Bilateral renal artery stenosis/occlusion and renovascular hypertension. Correlation of angiographic findings with blood pressure response after surgery

In a previous study of unilateral renal artery stenosis the angiograms of patients with a favourable blood pressure response after surgery were found to be characterized by a reduction of renal arterial lumen greater than or equal to 90% and/or renal collateral circulation. Ancillary features were post-stenotic dilatation and a reduction of kidney length greater than or equal to 1 cm (Andersson; Andersson, Bergentz, Dymling, Ericsson, Hansson & H?kfelt). This report deals with 32 patients with bilateral renal artery stenosis who were followed 6--54 months after operation. The preoperative angiograms were analysed retrospectively without knowledge of the blood pressure response. In patients with bilateral fibromuscular dysplasia a good correlation was found between the above-mentioned criteria and a favourable blood pressure respone. In patients with bilateral arteriosclerotic stenosis no correlation was found. It was concluded that renal angiography constitutes a valuable predictive test in bilateral non-arteriosclerotic stenosis. In the presence of bilateral arteriosclerotic stenosis the selection of patients for surgery should be based on other parameters such as kidney function, age and general vascular status of the patient.     

Intraoperative measurement of pharynx/esophagus retraction during anterior cervical surgery. Part I: pressure

Temporary dysphagia after anterior cervical discectomy (ACD) is common. However, its mechanism is poorly understood. Pressure induced by retractor blades onto pharynx/esophagus were measured intraoperatively in order to gain more information regarding traumatization of the pharynx/esophagus wall. Thirty-one patients underwent anterior cervical discectomy and fusion (ACDF) for degenerative disc disease. An online pressure transducer was applied to the rear side of the medial retractor blade (epi-esophageal-pressure, epi-P) and a cylindric, inflatable transducer was preoperatively inserted into the pharynx/esophagus under fluoroscopic guidance at the level to be operated on (endo-esophageal-pressure, endo-P). Pressure values were recorded continuously during the operation. Mean arterial pressure (MAP) and endotracheal cuff pressure (ETCP) were recorded additionally. An in vitro model was developed in order to analyze the impact of the retractor blade design onto the epi-esophageal-pressure. Mean epi-P before and following adequate retractor opening for exposure of the disc space was 58.3 and 92.7 mmHg. Thirty, 60 and 90 min later the epi-P decreased to 79, 70 and 66%, respectively. Mean basal endo-P was 9.8 mmHg and increased to 20.6 mmHg after retractor placement. Thirty, 60 and 90 min later the endo-P decreased to 80, 71 and 62%, respectively. The mean MAP was 76 mmHg and the ECTP was adjusted to 25 mmHg during the procedures. In the in vitro model retraction pressure correlated inversely with the contact area between visceral wall and retractor blade. During ACDF the retraction pressure onto the pharyngeal/esophageal wall exceeds MAP and even more the mucosal perfusion pressure of 25 mmHg. Over time the pharynx/esophageal wall adapts to the applied pressure induced by the retractor blade. The contact area between them influences the retraction pressure.Part II of this article can be found under http://dx.doi.org/10.1007/s00586-006-0070-7     

Use of balloon occlusion and substances to protect ischemic brain during resection of posterior fossa AVM. Case report

The successful resection of a large posterior fossa arteriovenous malformation (AVM) is reported. A balloon catheter was used for temporary intraoperative occlusion of the basilar artery and feeding vessels of the AVM. Prior to occlusion of these arteries, newly tested substances to protect the ischemic brain were administered to prolong occlusion time. Resection of the AVM was completed without complication, and the patient returned to normal life. This is a useful intraoperative procedure for the resection of AVM's considered inoperable by conventional approaches.     

Chiari畸形Ⅰ型患者小脑扁桃体下疝程度及脊髓空洞形态与后颅窝容积的相关性

目的:分析Chiari畸形Ⅰ型(Chiari malformation typeⅠ,CMⅠ)患者小脑扁桃体下疝程度及脊髓空洞形态与后颅窝线性容积的关系,探讨影响小脑扁桃体下疝程度的后颅窝解剖学因素。方法:2003年6月~2011年6月在我科接受治疗并符合入选标准的CMⅠ患者共59例,男34例,女25例,年龄16~20岁,平均17.9岁,Risser征5级,均有完整MRI资料(包括头枕部及全脊髓矢状面扫描图像);均无颅内占位性病变、颅骨破坏、后颅窝手术史或获得性Chiari畸形。均伴有不同形态的脊髓空洞,55例(93.2%)伴有不同程度的脊柱侧凸畸形。在MRI T1加权像正中矢状位扫描层面上评估患者的小脑扁桃体下疝程度和脊髓空洞类型;测量后颅窝斜坡长度、枕骨大孔前后径、枕骨鳞部长度、后颅窝矢状径、后颅窝高径和斜坡倾斜角。将CMⅠ患者按照小脑扁桃体下疝严重程度分为三度:Ⅰ度,小脑扁桃体下缘超过枕骨大孔水平5mm但没有到达C1后弓上缘;Ⅱ度,小脑扁桃体下缘尾向移位超过C1后弓上缘但未超过C1后弓下缘;Ⅲ度,小脑扁桃体下缘尾向移位超过C1后弓下缘。依据脊髓空洞类型分为膨胀型、念珠型、细长型和局限型四组。比较不同组间后颅窝线性容积的差异,并对相关指标进行相关性分析。结果:Ⅰ度扁桃体下疝CMⅠ患者的后颅窝斜坡长度明显大于Ⅱ、Ⅲ度扁桃体下疝CMⅠ患者(P<0.05),Ⅲ度扁桃体下疝患者的斜坡倾斜角较Ⅰ、Ⅱ度患者明显减小(P<0.05),其余指标三组间无显著性差异;CMⅠ患者的斜坡倾斜角与小脑扁桃体下疝程度之间存在显著性负相关关系(r=-0.626,P=0.005)。膨胀型脊髓空洞患者的斜坡倾斜角显著小于其他类型的脊髓空洞患者(P<0.05),其余指标各类型之间无显著性差异。结论:后颅窝斜坡短平可能是促使CMⅠ患者小脑扁桃体下疝加重的重要因素之一,同时对CMⅠ患者的脊髓空洞的形成和发展也存在影响。     

Improvement in the results of the simple-foot-tapping test and cross-sectional area of the dural sac in patients with C5 palsy after posterior cervical spine surgery

European Journal of Orthopaedic Surgery & Traumatology - The smaller cross-sectional areas of the dural sacs in patients without C5 palsy after posterior cervical spine surgery may lead to less...     

The fate of autogenous free-fat grafts after posterior lumbar surgery: part 2. Magnetic resonance imaging and histologic studies in repeated surgery cases

STUDY DESIGN: Histologic changes of free-grafted fat were investigated from surgical specimens taken at repeated lumbar surgery in 18 patients with degenerative spinal disease who previously had undergone posterior lumbar decompression and free fat graft. OBJECTIVE: To clarify the clinical usefulness of free-grafted fat by histologic analysis. SUMMARY OF BACKGROUND DATA: The clinical postoperative serial magnetic resonance imaging studies in Part 1 showed that the size of grafted fat was reduced, and that the shape changed along with the shape of the dura mater. The shape of the grafted fat was remodeled in relation to the postoperative transient shrinkage and reexpansion of the dura mater. METHODS: From repeated surgery cases, the status of the previously grafted fat tissue in the virgin operation was analyzed. Sections from the specimens resected surgically during repeated surgery were stained with hematoxylin and eosin or osmium. The size and quality of the grafted fat globules were analyzed by computer. RESULTS: In all cases, grafted fat tissue was identified as a survival. Hematoxylin and eosin staining showed increased collagen fiber and hyperplasia of blood vessels entering the fat tissue that survived. From osmium staining, the size of fat globules was reduced. The shape and quality of the fat globules were analyzed by original staging. They showed various sizes, polymorphism, and vacuolar degeneration. CONCLUSIONS: Finding showed that the grafted fat used in posterior lumbar surgery reduced the size and quality of the fat globules, as compared with normal fat tissue. However, the grafted fat tissues were confirmed to be alive over the long term. This study clarified the fate of the grafted fat as observed by magnetic resonance imaging and histology from repeated surgery cases.     

Venous air emboli occur during release of positive end-expiratory pressure and repositioning after sitting position surgery.

We studied the effect of positive end-expiratory pressure (PEEP) release and positioning on the occurrence of venous air embolism (VAE). Eighteen consecutive patients (8 women, 10 men; ASA grade I-III) undergoing neurosurgery in the sitting position were studied. After induction of anesthesia ventilation was controlled with a PEEP of 5 cm H(2)O in an oxygen-air gas mixture. A transesophageal echocardiographic (TEE) probe was inserted. Preoperatively, a patent foramen ovale was excluded in all patients. TEE monitoring was performed during surgery, during PEEP release at the end of surgery with the patient still in the sitting position, and during change of the patient position into the supine position. The severity of VAE was differentiated as follows: grade 1 = only microbubbles; grade 2 = microbubbles and decrease of end-tidal carbon dioxide partial pressure (PETCO(2)) by more than 1.5 mm Hg; grade 3 = microbubbles combined with a decrease of PETCO(2) by more than 1.5 mm Hg, and a decrease of mean arterial blood pressure by at least 20 mm Hg. During surgery, VAE with a grade of 1, 2 or 3 occurred in 7, 4, and 2 patients, respectively. After PEEP release, VAE of grades 1, 2, and 3 were observed in 7, 2, and 1 patients, respectively. During repositioning from sitting to supine position, VAE of grades 1, 2, and 3 was observed in 6, 1, and 1 patients, respectively. The patient with VAE grade 3 needed inotropic support until 2 h after surgery to maintain sufficient blood pressure. No patient showed any sign of paradoxical arterial embolism or cardiac dysfunction. We conclude that VAE occurs not only during surgery in the sitting position, but also with release of PEEP and during repositioning to the supine position. IMPLICATIONS: This study shows that venous air embolism (VAE) occurs not only during surgery in the sitting position but also during positive end-expiratory pressure release and repositioning of the patient into the supine position. Continuous monitoring for VAE should be performed until the patient is returned to the supine position.     

Evaluation of buttock claudication with hypogastric artery stump pressure measurement and near infrared spectroscopy after abdominal aortic aneurysm repair.

OBJECTIVE: We explored the usefulness of intraoperative measurement of hypogastric artery (HGA) stump pressure (HGA-SP) and postoperative near infrared spectroscopy (NIRS) in evaluating buttock claudication (BC) after abdominal aortic aneurysm (AAA) repair. DESIGN: Retrospective clinical study. PATIENTS AND METHODS: Twenty patients who were undergoing AAA repair were enrolled. The HGA was ligated bilaterally in 5 patients, unilaterally in 12, and preserved in 3. The HGA-SP was measured intraoperatively. Postoperatively, NIRS was used to evaluate buttock muscle ischemia during walking. RESULTS: Six patients had unilateral and 1 bilateral BC after AAA repairs. The median HGA-SP brachial pressure index (HBI) was 0.62 (range: 0.45-0.64) in 8 claudicating buttocks and 0.76 (range: 0.63-0.90) in 13 asymptomatic buttocks (p < 0.0005). The HBI was <0.65 in all claudicating buttocks, whereas it was >0.63 in asymptomatic buttocks. In all 8 claudicating buttocks, NIRS showed the ischemic pattern with recovery time lasting more than 240 s. CONCLUSIONS: An HBI below 0.65 may be a predictor of BC after AAA repair. NIRS appears to be a useful noninvasive method for evaluating BC after AAA.     

The association of hypotension during non‐cardiac surgery,before and after skin incision,with postoperative acute kidney injury: a retrospective cohort analysis

Intra‐operative hypotension is associated with acute postoperative kidney injury. It is unclear how much hypotension occurs before skin incision compared with after, or whether hypotension in these two periods is similarly associated with postoperative kidney injury. We analysed the association of mean arterial pressure < 65 mmHg with postoperative kidney injury in 42,825 patients who were anaesthetised for elective non‐cardiac surgery. Intra‐operative hypotension occurred in 30,423 (71%) patients: 22,569 (53%) patients before skin incision; and 24,102 (56%) patients after incision. Anaesthetised patients who were hypotensive had mean arterial pressures < 65 mmHg for a median (IQR [range]) of 5.5 (0.0–14.7 [0.0–60.0]) min.h^?1 before skin incision, compared with 1.7 [0.3–5.1 [0.0–57.5]) min.h^?1 after incision: a median (IQR [range]) of 36% (0%–84% [0%–100%]) of hypotensive readings were before incision. We diagnosed postoperative kidney injury in 2328 (5%) patients. The odds ratio (95%CI) for acute kidney injury was 1.05 (1.02–1.07) for each doubling of the duration of hypotension, p < 0.001. Postoperative kidney injury was associated with the product of hypotension duration and severity, that is, area under the curve, before skin incision and after, odds ratio (95%CI): 1.02 (1.01–1.04), p = 0.004; and 1.02 (1.00–1.04), p = 0.016, respectively. A substantial fraction of all hypotension happened before surgical incision and was thus completely due to anaesthetic management. We recommend that anaesthetists should avoid mean arterial pressure < 65 mmHg during surgery, especially after induction, assuming that its association with postoperative kidney injury is, at least in part, causal.     

Treatment of hemorrhagic hypotension with hypertonic/hyperoncotic solutions: effects on regional cerebral blood flow and brain surface oxygen tension.

Hypertonic/hyperoncotic solutions (e.g. HHS: 7.2% NaCl/10% dextran-60) are highly effective to normalize cardiovascular function in hemorrhagic shock due to rapid mobilization of fluid from the extravascular compartment. Since experiences are limited with regard to potential side effects of this treatment on the central nervous system, the present studies were carried out under particular consideration of the cerebral blood flow and O2 supply. HHS was administered in albino rabbits subjected to alpha-chloralose anesthesia and artificial ventilation with and without hemorrhagic hypovolemia. Hemorrhagic hypovolemia of 30 min duration was induced by withdrawal of approximately one third of the circulating blood volume resulting in a decrease in arterial blood pressure to 40 mm Hg. HHS was studied in addition to normovolemic animals. Cardiac output was rapidly normalized by infusion of HHS in animals with hypovolemia, while it increased intermittently in normovolemic animals. In animals with hemorrhagic shock arterial blood pressure recovered by treatment to approximately 70% of normal, whereas blood pressure remained unchanged after infusion of HHS in normovolemic controls. Cerebral blood flow, which was assessed by H2 clearance at the brain surface, had a range of 43.0-50.3 ml/100 g/min under control conditions. It remained virtually unchanged during hemorrhagic hypovolemia and also after infusion of HHS in normovolemic animals. Treatment of shock by HHS was followed 90 or 120 min later by a moderate increase in regional cerebral blood flow to 61 ml/100 g/min. Local tissue PO2 at the brain surface was obtained by an O2 multiwire electrode in the vicinity of the H2 clearance measurements using a weightless suspension system to avoid compression of the brain surface. Infusion of HHS in normovolemic animals did not affect the O2 supply of the brain. Hemorrhagic hypovolemia which led to a left shift of the cerebral PO2 histogram was followed by gradual normalization after fluid resuscitation. The current findings taken together do not indicate adverse side effects of this efficient method of fluid resuscitation with regard to the cerebral blood and O2 supply. The results make worthwhile further investigations on HHS in the presence of a focal brain lesion causing brain edema to find out whether the HHS are useful also for the treatment of intracranial hypertension.     

Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery.

BACKGROUND: There is controversy about the benefit of surgical repair for atrial septal defect in adults, especially its effect on the incidence of supraventricular dysrhythmias, atrial flutter and fibrillation. We studied their incidence before and after operation. METHODS: We examined surface and 24-hour Holter electrocardiograms before, early (between 3 and 7 days), and late (more than 6 months) after operation, performed at age 42.2 years (range, 18.5 to 74.9 years), in 211 adults with atrial septal defect. Patients were arbitrarily divided into three groups: age 18 to 40 years (n = 101), age 40 to 60 years (n = 83), and age more than 60 years (n = 27). All consecutive patients operated on between January 1988 and December 1996 and having a pulmonary to systemic flow ratio of 1.5:1 or greater were included in this study. RESULTS: The age of patients without arrhythmias before or after atrial septal defect closure (39+/-13 years) was significantly lower than that of patients with flutter (54+/-12 years) or fibrillation (59+/-8 years). The incidence of atrial flutter was influenced by surgical repair as atrial flutter converted to sinus rhythm late after operation in 10 of 18 patients. However, there was no change in the incidence of atrial fibrillation before (n = 28) and after (n = 21) operation. CONCLUSIONS: Our data show that surgical correction of atrial septal defect leads to regression of the incidence of atrial flutter but not fibrillation. Thus, surgical repair of atrial septal defect to abolish supraventricular tachyarrhythmias in adults is warranted, but in patients with fibrillation, it may have to be combined with a Maze operation in the future.     

A decreased serum concentration of nitrite/nitrate correlates with an increased plasma concentration of lactate during and after major surgery

A decrease in the production of nitric oxide (NO) due to surgical stress has been reported. We investigated whether this decrease in NO production was related to cytokine induction and/or other clinical parameters. We therefore measured the concentrations of serum nitrite/nitrate (a stable end product of NO), serum interleukin (IL)-6, and standard clinical parameters in 13 patients undergoing major upper abdominal and thracoabdominal surgery at preanesthesia (PRE), 2 h after a surgical incision (2H), at the end of surgery (END), and on the morning of postoperative days 1 (POD 1) and 3 (POD 3). The serum concentration of nitrite/nitrate was thus found to have significantly decreased at END, POD 1, and POD 3 compared with PRE. In addition, the serum nitrite/nitrate concentration correlated negatively with the plasma lactate level, and no relationship was observed between the serum nitrite/nitrate level and either the serum IL-6 level or any other clinical parameters. Our findings thus suggest that the decrease in the serum nitrite/nitrate level might therefore be related to tissue hypoperfusion both during and after major surgery. Received: October 6, 1999 / Accepted: May 30, 2000     

Head injury and hemorrhagic shock: studies of the blood brain barrier and intracranial pressure after resuscitation with normal saline solution, 3% saline solution, and dextran-40

The effect of fluid resuscitation from hemorrhagic shock on cerebral edema, intracranial pressure (ICP), and blood brain barrier function was investigated in the presence of a simulated head injury. Beagle dogs were anesthetized and ICP was measured via a right subarachnoid bolt while a contralateral epidural balloon was inflated in the left hemicranium to mimic a closed head injury. Forty percent of the dogs' blood was shed and the shock state was maintained for 1 hour. Resuscitation was initiated with shed blood and a volume of either normal saline solution (NS, n = 5), 10% dextran-40 (D-40, n = 6), or hypertonic (3%) saline solution (HS, n = 6) equal to the amount of shed blood. Evans blue solution was infused intravenously, and intravascular volume was then maintained with normal saline solution. Control (n = 5) dogs did not undergo shock, but received equivalent volumes of normal saline solution and Evans blue solution. The dogs were killed after 2 hours of resuscitation, and the brains were removed, weighed, and fixed in formalin. The average intracranial pressure value after epidural balloon inflation was 18.6 +/- 0.80 mm Hg and decreased equally in all groups during the shock period, averaging 10.8 +/- 1.24 mm Hg at the end of the shock period. Fluid resuscitation markedly elevated ICP in the NS and D-40 groups, reaching maximal values of 46.6 +/- 12.11 mm Hg and 45.3 +/- 28.95 mm Hg, respectively. Maximal ICP values in control and HS groups measured 21.8 +/- 1.36 mm Hg and 15.8 +/- 2.04 mm Hg, respectively (p less than 0.25 for HS versus NS control). Wet brain weights were significantly less in the HS group compared with either NS or D-40 groups (p less than 0.05). Coronal sections of fixed HS brains showed deep cortical Evans blue staining on the side of balloon injury. Therefore, in the presence of an intracranial mass lesion, resuscitation with hypertonic (3%) saline solution is accompanied by lower ICP values and less cerebral edema than is isotonic saline or colloid resuscitation. Blood brain barrier function is not restored by hypertonic saline solution resuscitation.     

A contrastive analysis of release patterns of biochemical markers of brain damage after coronary artery bypass grafting and valve replacement and their association with the neurobehavioral outcome after cardiac surgery.

OBJECTIVE: The present study aimed at a comparative analysis of neurobiochemical markers of brain damage and the neurobehavioral outcome in patients undergoing either valve replacement (VR) or isolated coronary artery bypass surgery (CABG). In order to control for well known risk factors both samples were strictly matched according to age, sex and preoperative neuropsychological performance. METHODS: We analysed neurone-specific enolase (NSE) and protein S-100B (S-100B) concentrations in serial venous blood samples taken preoperatively and 1, 6, 20 and 30 h postoperatively in 36 patients undergoing VR (N = 18) or isolated CABG surgery (N = 18). Mini Mental State Examination (MMS) was performed preoperatively, 3 and 7 days after surgery and 0.5 years later. Neuropsychiatric assessments were based on the diagnosis of postoperative delirium according to DMS-IIIR criteria and the Brief Psychiatric and the Delirium Rating Scale. RESULTS: VR and CABG patients, respectively, showed an increase of both S-100B (exact two-tailed Wilcoxon signed ranks test: P = 0.0001) and NSE (P = 0.0001) concentrations followed by a decrease during the next 30 h. Whereas S-100B values did not differ between patients groups subjects undergoing VR surgery exhibited higher NSE values during the postoperative course. Furthermore, VR patients showed a higher decline in cognitive performance which was also detectable 0.5 years after surgery. We found a weak association between the degree of individual postoperative decline of cognitive performance and S-100B area under curve values. CONCLUSIONS: Our data indicate that--apart from patients' age and preoperative neuropsychological performance--type of surgery remains a risk factor for postoperative neurobehavioral disorders. The different vulnerability of neurobehavioral disorders might be mirrored in different postoperative release patterns of NSE. We assume that both, NSE release and neurobehavioral disorders might be caused by a higher amount of intraoperative cerebral embolic events in VR patients.     

Hyperacute measurement of brain-tissue oxygen, carbon dioxide, pH, and intracranial pressure before, during, and after cerebral angiography in patients with aneurysmatic subarachnoid hemorrhage in poor condition

BACKGROUND: The objective of this study was to examine early changes of intracranial pressure (ICP) and brain oxygenation before, during, and after cerebral angiography in patients with poor-grade subarachnoid hemorrhage (SAH). METHODS: Fourteen patients with poor-grade SAH without intracerebral hematoma were studied. A significant change in monitored variables (arterial gases, ICP, brain-tissue oxygen pressure [Ptio(2)], brain-tissue carbon dioxide pressure, and pH) was defined as a register deviation of more than 20% compared with the baseline. Critical Ptio(2) values (<15 mm Hg) or significant Ptio(2) decreases were considered to be impaired brain oxygenation. These data were correlated with the angiography findings and the presence of massive brain edema and hypodense areas in follow-up computed tomography (CT) scan controls. RESULTS: Neurotrend data were unavailable in 4 patients because of calibration failure. Impaired brain oxygenation during angiography was observed in 5 patients. Initial critical Ptio(2) values were found in 1 patient. Four patients developed a linear Ptio(2) and pH decrease after the angio-catheter canalized the examined vessels in the neck. Statistically significant correlation was found between brain pH and Ptio(2) changes in these patients (P < .001, Spearman rho). Arterial gases, ICP, and cerebral perfusion pressure did not show significant alterations at this time. Significant correlations existed between severe intracranial angiographic arterial caliber reduction and impaired Ptio(2) values (P < .01). Patients with impaired Ptio(2) values frequently showed lesions in CT scan controls (P < .05). CONCLUSIONS: This study documented several fluctuations in the brain oxygenation of patients with poor-grade SAH during angiography. Patients with severe intracranial angiographic arterial caliber reduction at this time have an increased risk for impaired brain oxygenation.     

Abciximab and bleeding during coronary surgery: results from the EPILOG and EPISTENT trials. Improve Long-term Outcome with abciximab GP IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibition in STENTing

BACKGROUND: Abciximab during percutaneous coronary revascularization reduces ischemic complications, but concern exists regarding increased bleeding risk should emergency coronary surgical procedures be required. METHODS: Outcomes were assessed among 85 patients who required coronary artery bypass grafting operations after coronary intervention in two randomized placebo-controlled trials of abciximab. Comparisons were made between patients in the pooled placebo and abciximab groups. RESULTS: The incidence of coronary surgical procedures was 2.17% and 1.28% among patients randomized to placebo and abciximab, respectively (p = 0.021). Platelet transfusions were administered to 32% and 52% of patients in the placebo and abciximab groups, respectively (p = 0.059). Rates of major blood loss were 79% and 88% in the placebo and abciximab groups, respectively (p = 0.27); transfusions of packed red blood cells or whole blood were administered in 74% and 80% of patients, respectively (p = 0.53). Surgical reexploration for bleeding was required in 3% and 12% of patients, respectively. Death and myocardial infarction tended to occur less frequently among patients who had received abciximab. CONCLUSIONS: Urgent coronary artery bypass grafting operations can be performed without an incremental increase in major hemorrhagic risk among patients on abciximab therapy.