Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy.

The proportion of high-risk coronary patients submitted to surgical myocardial revascularization (CABG) is steadily increasing. High-risk patients utilize more hospital resources and have a higher procedural cost than low-moderate risk CABG patients. An efficient management is essential to improve outcome and reduce costs.

Should a regurgitant mitral valve be replaced simulataneously with a stenotic aortic valve?

Mitral valve regurgitation frequently accompanies aortic valve stenosis. It has been suggested that mitral regurgitation improves after aortic valve replacement alone and that the mitral valve need not be replaced simultaneously Furthermore, mitral regurgitation associated with coronary artery disease, particularly in patients with poor left ventricular function, shows immediate improvement after coronary artery bypass grafting. We studied 60 consecutive patients with aortic stenosis and mitral regurgitation to determine the degree of improvement in mitral regurgitation after aortic valve replacement alone versus aortic valve replacement combined with coronary artery bypass grafting.

Economic impact of preoperative intraaortic balloon pump therapy in high-risk coronary patients.

Background: The efficacy of preoperative intraaortic balloon pump therapy in high-risk coronary patients has been demonstrated earlier.

Methods: This study investigates the economic aspect by a detailed cost analysis of pooled information from two previously published randomized studies and 144 consecutive low-risk coronary artery bypass graft operations. Costs for patients receiving preoperative intraaortic balloon pump therapy before aortic cross-clamping (n = 62) were compared to those in a control group (n = 50).

Optimal timing of preoperative intraaortic balloon pump support in high-risk coronary patients.

Background: Beneficial effects of preoperative intraaortic balloon pump (IABP) treatment, on outcome and cost, in high-risk patients who have coronary artery bypass grafting have been demonstrated. We conducted a prospective, randomized study to determine the optimal timing for preoperative IABP support in a cohort of high-risk patients.

Methods: Sixty consecutive high-risk patients who had coronary artery bypass grafting (presenting with two or more of the following criteria: left ventricular ejection fraction less than 0.

The influence of age on the outcome of primary coronary artery bypass grafting.

Background: With the steady increase in the number of elderly patients requiring coronary artery bypass grafting (CABG), scepticism still exists as to whether this operation is justified in older patients or not, and whether there is an upper age limit. The aim of this study was to examine the effects of increasing age on the outcome of CABG.

Methods: A retrospective review was performed on 2127 consecutive patients undergoing primary CABG from January 1990 through June 1996.

Inflammatory response and oligo-element alterations following cardiopulmonary bypass in patients undergoing coronary artery bypass grafting.

Oligo-elements such as zinc (Zn), selenium (Se) and copper (Cu) have a significant influence on the function of the immune system. Various immunological and inflammatory changes are known to occur in patients undergoing cardiopulmonary bypass. The aim of this study was to evaluate changes in serum oligo-elements levels during and following cardiopulmonary bypass.

Sequential vein bypass grafting: tactics and long-term results.

The sequential bypass grafting technique has many advantages over coronary artery bypass grafting with single grafts. The aim of this study was to evaluate the consequences of sequential bypass graft failure. Between 1 January 1984 and 31 December 1996, 3846 patients underwent primary coronary artery bypass vein grafting.

[Symptomatic coronary disease associated with mitral insufficiency: surgical strategy].

In recent years coronary artery bypass grafting (CABG) has been extended to include patients with very low left ventricular ejection fractions (LVEF), also frequently with co-existing mild to moderate mitral valve regurgitation (MR). The question is, should MR be corrected simultaneously with a myocardial revascularization or not? Between January 1990 and December 1996, 82 patients with preoperative LVEF < or = 0.25 and echocardiographic evidence of co-existing MR without chordal or papillary muscle rupture (Grade I-28%, II-35%, III-32% and IV-5%) underwent primary CABG.

Late pseudoaneurysm formation after repair of the descending aorta.

We report a case of a 71-year-old hypertensive female patient presenting with haemoptysis and retrosternal pain from a leaking pseudo-aneurysm associated with a Dacron onlay patch used to repair a coarctation of the aorta 27 years earlier. This case illustrates a late and potentially fatal complication of this type of operation and describes a recent technique to reach the exact diagnosis and location of the aneurysm.

Preoperative intraaortic balloon pump enhances cardiac performance and improves the outcome of redo CABG.

Background: Reoperative coronary artery bypass grafting (redo CABG) is associated with an increased operative risk compared with primary CABG. Because the hospital mortality in redo CABG is known to be influenced by poor left ventricular function (left ventricular ejection fraction < or = 0.40), unstable angina, and left main stem stenosis greater than or equal to 70%, a preoperative intraaortic balloon pump (IABP) support could be beneficial to improve the outcome in high-risk redo CABG.

The effect of preoperative intra-aortic balloon pump support in high risk patients requiring myocardial revascularization.

The intra-aortic balloon pump (IABP) is an established additional support to pharmacologic treatment of the failing heart after myocardial infarction, unstable angina and cardiac surgery. The physiologic effect of IABP are: increased coronary perfusion and decreased left ventricular outflow impendance. The effects of preoperative IABP are not established.

Evaluation of preoperative intra-aortic balloon pump support in high risk coronary patients.

Objective: The intra-aortic balloon pump (IABP) is an established additional support to pharmacological treatment of the failing heart after myocardial infarction, unstable angina and cardiac surgery. The effect of preoperative IABP in high risk patients was evaluated.

Methods: Between June 1994 and March 1996 all high risk patients for CABG (two or more of these criteria: Left ventricular ejection fraction (LVEF) < or = 40%, left main stem stenosis > or = 70%, REDO-CABG, unstable angina) were randomized into either of 3 groups: (1) IABP 1 day prior to surgery, (2) IABP 1-2 h prior to CPB and (3) no preoperative IABP, controls.

The effect of preoperative intra-aortic balloon pump support in patients with coronary artery disease, poor left-ventricular function (LVEF < 40%), and hypertensive LV hypertrophy.

Poor left-ventricular function, hypertension, and left-ventricular hypertrophy in patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG) are associated with increased operative risks. Between June 1994 and March 1996, 33 patients undergoing CABG, were randomized into 2 groups. One group (IABP group, n = 19) received IABP treatment on average for 2 hours prior to CPB, the other group (control group, n = 14) had no preoperative IABP, Cardiac performance was measured pre- and postoperatively by Swan-Ganz catheter.

The influence of age on the results of reoperative coronary artery bypass grafting.

Background: With a steady increase in the number of elderly patients requiring coronary artery bypass grafting (CABG), a larger portion of elderly patients will also become candidates for reoperative CABG. Scepticism still exists as to whether this operation is justified in older patients. The purpose of this study was to examine the effect of increasing age on the outcome after reoperative CABG.

Sequential venous bypass grafts: results 10 years later.

Background: To evaluate the long-term outcome of the sequential vein bypass grafting technique, we studied 92 patients with coronary artery disease undergoing coronary artery bypass grafting in 1984 by one surgeon and receiving at least one sequential vein bypass graft (total of 170 sequential bypass grafts).

Methods: There was one hospital death and 1 patient was lost to follow-up. The remaining 90 patients were followed up by clinical evaluation, and 80% of the patients underwent coronary angiography within 1 year from the end point of the follow-up (June 1995), or before recurrence of symptoms or death.

[Hypertension, coronary disease and impact of arterial hypertension on results of coronary surgery].

Arterial hypertension is a major risk factor for myocardial infarction and cardiovascular disease. The presence of left-ventricular hypertrophy in hypertensive patients is associated with a risk of mortality from cardiovascular disease three times greater than the risk with hypertension alone. Hypertension is also associated with an increased mortality and morbidity following myocardial revascularization.

Reoperative coronary artery bypass procedures: risk factors for early mortality and late survival.

Objectives: The number of coronary artery disease reoperations is increasing. The aim of this paper is to identify risk factors and evaluate the results of REDO coronary artery bypass grafting (CABG).

Material: Between January 1984 and October 1994, 594 patients underwent REDO-CABG and 3157 underwent primary-CABG.

[Surgical correction of the ventricular geometry in post-infarction left ventricular aneurysms].

Left ventricular aneurysm (LVA) following myocardial infarction carry a high morbidity and mortality, which may be reduced by appropriate surgical treatment. The Jatene correction is an attractive technique for aneurysm repair. We have employed a modified Jatene correction in 72 patients between July 1986 and May 1995.

The impact of a short interval ( < or = 1 year) between primary and reoperative coronary artery bypass grafting procedures.

Reoperative (redo) coronary artery bypass grafting is an efficient treatment for patients with progressive coronary artery disease and those with conduit failure. Previous studies have demonstrated that a short time interval between primary and redo coronary artery bypass grafting is associated with a significantly higher mortality rate. In the present report this particular group have been specifically evaluated.

[Reactive thrombocytosis, a lipid dysfunction?].

Reactive thrombocytosis (RT, platelet counts > 400 x 10(3)/mm3) following coronary artery bypass grafting (CABG) has previously been reported to occur frequently (20%) and is associated with thrombotic complications, e.g. vein graft occlusion.

Plateletpheresis before redo CABG diminishes excessive blood transfusion.

Background: Blood conservation remains an important element for patients undergoing cardiac operations with cardiopulmonary bypass. Preoperative platelet-rich plasma (PRP) harvest is an autologous blood conservation method. The efficacy of preoperative PRP harvest and post-cardiopulmonary bypass reinfusion on postoperative bleeding and need for postoperative blood transfusion was evaluated in patients undergoing redo coronary artery bypass grafting in a prospective, randomized manner.

Reactive thrombocytosis following coronary artery bypass surgery: a possible link to a lipid dysfunction.

Reactive thrombocytosis (RT, Platelet counts >400x10(3)/mm3) following coronary artery bypass grafting (CABG) has earlier been described to occur frequently (20%) and is associated with thrombotic complications eg. vein graft occlusion. This prospective study was undertaken in an attempt to identify the underlaying causes of RT following CABG.

The impact of arterial hypertension on the results of coronary artery bypass grafting.

Arterial hypertension is though to be associated with reduced coronary vasodilator reserve in the coronary microcirculation. Increased ventricular mass and coronary arteriolar abnormalities are the dominant features in patients with severe hypertension, while large-vessel coronary disease is the predominant feature in patients with mild hypertension. In the present study we have evaluated how hypertension influences the outcome of coronary artery bypass grafting (CABG), with emphasis on patients with preoperative left-ventricular ejection fraction (LVEF) < or = 25%.

Surgical patch ostiumplasty of the left main coronary artery.

The prevalence of ostium stenosis of the left main coronary artery, isolated or not, varies from 0.1% to 1.9%.

Adult respiratory distress syndrome after cardiac surgery.

Adult respiratory distress syndrome, characterized by high permeability pulmonary oedema caused by endothelial cell damage, resulting in refractory hypoxemia, has a very high mortality. Cardiopulmonary bypass is said to be responsible for the development of adult respiratory distress syndrome after cardiac surgery. The present study was performed in order to identify predicting and aetiological factors of adult respiratory distress syndrome and multiple organ failure after cardiac surgery.