analysis of segmental wall motion on cineventriculography, and during maximal treadmill exercise by measurement of serial cardiac outputs (Fick method) with the use of indwelling pulmonary artery and radial artery catheters. The patient had single vessel coronary disease and exertional angina. Following placement of a bypass graft to the proximally occluded left anterior descenting coronary artery, and despite the presence of arterial hypoxemia secondary to interstitial pulmonary fibrosis, a striking increase in maximal cardiac output occurred, mediated by a rise in both maximal heart rate and stroke volume. In this patient, resting ventricular volumes and ejection fraction were normal both before and after surgery, but preoperative abnormalities in extent of segmental wall motion, identified quantitatively, were restored to normal after bypass grafting. These investigations indicate that bypass surgery can provide substantial physiologic benefits in addition to providing subjective relief of anginal symptoms.     

Incidence of erysipelas following venectomy for coronary artery bypass surgery

Summary The incidence of erysipelas in extremities used for saphenous vein donation was evaluated by interviewing 302 patients who had undergone coronary artery bypass surgery. Erysipelas occurred in 6.2% of patients, and was twice as common as in patients with a history of varicose vein stripping. The difference, however, was not statistically significant.

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Inzidenz von Erysipel nach Entnahme von Venen für die Koronararterien-Bypassoperation

Zusammenfassung Durch Befragung von 302 Patienten nach Koronararterien-Bypassoperationen wurde die Inzidenz von Erysipel nach Entnahme von Vena saphena bestimmt. Bei 6,2% der Patienten trat an der entsprechenden Extremität ein Erysipel auf, dies ist zweimal so häufig wie bei Patienten, bei denen ein Stripping variköser Venen durchgeführt wurde. Der Unterschied ist jedoch nicht statistisch signifikant.

     

桡动脉在冠状动脉旁路移植术中的应用(附18例报告)

目的　总结以桡动脉为旁路移植物的冠状动脉旁路移植术中的桡动脉制备方法和早期结果。方法　对 18例患者以桡动脉行冠状动脉旁路移植术。术前以改良 Allen试验评判桡、尺动脉通畅性。术中上肢外展 90°,肘窝以远 3cm至腕关节线内 2 cm做弧形皮肤切口 ,将桡动脉连同伴行静脉和脂肪组织一并游离。分支以钛夹夹闭。严格避免夹镊桡动脉本身。离断后腔内注入肝素化罂粟碱 ,并置于该液中备用。共制取桡动脉 18根。远端吻合至后降支及钝缘支 ,近端均吻合至主动脉。术后常规应用钙阻滞剂 12个月。结果　术后患者心绞痛消失 ,心功能显著改善。无手臂缺血发生 ,未见围术期心肌梗死。结论　应用桡动脉行冠状动脉旁路移植术简便、安全 ,手术效果好。严格的“免触”制备技术和术后应用钙通道阻滞剂是保证桡动脉良好功能的关键     

Determinants of discharge following coronary artery bypass graft surgery

The optimal time for discharge following coronary artery bypass graft (CABG) surgery is uncertain and varies among institutions. This study was undertaken to determine what factors may discriminate between early and late discharge following surgery. In 177 consecutive patients undergoing isolated CABG procedures, three groups were formed retrospectively according to the number of days hospitalized post CABG: group 1, less than or equal to 8; group 2, 9 to 11; group 3, greater than or equal to 12. Parameters found to discriminate between group 1 and group 3 (p less than .05; chi square analysis) included female sex, unstable angina, congestive heart failure (CHF), age greater than or equal to 65 years, and the development of major postoperative complications. Angina class, prior myocardial infarction, extent of coronary artery disease, aortic cross-clamp time, number of bypass grafts, ejection fraction less than 40 percent, or "minor" postoperative complications were not different among groups. Patients discharged less than or equal to 8 days following CABG had no increase in return visits or readmissions less than 60 days post CABG. We conclude that while certain patients can be safely discharged less than or equal to 8 days post CABG, patients who are female, greater than or equal to 65 years, have unstable angina, CHF, or a major postoperative complication are likely to be hospitalized longer.     

Acute ischemic syndromes following coronary artery bypass graft surgery

Coronary artery bypass graft (CABG) surgery, performed for the control of angina pectoris, leads to postoperative relief from symptoms in most patients. Amelioration of ischemia and improvement in exercise capacity after CABG are well documented. However, patients currently undergoing CABG are more complex than in the past—they are older and are maintained on medical therapy for longer periods. A large number of these patients have had one or more previous myocardial revascularization procedures. The postoperative period would appear to be a time of vulnerability for coronary events. However, previous investigators have focused on the pre- and intraoperative aspects of peri-CABG ischemia. Outcome data suggest that the postoperative interval is at least equally important as a determinant of short- and long-term morbidity and mortality. We discuss the epidemiology, etiology, pathophysiology, and treatment of ischemic syndromes in the postoperative period after CABG. In addition, we review recent data from a series of 14 patients, observed at our institution, who underwent cardiac catheterization and, in some cases, angioplasty of the culprit vessel in the immediate postoperative period.     

Primary angioplasty in patients following coronary artery bypass surgery

Objectives : We aimed to study the trends in management and outcome of post CABG patients presenting with acute MI. Background: Primary angioplasty is the treatment of choice in patients with acute myocardial infarction. Saphenous vein grafts used for CABG are large‐diameter conduits that tend to accumulate a large mass of thrombus when they are the culprit artery for acute myocardial infarction (MI). We hypothesized that performing PCI in these patients is more complex and possibly results in worse outcome compared to non‐CABG patients. Methods : Data for patients with STEMI was obtained from five acute coronary syndromes Israeli biennial Surveys (ACSIS) during 2000–2008. Baseline characteristics, management and outcome of post‐CABG patients were compared to non‐post CABG patients during 2006–2008 surveys. Results : A total of 9,781 patients were included. About 1,002 (10.2%) were post‐CABG. Reperfusion therapy for post‐CABG patients (34–48%) was consistently lower compared to non‐CABG patients (57–65%). Angiographic outcome in patients with STEMI who underwent primary PCI (17 post‐CABG, mean age 66.6 ± 9.1 and 821 non‐CABG, age 60.1 ± 12.9) was successful (TIMI flow 3) in 86 and 88%, respectively. Thirty‐day mortality was 5.9 and 5.1% (P = 0.89) and MACE rates were 17.6 and 12.5%, respectively (P = 0.54). Conclusions : Use of primary PCI in post‐CABG patients was lower than in non‐CABG patients but increased steadily and to a similar extent in both groups. Angiographic and clinical outcome was similar despite assumingly larger thrombus burden in post CABG patients. Therefore, primary angioplasty is appropriate also in post‐CABG patients presenting with STEMI. © 2011 Wiley‐Liss, Inc.     

Total inferior vena cava thrombosis following coronary artery bypass surgery

A 44-yr-old male presented with abdominal and back pain following coronary bypass surgery (CABG). Total inferior vena cava (IVC) thrombosis was then documented by computed tomography as well as IVC contrast cineangiography. Furthermore, the patient developed multiple pulmonary emboli. This presentation with severe abdominal and back pain with lack of early peripheral edema without apparent hepatic or renal dysfunction and with extreme elevation of erythrocyte sedimentation rate seems rather unusual. To our knowledge, such massive IVC thrombosis has not been reported following CABG. Thrombolytic and anticoagulant therapy was utilized with good recovery.