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cardiac, cabg, hemodynamics

Dharmesh Radheshyam Agrawal, Sathyaki Purushottam Nambala
Minimally invasive cardiac surgery is establishing itself as the standard of care across the world. MICS CABG is currently performed in only a few centers. Hemodynamics disturbances are peculiar during MICS CABG due to space constraints. We report a 70-year-old man who underwent MICS CABG who developed tension pneumothorax during revascularization that was diagnosed in a novel way.
October 2016: Annals of Cardiac Anaesthesia
David Freiermuth, Berend Mets, Daniel Bolliger, Oliver Reuthebuch, Thomas Doebele, Markus Scholz, Michael Gregor, Matthias Haschke, Manfred Daniel Seeberger, Jens Fassl
OBJECTIVES: This study aimed to evaluate the pharmacokinetic profiles of sevoflurane and isoflurane during use of minimized extracorporeal circulation to perform coronary artery bypass graft surgery. Furthermore, cardiovascular stability during bypass and the postoperative release of troponins were evaluated. DESIGN: Prospective, randomized study. SETTING: University hospital. PARTICIPANTS: The study comprised 31 adult patients undergoing coronary artery bypass grafting...
July 12, 2016: Journal of Cardiothoracic and Vascular Anesthesia
J-M Sinning, A Welz, G Nickenig
The heart team, consisting of conservative cardiologists, cardiac surgeons and interventional cardiologists, is important for a balanced, multidisciplinary decision-making process for patients suffering from coronary artery disease (CAD). Standard evidence-based, interdisciplinary, institutional protocols can be used for commonly encountered case scenarios to avoid the need for a systematic case by case review. Complex cases with a SYNTAX score of more than 32, diabetes mellitus and lesions of the left main stem or three-vessel disease should in general not be treated by an ad hoc percutaneous coronary intervention (PCI) but first discussed in the heart team...
September 5, 2016: Herz
Zeki Temizturk, Davut Azboy, Atakan Atalay, Hakan Atalay, Omer Faruk Dogan
OBJECTIVE: The aim of our study was to research the effects of levosimendan (LS) and sodium nitroprusside (SNP) combination on systolic and diastolic ventricular function after coronary artery bypass grafting (CABG) who required endoventricular patch repair (EVPR). PATIENTS AND METHODS: We studied 70 patients with ischemic dilated cardiomyopathy. LS and SNP combination was administered in 35 patients (study group, SG). In the remaining patients, normal saline solution was given (placebo group, PG)...
2016: Open Cardiovascular Medicine Journal
Aris Karatasakis, Yasir N Akhtar, Emmanouil S Brilakis
In patients with prior coronary artery bypass graft (CABG) surgery, distal coronary perforations are commonly considered to be at low risk for causing cardiac tamponade due to a potential protective role of pericardial adhesions, which obliterate the pericardial space. Loculated effusions can however form in such patients, compressing various cardiac structures and causing hemodynamic compromise. We present two cases of distal coronary perforation in prior CABG patients undergoing chronic total occlusion percutaneous coronary intervention...
September 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Shih-Ying Sung, Po-Shun Hsu, Jia-Lin Chen, Chien-Sung Tsai, Yi-Ting Tsai, Chih-Yuan Lin, Chung-Yi Lee, Hong-Yan Ke, Yi-Chang Lin
UNLABELLED: A 61-year-old male presented to our emergency room with chest tightness, dyspnea, and cold sweat. He underwent a 12-lead EKG which showed ST-elevation from leads V1-V4 and T wave inversion in leads II, III, and aVF. His troponin-I level was elevated to 70.3 ng/ml. He went into cardiogenic shock when he was in the catheter room. After advanced cardiac life support was administered for 30 min, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation was set up using 21-french arterial and 21-french venous cannula through the right femoral artery and right femoral vein by the puncture method for hemodynamic support...
May 2015: Acta Cardiol Sin
Fabiano Timbó Barbosa, Célio Fernando de Sousa Rodrigues, Aldemar Araújo Castro, Rafael Martins da Cunha, Tatiana Roa Bezerra Wanderley Barbosa
BACKGROUND AND OBJECTIVES: The use of neuraxial anesthesia in cardiac surgery is recent, but the hemodynamic effects of local anesthetics and anticoagulation can result in risk to patients. OBJECTIVE: To review the benefits of neuraxial anesthesia in cardiac surgery for CABG through a systematic review of systematic reviews. CONTENT: The search was performed in Pubmed (January 1966 to December 2012), Embase (1974 to December 2012), The Cochrane Library (volume 10, 2012) and Lilacs (1982 to December 2012) databases, in search of articles of systematic reviews...
May 2016: Brazilian Journal of Anesthesiology
Deepak Prakash Borde, Balaji Asegaonkar, Pramod Apsingekar, Sujeet Khade, Savni Futane, Bapu Khodve, Mahesh Kedar, Anand Deodhar, Unmesh Takalkar, Antony George, Shreedhar Joshi
CONTEXT: Left ventricle diastolic dysfunction (LVDD) is gaining importance as useful marker of mortality and morbidity in cardiac surgical patients. Different algorithms have been proposed for the intraoperative grading of DD. Knowledge of the particular grade of DD has clinical implications with the potential to modify therapy, but there is a paucity of literature on the role of diastolic function evaluation during off-pump coronary artery bypass grafting (OPCABG) surgery. AIMS: The aim of this study was to monitor changes in LVDD using simplified algorithm proposed by Swaminathan et al...
April 2016: Annals of Cardiac Anaesthesia
José Hinz, Ashham Mansur, Gerd G Hanekop, Andreas Weyland, Aron F Popov, Jan D Schmitto, Frank F G Grüne, Martin Bauer, Stephan Kazmaier
The effects of isoflurane on the determinants of blood flow during Coronary Artery Bypass Graft (CABG) surgery are not completely understood. This study characterized the influence of isoflurane on the diastolic Pressure-Flow (P-F) relationship and Critical Occlusion Pressure (COP) during CABG surgery. Twenty patients undergoing CABG surgery were studied. Patients were assigned to an isoflurane or control group. Hemodynamic and flow measurements during CABG surgery were performed twice (15 minutes after the discontinuation of extracorporeal circulation (T15) and again 15 minutes later (T30))...
2016: PeerJ
Orkut Guclu, Oguz Karahan, Mustafa Karabacak, Volkan Yuksel, Serhat Huseyin, Binali Mavitas
Background Neurohumoral and hemodynamic mechanisms have an effect on cardiac activity. C-type natriuretic peptide (CNP) is accessible in the cardiovascular system. The aim of this study was to determine whether CNP concentrations in pericardial fluid and blood are related to cardiac dysfunction in patients undergoing coronary artery bypass graft surgery. Materials and Methods In this study, 40 patients undergoing coronary artery bypass grafting were enrolled. The patients were separated into two groups according to left ventricular (LV) ejection fraction (EF): group 1 contained 28 patients with normal LV systolic function (LVEF ≥ 50%) and group 2 contained 12 patients with impaired LV systolic function (LVEF < 45%)...
March 10, 2016: Thoracic and Cardiovascular Surgeon
Miha Antonic, Robert Lipovec, Franc Gregorcic, Peter Juric, Gorazd Kosir
BACKGROUND: Atrial fibrillation is the most common arrhythmia following cardiac surgery. It is associated with increased hemodynamic instability, systemic embolization, and complications linked to anticoagulant therapy. Oxidative stress and consequent electrophysiological remodeling have been proposed as a cause of postoperative atrial fibrillation. Ascorbic acid supplementation was suggested as a novel and effective preventive agent. The aim of this study was to evaluate the capability of ascorbic acid to reduce the incidence of postoperative atrial fibrillation in coronary artery bypass grafting (CABG) patients...
February 22, 2016: Journal of Cardiology
David M Shavelle, Ajay J Kirtane, Theodore L Schreiber, Neel K Kapasi, William W O'Neill, Jeffrey W Moses, Jeffrey Popma, Ray V Matthews
BACKGROUND: In observational studies of patients undergoing percutaneous coronary intervention (PCI), surgical ineligibility is associated with increased mortality. Whether the use of hemodynamic support during PCI can mitigate the adverse prognostic importance of surgical ineligibility is unknown. METHODS AND RESULTS: We sought to evaluate the association between request for surgical consultation (presumed surgical ineligibility) prior to PCI and clinical outcomes in 427 patients with multivessel coronary artery disease or unprotected left main disease and severely reduced left ventricular systolic function undergoing PCI assisted by hemodynamic support (intraaortic balloon pump or Impella) from the PROTECT II randomized trial...
May 2016: Journal of Invasive Cardiology
Manoj K Sahu, Anupam Das, Vishwas Malik, Arun Subramanian, Sarvesh Pal Singh, Milind Hote
BACKGROUND: Levosimendan a calcium ion sensitizer improves both systolic and diastolic functions. This novel lusitropic drug has predictable antiischemic properties which are mediated via the opening of mitochondrial adenosine triphosphate-sensitive potassium channels. This action of levosimendan is beneficial in cardiac surgical patients as it improves myocardial contractility, decreases systemic vascular resistance (SVR), and increases cardiac index (CI) and is thought to be cardioprotective...
January 2016: Annals of Cardiac Anaesthesia
Ethan Y Brovman, Rodney A Gabriel, Robert W Lekowski, Richard P Dutton, Richard D Urman
OBJECTIVES: To examine anesthesia-centered outcomes in a large cohort of patients undergoing coronary artery bypass grafting (CABG) or valvular heart surgery. DESIGN: A retrospective study with univariate and multivariate logistic regression to identify independent predictors for mortality. SETTING: Diverse setting including university, small, medium, and large community hospitals. PARTICIPANTS: All patients undergoing CABG or valve surgery in the National Anesthesia Clinical Outcomes Registry (NACOR) from the Anesthesia Quality Institute...
April 2016: Journal of Cardiothoracic and Vascular Anesthesia
Zh V Vesnina, N G Krivonogov, Iu Iu Vecherskiĭ, Iu B Lishmanov
OBJECTIVE: By means of scintigraphic methods to assess alterations in cardiopulmonary haemodynamics and renal functional activity in patients with coronary artery disease (CAD) after endured coronary artery bypass grafting (CABG) performed in conditions of extracorporeal circulation (EC) and on the functioning heart. MATERIAL AND METHODS: We examined a total of 40 patients presenting with CAD (mean age 54.90±1.12 years) after endured CABG. All patients were subdivided into 2 groups: Group One consisting of 20 patients subjected to CABG performed on the beating heart with the use of myocardial "stabilizer" "Acrobat" (Study Group) and Group Two also comprising 20 patients but undergoing surgery with the use of extracorporeal circulation (Comparison Group)...
2015: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Marcello Fonseca Salgado Filho, Marselha Barral, Louis Barrucand, Ismar Lima Cavalcanti, Nubia Verçosa
BACKGROUND: The objective was to evaluate the effect of epinephrine and levosimendan on the left ventricle myocardial performance index in patients undergoing on-pump coronary artery by-pass grafting (CABG). METHODS: In a double-blind, randomized clinical trial, 81 patients (age: 45-65 years) of both genders were randomly divided to receive either epinephrine at a dosage of 0.06 (epinephrine group, 39 patients) or levosimendan at 0.2
2015: PloS One
Aleksandra Gavrilovska-Brzanov, Mohhamed Al Jarallah, Andrea Cogliati, Maja Mojsova-Mijovska, Dragan Mijuskovic, Dimce Slaveski
INTRODUCTION: Cardiac patients are more prone to develop hemodynamic instability on induction of anesthesia and endotracheal intubation. The Airtraq(®) optical laryngoscope is a single-use rigid video laryngoscope that has been developed to facilitate tracheal intubation. There are limited studies comparing differences in the circulatory responses to Airtraq(®) and direct Macintosh larynngoscopy in cardiac patients. AIM: The purpose of our study was to evaluate whether there was clinically significant difference between the hemodynamic response to orotracheal intubation guided by either of the two devices (Airtraq(®) and Macintosh laryngoscopes) in patients who underwent coronary artery bypass grafting surgery...
October 2015: Acta Informatica Medica: AIM
Islam Y Elgendy, Calvin Choi, Anthony A Bavry
INTRODUCTION: Fractional flow reserve (FFR) is recommended by society guidelines for assessment of the hemodynamic significance of intermediate coronary lesions when non-invasive evidence of myocardial ischemia is unavailable. However, the prevalence of FFR usage in current practice and how FFR values impact revascularization decisions are not well known. METHODS: At a single-center Veterans Administration Hospital, all subjects referred for coronary angiography for any indication from the period from May 2012 until January 2014 were prospectively entered into a database...
December 2015: Cardiology and Therapy
Funda Yildirim, Ihsan Iskesen, Adnan Taner Kurdal, Tulun Ozturk, Fatma Taneli, Ceyhun Gozukara, Alper Ozbakkaloglu
OBJECTIVES: The aim of this study was to determine the effect of remote ischemic preconditioning (RIPC) on markers of cardiac ischemia and response to oxidative stress in patients undergoing coronary artery bypass grafting (CABG) surgery. DESIGN: A prospective, randomized, and blinded study. SETTING: A single-center university hospital. PARTICIPANTS: This study included patients who underwent isolated CABG surgery with cardiopulmonary bypass who were selected carefully to prevent confounding with factors known to affect markers of ischemia-reperfusion and response to oxidative stress...
January 2016: Journal of Cardiothoracic and Vascular Anesthesia
Mehrnaz Shoushtarian, Desmond P McGlade, Louis J Delacretaz, David T J Liley
The brain anaesthesia response (BAR) monitor uses a method of EEG analysis, based on a model of brain electrical activity, to monitor the cerebral response to anaesthetic and sedative agents via two indices, composite cortical state (CCS) and cortical input (CI). It was hypothesised that CCS would respond to the hypnotic component of anaesthesia and CI would differentiate between two groups of patients receiving different doses of fentanyl. Twenty-five patients scheduled to undergo elective first-time coronary artery bypass graft surgery were randomised to receive a total fentanyl dose of either 12 μg/kg (fentanyl low dose, FLD) or 24 μg/kg (fentanyl moderate dose, FMD), both administered in two divided doses...
September 25, 2015: Journal of Clinical Monitoring and Computing
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